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Cochrane Database of Systematic Reviews

Gonadotropinas para la subfertilidad idiopática de factor masculino

Información

DOI:
https://doi.org/10.1002/14651858.CD005071.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 23 agosto 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Ginecología y fertilidad

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Abdelhamid M Attia

    Correspondencia a: Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt

    [email protected]

    [email protected]

  • Ahmed M Abou‐Setta

    Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada

  • Hesham G Al‐Inany

    Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt

Contributions of authors

AMA registered the title and took the lead in writing the text of the protocol. For the review, he was responsible for performing searches of databases for trials, selecting trials for inclusion, independently extracting data and providing quality assessment, performing statistical analyses and interpreting the data.

AMA also had the search revised and rerun in 2007 and in 2013. One study was identified and excluded in 2007.

AMAS revised the review, provided methodological support and commented on the final draft.

HGAl initiated and conceptualised the review topic and shared writing of the protocol. For the review, he was responsible for selecting trials for inclusion, independently extracting data and providing quality assessment; he also commented on drafts of the review.

Sources of support

Internal sources

  • None, Not specified.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

We would like to acknowledge the work of:

  • Michelle L Proctor, a former Review Group Co‐ordinator of the Cochrane Menstrual Disorders and Subfertility Group. She shared in authoring of the first version of this review by commenting on drafts of the text of the protocol, in particular the search strategy and methods sections. For the first version of the review, she was responsible for resolving disagreements in data extraction and quality assessment; and

  • Marian Showell, the Trials Search Co‐ordinator of the Cochrane Menstrual Disorders and Subfertility Group, who provided us with the main search in major databases in February 2012 and January 2013.

Version history

Published

Title

Stage

Authors

Version

2013 Aug 23

Gonadotrophins for idiopathic male factor subfertility

Review

Abdelhamid M Attia, Ahmed M Abou‐Setta, Hesham G Al‐Inany

https://doi.org/10.1002/14651858.CD005071.pub4

2007 Oct 17

Gonadotrophins for idiopathic male factor subfertility

Review

Abdelhamid M Attia, Hesham G Al‐Inany

https://doi.org/10.1002/14651858.CD005071.pub3

2006 Jan 25

Gonadotrophins for idiopathic male factor subfertility

Review

Abdelhamid M. Attia, Hesham G Al‐Inany, Michelle Proctor

https://doi.org/10.1002/14651858.CD005071.pub2

2005 Jan 24

Gonadotrophins for male factor subfertility

Protocol

Abdelhamid Mohamed A. M. A. Attia, Hesham G Al‐Inany, Michelle L Proctor

https://doi.org/10.1002/14651858.CD005071

Differences between protocol and review

Types of interventions: In the first protocol, we included only couples who were undergoing IUI/IVF/ICSI, but upon finding some studies that looked for spontaneous pregnancy and others that analysed both spontaneous pregnancies and those after ARTs, we removed this restriction.

Outcome measures: We included pregnancies diagnosed by pregnancy test and removed semen parameters from secondary outcomes, as this is a surrogate outcome that provides no value when compared with pregnancy rate.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; Male; Pregnancy;

Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.2 Pregnancy rate per couple randomly assigned.
Figuras y tablas -
Figure 1

Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.2 Pregnancy rate per couple randomly assigned.

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Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.3 Subgroup analysis: pregnancy rate per couple randomly assigned with no female factor.
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.3 Subgroup analysis: pregnancy rate per couple randomly assigned with no female factor.

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 4

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.1 live‐birth rate per couple randomly assigned.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.1 live‐birth rate per couple randomly assigned.

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Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 1 Live birth rate per couple.
Figuras y tablas -
Analysis 1.1

Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 1 Live birth rate per couple.

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Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 2 Pregnancy rate per couple.
Figuras y tablas -
Analysis 1.2

Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 2 Pregnancy rate per couple.

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Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 3 Subgroup analysis: Pregnancy rate per couple with no female factor.
Figuras y tablas -
Analysis 1.3

Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 3 Subgroup analysis: Pregnancy rate per couple with no female factor.

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Summary of findings for the main comparison. Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility for idiopathic male factor subfertility

Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility

Population: Men with idiopathic male factor subfertility

Setting: Assisted reproduction

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo/no treatment for the treatment of idiopathic male subfertility

Gonadotrophins

Live birth rate per couple randomly assigned

0 per 1000

0 per 1000
(0 to 0)

OR 9.31
(1.17 to 73.75)

30
(1 study)

⊕⊝⊝⊝
very low1,2

Spontaneous pregnancy rate per couple randomly assigned

14 per 1000

67 per 1000
(30 to 142)

OR 4.94
(2.13 to 11.44)

412
(5 studies)

⊕⊕⊕⊝
moderate3

*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; OR: Odds 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.

1Authors did not report on allocation concealment.
2Only one included trial (i.e. inconsistency cannot be assessed).
3All trials suffered from at least one potential risk of bias.

Figuras y tablas -
Summary of findings for the main comparison. Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility for idiopathic male factor subfertility
Ir a la tabla de la revisión
Comparison 1. Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth rate per couple Show forest plot

1

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

Subtotals only

1.1 Live birth rate per couple

1

30

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

9.31 [1.17, 73.75]

2 Pregnancy rate per couple Show forest plot

6

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

Subtotals only

2.1 Spontaneous pregnancy rate per couple

5

412

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

4.94 [2.13, 11.44]

2.2 Pregnancy rate per couple after ICSI

1

44

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

1.93 [0.52, 7.20]

2.3 Pregnancy rate per couple after IUI

1

148

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

1.05 [0.38, 2.89]

3 Subgroup analysis: Pregnancy rate per couple with no female factor Show forest plot

5

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

Subtotals only

3.1 Spontaneous pregnancy rate per couple with no female factor

4

264

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

5.00 [1.88, 13.34]

3.2 Pregnancy rate per couple after ICSI with no female factor

1

44

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

1.93 [0.52, 7.20]
Figuras y tablas -
Comparison 1. Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility
Ir a la tabla de la revisión