Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Administración intrauterina de la gonadotrofina coriónica humana (hCG) para pacientes subfértiles sometidas a reproducción asistida

This is not the most recent version

Information

DOI:
https://doi.org/10.1002/14651858.CD011537.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 19 May 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Gynaecology and Fertility Group

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Laurentiu Craciunas

    Correspondence to: Obstetrics and Gynaecology, Newcastle University, Newcastle upon Tyne, UK

    [email protected]

  • Nikolaos Tsampras

    Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK

  • Arri Coomarasamy

    School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK

  • Nick Raine‐Fenning

    Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK

Contributions of authors

LC and NT performed the literature search, assessed the studies for eligibility and extracted the data.

LC performed the analyses and drafted the review.

NT, AC and NRF provided feedback and edited the review.

All authors agree with the final version of the review.

Sources of support

Internal sources

  • None, Other.

External sources

  • None, Other.

Declarations of interest

None of the authors have any conflicts of interest to disclose.

Acknowledgements

We thank Helen Nagels (Managing Editor), Marian Showell (Trials Search Co‐ordinator), and the editorial board of the Cochrane Gynaecology and Fertility Group for their invaluable assistance in developing this review.

Version history

Published

Title

Stage

Authors

Version

2018 Oct 20

Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

Review

Laurentiu Craciunas, Nikolaos Tsampras, Nick Raine‐Fenning, Arri Coomarasamy

https://doi.org/10.1002/14651858.CD011537.pub3

2016 May 19

Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

Review

Laurentiu Craciunas, Nikolaos Tsampras, Arri Coomarasamy, Nick Raine‐Fenning

https://doi.org/10.1002/14651858.CD011537.pub2

2015 Feb 14

Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

Protocol

Laurentiu Craciunas, Nikolaos Tsampras, Arri Coomarasamy, Nick Raine‐Fenning

https://doi.org/10.1002/14651858.CD011537

Differences between protocol and review

Slight narrowing of the Cochrane Gynaecology and Fertility Group Specialised Register search strategy.

We performed a subgroup analysis based on IC‐hCG dose to address the heterogeneity.

For outcomes with event rates below 1%, we used the Peto one‐step odds ratio (OR) method to calculate the combined outcome with 95% confidence interval.

If a study included multiple treatment arms receiving different doses of hCG, we split the control group proportionally with the experimental groups in order to avoid analysing control participants in duplicate.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.1 Live birth.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.1 Live birth.

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.2 Miscarriage.
Figures and Tables -
Figure 5

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.2 Miscarriage.

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.4 Clinical pregnancy.
Figures and Tables -
Figure 6

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.4 Clinical pregnancy.

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.5 Complications: intrauterine death.
Figures and Tables -
Figure 7

Forest plot of comparison: 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, outcome: 1.5 Complications: intrauterine death.

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 1 Live birth.
Figures and Tables -
Analysis 1.1

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 1 Live birth.

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 2 Miscarriage.
Figures and Tables -
Analysis 1.2

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 2 Miscarriage.

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 3 Miscarriage per clinical pregnancy.
Figures and Tables -
Analysis 1.3

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 3 Miscarriage per clinical pregnancy.

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 4 Clinical pregnancy.
Figures and Tables -
Analysis 1.4

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 4 Clinical pregnancy.

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 5 Complications: intrauterine death.
Figures and Tables -
Analysis 1.5

Comparison 1 Intrauterine human chorionic gonadotropin (hCG) versus no hCG, Outcome 5 Complications: intrauterine death.

