Interventions for endometriosis-related infertility: a systematic review and network meta-analysis

Ruth Mary Hodgson, Ruth Hodgson, Hodgson RM, Lee HL, Hui Linn Lee, Rui Wang, Ben Williem Mol, Ben W. Mol, Neil Johnson, Johnson N
Fertility and sterility · 2020 · vol. 113(2) , pp. 374–382.e2 · doi:10.1016/j.fertnstert.2019.09.031 · PMID:32106991 · W3007768130
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This systematic review and network meta-analysis compared various interventions for endometriosis-related infertility to determine their effectiveness.

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Abstract

ObjectiveTo compare the effectiveness of different treatments for women with endometriosis-related infertility.DesignA systematic review and network meta-analysis of randomized controlled trials (RCTs).SettingNot applicable.Patient(s)Women with endometriosis confirmed by laparoscopy with associated infertility.Intervention(s)An extensive electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and Embase.Main outcome measure(s)Clinical pregnancy, live birth rate, miscarriage, and adverse events.Result(s)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.Conclusion(s)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.Registration numberPROSPERO registration number, CRD42018087572.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Fertility Infertility, Female Reproductive Techniques, Assisted Reproductive Techniques, Assisted Abortion, Spontaneous Abortion, Spontaneous Endometriosis Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Infertility, Female Live Birth Pregnancy Pregnancy Rate Randomized Controlled Trials as Topic Risk Factors

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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