| BackgroundAs we all know,uterine malformations often affect pregnancy outcomes due to structural abnormalities,such as premature delivery,high cesarean delivery rate,and restricted fetal growth.Regarding the classification of uterine malformations,different types of medical institutions have different definitions.The most common classification standards are based on the American Fertility Association in 1988 and European Human Reproduction and Embryology and European Gynecology Endoscope association in 2013.Common uterine malformations such as double-horned uterus,mediastinal uterus,and unicorne uterus.The unicorne uterus is one of them.It is worth noting that the unicorne uterus is often associated with malformations of the urinary system,such as a lack of kidney,and malformations of the kidney.Most of them have not obvious symptoms and can be pregnant naturally,but the incidence of adverse pregnancy outcomes is high in clinical practice,especially premature delivery,abortion,low birth weight infants and very low birth weight infants,abnormal fetal position and the like.The update of examination methods and the improvement of people’s awareness of eugenics,and the widespread application of ultrasound,laparoscopy,MRI or CT,and more and more problems of patients with unicorne uterus have been exposed.With the development of assisted reproductive technology,a great number of patients with unicorne uterus combined with infertility are receiving attention.ObjectiveThis meta-analysis is made to compare the differences in the clinical outcomes of unicornuate uterine and normal uterine infertile patients who underwent IVF/ICSI-ET treatment.MethodsA combination of computer and manual retrieval was used to search the Chinese and foreign databases such as Pubmed,Embase,Wed of Science,Cochrane,CKNI,Wanfang database and other from the establishment of the database to August 10,2019.We collected and compared the outcomes of infertile patients who underwent IVF/ICSI assisted fertility treatment in the unicornuate uterus and normal uterus.Pregnancy outcomes include pregnancy rate,clinical pregnancy rate,ongoing pregnancy rate,implantation rate,live birth rate,abortion rate,ectopic pregnancy rate,full-term birth rate,preterm birth rate,average newborn weight,low birth weight newborn,very low birth weight newborn and so on.According to the inclusion criteria,uterine pattern was divided into normal uterine groups and unicornuate uterine groups.Two researchers independently screened and analyzed the literature.The clinical indicators of the two groups are compared.The RR value and 95%confidence interval are used for binary variables and the MD value and 95%confidence interval for continuous variables.The meta analysis was conducted with Revman5.3 software.ResultsThis study finally includes six researches.The results of 6 non-randomized controlled studies show that,compared with normal uterus groups,pregnancy rate,live birth rate,the average birth gestational weeks,full term delivery rate,average newborns weight of unicornuate uterine groups were reduced(P＜0.05),the number of low birth weight newborns,the number of very low birth weight,abortion rate,and premature birth rate of unicornuate uterine groups were increased(P＜0.05),and clinical pregnancy rate,ongoing pregnancy rate,planting rate,and ectopic pregnancy rate between two groups were no significant difference(P＞0.05).There are no significant differences between the two groups(4 indicators):1.Clinical pregnancy rate:RR=0.90,95%CI(0.77,1.05),P=0.20,that is to say,the clinical pregnancy rate of the normal uterine group is similar to that of the unicornuate uterine.2.Ongoing pregnancy rate:RR=0.67,95%CI(0.44,1.01),P=0.05,that is to say,the ongoing pregnancy rate of the normal uterine group is similar to the unicornuate uterine group.3.Implantation rate:RR=0.80,95%CI(0.57,1.11),P=0.18,namely,the implantation rate of the normal uterine infertility group is similar to that of unicornuate uterine group.4.Ectopic pregnancy rate:RR=0.89,95%CI(0.42,1.91),P=0.77,that is to say,the ectopic pregnancy rate in the normal uterine group is similar to that in the unicornuate uterine group.These clinical indicators showed that normal uterine group were high between the two groups(5 indicators):1.Pregnancy rate:RR=0.88,95%CI(0.81,0.95),P=0.002,that is to say,the pregnancy rate in the normal uterine group is higher than that in the unicornuate uterine group.2.Live birth rate:RR=0.88,95%CI(0.77,0.99),P=0.04,that is to say,the live birth rate in the normal uterine group is higher than