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The Cochrane Database of Systematic... Jan 2014Inflammatory bowel disease (IBD) is a chronic, globally-occurring gastrointestinal disorder and a major cause of illness and disability. It is conventionally classified... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inflammatory bowel disease (IBD) is a chronic, globally-occurring gastrointestinal disorder and a major cause of illness and disability. It is conventionally classified into Crohn's disease (CD) and ulcerative colitis (UC). Helminths are parasitic worms with complex life cycles involving tissue- or lumen-dwelling stages in their hosts, and causing long-lasting or chronic infections that are frequently asymptomatic. Helminths modulate immune responses of their hosts, and many observational and experimental studies support the hypothesis that helminths suppress immune-mediated chronic inflammation that occurs in asthma, allergy and IBD.
OBJECTIVES
The objective was to evaluate the efficacy and safety of helminth treatment for induction of remission in IBD.
SEARCH METHODS
We searched the following databases from inception to 13 July 2013: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register. We also searched four online trials registries, and abstracts from major meetings. There were no language restrictions.
SELECTION CRITERIA
Randomised controlled trials (RCTs) where the intervention was any helminth species or combination of helminth species, administered in any dose and by any route and for any duration of exposure to people with active CD or UC, confirmed through any combination of clinical, endoscopic and histological criteria were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data and assessed eligibility using a standardized data collection form. We used the RevMan software for analyses. The primary outcome was induction of remission as defined by the included studies. Secondary outcomes included clinical, histologic, or endoscopic improvement as defined by the authors, endoscopic mucosal healing, change in disease activity index score, change in quality of life score, hospital admissions, requirement for intravenous corticosteroids, surgery, study withdrawal and the incidence of adverse events. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. We calculated the mean difference (MD) and 95% CI for continuous outcomes. We assessed the methodological quality of included studies using the Cochrane risk of bias tool. The overall quality of the evidence supporting each outcome was assessed using the GRADE criteria.
MAIN RESULTS
Two RCTs (90 participants) were included. One trial assessed the efficacy and safety of Trichuris suis (T. suis) ova in patients with UC (n = 54). The other RCT was a phase one that assessed the safety and tolerability of T. suis ova in patients with CD (n = 36). The risk of bias in both studies was judged to be low. In the UC study, during the 12-week study period, participants in the active arm received 2-weekly aliquots of 2500 T. suis eggs, added to 0.8 mL of saline; those in the placebo arm received 0.8 mL saline only. There were sparse data available for the outcomes clinical remission and clinical improvement. Ten per cent (3/30) of patients in the T. suis arm entered remission compared to 4% (1/24) of patients in the placebo arm (RR 2.40, 95% CI 0.27 to 21.63). Forty-three per cent (13/30) of patients in the T. suis group achieved clinical improvement compared to 17% (4/24) of placebo patients (RR 2.60, 95% CI 0.97 to 6.95). The mean ulcerative colitis disease activity index (UCDAI) score was lower in the T. suis group (6.1 +/- 0.61) compared to the placebo group (7.5 +/- 0.66) after 12 weeks of treatment (MD -1.40, 95% CI -1.75 to -1.05). There was only limited evidence relating to the proportion of patients who experienced an adverse event. Three per cent (1/30) of patients in the T. suis group experienced at least one adverse event compared to 12% (3/24) of placebo patients (RR 0.27, 95% CI 0.03 to 2.40). None of the adverse events reported in this study were judged to be related to the study treatment. GRADE analyses rated the overall quality of the evidence for the primary and secondary outcomes (i.e. clinical remission and improvement) as low due to serious imprecision. In the CD study, participants received a single treatment of T. suis ova at a dosage of 500 (n = 9), 2500 (n = 9), or 7500 (n = 9) embryonated eggs or matching placebo (n = 9). The CD study did not assess clinical remission or improvement as outcomes. There were sparse data on adverse events at two weeks. Thirty-seven per cent (10/27) of patients in the T. suis group experienced at least one adverse event compared to 44% (4/9) of placebo patients (RR 0.83, 95% CI 0.35 to 2.01). Only one adverse event (dysgeusia) was judged to be possibly related to treatment in this study. Dysgeusia was reported in one patient in the T. suis group and in one patient in the placebo group.
