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目的系统评价体外受精-胚胎移植(IVF-ET)治疗中短时受精与常规受精两种受精方式的临床效果。方法计算机检索Pub Med、h e Cochrane Library(2014年第8期)、EMbase、CBM、CNKI、Wan Fang Data和VIP,搜集IVF治疗中短时受精与常规受精疗效比较的随机对照试验(RCT),检索时限均为从建库至2014年8月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量,然后采用Rev Man 5.2软件进行Meta分析。结果最终纳入6个RCT,共计1 373例患者。Meta分析结果显示:短时受精在提高优质胚胎率[OR=1.42,95%CI(1.18,1.70),P=0.000 2]和临床妊娠率方面[OR=1.67,95%CI(1.33,2.09),P<0.000 01]优于常规受精,但两组的受精率、多精受精率和流产率无明显差异。结论现有证据显示,短时受精在提高优质胚胎率及临床妊娠率方面优于常规受精。受纳入研究数量及质量限制,上述结论尚需开展更多大样本、高质量、长期随访的RCT来加以验证。
Objective To systematically evaluate the clinical effects of in vitro fertilization-embryo transfer (IVF-ET) on short-term and conventional fertilization. Methods Randomized controlled trials (RCTs) comparing short-term IVF with conventional fertilization in IVF were searched by Pub Med, he Cochrane Library (2014 Issue 8), EMbase, CBM, CNKI, Wan Fang Data and VIP. The time limit is from the construction of the library to August 2014. Two reviewers independently screened the literature for inclusion and exclusion, extracted data, and assessed the quality of the methodology included in the study, followed by Meta-analysis using Rev Man 5.2 software. The results eventually included 6 RCTs for a total of 1 373 patients. Meta-analysis showed that short-term fertilization was significantly associated with higher quality embryo rates [OR = 1.42, 95% CI (1.18,1.70), P = 0.0002] and clinical pregnancy rates , P <0.000 01] than conventional fertilization, but there was no significant difference in fertilization rate, fertilization rate and abortion rate between the two groups. Conclusion The available evidence shows that short-term fertilization is superior to conventional fertilization in improving high-quality embryo rates and clinical pregnancy rates. Due to the number of studies included and quality limitations, the above conclusion still needs to be verified by a large sample of high-quality, long-term follow-up RCTs.