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Human Reproduction (Oxford, England) Aug 2005The objective of this systematic review was to assess the safety and efficacy of subcutaneous recombinant (r) HCG and high-dose rLH compared with intramuscular urinary... (Review)
Review
BACKGROUND
The objective of this systematic review was to assess the safety and efficacy of subcutaneous recombinant (r) HCG and high-dose rLH compared with intramuscular urinary (u) uHCG for inducing final oocyte maturation and triggering ovulation.
METHODS
We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (August 27, 2003), the Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, issue 4, 2003), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004). Searches were not limited by language. The bibliographies of included and excluded trials and abstracts of major meetings were searched for additional trials. Authors and pharmaceutical companies were contacted for missing and unpublished data. Only truly randomized controlled trials (RCTs) were included. Assessment of inclusion/exclusion, quality assessment and data extraction were performed independently by at least two reviewers.
RESULTS
Seven RCTs were identified, four comparing rHCG and uHCG and three comparing rhLH and uHCG. There was no statistically significant difference between rHCG and uHCG regarding the ongoing pregnancy/live birth rate [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.69-1.39], clinical pregnancy rate, miscarriage rate or incidence of ovarian hyperstimulation syndrome (OHSS). There was no statistically significant difference between rhLH and uHCG regarding the ongoing pregnancy/live birth rate (OR 0.94; 95% CI 0.50-1.76), pregnancy rate, miscarriage rate or incidence of OHSS. rHCG was associated with a reduction in the incidence of local site reactions (OR 0.47; 95% CI 0.32-0.70).
CONCLUSIONS
According to these data, there is no evidence of a difference in clinical outcomes between urinary and recombinant gonadotrophins used for induction of final follicular maturation. Additional factors should be considered when choosing gonadotrophin type, including safety, cost and drug availability.
Topics: Chorionic Gonadotropin; Female; Humans; Luteinizing Hormone; Ovulation Induction; Pregnancy; Randomized Controlled Trials as Topic; Recombinant Proteins
PubMed: 16024539
DOI: 10.1093/humrep/dei035 -
BMC Pregnancy and Childbirth May 2023Nausea and vomiting in pregnancy (NVP) affects 50-80% of pregnant women and is correlated to the level of human chorionic gonadotropin (hCG). Hyperemesis gravidarum (HG)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nausea and vomiting in pregnancy (NVP) affects 50-80% of pregnant women and is correlated to the level of human chorionic gonadotropin (hCG). Hyperemesis gravidarum (HG) is a severe condition, with an incidence of 0.2-1.5%, characterized by consistent nausea, vomiting, weight loss and dehydration continuing after the second trimester.
AIM
The aim of this systematic review was to investigate a potential correlation between NVP or HG with adverse pregnancy outcomes and hCG levels.
METHOD
A systematic search in PubMed, Embase and CINAHL Complete was conducted. Studies on pregnant women with nausea in the first or second trimester, reporting either pregnancy outcomes or levels of hCG were included. The primary outcomes were preterm delivery (PTD), preeclampsia, miscarriage, and fetal growth restriction. Risk of bias was assessed using ROBINS-I. The overall certainty of evidence was assessed using GRADE.
RESULTS
The search resulted in 2023 potentially relevant studies; 23 were included. The evidence was uncertain for all outcomes, however women with HG had a tendency to have an increased risk for preeclampsia [odds ratio (OR) 1.18, 95% confidence of interval (CI) 1.03 to 1.35], PTD [OR 1.35, 95% CI 1.13 to 1.61], small for gestational age (SGA) [OR 1.24, 95% CI 1.13 to 1.35], and low birth weight (LBW) [OR 1.35, 95% CI 1.26 to 1.44]. Further, a higher fetal female/male ratio was observed [OR 1.36, 95% CI 1.15 to 1.60]. Meta-analyses were not performed for women with NVP; however, most of these studies indicated that women with NVP have a lower risk for PTD and LBW and a higher risk for SGA, and a higher fetal female/male ratio.
CONCLUSION
There may be an increased risk in women with HG and a decreased risk in women with NVP for adverse placenta-associated pregnancy outcomes, however the evidence is very uncertain.
TRIAL REGISTRATION
PROSPERO: CRD42021281218.
