TEAS, DHEA, CoQ10, and GH for poor ovarian response undergoing IVF-ET: a systematic review and network meta-analysis

Reproductive Biology and Endocrinology

Research

Bin Yang¹  Tianyu Wang¹  Fengya Zhu²  Shao Yin³  Xia Feng⁴  Siyun Li⁴  Deya Che⁴ 

[1] Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China;Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China;Zigong First People’s Hospital, Zigong, China;Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China;Zigong First People’s Hospital, Zigong, China;

关键词: Poor ovarian response;    IVF-ET;    Assisted reproductive technology;    NMA;    Systematic review;   

DOI  :  10.1186/s12958-023-01119-0

 received in 2023-06-07, accepted in 2023-07-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAssisted reproductive technology (ART) has brought good news to infertile patients, but how to improve the pregnancy outcome of poor ovarian response (POR) patients is still a serious challenge and the scientific evidence of some adjuvant therapies remains controversial.AimBased on previous evidence, the purpose of this systematic review and network meta-analysis was to evaluate the effects of DHEA, CoQ10, GH and TEAS on pregnancy outcomes in POR patients undergoing in vitro fertilization and embryo transplantation (IVF-ET). In addition, we aimed to determine the current optimal adjuvant treatment strategies for POR.MethodsPubMed, Embase, The Cochrane Library and four databases in China (CNKI, Wanfang, VIP, SinoMed) were systematically searched up to July 30, 2022, with no restrictions on language. We included randomized controlled trials (RCTs) of adjuvant treatment strategies (DHEA, CoQ10, GH and TEAS) before IVF-ET to improve pregnancy outcomes in POR patients, while the control group received a controlled ovarian stimulation (COS) regimen only. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The surface under the cumulative ranking curve (SUCRA) was used to provide a pooled measure of cumulative ranking for each outcome.ResultsSixteen RCTs (2323 women) with POR defined using the Bologna criteria were included in the network meta-analysis. Compared with the control group, CoQ10 (OR 2.22, 95% CI: 1.05 to 4.71) and DHEA (OR 1.92, 95% CI: 1.16 to 3.16) had obvious advantages in improving the clinical pregnancy rate. CoQ10 was the best in improving the live birth rate (OR 2.36, 95% CI: 1.07 to 5.38). DHEA increased the embryo implantation rate (OR 2.80, 95%CI: 1.41 to 5.57) and the high-quality embryo rate (OR 2.01, 95% CI: 1.07 to 3.78) and number of oocytes retrieved (WMD 1.63, 95% CI: 0.34 to 2.92) showed a greater advantage, with GH in second place. Several adjuvant treatment strategies had no significant effect on reducing the cycle canceling rate compared with the control group. TEAS was the least effective of the four adjuvant treatments in most pooled results, but the overall effect appeared to be better than that of the control group.ConclusionCompared with COS regimen, the adjuvant use of CoQ10, DHEA and GH before IVF may have a better clinical effect on the pregnancy outcome of POR patients. TEAS needs careful consideration in improving the clinical pregnancy rate. Future large-scale RCTs with direct comparisons are needed to validate or update this conclusion.Systematic review registrationPROSPERO CRD42022304723

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2

Fig. 7

Fig. 5