1.
Chinese herbal medicines for the treatment of non-structural abnormal uterine bleeding in perimenopause: A systematic review and a meta-analysis
Shang Y, Lu S, Chen Y, Sun X
Complementary therapies in medicine. 2018;41:252-260.
Abstract
OBJECTIVE Chinese herbal medicines (CHM) have been the mainstream therapy in Asia for thousands of years and become more popular as the alternative treatment recently. The objective of this study is to evaluate the efficacy and safety of CHM for non-structural abnormal uterine bleeding (AUB) in perimenopause. METHODS Seven databases were searched from inception to December 31 st, 2017. Randomized controlled trials (RCTs) which compared CHM versus western therapy in treating non-structural AUB in perimenopause were extracted. The primary outcome measures were hemostasis rate, normalization rate of menstruation, hemoglobin count, and improvement of menopausal symptoms. The secondary outcome measures were adverse effects and recurrence rate. The methodological quality of included trials was assessed in line with the criteria of the Cochrane Risk of Bias assessment tool. Data analyses were performed by Review Manager 5.3 software. The results were expressed as risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI). RESULTS Fifteen RCTs with 1344 participants were analyzed. Compared with Western therapies, CHM showed advantages in normalization rate of menstruation (RR 1.20; 95% CI 1.06-1.34;P = 0.003), improving menopausal symptoms (RR 1.20, 95% CI 1.10-1.31, P <0.0001; MD -2.80, 95% CI -3.35 to -2.25, P <0.00001) and the hemoglobin count (MD 7.85, 95% CI 4.05-11.65, P <0.0001) with lower incidence of adverse reactions (RR 0.23, 95% CI 0.12 to 0.43, P <0.00001) and lower recurrence rate (RR 0.38, 95% CI 0.26 to 0.54, P <0.00001). However, we found insufficient evidence that CHM was any more or less effective than CWT for hemostasis rate (RR 1.02, 95% CI 0.95-1.10, P = 0.62). CONCLUSIONS The findings of our study suggest that CHM may be the effective, acceptable and safe treatment for non-structural abnormal uterine bleeding during perimenopause when compared with Western medicine. However, due to high clinical heterogeneity, low methodological quality and without a proper placebo control, the conclusion is inconclusive and limited, and it should be further examined and updated in future work.
2.
Intravenous immunoglobulin treatment for repeated IVF/ICSI failure and unexplained infertility: a systematic review and a meta-analysis
Li J, Chen Y, Liu C, Hu Y, Li L
American Journal of Reproductive Immunology. 2013;70((6):):434-47.
Abstract
Intravenous immunoglobulin (IVIG) has been introduced empirically into IVF/ICSI programs with the hopes of improving in vitro fertilization (IVF) success. However, the effects of IVIG have been inconsistent. We investigated the effects of IVIG on hard outcomes, including implantation rate, clinical pregnancy rate, live birth rate, miscarriage rate, and live birth rate per embryo transferred. The PubMed, EMBASE, and CNKI databases were searched up to June of 2013 and 10 studies were included. Case-controlled studies comparing IVIG with placebo in IVF/ICSI women and/or unexplained infertility were included. Using fixed and random effects models, the pooled risk ratios (RR) with 95% confidence intervals (CIs) were calculated. The use of IVIG was significantly associated with a higher implantation rate and RR was 2.708 (95%CI: 1.302-5.629) compared with the placebo. The clinical pregnancy rate and the live birth rate were significantly increased in patients randomized to IVIG; RR was 1.475 (95%CI: 1.191-1.825) for the clinical pregnancy rate and RR was 1.616 (95%CI: 1.243-2.101) for the live birth rate. Moreover, the miscarriage rate was significantly less in patients randomized to IVIG (0.352, 95%CI: 0.168-0.738), but the live birthrate per embryo transferred was not (2.893; 95%CI: 0.810-10.331) less. Our results strongly support that IVIG is a useful treatment option for women undergoing repeated IVF failure. 2013 John Wiley & Sons Ltd.