Surgery For Infertility Patients The Effect Of The Meta-analysis

Objectives:To evaluate the effect of varicocele treatment on pregnancy rate in subfertile couples.Methods: Searches were applied to the following electronic database: Pubmed (1966.1-2008.3); CNKI (1980-2008); Cochrane Liberary.Meanwhile,handsearch was applied in recent Chinese Journal of Andrology and other two Journals.. In addition, We also checked cross references, references from review articles, and contacted researchers in the field.RCTs were included if they were relevant to the clinical question posed, if they reported pregnancy rates as an outcome measure, and if they reported data in treated (surgical ligation or radiological embolization of the internal spermatic vein) and untreated groups. Data were extracted independently by two reviewer. Statistical analysis were performed with Ravman4.2.Result: Nine studies met the inclusion criteria for this review. One was an extension of a previously published study (Nieschlag 1995/1998), which left eight studies for analysis (Nilsson 1979; Breznik 1993; Madgar 1995; Yamamoto 1996; Nieschlag 1995/1998; Grasso 2000;Unal 2001; Krause 2002). All eight only included men from couples with subfertility problems, The combined Peto odds ratio (OR) of the eight studies is 1.10 (95%CI 0.73 to 1.67), indicating no benefit of varicocele treatment over expectant management in subfertility couples in whom varicocele in the man is the only abnormal finding.Conclusion: There is no evidence that treatment of varicocele in men from couples with otherwise unexplained subfertility improves the couple's chance of conception. Objectives:To assess the value of surgical treatment for tubal disease prior to IVF.Methods: Searches were applied to the following electronic database: Pubmed (1966.1-2008.3); CNKI (1980-2008); Cochrane Liberary.Meanwhile,handsearch was applied in recent Chinese Journal of Obstetrics and Gynecology and other three Journals.. In addition, We also checked cross references, references from review articles, and contacted researchers in the field. All trials comparing a surgical treatment for tubal disease with a control group generated by randomisation were considered for inclusion in the review. Data were extracted independently by two reviewer. Statistical analysis were performed with Ravman4.2.Result: Four randomised controlled trials (Dechaud 1998; Goldstein1998; Strandell 1999;Kontoravdis A2006) involving 401 (or couples) were included in this review. The odds of live birth (Peto OR 2.13 , 95%CI 1.24 to3.65, P=0.006) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. The odds of pregnancy were also increased (Peto OR 1.99, 95%CI 1.27 to 3.12,P=0.003). There was no significant difference in the odds of ectopic pregnancy (Peto OR 0.49, 95%CI 0.10 to 2.33,P=0.37), miscarriage (Peto OR 0.42, 95%CI 0.13 to 1.32) or treatment complications (Peto OR 5.86, 95%CI 0.35 to 96.79,P=0.22). No data were available concerning the odds of multiple pregnancy .Conclusion: Laparoscopic salpingectomy should be recommended for all women with hydrosalpinges prior to IVF treatment.