Topics: Pregnancy; Infant, Newborn; Female; Male; Humans; Hyperemesis Gravidarum; Pregnancy Outcome; Pre-Eclampsia; Placenta; Premature Birth; Chorionic Gonadotropin; Fetal Growth Retardation; Nausea
PubMed: 37226133
DOI: 10.1186/s12884-023-05691-6 -
BJOG : An International Journal of... Sep 2016Controversies about the performance of conventional prenatal screening using maternal serum and ultrasound markers (PSMSUM) in detecting Down syndrome (DS) have been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversies about the performance of conventional prenatal screening using maternal serum and ultrasound markers (PSMSUM) in detecting Down syndrome (DS) have been raised as a result of a recently available noninvasive prenatal test based on cell-free fetal DNA sequencing.
OBJECTIVES
To evaluate the screening performance of PSMSUM in detecting DS in Chinese women.
SEARCH STRATEGY
An exhaustive literature search of MEDLINE, Embase, the Cochrane Library, ISI Web of Science and China BioMedical Disc.
SELECTION CRITERIA
Primary studies, published from January 2004 to November 2014, which examined the screening accuracy of PSMSUM in pregnant Chinese women, compared with a reference standard, either chromosomal verification or inspection of the newborn.
DATA COLLECTION AND ANALYSIS
Data were extracted as screening positive/negative results for Down and non-Down syndrome pregnancies, allowing estimation of sensitivities and specificities. Risks of bias within and across studies were assessed. Screening accuracy measures were pooled using a bivariate random effects regression model.
MAIN RESULTS
Seventy-eight studies, involving six categories of PSMSUM, were included. Second-trimester double serum [pooled sensitivity (SEN) = 0.80, pooled specificity (SPE) = 0.95] and triple-serum (pooled SEN = 0.79, pooled SPE = 0.96) screening were the predominant PSMSUM methods. The screening performances of these methods achieved the national standard but varied enormously across studies. First-trimester combined screening (pooled SEN = 0.92, pooled SPE = 0.93) and second-trimester quadruple serum screening (median SEN = 0.86, median SPE = 0.96) performed better, but were rarely used.
AUTHOR'S CONCLUSIONS
Second-trimester maternal serum screening has the potential to achieve satisfactory screening performance in middle- and low-income countries. The reported enormous range in screening performance of second-trimester PSMSUM calls for urgent implementation of methods for performance optimization.
TWEETABLE ABSTRACT
Meta-analysis results show good accuracy of maternal serum and ultrasound screening for trisomy 21 in Chinese women.
Topics: Asian People; Biomarkers; China; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Down Syndrome; Female; Humans; Maternal Age; Maternal Serum Screening Tests; Pregnancy; Pregnancy-Associated Plasma Protein-A; Prenatal Diagnosis; Ultrasonography; alpha-Fetoproteins
PubMed: 27627591
DOI: 10.1111/1471-0528.14009 -
The Journal of Urology Aug 2013We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair.
MATERIALS AND METHODS
We comprehensively searched the published and unpublished literature between 1990 and 2010. Eligibility criteria were applied. Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus. Heterogeneity between studies was tested using Cochran chi-square Q test and quantified by calculating I(2). Quality appraisal of included studies was performed. Meta-analysis was conducted when appropriate using a random effects model.
RESULTS
Our search yielded 288 citations, of which 11 (622 patients) met inclusion criteria and were incorporated into the systematic review. Most series were retrospective observational studies of moderate or low methodological quality. Of the patients 45% underwent administration of preoperative hormonal stimulation, with intramuscular testosterone being the most commonly prescribed formulation. Four studies addressed postoperative complication rate stratified by preoperative hormonal stimulation use and were included in a meta-analysis. The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96-2.91, p = 0.07, I(2) = 0%). No persistent side effects due to preoperative hormonal stimulation were reported.
CONCLUSIONS
To our knowledge this is the only systematic review and meta-analysis thus far that has critically assessed the effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair. The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation.