AUTHORS' CONCLUSIONS
Currently, there is insufficient evidence to allow any firm conclusions regarding the efficacy and safety of helminths used to treat patients with IBD. The evidence for our primary efficacy outcomes in this review comes from one small study and is of low quality due to serious imprecision. We do not have enough evidence to determine whether helminths are safe when used in patients with UC and CD. Further RCTs are required to assess the efficacy and safety of helminth therapy in IBD.
Topics: Animals; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Ovum; Randomized Controlled Trials as Topic; Remission Induction; Therapy with Helminths; Trichuris
PubMed: 24442917
DOI: 10.1002/14651858.CD009400.pub2 -
BioMed Research International 2013The limited predictive value of semen analysis in achieving natural conception or in IVF outcome confirms the need for sperm function tests to determine optimal... (Review)
Review
The limited predictive value of semen analysis in achieving natural conception or in IVF outcome confirms the need for sperm function tests to determine optimal management. We reviewed HZA and SPA predictive power in IVF outcome, with statistical significance of diagnostic power of the assays. HZA was readily efficient in predicting IVF outcome, while evident inconsistency among the studies analysed framed the SPA's role in male fertility evaluation. Considerable variation was noted in the diagnostic accuracy values of SPA with wide sensitivity (52-100%), specificity (0-100%), and PPV (18-100%) and NPV (0-100%) together with fluctuation and notable differentiation in methodology and cutoff values employed by each group. HZA methodology was overall consistent with minor variation in cutoff values and oocyte source, while data analysis reported strong correlation between HZA results with IVF outcome, high sensitivity (75-100%), good specificity (57-100%), and high PPV (79-100%) and NPV (68-100%). HZA correlated well with IVF outcome and demonstrated better sensitivity/specificity and positive/negative predictive power. Males with normal or slightly abnormal semen profiles could benefit by this intervention and could be evaluated prior to referral to assisted reproduction. HZA should be used in a sequential fashion with semen analysis and potentially other bioassays in an IVF setting.
Topics: Female; Fertilization in Vitro; Humans; Male; Predictive Value of Tests; Pregnancy; Semen Analysis; Sperm-Ovum Interactions; Treatment Outcome; Zona Pellucida
PubMed: 24228261
DOI: 10.1155/2013/945825 -
Reproductive Biology and Endocrinology... May 2017Comparative neonatal outcomes with respect to singleton births from blastocyst transfers or cleavage-state embryo transfers are controversial with respect to which... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Comparative neonatal outcomes with respect to singleton births from blastocyst transfers or cleavage-state embryo transfers are controversial with respect to which method is superior. Many studies have yielded contradictory results. We performed a systematic review and meta-analysis for the purpose of comparing neonatal outcomes in single births following IVF/ICSI.
METHODS
We searched the Medline, Embase and Cochrane Central Register of Clinical Trials (CCTR) databases until October 2016. Studies and trials that contained neonatal outcomes for singleton births were included. Data were extracted in 2 × 2 tables. The analysis was performed using Rev Man 5.1 software. Risk ratios (RRs) and risk differences, with 95% confidence intervals, were calculated to assess the results of each outcome. Subgroups were applied in all outcomes. Newcastle-Ottawa scale (NOS) checklists were used to assess the quality of the referenced studies.
