1.
Autologous platelet-rich plasma intrauterine perfusion to improve pregnancy outcomes after implantation failure: A systematic review and meta-analysis
Liu K, Cheng H, Guo Y, Liu Y, Li L, Zhang X
The journal of obstetrics and gynaecology research. 2022
Abstract
AIMS: Previous studies have reported inconsistent findings on the efficacy of platelet-rich plasma (PRP) therapy in women with implantation failure. The objective of this review was to evaluate whether PRP administration could improve pregnancy outcomes in women with implantation failure undergoing in vitro fertilization. METHODS Electronic databases were searched for studies that explored the effects of PRP for patients with implantation failure. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Based on the available data, we performed subgroup analyses and sensitivity analyses. RESULTS Eight studies were included. PRP treatment improved pregnancy outcomes for all women compared with no treatment or placebo (clinical pregnancy rate: OR 2.24, 95% CI 1.41-3.54; live birth rate: OR 5.76, 95% CI 1.55-21.44; miscarriage rate: OR 0.18, 95% CI 0.05-0.63), especially in randomized controlled trials. No significant differences were detected in multiple pregnancy rates (OR 2.54, 95% CI 0.67-9.67). Furthermore, subgroup analysis based on the number of previous implantation failures showed that PRP treatment improved pregnancy outcomes in women with recurrent implantation failure (clinical pregnancy rate: OR 2.55, 95% CI 1.49-4.38; live birth rate: OR 5.07, 95% CI 1.15-22.34; miscarriage rate: OR 0.20, 95% CI 0.05-0.78). CONCLUSION PRP administration could improve pregnancy outcomes in women with recurrent implantation failure. Due to the limited evidence available, the efficacy of PRP in women with recurrent implantation failure needs to be further verified in high-quality studies with larger sample sizes.
2.
Efficacy of intravenous immunoglobulin in the treatment of recurrent spontaneous abortion: a systematic review and meta-analysis
Shi Y, Tan D, Hao B, Zhang X, Geng W, Wang Y, Sun J, Zhao Y
American journal of reproductive immunology (New York, N.Y. : 1989). 2022
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Abstract
OBJECTIVE we aimed to evalute the efficacy of IVIG in the treatment with patients with recurrent spontaneous abortion (RSA). METHODS Pubmed, Embase, Web of science, Cochrane library we searched for randomized controlled (RCTs) about effect of IVIG on RSA from inception to August 20, 2021. Values of standardized mean differences (SMD) were determined for continuous outcomes. RESULTS A total of fifteen articles involving 902 patients were included in meta-analysis. Compared with the control group, IVIG can increase the live birth rate of recurrent spontaneous abortion patients[OR = 3.06, 95%CI(1.23, 7.64, P = 0.02]. However, recurrent abortion was divided into primary and secondary abortion for subgroup analysis, and there was no statistical difference. Besides, IVIG can also increase the expression in peripheral blood CD3+[OR = 0.4, 95%CI(-2.47, 3.15, P = 0.81],CD4+[OR = 1.16, 95%CI(-4.60, 6.93, P = 0.69], and decrease the expression of CD8+[OR = -1.78, 95%CI(-5.30, 1.75, P = 0.32], but there is no statistical significance. CONCLUSIONS IVIG can significantly increase the live birth rate of recurrent spontaneous abortion. However, the evidence needs further verification and the curative effect is uncertain. It is necessary to further explore the pathogenesis of recurrent abortion and the mechanism of IVIG in the treatment of recurrent spontaneous abortion. Besides, more high-quality randomized controlled trials suitable for population, race, dosage and timing of IVIG in the treatment of recurrent abortion are needed to confirm its effectiveness, and effective systematic evaluation is also needed to evaluate its use benefit. This article is protected by copyright. All rights reserved.
3.
