Cochrane reviews Flashcards
Individualised gonadotrophin dose selection using markers of ovarian reserve for women undergoing IVF/ICSI
2024
26 studies, involving 8520 women
We did not find that tailoring the FSH dose in any particular ORT population (low, normal, high ORT) affected live birth/ongoing pregnancy rates, but we could not rule out differences, due to sample size limitations. Low‐certainty evidence
Progesterone for prevention of LH surge in women undergoing COH
2023
14 RCTs, involving 2643 subfertile women, 47 women using oocyte freezing for fert pres and 534 oocyte donors.
Little or no differences in LBR may exist when comparing MPA 4 mg with GnRH agonists in normo‐responders. OOcyte pick up cancellation rate (OPCR) may be slightly increased in the MPA 4 mg group, but MPA 4 mg reduces the doses of gonadotropins in comparison to GnRH agonists.
Little or no differences in OPCR may exist between progestogens and GnRH antagonists in normo‐responders and donors. However, micronised progesterone could improve by 2 to 6 MII oocytes.
When comparing one progestogen to another, dydrogesterone suggested slightly lower OPCR than MPA and micronised progesterone, and MPA suggested slightly lower OPCR than the micronised progesterone 100 mg. Finally, MPA 10 mg suggests a lower OPCR than MPA 4 mg.
There is uncertainty regarding the rest of the outcomes due to imprecision and no solid conclusions can be drawn.
Antibiotics at prior to or at the time of embryo transfer
2023
Two RCTs with 377 women in the review. Using the GRADE method, we assessed the certainty of the evidence as very low to low across measured outcomes.
We are uncertain if administration of antibiotics prior to or at the time of ET improves LBR in women undergoing ART based on a single study of 27 women with low‐certainty evidence
IVF for UE
2023
IVF versus expectant management (2 RCTs) - uncertain due to low quality evidence (OR 22.0 (95% CI 2.56-189.37) I RCT with 51 women.
IVF versus IUI(unstimulated) - IVF may improve LBR compared to unstimulated IUI (OR 2.47, 95% CI 1.19 to 5.12; 2 RCTs; 156 women; I2 = 60%; low‐quality evidence)
IVF versus IUI-OS - Treatment‐naive women
There may be little or no difference in LBR between IVF and IUI + gonadotropins
(1 IVF to 2 to 3 IUI cycles: OR 1.19, 95% CI 0.87 to 1.61; 3 RCTs; 731 women; I2 = 0%; low‐quality evidence; 1
IVF to 1 IUI cycle: OR 1.63, 95% CI 0.91 to 2.92; 2 RCTs; 221 women; I2 = 54%; low‐quality evidence);
or between IVF and IUI + CC (OR 2.51, 95% CI 0.96 to 6.55; 1 RCT; 103 women; low‐quality evidence).
IVF versus IUI-OS In women pretreated with IUI + CC
IVF may improve LBR compared with IUI + gonadotropins (OR 3.90, 95% CI 2.32 to 6.57; 1 RCT; 280 women; low‐quality evidence).
ICSI versus IVF in males with normal total sperm count and motility
2023
3 RCTs 1539 couples
We are uncertain of the effect of ICSI versus c‐IVF for live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI 0.94 to 1.30, I2 = 0%, 2 studies, n = 1124, low‐certainty evidence)
The current available studies that compare ICSI and c‐IVF in couples with males presenting with normal total sperm count and motility, show neither method was superior to the other, in achieving live birth, adverse events (multiple pregnancy, ectopic pregnancy, pre‐eclampsia and prematurity), also alongside secondary outcomes, clinical pregnancy, viable intrauterine pregnancy or miscarriage.
Oocyte flushing during OPU in ART
2023
15 studies with a total of 1643 women
We are uncertain of the effect of follicular flushing on live birth rate compared to aspiration alone (OR 0.93, 95% CI 0.59 to 1.46; 4 RCTs; n = 467; I2 = 0%; moderate‐certainty evidence)
The effect of follicular flushing on both live birth and miscarriage rates compared with aspiration alone is uncertain. Although the evidence does not permit any firm conclusions on the impact of follicular flushing on oocyte yield, total number of embryos, number of cryopreserved embryos, or clinical pregnancy rate, it may be that the procedure itself takes longer than aspiration alone. The evidence was insufficient to permit any firm conclusions with respect to adverse events or safety
Endometrial injury for pregnancy following sexual intercourse or IUI
2022
22 RCTS 3703 women
Evidence is insufficient to show whether there is a difference in live birth/ongoing pregnancy between endometrial injury and no intervention/a sham procedure in women undergoing IUI or attempting to conceive via sexual intercourse. The pooled results should be interpreted with caution, as the evidence was of low to very low quality due to high risk of bias present in most included studies and an overall low level of precision.