RESULTS
Twelve studies met the criteria in this meta-analysis. There was a high risk of preterm birth after blastocyst embryo transfer versus the risk after cleavage-stage transfer (RR: 1.11, 95% CI: 1.01-1.22). For the "only fresh" subgroup, the outcome was coincident (RR: 1.16, 95% CI: 1.06-1.27). For the "fresh and frozen" and "only frozen" subgroups, there were no differences. Patients who received fresh blastocyst embryo transfers had a high risk of very preterm births (RR: 1.16, 95% CI: 1.02-1.31). Finally, cleavage-stage embryo transfers were associated with a high risk of infants who were small for gestational age (0.83, 95% CI: 0.76-0.92) and a low risk of those who were large for gestation age (1.14, 95% CI: 1.04-1.25).
CONCLUSIONS
The risks of preterm and very preterm births increased after fresh blastocyst transfers versus the risks after fresh cleavage-stage embryo transfers. However, in frozen embryo transfers, there were no differences. Blastocyst embryo transfers resulted in high risks of infants who were large for gestational age, and cleavage-stage embryo transfers resulted in high risks of infants who were small for gestational age.
Topics: Blastocyst; Cleavage Stage, Ovum; Embryo Transfer; Female; Humans; Infant, Newborn; Parturition; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Single Embryo Transfer
PubMed: 28472983
DOI: 10.1186/s12958-017-0255-4 -
Fertility and Sterility Dec 2012To evaluate serum antimüllerian hormone (AMH) level modification after surgical excision of ovarian endometriomas. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate serum antimüllerian hormone (AMH) level modification after surgical excision of ovarian endometriomas.
DESIGN
Systematic review. MEDLINE search from January 1990 to April 2012 using the combination of medical terms endometriosis, endometrioma, endometriotic cyst, and AMH or antimüllerian hormone, MIF or müllerian inhibiting factor. Reference lists of selected studies were checked for additional potential contributions.
SETTING
Not applicable.
PATIENT(S)
Women with ovarian endometriomas requiring surgery.
INTERVENTION(S)
Serum AMH level assessment.
MAIN OUTCOME MEASURE(S)
Serum AMH level modifications.
RESULT(S)
Eleven articles satisfied our selection criteria. Data pooling were deemed inopportune owing to the heterogeneity of the study designs and of the reported parameters. Nine of 11 studies documented a statistically significant reduction of serum AMH level after surgery. The two studies failing to document this decrease were published by the same study group and partly overlapped. The magnitude of the decline was more evident in women operated on for bilateral endometriomas.
CONCLUSION(S)
Evidence deriving from the evaluation of serum AMH level modifications after surgical excision of endometriomas supports a surgery-related damage to ovarian reserve.
Topics: Anti-Mullerian Hormone; Cell Count; Endometriosis; Female; Humans; Oocytes; Ovarian Diseases; Prevalence
PubMed: 22975114
DOI: 10.1016/j.fertnstert.2012.08.009 -
Scientific Reports Aug 2016Emerging evidence suggests that assisted hatching (AH) techniques may improve clinical pregnancy rates, particularly in poor prognosis patients; however, there still... (Meta-Analysis)
Meta-Analysis Review
Emerging evidence suggests that assisted hatching (AH) techniques may improve clinical pregnancy rates, particularly in poor prognosis patients; however, there still remains considerable uncertainty. We conducted a meta-analysis to verify the effect of AH on pregnancy outcomes. We searched for related studies published in PubMed, Web of Science, and Cochrane library databases from start dates to October 10, 2015. Totally, 36 randomized controlled trials with 6459 participants were included. Summary odds ratios (ORs) with 95% confidence intervals (CIs) for whether by AH or not were estimated. We found a significant increase in clinical pregnancy (OR = 1.16, 95% CI = 1.00-1.36, I(2) = 48.3%) and multiple pregnancy rates (OR = 1.50, 95% CI = 1.11-2.01, I(2) = 44.0%) with AH when compared to the control. Numerous subgroup analyses stratified by hatching method, conception mode, extent of AH, embryos transfer status, and previous failure history were also carried out. Interestingly, significant results of clinical pregnancy as well as multiple pregnancy rates were observed among women who received intracytoplasmic sperm injection, and who received AH which the zona were completely removed. In summary, this meta-analysis supports that AH was associated with an increased chance of achieving clinical pregnancy and multiple pregnancy. Whether AH significantly changes live birth and miscarriage rates needs further investigations.
