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目的探讨不引起宫腔变形或受压的子宫肌壁间肌瘤对体外受精(in-vitro fertilization,IVF)或卵细胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)结局的影响。方法采用Meta分析方法,计算机检索MEDLINE、PREMEDLINE、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库等,收集有关随机对照试验或半随机对照试验,由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用Rev Man 5.2和Stata 12.0软件进行Meta分析和Egger’s检验。结果共纳入10个研究,Egger’s检验(P=0.093),说明不存在出版及相关偏倚。Meta分析结果显示,有不引起宫腔变形或受压的子宫肌壁间肌瘤者行IVF或ICSI助孕,活产率(RR=0.75,95% CI0.64～0.87)和临床妊娠率(RR=0.82,95%CI0.74～0.92),均低于无肌瘤者(P<0.05);而胚胎植入率(RR=0.95,95% CI0.75～1.19)、流产率(RR=1.38,95% CI0.97～1.96)与无肌瘤者相比差异均无统计学意义(P>0.05)。结论子宫肌壁间肌瘤即使不引起宫腔变形或受压也可能影响IVF或ICSI助孕患者活产率和临床妊娠率。
Objective To investigate the effect of intrauterine sphincter sperm injection (ICSI) on in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) without uterine cavity deformation or compression. Methods Meta-analysis was used to search MEDLINE, PREMEDLINE, Cochrane Library, Chinese Journal Full-text Database (CNKI), Wanfang database, etc. to collect randomized controlled trials or semi-randomized controlled trials. The two researchers independently screened the literature, After extraction and methodological quality evaluation, Meta analysis and Egger’s test were performed using Rev Man 5.2 and Stata 12.0 software. Results A total of 10 studies were included, Egger’s test (P = 0.093), indicating no publication and related bias. Meta-analysis showed that IVF or ICSI-assisted pregnancy with uterine fibroids without uterine deformation or compression led to a significant increase in live births (RR = 0.75, 95% CI 0.64 to 0.87) and clinical pregnancy rates RR = 0.82,95% CI0.74-0.92), which were lower than those without fibroids (P <0.05). However, the rate of embryo implantation (RR = 0.95,95% CI0.75-1.19) 1.38,95% CI0.97 ~ 1.96) compared with non-fibroid no significant difference (P> 0.05). Conclusion Intrauterine myometrial myomectomy may affect the live birth rate and clinical pregnancy rate of IVF or ICSI-assisted pregnancies even if they do not cause uterine deformation or compression.