scholarly journals Recombinant human luteinizing hormone co-treatment in ovarian stimulation for assisted reproductive technology in women of advanced reproductive age: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alessandro Conforti ◽  
Sandro C. Esteves ◽  
Peter Humaidan ◽  
Salvatore Longobardi ◽  
Thomas D’Hooghe ◽  
...  
Keyword(s):  
Luteinizing Hormone ◽  
Ovarian Stimulation ◽  
Meta Analysis ◽  
Reproductive Technology ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Advanced Reproductive Age ◽  
Implantation Rates

Abstract Introduction Several studies suggest that luteinizing hormone (LH) could improve IVF outcome in women of advanced reproductive age by optimizing androgen production. In this review, we assessed the role of recombinant-human LH (r-hLH) and recombinant human follicle stimulating hormone (r-hFSH) co-treatment in ovarian stimulation for assisted reproductive technology in women of advanced reproductive age candidates for assisted reproduction. Material and methods Using a preregistered protocol we systematically searched Medline/PubMed, Scopus and the ISI Web of Science databases to identify randomized controlled trials in which r-hFSH monotherapy protocols were compared with r-hFSH/r-hLH co-treatment in women ≥35 years undergoing fresh IVF cycles. We calculated the pooled odds ratio (OR) for dichotomous data and the weight mean difference (WMD) for continuous data with an associated 95% confidence interval (CI). The meta-analyses were conducted using the random-effect model. P values < 0.05 were considered statistically significant. Subgroup analyses of all primary and secondary outcomes were performed only in women aged 35–40 years. Results Twelve studies were identified. In women aged between 35 and 40 years, r-hFSH/r-hLH co-treatment was associated with higher clinical pregnancy rates (OR 1.45, CI 95% 1.05–2.00, I2 = 0%, P = 0.03) and implantation rates (OR 1.49, CI 95% 1.10–2.01, I2 = 13%, P = 0.01) versus r-hFSH monotherapy. Fewer oocytes were retrieved in r-hFSH/r-hLH-treated patients than in r-hFSH-treated patients both in women aged ≥35 years (WMD -0.82 CI 95% -1.40 to − 0.24, I2 = 88%, P = 0.005) and in those aged between 35 and 40 years (WMD -1.03, CI − 1.89 to − 0.17, I2 = 0%, P = 0.02). The number of metaphase II oocytes, miscarriage rates and live birth rates did not differ between the two groups of women overall or in subgroup analysis. Conclusion Although more oocytes were retrieved in patients who underwent r-hFSH monotherapy, this meta-analysis suggests that r-hFSH/r-hLH co-treatment improves clinical pregnancy and implantation rates in women between 35 and 40 years of age undergoing ovarian stimulation for assisted reproduction technology. However, more RCTs using narrower age ranges in advanced age women are warranted to corroborate these findings.

scholarly journals Effect of sildenafil citrate in women undergoing assisted reproduction: a meta-analysis based on randomized controlled trials

2020 ◽  
Author(s):  
Safoura Rouholamin ◽  
Mahdi Sepidarkish ◽  
Maryam Razavi ◽  
Azar Nabati ◽  
Saman Maroufizadeh ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Assisted Reproduction ◽  
Meta Analysis ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Sildenafil Citrate ◽  
Current Evidence ◽  
Estradiol Valerate ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background to evaluate whether the sildenafil citrate in women undergoing assisted reproduction ameliorate the clinical outcomes. Methods We performed a comprehensive literature search for published randomized controlled trials (RCT) in Medline, Embase, Scopus, Web of Science and Cochrane Central Register of Controlled Trials from inception to 25 Jun 2020. Literature screening, selection of relevant studies, assessment risk of bias and data extraction was conducted independently by two reviewers. We combined study data using the random-effects model. Results Sixteen trials including 1,589 women (771 cases and 818 controls) were included in meta-analysis. Pooling results from five trials, which compared clinical pregnancy between sildenafil citrate and placebo, showed a significantly higher probability of clinical pregnancy in sildenafil citrate group (RR: 1.57, 95% CI: 1.05, 2.36, I2 = 0%). The probability of clinical pregnancy was significantly higher in women who received the combination of sildenafil citrate and clomiphene citrate compared with clomiphene citrate alone (RR: 1.31, 95% CI: 1.12, 1.53, I2 = 0%). Following the intervention, clinical pregnancy significantly increased in women who received the combination of estradiol valerate and sildenafil citrate compared to estradiol valerate (RR: 1.59, 95% CI: 1.05, 2.43, I2 = 0%). Following the intervention, endometrial thickness (ET) increased in women who received sildenafil citrate compared to women who received placebo (SMD: 1.32, 95% CI: 0.30, 2.34, I2 = 92.41%). The mean of ET was significantly higher in women who received the combination of sildenafil citrate and clomiphene citrate compared to women who received clomiphene citrate (SMD: 0.92, 95% CI: 0.49, 1.36). Conclusion Our systematic review and meta-analysis showed that luteal supplementation of sildenafil citrate (oral or vaginal), alone or adjuvant therapy can be used for improving the EM and clinical pregnancy rate in women undergoing assisted reproduction. However, given the methodological limitations the current evidence does not support its use in clinical practice yet.