Topics: Abortion, Spontaneous; Adult; Embryo Implantation; Female; Fertilization in Vitro; Humans; Live Birth; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Randomized Controlled Trials as Topic; Sperm Injections, Intracytoplasmic; Zona Pellucida
PubMed: 27503701
DOI: 10.1038/srep31228 -
Human Reproduction (Oxford, England) Aug 2012Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved? (Meta-Analysis)
Meta-Analysis Review
STUDY QUESTION
Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved?
SUMMARY ANSWER
Follicular flushing during ART does not result in a greater number of oocytes in normal responders.
WHAT IS KNOWN ALREADY
Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval.
STUDY DESIGN, SIZE, DURATION
Systematic review and meta-analysis of 518 patients who participated in 6 randomized trials over 20 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Literature searches were conducted to retrieve randomized controlled trials on follicle or ovarian flushing in ART. Databases searched included PubMed, EMBASE, Web of Science and the Cochrane Database of Clinical Trials (CENTRAL). Six trials that included 518 subjects matched the inclusion criteria. Studies included were limited to trials that were published, randomized trials comparing oocyte retrieval with a single-lumen pick-up needle versus follicle flushing after direct aspiration with a multi-channel oocyte pick-up needle in ART patients.
MAIN RESULTS AND THE ROLE OF CHANCE
In each of the trials, measures of the oocyte yield (oocytes retrieved divided by follicles aspirated), total oocytes retrieved, fertilization or pregnancy were not different when comparing direct aspiration with follicle flushing. Four trials reported a higher operative time with follicle flushing. Results of the meta-analysis indicated no significant differences in the oocytes retrieved [weighted mean difference: 0.07, 95% confidence interval (CI): -0.13 to 0.29] or the oocyte yield (odds ratio: 1.06, 95% CI: 0.95-1.18) between the non-flushing and flushing groups.
LIMITATIONS, REASONS FOR CAUTION
All trials featured an open label design and the majority of patients in this meta-analysis were normal responders. The applications of these results to poor responders, patients undergoing natural cycle ART or minimal stimulation ART should be made with caution.
WIDER IMPLICATIONS OF THE FINDINGS
Follicle flushing does not improve ART outcomes in normal-responding patients and should not be performed. This meta-analysis should solidify this recommendation as it includes the largest trial published on the subject and is consistent with a recently published Cochrane review.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Adult; Databases, Factual; Female; Fertilization; Fertilization in Vitro; Humans; Oocyte Retrieval; Oocytes; Ovarian Follicle; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted; Risk
PubMed: 22647450
DOI: 10.1093/humrep/des174 -
Fertility and Sterility Feb 2011To determine whether "pregnancy rate (PR) per thawed embryo," accounting for embryo losses, is more relevant than "PR per ET," generally used in the literature for... (Review)
Review
OBJECTIVE
To determine whether "pregnancy rate (PR) per thawed embryo," accounting for embryo losses, is more relevant than "PR per ET," generally used in the literature for expressing embryo cryopreservation results.
DESIGN
Systematic review.
SETTING
University teaching hospital.
PATIENT(S)
None.
INTERVENTION(S)
Analysis of reports from January 1983 to February 2009 involving thawing of human cryopreserved embryos. Of the 1,275 articles that were initially identified, 102 met the inclusion criteria.
MAIN OUTCOME MEASURE(S)
Comparisons between PR per ET and PR per thawed embryo, contribution of embryo loss to PR.
RESULT(S)
Overall PR, expressed per ET and per thawed embryo, was compared according to the different freezing speeds and cryoprotectants used. Statistical analysis revealed significant differences for four comparisons with one approach to expressing results, not identified with the other. All other statistical analyses gave similar results whichever way the results were expressed. The rate of thawed transferred embryos, a measure accounting for embryo losses, is a good prognostic factor for PR.
