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. 2022 Aug 29:13:959121.
doi: 10.3389/fendo.2022.959121. eCollection 2022.

Intrauterine interventions for women with two or more implantation failures: A systematic review and network meta-analysis

Xin Hang Jin  1 , Yang Li  2 , Dan Li  3
Affiliations

Intrauterine interventions for women with two or more implantation failures: A systematic review and network meta-analysis

Xin Hang Jin et al. Front Endocrinol (Lausanne). .

Abstract

Objective: To compare the effectiveness of different intrauterine interventions for women with two or more unexplained implantation failures.

Design: A systematic review and network meta-analysis of randomized controlled trials (RCTs).

Patients: Women with two or more implantation failures undergoing fresh or frozen embryo transfer (ET).

Interventions: An electronic search of the following databases: Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase.

Main outcome measures: Clinical pregnancy, live birth/ongoing pregnancy, and miscarriage.

Results: We included 21 RCTs(3079 women) in the network meta-analysis. The network meta-analysis showed that compared with control treatment, platelet-rich plasma(PRP), peripheral blood mononuclear cells (PBMC), granulocyte colony-stimulating factor(G-CSF), human chorionic gonadotropin(HCG), and endometrial scratch(ES) significantly increased clinical pregnancy(OR 3.78, 95% CI 2.72 to 5.25; 2.79, 95% CI 1.75 to 4.45; 1.93, 95% CI 1.37 to 2.72; 1.80, 95% CI 1.18 to 2.72; 1.75, 95% CI 1.29 to 2.36, respectively). PRP ranked the highest in improving clinical pregnancy, followed by PBMC, G-CSF, HCG, and ES. Compared with control treatment, PRP, PBMC, and ES significantly increased live birth/ongoing pregnancy (OR 5.96, 95% CI 3.38 to 10.52; OR 2.55, 95% CI 1.27 to 5.11; OR 1.70, 95% CI 1.07 to 2.69, respectively). PRP ranked the highest in improving live birth/ongoing pregnancy, followed by PBMC, and ES.

Conclusions: PRP is the most effective intrauterine intervention in improving pregnancy outcome in women with two or more implantation failures.

Keywords: PBMC; PRP; endometrial scratch; implantation failure; intrauterine.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
Network plot for clinical pregnancy.
Figure 3
Figure 3
The results of the network meta-analysis for clinical pregnancy.
Figure 4
Figure 4
The ranking of intrauterine interventions for clinical pregnancy.
See this image and copyright information in PMC

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