Interventions for endometriosis-related infertility: a systematic review and network meta-analysis
To compare the effectiveness of different treatments for women with endometriosis-related infertility. A systematic review and network meta-analysis of randomized controlled trials (RCTs). Not applicable. Women with endometriosis confirmed by laparoscopy with associated infertility. An extensive ele...
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| Published in: | Fertility and sterility Vol. 113; no. 2; pp. 374 - 382.e2 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Elsevier Inc
01-02-2020
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | To compare the effectiveness of different treatments for women with endometriosis-related infertility.
A systematic review and network meta-analysis of randomized controlled trials (RCTs).
Not applicable.
Women with endometriosis confirmed by laparoscopy with associated infertility.
An extensive electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and Embase.
Clinical pregnancy, live birth rate, miscarriage, and adverse events.
A total of 4,252 trials/abstracts were identified through the literature search, of which we included 36 trials in the systematic review and 26 trials reporting on 2,245 women with endometriosis-related infertility in the network meta-analysis. Network meta-analysis showed that compared with placebo, surgical laparoscopy alone (odds ratio = 1.63; 95% confidence interval, 1.13–2.35) or GnRH agonist alone (odds ratio = 1.68; 95% confidence interval, 1.07–2.46) results in higher odds of pregnancy. The evidence on the other interventions versus placebo or on the secondary outcomes including live birth, miscarriage, and adverse events is insufficient.
The most important conclusion is that more RCTs are needed to clarify the relative effectiveness of treatments for endometriosis-related infertility, ideally comparing interventions to existing recommended interventions such as surgical laparoscopy. In addition, further RCTs comparing IVF and IUI to other treatments are essential.
PROSPERO registration number, CRD42018087572
Intervenciones para la infertilidad asociada a endometriosis: una revisión sistemática y meta-análisis de la red
Comparar la eficacia de diferentes tratamientos en mujeres con infertilidad asociada a endometriosis.
Una revisión sistemática y meta-análisis de la red de los estudios controlados aleatorizados (RCTs).
No aplica.
Mujeres con endometriosis confirmada por laparoscopia con esterilidad asociada.
Una investigación electrónica extensa de las siguientes bases de datos: registro central Cochrane de estudios controlados (CENTRAL), MEDLINE, clinicaltrials.gov, y Embase.
Embarazo clínico, tasa de nacido vivo, tasa de aborto y eventos adversos.
Del total de 4252 estudios/abstracts, 36 de ellos se analizaron en la revisión sistemática y 26 estudios en el meta-análisis, que incluyeron 2245 mujeres con esterilidad asociada a endometriosis. El meta-análisis de red, demostró que comparado con placebo la cirugía laparoscópica sola (Odds Ratio=1.63; intervalo de confianza 95%, 1.13-2.35) o el uso sólo de agonistas de GnRH (Odds Ratio= 1.68; intervalo de confianza de 95%, 1.07-2.4) resultó en mayores probabilidades de embarazo. La evidencia en otras intervenciones comparado con placebo o en resultados secundarios como la tasa de nacido vivo, abortos o eventos adversos es insuficiente.
La conclusión más importante es que se necesitan más RCTs para aclarar la relativa efectividad de los tratamientos de la esterilidad asociada a endometriosis, idealmente comparando intervenciones con las actuaciones recomendadas existentes como la laparoscopia quirúrgica. Además, es esencial comparar FIV e inseminación intrauterina con otros tratamientos mediante más RCTs. |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
| ISSN: | 0015-0282 1556-5653 |
| DOI: | 10.1016/j.fertnstert.2019.09.031 |