scholarly journals The Effect of Intrauterine Administration of Human Chorionic Gonadotropin (hCG) Before Embryo Transfer During Assisted Reproductive Cycles: a Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 79 (07) ◽  
pp. 713-722
Author(s):  
Huiping Tan ◽  
Shifu Hu ◽  
Yuan Chen ◽  
Lei Jin ◽  
Chunlin Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Meta Analysis ◽  
Implantation Rate ◽  
Clinical Pregnancy ◽  
Controlled Trials ◽  
Ongoing Pregnancy ◽  
Cleavage Stage ◽  
Randomized Controlled

AbstractThe fertility success rates of clinical and laboratory-assisted reproductive techniques (ART) remain low, despite major advances. The aim of this study was to conduct a systematic literature review and assess whether the intrauterine administration of human chorionic gonadotropin (hCG) before embryo transfer (ET) improved the clinical outcomes of sub-fertile women undergoing assisted reproduction. The electronic databases PUBMED, EMBASE and Web of Science were systematically searched for randomized controlled trials (RCTs) published from inception to June 2018. The trial data were independently extracted and analyzed using risk ratios (RRs) and 95% confidence intervals (CIs) according to a random- or fixed-effect model (as appropriate), and a meta-analysis was conducted using Review Manager 5.2 software. The meta-analysis included 3241 patients from 12 RCTs, and the combined results demonstrated that intrauterine hCG injection significantly improved the rates of clinical (RR = 1.33; 95% CI: 1.12 – 1.58) and ongoing pregnancy (RR = 1.87; 95% CI: 1.54 – 2.27), compared with controls. However, intrauterine hCG injection had no significant effect on the implantation rate (RR = 1.30; 95% CI: 0.89 – 1.90), abortion rate (RR = 1.06; 95% CI: 0.78 – 1.44), ectopic pregnancy rate (RR = 0.77; 95% CI: 0.17 – 3.42) or live birth rate (RR = 0.99; 95% CI: 0.60 – 1.63). In a subgroup analysis, the intrauterine injection of > 500 IU hCG led to a significant increase in the implantation rate (RR = 1.64; 95% CI: 1.04 – 2.61) relative to controls. Furthermore, the subgroup of women with cleavage-stage ETs who received an intracavity injection of hCG (IC-hCG) exhibited increases in the implantation, clinical pregnancy and ongoing pregnancy rates, compared to women with cleavage-stage ETs and no IC-hCG. The current evidence indicates that intrauterine hCG administration before ET provides an advantage in terms of the clinical pregnancy and ongoing pregnancy rates.

The treatment of premenstrual syndrome with preparations of Vitex Agnus Castus (Chaste-berry): A systematic review and meta-analysis

2017 ◽  
Vol 41 (S1) ◽  
pp. s907-s908
Author(s):  
P. Schulte ◽  
A. Verkaik ◽  
A. Kamperman ◽  
R. Van Westrhenen
Keyword(s):  
High Risk ◽  
Randomized Controlled Trials ◽  
Premenstrual Syndrome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Reproductive Age ◽  
Controlled Trials ◽  
Extensive Literature ◽  
Randomized Controlled ◽  
Agnus Castus

IntroductionFive to 8% of women of reproductive age suffer from moderate to severe symptoms of premenstrual syndrome associated with substantial distress or functional impairment.ObjectiveTo determine the efficacy, tolerability and acceptability of Vitex agnus castus (VAC, chaste-berry) preparations for treatment of premenstrual syndrome (PMS).MethodsAfter an extensive literature search all randomized controlled trials of VAC in women with PMS and/or premenstrual dysphoric disorder were included.ResultsWe found 17 randomized controlled trials of VAC in the treatment of PMS of which 14 studies could be included in the quantitative analysis. All trials, except one, found the Vitex agnus castus preparation to be more efficacious than placebo, pyridoxine and magnesium for either total symptom score or individual symptoms or symptom clusters. Unfortunately, the majority of trials is hampered by a high risk of bias. The pooled effect of VAC in placebo-controlled trials was large (Hedge's g: −1.21; 95% CI: −1.53 to −0.88), but heterogeneity extremely high (I2 = 91%). We could not single out distinct factors that could explain this heterogeneity. The funnel plot and Egger's tests suggest the presence of bias over the full set of studies and effect sizes.ConclusionAlthough meta-analysis shows a large pooled effect of VAC in placebo-controlled trials the high risk of bias, high heterogeneity and risk of publication bias of the included studies preclude a definitive conclusion. The pooled treatment effects should be viewed as merely explorative and, at best, overestimating the real treatment effect of VAC for PMS symptomatology.Disclosure of interestP.S. reports personal fees from H. Lundbeck A/S, outside the submitted work. The other authors have not supplied their declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document