Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

摘要: Background Subfertility affects 15% of couples and represents the inability to conceive naturally following 12 months regular unprotected sexual intercourse. Assisted reproduction refers procedures involving in vitro handling both human gametes a key option for many subfertile couples. Most women undergoing assisted treatment will reach stage embryo transfer (ET) but proportion embryos that successfully implant ET has remained small since mid-1990s. Human chorionic gonadotropin (hCG) is hormone synthesised released by syncytiotrophoblast fundamental role implantation early stages pregnancy. Intrauterine administration synthetic or natural hCG via an catheter during mock procedure around time novel approach recently been suggested improve outcomes reproduction. Objectives To investigate whether intrauterine improves clinical reproduction. Search methods We performed comprehensive literature search Cochrane Gynaecology Fertility Group Specialised Register, Central Register Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, registers ongoing trials reference lists all included studies relevant reviews (from inception 10 November 2015), consultation with Search Co-ordinator. Selection criteria We randomised controlled (RCTs) evaluating this review irrespective language country origin. Data collection analysis Two authors independently selected studies, assessed risk bias, extracted data from attempted contact where were missing. We statistical analysis using Review Manager 5 accordance Handbook Systematic Reviews Interventions. evidence quality GRADE methods. Main results Twelve RCTs investigated effect 4038 reproduction. The intra-cavity (IC-hCG) was administered variable doses at different timings before ET. source urine pregnant cell cultures recombinant DNA technology. Most (9/12) high bias least one seven domains assessed. Common problems unclear reporting study methods lack blinding. main limitations overall serious imprecision. For analyses live birth pregnancy, there considerable heterogeneity (I2 greater than 75%) we did not undertake meta-analysis. Exploration sources identified two pre-specified variables as important determinants: (cleavage versus blastocyst stage) dose IC-hCG (less 500 international units (IU) IU greater). then meta-analysis these within subgroups defined IC-hCG. There increase rate subgroup having cleavage-stage ETs compared no (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.32 1.87, three RCTs, n = 914, I2 0%, moderate evidence). In clinic 25% per cycle use -500 would be associated varies 33% 46%. observe significant on any other subgroups. The pregnancy (RR 1.41, CI 1.25 1.58, 1414, either subgroups. There miscarriage influenced 1.09, 0.83 1.43, 3395, very low evidence). Other complications reported ectopic (three 915, events overall), heterotopic (one RCT, 495, event), death (two 978, 21 events) triplets 48, events). There difference between groups, too few allow conclusions drawn quality. Authors' conclusions The outcome promising. However, given size fact positive finding analysis, current does support its cycles. A definitive large trial primary recommended. administration, IC-hCG. regard complications.