人類胚胎輔助孵化會不會增加懷孕率(最新文章)

左:透明帶(殼)

右:著床的囊胚

摘自不孕症第一名的期刊Hum Reprod Update.

2011 Apr 7. [Epub ahead of print]

 

 

人類胚胎輔助孵化：

 

 

系統性回顧和綜合分析的隨機對照試驗

摘要

 

輔助孵化(剝殼或溶殼)（AH）的操縱是透明帶變薄或溶出小洞，目的是方便胚

 

胎孵化著床。方法系統評價和綜合分析醫學文獻是用來評價的效果啊對輔助生

 

育的結果：臨床妊娠率，活產，多胎妊娠和流產。額外的分析，在這些分組：

 

(一）新鮮胚胎移植到未特定狀況或者非預後不佳的婦女;（二）新鮮胚胎轉移

 

到婦女與以往多次的著床失敗;（三）新鮮胚胎轉移到高齡的婦女;（四）冷凍

 

胚胎轉移到未選定或非預後不良的婦女。結論是輔助孵化(剝殼或溶殼)對以前

 

的多次失敗的婦女或冷凍解凍胚胎增加臨床懷孕率和多胎率。不過，AH

 

輔助孵化(剝殼或溶殼)對新鮮胚胎來自未特定狀況或非預後不佳的婦女或高

 

齡的不孕婦女是不能提高臨床懷孕率的。由於小樣本納入研究，沒有適當

 

的結論可以得出關於流產或活產。 

原文

 

Assisted hatching of human embryos: a systematic review and meta-analysis of randomized controlled trials.

Martins WP, Rocha IA, Ferriani RA, Nastri CO.

 

Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da, Universidade de São Paulo (DGO FMRP-USP), Av. dos Bandeirantes, 3900, Monte Alegre, 8 andar, Ribeirão Preto, SP 14049-900, Brasil, CEP.

 

Abstract

BACKGROUND Assisted hatching (AH) is a manipulation of zona pellucida aiming to facilitate embryo implantation. METHODS Systematic review and meta-analysis of medical literature was used to evaluate the effect of AH on assisted reproduction outcomes: clinical pregnancy, live birth, multiple pregnancy and miscarriage. Additional analysis was performed in these subgroups: (i) fresh embryos transferred to unselected or non-poor prognosis women; (ii) fresh embryos transferred to women with previous repeated failure; (iii) fresh embryos transferred to women of advanced age; (iv) frozen-thawed embryos transferred to unselected or non-poor prognosis women. Analyses were based on risk ratio and 95% confidence intervals (RR, 95% CIs) using Mantel-Haenszel random effects model. RESULTS There were 28 studies (5507 participants) included. AH was related to a trend toward increased clinical pregnancy for all participants (RR = 1.11, 95% CI = 1.00-1.24), with a significant increase in subgroups 2 (RR = 1.73; 95% CI = 1.37-2.17) and 4 (RR = 1.36; 95% CI = 1.08-1.72, P< 0.01), but not for subgroups 1 and 3. For multiple pregnancy, a significant increase was observed for all participants (RR = 1.45; 95% CI = 1.11-1.90) and for subgroups 2 (RR = 2.53; 95% CI = 1.23-5.21) and 4 (RR = 3.40; 95% CI = 1.93-6.01). No significant heterogeneity was observed in subgroup analysis. CONCLUSIONS AH was related to increased clinical pregnancy and multiple pregnancy rates in women with previous repeated failure or frozen-thawed embryos. However, AH is unlikely to increase clinical pregnancy rates when performed in fresh embryos transferred to unselected or non-poor prognosis women or to women of advanced age. Due to the small sample evaluated by the pool of included studies, no proper conclusions could be drawn regarding miscarriage or live birth.