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目的系统评价辅助孵化(AH)对反复种植失败(RIF)患者再次助孕治疗的临床妊娠结局的影响。方法计算机检索Medline、Cochrane图书馆、中国期刊全文数据库、中国生物医学文献数据库等中外期刊数据库,检索时限至2019年7月。纳入在RIF患者应用AH的随机对照试验,由两名评价员独立提取资料,并对其方法学质量进行评价。对符合纳入标准的研究用Rev Man 5.3软件进行Meta分析。结果共检索到符合纳入标准随机对照的文献10篇,共有研究对象2 256例,其中AH组1 106例,对照组1 150例。Meta分析结果显示:与对照组对比,AH组的临床妊娠率[OR=0.13,95%CI(0.06,0.20),P=0.000 2]、每胚胎的种植率[OR=2.13,95%CI(1.33,3.41),P=0.002]、活产率[OR=2.16,95%CI(1.40,3.35),P=0.000 5]较高;但对于多胎妊娠率的比较,对照组的多胎妊娠率相对较低[OR=1.56,95%CI(1.06,2.31),P=0.02];流产率比较两组无统计学差异[OR=1.26,95%CI(0.84,1.91),P=0.27]。结论 AH可以改善RIF患者再次助孕治疗的某些临床结局,如提高妊娠率、每胚胎种植率和活产率。AH不会增加流产率,但有增加多胎妊娠率的风险。此外,由于本研究的局限性,该结论尚需高质量、大样本的随机对照试验进一步证实。
Abstract：Objective To assess the effect of assisted reproductive technology with assisted hatching(AH) in treatment of patients with repeated implantation failure(RIF). Methods All randomized controlled trials(RCTs) about AH in the treatment of patients with RIF were retrieved from databases including Cochrane Library, MEDLINE, CNKI, VIP and Wanfang databases updating to Jul, 2019. Information was collected by two evaluaters independently. The quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions, and the Cochrane Collaboration's software Rev Man 5.3 was used for meta-analysis. Results There were 10 RCTs(2,256 participants) included. Compare with the control group, the clinical pregnancy rate(OR=0.13, 95%CI 0.06 to 0.20, P=0.000 2), the implantation rate(OR=2.13, 95%CI 1.33 to 3.41, P=0.002) and the live birth rate(OR=2.16, 95%CI 1.40 to 3.35, P=0.000 5) were increased in the AH group. Compare with the control group, the multiple pregnancy rate in the AH group was higher(OR=1.56, 95%CI 1.06 to 2.31, P=0.02). The differences of the miscarriage rate between the two groups had no statically significance(OR=1.26, 95%CI 0.84 to 1.91, P=0.27). Conclusion Current evidence showed that AH was related to improve the clinical pregnancy, the implantation and live birth rates in women with previous repeated implantation failure. AH was unlikely to increase the miscarriage rate, but it may increased the multiple pregnancy rate. However, considering the limitation of the methodological quality and sample size of the included studies, more high-quality, large-scale RCTs are still needed to confirm this conclusion.
[1] 全松,刘靖.反复种植失败的定义及影响因素[J].实用妇产科杂志,2018,34(5):321-324.
[2] 王秀霞,李达.辅助孵化技术新证据[J].生殖医学杂志,2017,26(7):627.
[3] MAK J,CHUNG C,CHUNG J,et al.The effect of endometrial scratch on natural-cycle cryopreserved embryo transfer outcomes:a randomized controlled study[J].Reprod Biomed Online,2017,35(1):28-36.
[4] STEIN A,RUFAS O,AMIT S,et al.Assisted hatching by partial zona dissection of human pre-embryos in patients with recurrent implantation failure after in vitro fertilization [J].Fertil Steril,1995,63:838-841.
[5] ANTINORI S,SELMAN HA,CAFFA B,PANCI C,Dani GL,VERSACI C et al.Zona opening of human embryos using a non-contact UV laser for hatching in patients with poor prognosis of pregnancy [J].Hum Reprod,1996,11:2488-2492.
[6] CHAO KH,CHEN SU,CHEN HF,et al.Assisted hatching increases the implantation and pregnancy rate of in vitro fertilization (IVF)-embryo transfer (ET),but not that of IVF-tubal ET in patients with repeated IVF failures [J].Fertil Steril,1997,67:904-908.