AI (letrozole) for OI in infertile women with PCOS
2022
41 RCTs (6522 women)
Live birth rates were higher with letrozole (with or without adjuncts) compared to SERMs followed by timed intercourse (OR 1.72, 95% CI 1.40 to 2.11; I2 = 0%; number needed to treat for an additional beneficial outcome (NNTB) = 10; 11 trials, 2060 participants; high‐certainty evidence).
multiple pregnancy rate (2.2% with SERMs versus 1.6% with letrozole: OR 0.74, 95% CI 0.42 to 1.32; I2 = 0%; 14 trials, 2247 participants; high‐certainty evidence)
Letrozole appears to improve live birth rates and pregnancy rates in infertile women with anovulatory PCOS, compared to SERMs, when used for ovulation induction, followed by intercourse. There is high‐certainty evidence that OHSS rates are similar with letrozole or SERMs. There was high‐certainty evidence of no difference in miscarriage rate and multiple pregnancy rate. We are uncertain if letrozole increases live birth rates compared to LOD.
Luteal phase support for women trying to conceive by intrauterine insemination or sexual intercourse
25 RCTs (5111 participants). Most studies were at unclear or high risk of bias. We graded the certainty of evidence as very low to low. The main limitations of the evidence were poor reporting and imprecision.
We are uncertain if vaginal progesterone supplementation during luteal phase is associated with a higher live birth/ongoing pregnancy rate. Vaginal progesterone may increase clinical pregnancy rate; however, its effect on miscarriage rate and multiple pregnancy rate is uncertain. We are uncertain if IM progesterone improves ongoing pregnancy rates or decreases miscarriage rate when compared to vaginal progesterone. Regarding the other reported comparisons, neither oral progesterone nor any other medication appears to be associated with an improvement in pregnancy outcomes (very low‐certainty evidence).
Peri-implantation glucocorticoid administration for ART cycles
2022
We included 16 RCTs (2232 couples analysed). We are uncertain whether glucocorticoids improved live birth rates (odds ratio (OR) 1.37, 95% confidence interval (CI) 0.69 to 2.71; 2 RCTs, n = 366; I2 = 7%; very low‐certainty evidence)
Cleavage‐stage versus blastocyst‐stage embryo transfer in assisted reproductive technology
2022
32 RCTs (5821 couples or women).
The live birth rate following fresh transfer was higher in the blastocyst‐stage transfer group (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.06 to 1.51; I2 = 53%; 15 studies, 2219 women; low‐quality evidence).
Antioxidants for male subfertility
12 RCTs looked at LB
Live birth: antioxidants may lead to increased live birth rates (odds ratio (OR) 1.43, 95% confidence interval (CI) 1.07 to 1.91, P = 0.02, 12 RCTs, 1283 men, I2 = 44%, very low‐certainty evidence).
Growth hormone for in vitro fertilisation (IVF)
2021
16 RCTs (1352 women). Two RCTs (80 women) studied GH in routine use, and 14 RCTs (1272 women) studied GH in poor responders.
The use of adjuvant GH in IVF treatment protocols has uncertain effect on live birth rates and mean number of oocytes retrieved in normal responders. However, it slightly increases the number of oocytes retrieved and pregnancy rates in poor responders, while there is an uncertain effect on live birth rates in this group. The results however, need to be interpreted with caution, as the included trials were small and few in number, with significant bias and imprecision. Also, the dose and regimen of GH used in trials was variable. Therefore, further research is necessary to fully define the role of GH as adjuvant therapy in IVF.
(NOT recommended in ESHRE guideline)
Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility
2021
82 studies, involving 12,614 women
Based on the available results, gonadotropins probably improve CLBR compared with anti‐oestrogens (moderate‐certainty evidence). Gonadotropins may also improve CLBR when compared with aromatase inhibitors (low‐certainty evidence). From the available data, there is no convincing evidence that aromatase inhibitors lead to higher live birth rates compared to anti‐oestrogens. None of the agents compared lead to significantly higher multiple pregnancy rates
Oxytocin antagonists for assisted reproduction
2021
We are uncertain whether intravenous atosiban improves pregnancy outcomes for women undergoing assisted reproductive technology. This conclusion is based on currently available data from seven RCTs, which provided very low‐ to low‐certainty evidence across studies.