CONCLUSION(S)
Statistical analysis accounting for embryo losses can give results different from those published in the literature. Consequently, the clinical PR per thawed embryo may be a more informative measure for accurate analysis of practices.
Topics: Cleavage Stage, Ovum; Cryopreservation; Efficiency; Embryo Transfer; Embryo, Mammalian; Female; Humans; Models, Biological; Pregnancy; Pregnancy Rate; Quality Indicators, Health Care; Research Design
PubMed: 20599194
DOI: 10.1016/j.fertnstert.2010.05.040 -
Asian Journal of Andrology 2021Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes... (Meta-Analysis)
Meta-Analysis
Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.
Topics: Humans; Male; Oocytes; Sperm Injections, Intracytoplasmic; Spermatids
PubMed: 33565426
DOI: 10.4103/aja.aja_85_20 -
Cells Dec 2019The recent discovery of microRNAs (miRNAs) in human reproductive tissues and cells indicates a possible functional role in reproductive function. However, the studies...
The recent discovery of microRNAs (miRNAs) in human reproductive tissues and cells indicates a possible functional role in reproductive function. However, the studies published to date in female reproductive tissues/cells and embryos are inconclusive and sometimes controversial. In order to update the knowledge of this field, the present study aimed to discuss, through a systematic review, the role of miRNAs in female human reproduction and early embryogenesis. We conducted a systematic review of the published literature in MEDLINE and EMBASE databases through June 2018 (plus a complementary search until July 2019), in accordance with the PRISMA guidelines. We have included descriptive and observational studies, in which fertile/infertile women were well-defined. The primary outcome was the miRNA expression in ovaries, oocytes, extracellular vesicles, and embryos. We identified 25,204 articles, of which 28 were selected for qualitative analysis: 18 in ovaries and extracellular vesicles, three in oocytes, and seven in embryos. The present systematic review of descriptive and observational studies demonstrates that aberrant miRNA expression in female reproductive tissues/cells and embryos is related with infertility and embryogenesis errors. The expression of specific miRNAs, particularly in extracellular vesicles, may be used in the future as biomarkers of infertility and prognostic tools of embryo development.
Topics: Blastocyst; Extracellular Vesicles; Female; Fertility; Humans; MicroRNAs; Oocytes; Ovary
PubMed: 31817143
DOI: 10.3390/cells8121564 -
European Journal of Obstetrics,... Aug 2022Dietary intake of omega-3 polyunsaturated fats (PUFAs) may be associated with successful assisted reproductive techniques (ART). However, heterogeneous studies were... (Review)
Review
Dietary intake of omega-3 polyunsaturated fats (PUFAs) may be associated with successful assisted reproductive techniques (ART). However, heterogeneous studies were conducted and opposing results were obtained. This systematic review aims to summarize the evidence on the effect of omega-3 dietary intake on oocyte and embryo quality for a positive ART outcome. The PRISMA 2020 statement was followed and the review protocol was registered with PROSPERO (CRD42021283881). Inclusion and exclusion criteria were: eligible studies examined women undergoing ART cycles whose diet was evaluated for omega-3 intake or experienced an increase in omega-3 compared with women who followed in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) but did not increase the omega-3 intake before the cycle. 5,412 records were identified and five studies were included in the analysis. Two studies focused on sub-fertile or infertile women specifically, yet all women in all studies went through IVF/ICSI procedures. All five studies demonstrated how omega-3 FAs may be beneficial by increasing the positive rate of ART outcomes and embryo quality evaluated according to morphology and morphokinetic parameters. More research focusing on comparable and/or equal outcomes is required to strengthen supporting evidence with the aim to provide valid recommendations for women seeking a pregnancy.
Topics: Diet; Eating; Fatty Acids, Omega-3; Female; Fertilization in Vitro; Humans; Infertility, Female; Male; Oocytes; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Semen
PubMed: 35779332
DOI: 10.1016/j.ejogrb.2022.06.019