Summary of findings for the main comparison. Intrauterine administration of hCG for women undergoing assisted reproduction

Intrauterine administration of hCG for women undergoing assisted reproduction

Population: women undergoing assisted reproduction
Settings: assisted reproduction units
Intervention: intrauterine administration of hCG

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Intrauterine administration of hCG

Live birth ‐ cleavage stage: hCG < 500 IU
RR
Follow‐up: mean 40 weeks

495 per 1000

376 per 1000
(287 to 500)

RR 0.76
(0.58 to 1.01)

280
(1 study)

⊕⊝⊝⊝
very low1,2

Live birth ‐ cleavage stage: hCG ≥ 500 IU
RR
Follow‐up: mean 40 weeks

247 per 1000

388 per 1000
(326 to 462)

RR 1.57
(1.32 to 1.87)

914
(3 studies)

⊕⊕⊕⊝
moderate3

Live birth ‐ blastocyst stage: hCG ≥ 500 IU
RR
Follow‐up: mean 40 weeks

366 per 1000

337 per 1000
(293 to 381)

RR 0.92
(0.80 to 1.04)

1666
(2 studies)

⊕⊕⊕⊝
moderate3

Pregnancy ‐ cleavage stage: hCG < 500 IU
RR
Follow‐up: mean 12 weeks

579 per 1000

509 per 1000

(405 to 637)

RR 0.88

(0.70 to 1.10)

280
(1 study)

⊕⊝⊝⊝
very low2,3,4

Pregnancy ‐ cleavage stage: hCG ≥ 500 IU
RR
Follow‐up: mean 12 weeks

321 per 1000

453 per 1000

(401 to 507)

RR 1.41

(1.25 to 1.58)

1414

(7 studies)

⊕⊕⊕⊝
moderate3

Pregnancy ‐ blastocyst stage: hCG ≥ 500 IU
RR
Follow‐up: mean 12 weeks

430 per 1000

408 per 1000

(370 to 455)

RR 0.95

(0.86 to 1.06)

1991

(3 studies)

⊕⊕⊕⊝
moderate3

Miscarriage

Follow‐up: mean 40 weeks

48 per 1000

52 per 1000

(40 to 68)

RR 1.09

(0.83 to 1.43)

3395

(7 studies)

⊕⊝⊝⊝
very low2,3,4

Other complications

Other complications reported in the included studies were ectopic pregnancy (3 studies, n = 915, 3 events overall), heterotopic pregnancy (1 study, n = 495, 1 event), intrauterine death (2 studies, n = 978, 21 events) and triplets (1 study, n = 48, 3 events). There were too few events to allow any conclusions to be drawn

⊕⊝⊝⊝
very low2,3,4

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; hCG: human chorionic gonadotropin; IU: international units; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded two levels due to very serious risk of bias: lack of blinding of participants and personnel, no clear description of allocation concealment and premature termination of the study following interim analysis.
2 Downgraded one level due to imprecision: total number of events was fewer than 300.
3 Downgraded one level due to serious risk of bias: lack of blinding of participants and personnel, no allocation concealment.
4 Downgraded two levels due to very serious imprecision: total number of events was fewer than 300 and 95% confidence interval around the pooled effect includes both no effect and appreciable benefit or appreciable harm.

Figures and Tables -
Summary of findings for the main comparison. Intrauterine administration of hCG for women undergoing assisted reproduction
Comparison 1. Intrauterine human chorionic gonadotropin (hCG) versus no hCG

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Cleavage stage: hCG < 500 IU

1

280

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.01]

1.2 Cleavage stage: hCG ≥ 500 IU

3

914

Risk Ratio (M‐H, Random, 95% CI)

1.57 [1.32, 1.87]

1.3 Blastocyst stage: hCG ≥ 500 IU

2

1666

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.04]

2 Miscarriage Show forest plot

7

3395

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.83, 1.43]

3 Miscarriage per clinical pregnancy Show forest plot

7

1450

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.77, 1.30]

4 Clinical pregnancy Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Cleavage stage: hCG < 500 IU

1

280

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.70, 1.10]

4.2 Cleavage stage: hCG ≥ 500 IU

7

1414

Risk Ratio (M‐H, Random, 95% CI)

1.41 [1.25, 1.58]

4.3 Blastocyst stage: hCG ≥ 500 IU

3

1991

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.86, 1.06]

5 Complications: intrauterine death Show forest plot

2

978

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.80 [0.33, 1.92]

Figures and Tables -
Comparison 1. Intrauterine human chorionic gonadotropin (hCG) versus no hCG