[Acupuncture artificial menstrual cycle method for abnormal uterine bleeding-ovulatory dysfunction (spleen deficiency syndrome)]
Zhang L, Li J, Pan S, Zhang X, Li Y, Hu S, Chen W
Zhongguo zhen jiu = Chinese acupuncture & moxibustion. 2019;39(5):489-94
Abstract
OBJECTIVE To compare the clinical efficacy between acupuncture artificial menstrual cycle method and medication artificial menstrual cycle method for abnormal uterine bleeding-ovulatory (AUB-O) dysfunction (spleen deficiency syndrome). METHODS Sixty patients were randomly assigned into an observation group and a control group, 30 cases in each one. 3 cases dropped out in the observation group and 27 cases were included into analysis; 2 cases dropped out in the control group and 28 cases were included into analysis. The patients in the observation group were treated with acupuncture artificial menstrual cycle method. The acupoints were selected according to different stages of menstrual cycle. The acupuncture was given for 30 min per treatment, once every other day; no treatment was given during menstrual period. Xuehai (SP 10), Sanyinjiao (SP 6), Taixi (KI 3), Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36) and Zhangmen (LR 13) were selected after menstrual period. Taichong (LR 3), Hegu (LI 4), Yaoyangguan (GV 3), Geshu (BL 17), Ganshu (BL 18), Sanyinjiao (SP 6), Pishu (BL 20) were selected in ovulaton periods. Baihui (GV 20), Shenshu (BL 23), Yaoyangguan (GV 3), Geshu (BL 17), Sanyinjiao (SP 6), Zusanli (ST 36), Gongsun (SP 4) were selected before menstrual period. The patients in the control group were treated with medication artificial menstrual cycle method. Femoston (estradiol tablets/estradiol dydrogesterone tablets) was taken orally. The white tablets were estradiol (1 mg), while the gray tablets were estradiol (1 mg) and dydrogesterone (10 mg). The Femoston was taken once a day, white tablets for the first 14 days, then gray tablets for the last 14 days. The 28-day treatment was taken as one session, and one cycle menstrual was taken as one treatment course, and totally 3 courses were given in the two groups. The clinical symptom score was observed before and after treatment as well as in follow-up visit (3 months after treatment). The clinical efficacy was evaluated based on the total effective rate, the marked effective rate of main symptoms (including menstrual cycle, menstrual period, menstrual volume) and basal body temperature (BBT). RESULTS 1 in circle Compared before treatment, the clinical symptom score in the two groups was decreased after treatment and in the follow-up visit (P<0.05). Compared with the control group, the clinical symptom score after treatment as well as the difference of that before and after treatment had no significant difference in the observation group (P>0.05). Compared with the control group, the clinical symptom score in the follow-up visit as well as the difference of that between pre-treatment and follow-up visit had significant difference in the observation group (P<0.05, P<0.01). 2 in circle The total effective rate was 81.5% (22/27) in the observation group and 85.7% (24/28) in the control group, without significant difference between the two groups (P>0.05). 3 in circle After treatment, the marked effective rate of menstrual cycle, menstrual period, menstrual volume had no significant difference between the two groups (P>0.05); during the follow-up visit, the marked effective rate of menstrual cycle in the observation group was superior to that in the control group (P<0.05), but that of menstrual period and menstrual volume had no significant difference between the two groups (P>0.05). 4 in circle After treatment, the diphasic curve rate of BBT had no significant difference between the two groups (P>0.05); during the follow-up visit, the diphasic curve rate of BBT in the observation group was higher than that in the control group (P<0.05). CONCLUSION Acupuncture artificial menstrual cycle method has superior efficacy for AUB-O dysfunction (spleen deficiency syndrome), which has similar efficacy with medication artificial menstrual cycle method. Moreover, acupuncture has advantages in regulating menstrual cycle and improving ovulation, and has a longer curative effect.
4.
Autologous peripheral blood mononuclear cells intrauterine instillation to improve pregnancy outcomes after recurrent implantation failure: a systematic review and meta-analysis
Wu Y, Li L, Liu L, Yang X, Yan P, Yang K, Zhang X
Archives of gynecology and obstetrics. 2019
Abstract
PURPOSE Recurrent implantation failure (RIF) is a common cause of disappointment and a big challenge after assisted reproduction technology treatments. The objective of this study was to evaluate the existing literature to explore whether peripheral blood mononuclear cells' (PBMCs) instillation could improve pregnancy outcomes among patients with RIF. METHODS We conducted a comprehensive search including PubMed, EMBASE, Cochrane library and various databases in China. Three randomized controlled trials (RCTs) and three non-randomized controlled trials (non-RCTs) were included. We included subgroup and sensitivity analyses using Stata 12.0. RESULTS The results of the three RCTs showed that PBMC improved outcomes in all patients compared with placebo or no-treatment [clinical pregnancy rate (CPR): odds ratio (OR) 2.45, 95% confidence interval (CI) 1.53-3.91; implantation rate (IR): OR 2.46, 95% CI 1.48-4.09; live birth rate (LBR): OR 2.43, 95% CI 1.32-4.49]. However, the results of the three non-RCTs indicated that there were no statistically significant differences in the outcomes and that the heterogeneity was higher (I(2) > 0%). Subgroup analysis further suggested that PBMCs treatment significantly increased the CPR, IR and LBR in the three or more implantation failure subgroups (CPR: OR 2.83, 95% CI 1.29-6.22; IR: OR 3.74, 95% CI 1.71-8.19; LBR: OR 3.03, 95% CI 1.15-7.98). CONCLUSIONS Among patients with three or more implantation failures, this treatment improved IR, LBR, and CPR compared to that in controls, due to the limited data available, PBMCs' intrauterine instillation should only be used in the context of clinical trials.