Topics: Chorionic Gonadotropin; Dihydrotestosterone; Humans; Hypospadias; Male; Postoperative Complications; Preoperative Care; Testosterone
PubMed: 23597451
DOI: 10.1016/j.juro.2013.02.3234 -
Journal of Minimally Invasive Gynecology 2016This systematic review and meta-analysis was performed to compare the efficacy and safety of uterine artery embolization (UAE) followed by curettage and methotrexate... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis was performed to compare the efficacy and safety of uterine artery embolization (UAE) followed by curettage and methotrexate (MTX) plus curettage in the treatment of cesarean scar pregnancy (CSP) in China. Studies published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System), and China National Knowledge Information were systematically searched. The main outcome measures included the time for serum β-human chorionic gonadotropin (β-hCG) normalization, the duration of hospital stay, blood losses, and adverse events. Results were expressed as the weighted mean difference (WMD) or risk ratio with 95% confidence intervals (CIs). Results showed that 11 studies involving a total of 725 patients were included in this meta-analysis. Compared with MTX plus curettage, UAE followed by curettage had 16.76 days less time for β-hCG normalization (WMD = -16.76 days; 95% CI, -24.60 to -8.92; p < .001), and 15.05 days less of hospital stay (WMD = -15.05 days; 95% CI, -25.42 to -4.67; p = .004). CSP patients who underwent UAE had 343.24 mL less blood loss compared with those treated with MTX plus curettage (WMD = -343.24 mL; 95% CI, -432.95 to -253.54; p < .001). Moreover, UAE was associated with a lower incidence of adverse events than those treated with MTX plus curettage (relative risk = 0.46; 95% CI, 0.26-0.81; p = .008). In conclusion, UAE combined with curettage significantly shortened the time for β-hCG normalization and hospital stay and reduced blood losses and adverse events compared with the administration of MTX plus curettage. For patients with CSP, UAE followed by curettage appears to be more advantageous and may be a priority option. Further well-conducted, large-scale trials are needed to validate these findings.
Topics: Abortifacient Agents, Nonsteroidal; Cesarean Section; China; Chorionic Gonadotropin, beta Subunit, Human; Cicatrix; Curettage; Female; Humans; Length of Stay; Methotrexate; Pregnancy; Pregnancy, Ectopic; Uterine Artery Embolization
PubMed: 27553186
DOI: 10.1016/j.jmig.2016.08.819 -
The Cochrane Database of Systematic... Sep 2015Thyroid dysfunction pre-pregnancy and during pregnancy (both hyper- and hypothyroidism) is associated with increased risk of adverse outcomes for mothers and infants in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thyroid dysfunction pre-pregnancy and during pregnancy (both hyper- and hypothyroidism) is associated with increased risk of adverse outcomes for mothers and infants in the short- and long-term. Managing the thyroid dysfunction (e.g. thyroxine for hypothyroidism, or antithyroid medication for hyperthyroidism) may improve outcomes. The best method of screening to identify and subsequently manage thyroid dysfunction pre-pregnancy and during pregnancy is unknown.
OBJECTIVES
To assess the effects of different screening methods (and subsequent management) for thyroid dysfunction pre-pregnancy and during pregnancy on maternal and infant outcomes.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials, comparing any screening method (e.g. tool, program, guideline/protocol) for detecting thyroid dysfunction (including hypothyroidism, hyperthyroidism, and/or thyroid autoimmunity) pre-pregnancy or during pregnancy with no screening, or alternative screening methods.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed eligibility of studies, extracted and checked data accuracy, and assessed the risk of bias of included studies.
