睾丸酮用于卵巢低反应患者辅助生殖治疗的荟萃分析

摘要

Objective To evaluate testosterone pretreatment on the pregnancy outcomes in poor ovarian response(POR) patients undergoing assisted reproductive therapy(ART). Methods Search the original research paper published on the PubMed, EMBASE, Cochrane library,CNKI,CBM and WanFang database and collect all the randomized controlled trials using testosterone pretreatment before or during ovarian stimulation. The literature was published from January 2006 to January 2018. Two assessors independently screened the studies according to the criteria for inclusion and exclusion and assessed methodological quality according to the Cochrane Handbook. Stata 12.0 was used to do the meta-analysis. Results A total of 505 patients from 6 studies were enrolled to Meta-analysis. The study population for testosterone treatment was the experimental group, and the study population without testosterone treatment was the control group. Compared to the control groups, experimental groups were associated with increased clinical pregnancy rates [odds ratio(OR) =2.50, 95 % confidence interval (CI) =1.47,4.23], live birth rates[ OR=2.35, 95 % CI=1.22,4.50] and more oocytes retrieved [standard mean difference( SMD) =0.76, 95 % CI =0.55,0.97]. The total FSH dose and the total duration of FSH stimulation were decreased, SMD calculated were -0.58(95 % CI= -0.77,-0.38) and -0. 46 (95 % Cl=-0.65,-0.26). Conclusion Current RCT evidence suggests that testosterone pretreatment in patients with POR increases clinical pregnancy rates, birth rates, number of oocytes obtained, reduces FSH dose and time course, and improves ovarian response and pregnancy outcomes. However, there are currently a small number of studies in this field. Among the above indicators, only the dose of total FSH is statistically significant, and other results are not statistically significant. Therefore, more high-quality RCT studies are needed to prove this.%目的 系统评价睾丸酮用于卵巢低反应(poor ovarian response,POR)患者辅助生殖( assisted reproductive therapy, ART)治疗后,对妊娠结局的影响.方法 计算机检索PubMed数据库、EMBASE数据库、Cochrane图书馆、中国知网(CNKI)数据库、中国生物医学文献数据库( CBM)和万方医学数据库中发表于2006年1月至2018年1月前的原创性研究论文;收集采取睾丸酮治疗措施的 POR 型患者,执行 ART 后的随机对照实验(randomized controlled trial,RCT)文献.由2 位评价员根据纳入及排除标准独立进行文献筛选,并对选取的文献进行质量评价.采用Stata 12.0软件对筛选到的RCT文献进行荟萃分析,分析睾丸酮用于POR患者ART后,对妊娠结局的影响.结果 共纳入6 项研究, 505 例患者.进行睾丸酮处理的研究人群为研究组,未进行睾丸酮处理的研究人群为对照组.研究组与对照组比较,临床妊娠率( OR =2.50,95 % CI 为1.47, 4.23)、出生率(OR =2.35,95 % CI为1.22,4.50)、获卵数(SMD=0.76,95 % CI 为0.55,0.97)均明显增加,卵泡刺激素(follicle stimulating hornone,FSH)的总剂量( SMD= -0.58,95 % CI为-0.77,-0.38),FSH 的使用时程(SMD= -0.46,95 % CI为-0.65,-0.26)均明显减少.结论 目前的RCT证据表明,对POR患者采用睾丸酮预处理会增加临床妊娠率、出生率、获卵数,减少 FSH 剂量和使用时程,改善卵巢反应和妊娠结局.但是目前该领域的研究样本量较少,上述指标中,只有FSH的总剂量具有统计学意义,其它结果尚无统计学意义,因此未来还需要更多的高质量RCT研究来进行佐证.