TY - JOUR
T1 - Comparative effectiveness and safety of 36 therapies or interventions for pregnancy outcomes with recurrent implantation failure
T2 - a systematic review and network meta-analysis
AU - He, Yunan
AU - Tang, Ruonan
AU - Yu, Haikun
AU - Mu, Hui
AU - Jin, Hongbin
AU - Dong, Jie
AU - Wang, Wenwen
AU - Wang, Lu
AU - Chen, Shuqiang
AU - Wang, Xiaohong
N1 - Funding Information:
This study was supported by Major Clinical Research Projects of the Second Affiliated Hospital, Air Force Medical University (2021LCYJ004), and was also supported by National Natural Science Foundation of China (82204152). The funders had no influence on the data collection, analyses or conclusions of the study, and the views expressed in the study were from all the authors themselves and not related to the funders. All authors declared that there were no conflicts of interests in the study.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/10
Y1 - 2023/10
N2 - Purpose: To investigate the effectiveness and safety of 36 different therapies for recurrent implantation failure (RIF) patients. Methods: We searched PubMed, Embase, the Cochrane Library (CENTRAL), Web of Science, and China National Knowledge Internet (CNKI) from inception to August 24, 2022, with language in both English and Chinese. Randomized controlled trials (RCTs) and observational studies that provided data with one of pregnancy outcomes on RIF patients were included in the network meta-analysis (NMA). The odds ratios (OR) and 95% credible interval (CrI) on pregnancy outcomes were summarized by NMA with a random-effects model. We also analyzed data from only RCTs and compared whether the optimal treatment is the same for different failed embryo transfer attempts. Results: The total of 29,906 RIF patients from 154 clinical studies (74 RCTs and 80 non-RCTs) were included in the NMA. In terms of implantation rate (IR), growth hormone (GH) (OR: 3.32, 95% CrI: 1.95–5.67) is the best treatment in all included studies; IVIG+PBMC (5.84, 2.44–14.1) is the best for clinical pregnancy rate (CPR); hyaluronic acid (HA) (12.9, 2.37–112.0) for live birth rate (LBR); and aspirin combined with glucocorticoids (0.208, 0.0494–0.777) for miscarriage rate (MR). The two-dimensional graphs showed that GH could maximize IR and CPR simultaneously; HA and GH could simultaneously increase IR and LBR to a large extent; HA could maximize IR and minimize MR. Conclusion: IVIG+PBMC, GH, and embryo medium enriched with HA could significantly improve pregnancy outcomes in patients with RIF. It appears that combination therapy is a potential administration strategy. Trial registration: This study has been registered on PROSPERO (CRD42022353423).
AB - Purpose: To investigate the effectiveness and safety of 36 different therapies for recurrent implantation failure (RIF) patients. Methods: We searched PubMed, Embase, the Cochrane Library (CENTRAL), Web of Science, and China National Knowledge Internet (CNKI) from inception to August 24, 2022, with language in both English and Chinese. Randomized controlled trials (RCTs) and observational studies that provided data with one of pregnancy outcomes on RIF patients were included in the network meta-analysis (NMA). The odds ratios (OR) and 95% credible interval (CrI) on pregnancy outcomes were summarized by NMA with a random-effects model. We also analyzed data from only RCTs and compared whether the optimal treatment is the same for different failed embryo transfer attempts. Results: The total of 29,906 RIF patients from 154 clinical studies (74 RCTs and 80 non-RCTs) were included in the NMA. In terms of implantation rate (IR), growth hormone (GH) (OR: 3.32, 95% CrI: 1.95–5.67) is the best treatment in all included studies; IVIG+PBMC (5.84, 2.44–14.1) is the best for clinical pregnancy rate (CPR); hyaluronic acid (HA) (12.9, 2.37–112.0) for live birth rate (LBR); and aspirin combined with glucocorticoids (0.208, 0.0494–0.777) for miscarriage rate (MR). The two-dimensional graphs showed that GH could maximize IR and CPR simultaneously; HA and GH could simultaneously increase IR and LBR to a large extent; HA could maximize IR and minimize MR. Conclusion: IVIG+PBMC, GH, and embryo medium enriched with HA could significantly improve pregnancy outcomes in patients with RIF. It appears that combination therapy is a potential administration strategy. Trial registration: This study has been registered on PROSPERO (CRD42022353423).
KW - Administration
KW - Clinical pregnancy rate
KW - Hyaluronic acid
KW - Meta-analysis
KW - Repeated implantation failure
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85169587834&partnerID=8YFLogxK
U2 - 10.1007/s10815-023-02923-8
DO - 10.1007/s10815-023-02923-8
M3 - Article
C2 - 37661207
AN - SCOPUS:85169587834
SN - 1058-0468
VL - 40
SP - 2343
EP - 2356
JO - Journal of Assisted Reproduction and Genetics
JF - Journal of Assisted Reproduction and Genetics
IS - 10
ER -