MAIN RESULTS
We included two randomised controlled trials (involving 26,408 women) - these trials were considered to be at low risk of bias. Universal screening (screening all women) versus case finding (screening only those at perceived increased risk) in pregnancy for thyroid dysfunctionOne trial (4562 women) compared universal screening with case finding for thyroid dysfunction. Before 11 weeks' gestation, women in the universal screening group, and 'high-risk' women in the case finding group had their sera tested for TSH (thyroid stimulating hormone), fT4 (free thyroxine) and TPO-Ab (thyroid peroxidase antibody); women with hypothyroidism (TSH > 2.5 mIU/litre) received levothyroxine; women with hyperthyroidism (undetectable TSH and elevated fT4) received antithyroid medication.In regards to this review's primary outcomes, compared with the case finding group, more women in the universal screening group were diagnosed with hypothyroidism (risk ratio (RR) 3.15, 95% confidence interval (CI) 1.91 to 5.20; 4562 women; GRADE: high quality evidence), with a trend towards more women being diagnosed with hyperthyroidism (RR 4.50, 95% CI 0.97 to 20.82; 4562 women; P = 0.05; GRADE: moderate quality evidence). No clear differences were seen in the risks of pre-eclampsia (RR 0.87, 95% CI 0.64 to 1.18; 4516 women; GRADE: moderate quality evidence), or preterm birth (RR 0.99, 95% CI 0.80 to 1.24; 4516 women; GRADE: high quality evidence) between groups. This trial did not report on neurosensory disability for the infant as a child.Considering this review's secondary outcomes, more women in the universal screening group received pharmacological treatment for thyroid dysfunction (RR 3.15, 95% CI 1.91 to 5.20; 4562 women). No clear differences between groups were observed for miscarriage (RR 0.90, 95% CI 0.68 to 1.19; 4516 women; GRADE: moderate quality evidence), fetal and neonatal death (RR 0.92, 95% CI 0.42 to 2.02; 4516 infants; GRADE: moderate quality evidence), or other secondary outcomes: pregnancy-induced hypertension, gestational diabetes, congestive heart failure, thyroid storm, mode of birth (caesarean section), preterm labour, placental abruption, respiratory distress syndrome, low birthweight, neonatal intensive care unit admission, or other congenital malformations. The trial did not report on a number of outcomes including adverse effects associated with the intervention. Universal screening versus no screening in pregnancy for hypothyroidismOne trial (21,846 women) compared universal screening with no screening for hypothyroidism. Before 15 + 6 weeks' gestation, women in the universal screening group had their sera tested; women who screened 'positive' (TSH > 97.5th percentile, fT4 < 2.5th percentile, or both) received levothyroxine.Considering primary review outcomes, compared with the no screening group, more women in the universal screening screened 'positive' for hypothyroidism (RR 998.18, 95% CI 62.36 to 15,978.48; 21,839 women; GRADE: high quality evidence). No data were provided for the outcome pre-eclampsia, and for preterm birth, the trial reported rates of 5.6% and 7.9% for the screening and no screening groups respectively (it was unclear if these percentages related to the entire cohort or women who screened positive). No clear difference was seen for neurosensory disability for the infant as a child (three-year follow-up IQ score < 85) (RR 0.85, 95% CI 0.60 to 1.22; 794 infants; GRADE: moderate quality evidence).More women in the universal screening group received pharmacological treatment for thyroid dysfunction (RR 1102.90, 95% CI 69.07 to 17,610.46; 1050 women); 10% had their dose lowered because of low TSH, high fT4 or minor side effects. No clear differences were observed for other secondary outcomes, including developmental delay/intellectual impairment at three years. Most of our secondary outcomes, including miscarriage, fetal or neonatal death were not reported.
AUTHORS' CONCLUSIONS
Based on the existing evidence, though universal screening for thyroid dysfunction in pregnancy increases the number of women diagnosed with hypothyroidism who can be subsequently treated, it does not clearly impact (benefit or harm) maternal and infant outcomes.While universal screening versus case finding for thyroid dysfunction increased diagnosis and subsequent treatment, we found no clear differences for the primary outcomes: pre-eclampsia or preterm birth. No clear differences were seen for secondary outcomes, including miscarriage and fetal or neonatal death; data were lacking for the primary outcome: neurosensory disability for the infant as a child, and for many secondary outcomes. Though universal screening versus no screening for hypothyroidism similarly increased diagnosis and subsequent treatment, no clear difference was seen for the primary outcome: neurosensory disability for the infant as a child (IQ < 85 at three years); data were lacking for the other primary outcomes: pre-eclampsia and preterm birth, and for the majority of secondary outcomes.For outcomes assessed using the GRADE approach the evidence was considered to be moderate or high quality, with any downgrading of the evidence based on the presence of wide confidence intervals crossing the line of no effect.More evidence is needed to assess the benefits or harms of different screening methods for thyroid dysfunction in pregnancy, on maternal, infant and child health outcomes. Future trials should assess impacts on use of health services and costs, and be adequately powered to evaluate the effects on short- and long-term outcomes.