that in the unicornuate uterine group.3.Average gestational week of delivery:MD=-0.69,95%CI(-1.07,-0.30),P＜0.01,that is to say,the average gestational week of delivery in the normal uterine group is higher than that in the unicornuate uterine group.4.The average weight of newborns:MD=-193.93,95%CI(-287.13,-100.73),P<0.01,that is to say,the average body weight of newborns in the normal uterine group is higher than that in the unicornuate uterine group.5.Full-term birth rate:RR=0.82,95%CI(0.69,0.96),P=0.01,that is to say,the full-term birth rate of the normal uterine group is higher than that in the unicornuate uterine group.Compared with the unicornuate uterine,the clinical indicators of the normal uterine group were low(4 indicators):1.Miscarriage rate:RR=1.28,95%CI(1.02,1.59),P=0.03,that is to say,the miscarriage rate in the normal uterine group is lower than that in the unicornuate uterine group.2.Premature birth rate:RR=1.63,95%CI(1.31,2.02),P<0.01],that is to say,the premature birth rate of the normal uterine group is lower than that in the unicornuate uterine group.3.The number of low-birth-weight neonates:RR=1.40,95%CI(1.14,1.72),P=0.001,that is to say,the number of low-birth-weight neonates in the normal uterine group is lower than that in the unicornuate uterine group.4.The number of very low-birth-weight neonates:RR=2.61,95%CI(1.63,4.20),P<0.01,that is to say,the number of very low-birth-weight neonates in the normal uterine group is lower than that in the unicornuate uterine group.Conclusionswhen treated with assisted pregnancy(IVF/ICSI-ET)after full evaluation of unicornuate uterine infertility patients,the unicornuate uterus patients are more likely to cause miscarriage,preterm delivery,and weight loss in newborns compared with normal uterine infertility.Background The causes of recurrent miscarriage are complex and involve many aspects such as abnormal uterine morphology,cervical insufficiency,embryonic chromosome abnormalities,chromosomal abnormalities of both couples,immune dysfunction and so on,and some of them are unknown causes.With the continuous improvement of the medical level and people’s understanding of recurrent miscarriage,male factors have become a hot topic in clinical practice for recurrent miscarriage.Male factors include semen routine,sperm DNA fragmentation index,sperm aneuploidy,oxidative stress,anti-oxidation drug treatment and the like.A higher sperm DNA fragmentation index has been observed in infertile men,but the relationship between sperm DNA fragmentation index and recurrent miscarriage is still controversial.Objective This systematic review aimed to explore and to clarify the correlation between sperm DNA fragmentation and recurrent miscarriages.Methods Using the key words " Sperm DNA integrity","The sperm DNA integrity","sperm DNA fragmentation index","sperm DNA fragmentation","SDF","DPI","Habitual Abortion","Habitual Abortions","Miscarriage,Recurrent ","Recurrent Miscarriage ","Recurrent Miscarriages","Abortion,Recurrent"," Recurrent Abortion "," Recurrent Abortions "," Recurrent Early Pregnancy Loss"," recurrent spontaneous abortion",we searched the PubMed,The Cochrane Library,Embase,Web of science,up to 2019 July 10 for the studies.We assessed the quality of non-randomized controlled trials by using the Newcastle-Ottawa Scale.According to common methods measuring sperm DNA fragmentation,the relevant data and conclusions of the included studies are presented in the form of tables.If there is a correlation between sperm DNA fragmentation index and recurrent miscarriage,it is indicated by a positive;if there is no correlation,it is indicated by a negative.Method of systematic reviews(not including meta analysis)was used to clarify the correlation.Results After careful search and exclusion,the final twenty eight studies were included.Four studies reported no difference in sperm DNA fragmentation between the two groups.The other 24 studies all supported an increase in the sperm DNA fragmentation index or a decrease in sperm DNA integrity in the recurrent abortion group.The results showed that methods of Acridine orange test(AO),Comet assay(Comet),Sperm Chromatin Structure assay(SCSA),Sperm Chromatin Dispersion(SCD),The terminal deoxyuridine nick labeling assay(TUNEL)used to determine sperm DNA fragmentation,reveals significant correlation between recurrent abortion with sperm DNA fragmentation.Conclusion Existing researches suggest that sperm DNA fragmentation was associated with recurrent spontaneous abortion. |
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