Meta-analysis Of The Pregnancy Outcome Of Embryo Transfer Patients With The Method Of Tonifying Kidney And Activating Blood

Objective:Through the method of meta-analysis,this paper analyzes and summarizes the influence of the traditional Chinese medicine treatment of tonifying kidney and activating blood therapy on the pregnancy outcome of embryo transfer patients.Compared with the western medicine treatment,tonifying kidney and activating blood therapy can provide a better treatment plan for embryo transfer patients,as well as provide a basis for scientific clinical medicine and evidence-based medicine.Methods: Through searching Pubmed,Cochrane Library,Embase database,Web of Science,CNKI,Wanfang database,Vip and other full-text databases,the Chinese key words are "tonifying kidney and activating blood therapy","kidney tonifying","blood activating","embryo transfer","in vitro fertilization-embryo transfer","assisted reproductive technology",etc;The English search words are "tonifying kidneys and activating blood","Make up the kidneys","kidneys","live blood","blood" and "embryo transfer","IVF","IVF-ET","ICSI","ART","randomized controlled trial",etc.The Chinese and English documents from the database establishment to October 31,2022 are searched,and references eligible for this study are screened strictly according to the inclusion and exclusion criteria,and the quality of the studies is assessed using the Cochrane Risk Assessment Tool,the required data are extracted from the included studies,and the data are analysed using the Rev Man 5.3 software provided by the Cochrane Library.Results: Through screening,a total of 22 eligible trials are included in this study,including 1057 cases in the experimental group and 1129 cases in the control group,a total of 2186 cases,including 37 cases of exfoliative disease caused by various reasons.The data after meta-analysis showes that tonifying kidney and activating blood therapy and control group could better improve the efficacy of embryo transfer patients than the simple control group,and could effectively improve the clinical pregnancy rate(OR=2.13,95%CI=[1.79,2.54],Z=8.43,P<0.05);It can improve the live birth rate(OR=2.33,95%CI=[1.52,3.57],Z=3.90,P<0.05);Failure to effectively increase the fertilization rate(OR=1.15,95%CI=[0.93,1.42],Z=1.27,P>0.05);It can effectively increase the rate of high-quality embryos(OR=1.45,95%CI=[1.20,1.76],Z=3.76,P<0.05);Improve the efficacy of TCM symptoms(OR=3.88,95%CI=[2.06,7.30],Z=4.21,P<0.05);It can increase the biochemical pregnancy rate(RR=1.31,95%CI=[1.12,1.52],Z=3.45,P<0.05);It also reduces the abortion rate(RR=0.46,95%CI=[0.22,0.96],Z=2.08,P<0.05);Reduce the incidence of ovarian hyperstimulation syndrome(OHSS)(RR=0.37,95%CI=[0.21,0.62],Z=3.72,P<0.05);Promote endometrial growth(MD=0.91,95%CI=[0.66,1.16],Z=7.07,P<0.05);It can help reduce the uterine artery pulsation index PI(MD=-0.38,95%CI=[-0.46,-0.30],Z=9.00,P<0.05);It can help reduce the uterine artery resistance RI(MD=-0.08,95%CI=[-0.10,-0.05],Z=5.90,P<0.05);It can significantly reduce the TCM syndrome score(MD=-3.20,95%CI=[-3.82,-2.58],Z=10.13,P<0.05).The time of taking traditional Chinese medicine in the intervention group of tonifying kidney and activating blood therapy is uneven,and the effect of different time of taking Chinese medicine on clinical pregnancy rate is studied in a subgroup.The clinical pregnancy rate of half cycle of taking Chinese medicine(OR=1.99,95%CI=[1.44,2.75],Z=4.18,P<0.05);Clinical pregnancy rate in one cycle after taking Chinese medicine(OR=2.18,95%CI=[1.65,2.89],Z=5.45,P<0.05);Clinical pregnancy rate in three cycles after taking Chinese medicine(OR=2.20,95%CI=[1.61,3.02],Z=4.91,P<0.05).Conclusion:1.Tonifying kidney and activating blood therapy can increase the endometrial thickness of HCG day in embryo transfer patients,improve uterine arterial blood flow(reduce uterine artery resistance and uterine pulse index),thereby improving endometrial receptivity,and facilitate embryo transfer implantation;Meta-analysis shows that kidney supplementation can improve the rate of high-quality embryos,reduce the incidence of OHSS,increase biochemical pregnancy rate,increase clinical pregnancy rate,reduce miscarriage rate,and finally effectively improve the live birth rate.However,it cannot improve the fertilization rate.Whether this is related to the decline of sperm quality remains to be verified clinically.2.Tonifying kidney and activating blood therapy combined with Western drugs can effectively the clinical pregnancy and live birth rates of embryo transfer patients than Western drugs alone,but the Chinese medicines included in the meta-analysis literature are not fixed,and whether a fixed prescription drug can be obtained to be used as a fixed drug in clinical Chinese and Western medicine hospitals needs to be verified by clinical large samples and multi-center trials;The taking time of Chinese medicine for tonifying kidney and activating blood varies,but from the three subgroup studies of the current meta-analysis,it is speculated that the longer the time of taking traditional Chinese medicine,the better the clinical effect,or whether the best drug cycle can be found to make the efficacy better,or whether the current subgroup analysis of the best effect of 3 months early intervention of traditional Chinese medicine can be speculated to combine with the time cycle theory of follicle recruitment,which requires a large number of basic experiments to verify;The literature included in this meta-analysis not only contains evidence of renal deficiency and blood stasis,but also renal deficiency,renal qi deficiency,renal yin deficiency and other unspecified symptoms,whether tonifying kidney and activating blood therapy is suitable for all types of embryo transfer patients,or that tonifying kidney and activating blood therapy is the basic treatment of embryo transfer patients also needs to be confirmed by multicenter trials.3.There are still some deficiencies in this research method,that is,the sample size of some of the documents included is too small.Because of taking Chinese medicine,the test method cannot be blind,and the quality of the documents needs to be improved,resulting in the low stability of Meta-analysis and the lack of persuasiveness,so the conclusions still need to be confirmed by a lot of literature.