Topics: Adult; Female; Humans; Hypothyroidism; Infant Health; Infant, Newborn; Mass Screening; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Thyroid Diseases
PubMed: 26387772
DOI: 10.1002/14651858.CD011263.pub2 -
The Cochrane Database of Systematic... Jan 2013Recurrent miscarriage (RM) is defined as the loss of three or more consecutive pregnancies. Further research is required to understand the causes of RM, which remain... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recurrent miscarriage (RM) is defined as the loss of three or more consecutive pregnancies. Further research is required to understand the causes of RM, which remain unknown for many couples. Human chorionic gonadotrophin (hCG) is vital for maintaining the corpus luteum, but may have additional roles during implantation which support its use as a therapeutic agent for RM.
OBJECTIVES
To determine the efficacy of hCG in preventing further miscarriage in women with a history of unexplained RM.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials investigating the efficacy of hCG versus placebo or no treatment in preventing RM. Quasi-randomised trials are included. Cluster-randomised trials and trials with a cross-over design are excluded.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and assessed the methodological quality of each study. Date were extracted by two review authors and checked for accuracy.
MAIN RESULTS
We included five studies (involving 596 women). Meta-analysis suggested a statistically significant reduction in miscarriage rate using hCG.The number of women needed to treat to prevent subsequent pregnancy loss was seven. However, when two studies of weaker methodological quality were removed, there was no longer a statistically significant benefit (risk ratio 0.74; 95% confidence interval 0.44 to 1.23). There were no documented adverse effects of using hCG.
AUTHORS' CONCLUSIONS
The evidence supporting hCG supplementation to prevent RM remains equivocal. A well-designed randomised controlled trial of adequate power and methodological quality is required to determine whether hCG is beneficial in RM.
Topics: Abortion, Habitual; Chorionic Gonadotropin; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Tocolytic Agents
PubMed: 23440828
DOI: 10.1002/14651858.CD008611.pub2 -
Journal of Obstetrics and Gynaecology... Feb 2012Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second... (Review)
Review
OBJECTIVE
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation.
DATA SOURCES AND STUDY SELECTION
Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes.
DATA EXTRACTION AND SYNTHESIS
Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three relatively homogeneous studies on prediction of PET, and two on prediction of SGA were meta-analyzed. Several single studies demonstrated utility in combining markers to predict adverse outcome; however, this effect was not confirmed after meta-analysis. The most common combination of markers evaluated was alpha fetoprotein and human chorionic gonadotrophin for all outcomes. The highest positive likelihood ratios for predicting PET (5.68; 95% CI 0.73 to 43.97) and SGA (6.18; 95% CI 1.84 to 20.85) were seen with combined alpha fetoprotein and human chorionic gonadotrophin (> 2.5 multiples of the median).
CONCLUSIONS
Currently, no identifiable combination of serum markers performs well as a screening test for preeclampsia, small for gestational age, and stillbirth beyond 24 weeks. Large cohort studies with standardized screening test parameters and outcomes are needed.
Topics: Aneuploidy; Biomarkers; Chorionic Gonadotropin; Estriol; Female; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Inhibins; Neural Tube Defects; Pre-Eclampsia; Pregnancy; Pregnancy-Associated Plasma Protein-A; Prenatal Diagnosis; Stillbirth; alpha-Fetoproteins
PubMed: 22340063
DOI: 10.1016/S1701-2163(16)35157-X -
Computational and Mathematical Methods... 2022The relationship among elevated serum -human chorionic gonadotropin (-hCG), the incidence of pregnancy complications, and adverse pregnancy outcomes has been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The relationship among elevated serum -human chorionic gonadotropin (-hCG), the incidence of pregnancy complications, and adverse pregnancy outcomes has been controversial. Differences in study design, subject bias due to demographic characteristics, and differences in local medical levels could contribute to inconsistent results.
