| With the development of assisted reproductive technology,its success rate continues to increase.However,about half of infertility patients still fail to pregnancy,which is mainly due to the failure of embryo implantation.Successful implantation of embryos depends on embryo quality,endometrial receptivity,and complex,synchronized interactions between them.In the treatment of in vitro fertilization and embryo transfer(IVF-ET),due to the use of controlled ovarian hyperstimulation(COH),high levels of estrogen in the mother will not only lead to the planting window appears and closes in advance and also affects the expression of endocrine-receptor-associated cytokines.Intrauterine infusion is a method of infusing certain drugs into the uterine cavity to stimulate the endometrium and improve endometrial receptivity.It is usually performed 1-3 days before the embryo is transplanted.It is mainly used for intrauterine perfusion of human chorionic gonadotropin(hCG),granulocyte colony stimulating factor(G-CSF),and peripheral blood mononuclear cells(PBMCs),Growth hormone,Danshen injection and so on.Traditional systematic reviews and meta-analysis methods can only evaluate two interventions and cannot compare two or more interventions.Meta-analysis of the web has evolved from traditional meta-analyses and uses a combination of direct and indirect evidence from the RCT to compare the efficacy of various interventions.In this study,network meta-analysis was used to compare the effect of three intrauterine infusion drugs(hCG,G-CSF,and PBMCs)on the outcomes of IVF-ET patients with different timing and dose of perfusion,in order to provide evidence-based evidence in clinical decisions.ObjectiveTo evaluate whether the three types of intrauterine perfusion drugs(hCG,G-CSF,PBMCs)at different perfusion time and dose impacts the in vitro fertilization-embryo transfer(IVF-ET)pregnancy outcomes and the difference in efficacy between them.MethodsDatabases included PubMed,EMBase,ISI Web of Science Cochrane Library,CNKI,Wanfang and VIP were searched for the study of the effect of hCG,G-CSF,PBMCs on pregnancy outcome.The literature screening according to the inclusion and exclusion criteria,followed by quality evaluation and data extraction.The retrieval period was from the date of database construction to Oct.2017.Pregnancy outcomes were measured by the implantation rate,clinical pregnancy rate,miscarriage rate,and live birth rate.The effect index was the odds ratio(OR)and its 95%confidence interval(CI).The direct comparison meta analysis was performed using Stata 14.0 software,and the I~2 value was used to judge the heterogeneity between studies.If I~2>50%,use a random effects model.If I~2<50%,use the fixed effect model.The online meta analysis uses Stata 14.0 software for data analysis.The“mvmeta”command is used to calculate the indirect comparison of OR values and confidence intervals,and different interventions are sorted by surface under the cumulative ranking(SUCRA).Results1.For the cleavage embryo transfer cycle:(1)Compared with the control group,500 IU hCG(OR=0.35,95%CI=0.18-0.69)was infused 3 days before transplantation,500 IU hCG was perfused on the day of transplantation(OR=0.60,95%CI=0.39-0.93),and 200 ul of PBMCs were infused 3days before transplantation.(OR=2.42,95%CI=1.18-4.97)the difference in the implantation rate was statistically significant.Three days before transplantation,500IU HCG was perfused to become the best improvement of the cleavage embryo transfer period.The perfusion method had the highest performance.Perfusion 200ul PBMCs 3days before transplantation and 500IU HCG perfusion the same day.(2)500 IU hCG(OR=0.20,95%CI=0.09-0.44)3 days before transplantation,500IU hCG 500 IU hCG per day(OR=0.48,95%CI=0.38-0.62),and 3 perfusions during monitoring 200ug G-CSF(OR=0.46,95%CI=0.27-0.78),150ug G-CSF(OR=0.30,95%CI=0.12-0.75)3 days before transplantation,and 200ul PBMCs infused 3 days before transplantation(OR=5.16,95%CI=2.61-10.20)Compared with the control group,the difference in pregnancy rate was statistically significant.Among them,200 ul of PBMCs infused 3 days before transplantation and 500 IU hCG perfusion 3 days before transplantation were the best perfusion methods.150ug G-CSF was infused before day,200ug G-CSF was infused three times during the monitoring,and 500IU hCG perfusion was performed on the same day.(2)Compared with the control group,all the perfusion methods included in this study had no statistically significant difference in the abortion rate,and there was no statistically significant difference between these methods(3)On the day of transplantation,500IU hCG(OR=0.48,95%CI=0.35-0.65)and200ul PBMCs(OR=3.15,95%CI=1.57-6.30)were infused 3 days before transplantation The difference in the rate was statistically significant.Among them,200ul of PBMCs perfused 3 days before transplantation became the best perfusion method with the highest performance,followed by 500 IU hCG perfusion on the same day.2.For the blastocyst transplantation cycle:500 IU hCG perfusion 2 days before transplantation,500 IU hCG perfusion the day of transplantation,perfusion day>500IU hCG compared with the control group,the pregnancy outcome indicators showed no statistically significant difference,and the three were sorted similarly.Conclusion1.In the cleavage embryo transfer cycle,injecting 200 ul of PBMCs 3 days before transplantation and 500 IU hCG perfusion 3 days before transplantation are the preferred perfusion methods to improve pregnancy outcomes.2.In the blastocyst transfer cycle,perfusion of 500IU hCG 2 days before transplantation,500IU hCG perfusion on the day of transplantation,and 500IU HCG perfusion on the day of transplantation did not improve pregnancy outcomes. |
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