有关不孕不育研究与管理英国指南 Investigating and treating subfertility.ppt

Anovulation不排卵症 Treatment OR (95% CI) Clomiphene vs no treatment 3.41 (1.23 to 9.48) Hughes et al. 2003, Cochrane FSH vs HMG 0.89 (0.53 to 1.49) Nugent et al. 2003, Cochrane GnRH agonist in PCOS 1.50 (0.72 to 3.12) Hughes et al. 2003, Cochrane 克罗米芬vs不予处置 促卵泡激素vs促性腺激素 促性腺激素释放激素激动剂在多囊卵巢综合征中应用 Clomiphene v Letrozole克罗米芬v来曲唑 Clomiphene (n=376) Letrozole (n=374) Significance Ovulation rates排卵率 48.3% 61.7% P=0.001 Live birth rates活产率 19.1% 27.5% P=0.007 Pregnancy loss流产率 29.1% 31.8% NS Twins双胞胎 7.4% 3.4% NS Congenital anomalies先天异常 1 4 P=0.65 Legro et al NEJM 2014 rFSH v urinary gonadotrophinsfor ovarian stimulation in ART cycles重组人卵泡促激素vs促性腺激素在辅助生殖技术周期卵巢刺激作用 Type of urinary gonadotrophin v rec FSH LB or OP with urinary LB or OP with rFSH Relative effect (95% CI) Number of participants (studies) Quality of the evidence (GRADE) All urinary gonadotrophins 245 / 1000 239 / 1000 OR – 0.97 (0.87 – 1.08) 7339 (28 studies) ???? high HMG/HMG-HP 255 / 1000 223 / 1000 OR – 0.84 (0.72-0.99) 3197 (11 studies) ???? High FSH-P 170 / 1000 205 / 1000 OR – 1.26 (0.96 – 1.64) 1430 (5 studies) ???? High FSH-HP 267 / 1000 273 / 1000 OR – 1.03 (0.86 – 1.22) 2712 (13 studies) ???? High OHSS 19 / 1000 22 / 1000 OR – 1.18 (0.86 – 1.61) 7740 (32 studies) ???? High Cochrane Database Syst Rev. 2011 Feb 16; Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles.van Wely M, Kwan I, Burt AL, Thomas J, Vail A, Van der Veen F, Al-Inany HG Endometriosis and Infertility (RCOG) 子宫内膜异位症与不孕不育（英国皇家妇产科学会） No role for medical treatment 药物治疗没有作用 (A) Mild disease: Laparoscopic ablation may improve fertility (A)病情较轻时：腹腔镜下切除可能提高生育能力 Mild disease: IUI + SO helpful (A) 病情较轻时：人工授精+超促排卵 Moderate disease: surgery may improve fertility (B)病情中等时：手术可能提高生育能力 Mild endometriosis and infertility: laparoscopic surgery轻度子宫内膜异位症与不孕不育：腹腔镜手术 Jacobson et al, 2003, Cochrane Mild endometriosis: IUI + superovulation 轻度子宫内膜异位症：人工授精+超促排卵 Peto O