METHODS
Literature searches were performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science Digital Library (CSDL) databases. Inclusion criteria were as follows: (1) research subjects were singleton pregnant women; (2) the study is identified as cohort study; (3) the subjects were assigned to the high -hCG group and control group according to whether the exposure factors increased -hCG in the second trimester; (4) the observed outcomes include at least pregnancy-induced hypertension (PIH), diabetes (gestational diabetes mellitus, GMD), preterm delivery (PD), and intrauterine growth restriction (IUGR); and (5) the odds ratio (OR) and 95% confidence interval (CI) of exposure factors are calculated based on literature dataset. To determine the risk bias of selected literatures, Newcastle-Ottawa scale was applied. The chi-square test was further used for heterogeneity analysis. If heterogeneity was identified, subgroup analyses were then performed for source investigation.
RESULTS
A total of 13 literatures were included and analyzed, including 67,355 pregnant women and 5980 pregnant women assigned to the high -HCG group and 61,375 pregnant women to the control group. The incidence of PIH in the high -HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], = 13.85, < 0.00001). There was no heterogeneity among literatures ( = 8.53, = 0.38, = 6%), and thus there is no identified publication bias ( > 0.05). The incidence of preterm birth in the high -HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], = 13.85, < 0.00001). The analysis suggested no heterogeneity among included literatures ( = 11.78, = 0.11, = 41%) and no publication bias ( > 0.05). Higher incidence of abortion was observed in the high -HCG group compared with the control group (OR = 2.80, 95% CI [1.92, 4.09], = 5.32, < 0.00001). There was no heterogeneity among literatures ( = 3.43, = 0.33, = 13%) and no publication bias ( > 0.05). The incidence of gestational diabetes was higher in the high -HCG group than in the control group (OR = 2.15, 95% CI [1.05, 4.40], = 2.09, = 0.04). Heterogeneity was identified among literatures ( = 47.01, < 0.00001, = 87%). Sensitivity analysis showed that the results were not robust, and there was no publication bias ( > 0.05). Compared with control, the incidence of IGUR was higher in the high -HCG group (OR = 2.70, 95% CI [1.75, 4.19], = 4.45, < 0.0001) with no heterogeneity among literatures ( = 3.92, = 0.14, = 49%) and no publication bias ( > 0.05).
CONCLUSION
High levels of -hCG during pregnancy in singleton women are associated with a high incidence of pregnancy complications and adverse pregnancy outcomes. Pregnant women with high levels of -hCG should be monitored more closely, followed up, and given timely medical interventions to reduce the incidence of pregnancy complications and adverse outcomes.
Topics: Chorionic Gonadotropin, beta Subunit, Human; Cohort Studies; Diabetes, Gestational; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth
PubMed: 36118828
DOI: 10.1155/2022/8315519 -
Current Pharmaceutical Biotechnology Mar 2012The current meta-analysis aimed to answer the following research question: is progesterone elevation on the day of hCG administration associated with the probability of... (Meta-Analysis)
Meta-Analysis Review
Significantly lower pregnancy rates in the presence of progesterone elevation in patients treated with GnRH antagonists and gonadotrophins: a systematic review and meta-analysis.
The current meta-analysis aimed to answer the following research question: is progesterone elevation on the day of hCG administration associated with the probability of clinical pregnancy in women undergoing ovarian stimulation for IVF using GnRH antagonists? A literature search in MEDLINE, EMBASE and CENTRAL electronic databases followed by extensive hand-searching from two independent reviewers was performed to identify relevant studies. Eventually five eligible studies (n=585 patients) were identified. No significant differences were present between patients with and those without progesterone elevation regarding female age, duration of stimulation and total dose of gonadotrophins required. However, patients with progesterone elevation were characterized by higher serum estradiol levels on the day of hCG administration (+956 pg/ml, 95% +248 to +1664, random effects model, p=0.008) and more COCs retrieved (+2.9, 95% CI +1.5 to +4.4, fixed effects model, p < 0.001). Progesterone elevation on the day of hCG administration was associated with a significantly decreased probability of clinical pregnancy per cycle (-9%, 95% CI -17 to -2, fixed model effects, p). In conclusion, in patients treated with GnRH antagonists and gonadotrophins, progesterone elevation on the day of hCG administration is significantly associated with a lower probability of clinical pregnancy.
Topics: Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Ovulation Induction; Pregnancy; Pregnancy Rate; Progesterone
PubMed: 21657997
DOI: 10.2174/138920112799361927