[7] JELINKOVA L,PAVELKOVA J,STREHLER E,et al.Improved implantation rate after chemical removal of the zona pellucida [J].Fertil Steril,2003,79:1299-1303.
[8] PETERSEN CG,MAURI AL,BARUFFI RL,et al.Implantation failures:success of assisted hatching with quarter-laser zona thinning[J].Reprod Biomed Online,2005,10:224-229.
[9] VALOJERDI MR,EFTEKHARI-YAZDI P,KARIMIAN L,et al.Effect of laser zona pellucida opening on clinical outcome of assisted reproduction technology in patients with advanced female age,recurrent implantation failure,or frozen-thawed embryos [J].Fertil Steril,2008,90:84-91.
[10] 聂玲,伍琼芳,曾韩,等.激光辅助孵化对反复种植失败及冻融胚胎移植患者妊娠结局的影响[J].江西医药,2012,47(1):1-4.
[11] 路新梅,徐晨,王亮,等.激光辅助孵化对种植失败患者冻融胚胎移植妊娠结局的影响[J].第二军医大学学报,2016,37(1):106-110.
[12] KATALIN KANYO,JOZSRF ZEKE,RITA KRISTON,et al.The impact of laser-assisted hatching on the outcome of frozen human embryo transfer cycles[J].Zygote,2016,24(10):742-747.
[13] 左阳花,冯播,仲纪祥,等.激光辅助孵化在反复移植失败及高龄患者冻融胚胎移植中的临床应用[J].中国优生与遗传杂志,2017,25(1):127-129.
[14] 敖磊,马艳萍,相立峰,等.两种不同激光辅助孵化方法在卵裂期冻融胚胎移植中的比较研究[J].实用妇产科杂志,2013,29(2):136-139.
[15] MANNA C,RIENZI L,GRECO E,et al.Zona pellucida solubility and cortical granule complements in human oocytes following assisted reproductive techniques[J].Zygote,2001,9:201-210.
[16] KANYO K,ZEKE J,KRISTON R,et al.The impact of laser-assisted hatching on the outcome of frozen human embryo transfer cycles[J].Zygote,2016,24(5):742-747.
[17] 王鹏,赵静,胡泊,等.激光辅助孵化对反复种植失败患者解冻周期妊娠结局的影响[J].新疆医科大学学报,2017,40(2):184-187.
[18] ZENG M,SU S,LI L.The effect of laser-assisted hatching on pregnancy outcomes of cryopreserved-thawed embryo transfer :meta-analysis of randomized controlled trials[J].Lasers Med Sci,2018,33(3):655-666.
[19] KANYó K,KONC J.A follow-up study of children born after diode laser assisted hatching[J].Eur J Obstet Gynecol Reprod Biol,2003,110(2):176-180.
[20] VALOJERDI MR,EFTEKHARI YP,KARIMIAN L,et al.Effect of laser zona thinning on vitrified-warmed embryo transfer at the cleavage stage:a prospective,randomized study[J].Reprod Biomed Online,2010,20(2):234-242.
[21] 黄建芳,付星,张文红,等.激光辅助孵化对胚胎移植妊娠结局影响的 Meta分析[J].生殖与避孕,2016,36(4):288-297.
[22] 樊文倩,孙莹璞,苏迎春,等.体外受精中各种因素与单卵双胎的相关性分析[J].国际生殖健康/计划生育杂志,2013,32(4):275-278.
[23] 马淳,师娟子,李明,等.鲜胚移植和冻融胚胎移植中单卵双胎发生的相关因素分析[J].生殖医学杂志,2016,25(12):1054-1058.
[24] WU D,HUANG SY,WU HM,et al.Monozygotic twinning after in vitro fertilization /intracytoplasmic sperm injection treatment is not related to advanced maternal age,intracytoplasmic sperm injection,assisted hatching,or blastocyst transfer[J].Taiwan J Obstet Gynecol,2014,53(3):324-329.
基本信息:
中图分类号:R714.8
引用信息:
[1]祁静,王致辉,宁冰雪,等.反复种植失败与辅助孵化的系统评价[J].新疆医科大学学报,2020,43(05):587-592+596.
基金信息:
新疆维吾尔自治区自然科学基金(2017D01C284)
2019-08-26
2019
2020-01-03
2020
1
2020-05-15
2020-05-15