Ovarian cyst aspiration prior to in vitro fertilization treatment for subfertility

Rose McDonnell; Jane Marjoribanks; Roger J Hart

doi:10.1002/14651858.CD005999.pub2

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Figure 1

Study flow diagram.

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Figure 2

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

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Figure 3

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

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Figure 4

Forest plot of comparison: 1 Cyst aspiration versus conservative management, outcome: 1.1 NEW Clinical Pregnancy Rate.

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Figure 5

Forest plot of comparison: 1 Cyst aspiration versus conservative management, outcome: 1.2 Number of Follicles Recruited.

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Analysis 1.1

Comparison 1 Cyst aspiration versus conservative management, Outcome 1 Clinical Pregnancy Rate.

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Analysis 1.2

Comparison 1 Cyst aspiration versus conservative management, Outcome 2 Number of Follicles Recruited.

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Analysis 1.3

Comparison 1 Cyst aspiration versus conservative management, Outcome 3 Number of Oocytes Collected.

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Analysis 1.4

Comparison 1 Cyst aspiration versus conservative management, Outcome 4 Cancellation rate.

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Summary of findings for the main comparison. Cyst aspiration versus conservative management for subfertility

Cyst aspiration versus conservative management for subfertility
Population: women with subfertility Settings: infertility and IVF centres in Jordan, Iran and the United Kingdom (London) Intervention: cyst aspiration versus conservative management
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Conservative management	Cyst aspiration
Live birth rate	This primary review outcome was not reported in any of the included studies		Not estimable
Adverse events rate	This primary review outcome was not reported in any of the included studies		Not estimable
Clinical pregnancy rate Ultrasound diagnosis of intrauterine pregnancy	62 per 1,000	72 per 1,000 (21 to 220)	OR 1.19 (0.33 to 4.29)	159 (2 studies)	⊕⊝⊝⊝ Very low^1,2
Number of follicles recruited Ultrasound diagnosis	The mean number of follicles recruited in the cyst aspiration groups was 0.55 higher (0.48 lower to 1.59 higher)			159 (2 studies)	⊕⊝⊝⊝ Very low^1,2
Number of oocytes collected Transvaginal oocyte aspiration	The mean number of oocytes collected in the cyst aspiration groups was 0.41 higher (0.04 lower to 0.85 higher)			339 (3 studies)	⊕⊕⊝⊝ low^1,3
Cancellation rate per cycle	239 per 1,000	237 per 1,000 (117 to 423)	OR 0.99 (0.42 to 2.33)	122 (1 study)	⊝⊝⊝⊝ Very low^1,2	Each woman had only one cycle
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.
¹ Downgraded one level for serious risk of bias; none of the studies adequately described their methods of randomization and allocation concealment ² Downgraded two levels for very serious imprecision: wide confidence interval compatible with benefit in either group or no effect, and/or very low event rate ³ Downgraded one level for serious imprecision: wide confidence interval compatible with benefit in either group or no effect

Summary of findings for the main comparison. Cyst aspiration versus conservative management for subfertility

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Table 1. Firouzabadi 2010

	Treatment group	Control	P
Randomised	90	90
Cycles cancelled prior to egg collection	2	13
Completed	88	77

Live birth rate	Not available	Not available
Clinical pregnancy rate	10.6%	14.3%	> 0.05
Number of follicles recruited	Not available	Not available
Number of oocytes collected	5.6±2.1	5.2±1.8	> 0.05

Table 1. Firouzabadi 2010

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Table 2. Qublan 2005

	Treatment group	Control
Randomised	76	46
Cycle cancelled (poor response)	17	12
Completed	59	34
Live birth rate	Not available	Not available
Clinical pregnancy rate	10.2%	8.8%	> 0.05
Number of follicles recruited	5.4 ± 3.1	5 ± 2.9	> 0.05
Number of oocytes collected	5.6 ± 1.8	5.2 ± 2.1	> 0.05

Table 2. Qublan 2005

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Table 3. Rizk 1990

	Treatment group	Control	P
Randomised	18	19
Discontinued	0	0
Completed	18	19

Live birth rate	Not available	Not available
Clinical pregnancy rate	1 out of 18 (5.56%)	1 out of 19 (5.26%)	> 0.05
Number of follicles recruited	10.9 ± 5.33	8.9 ± 5.05	> 0.05
Number of oocytes collected	7.33 ± 4.0	6.7 ± 5.15	> 0.05

Table 3. Rizk 1990

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Comparison 1. Cyst aspiration versus conservative management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical Pregnancy Rate Show forest plot	2	159	Odds Ratio (M‐H, Fixed, 95% CI)	1.19 [0.33, 4.29]

2 Number of Follicles Recruited Show forest plot	2	159	Mean Difference (IV, Fixed, 95% CI)	0.55 [‐0.48, 1.59]

3 Number of Oocytes Collected Show forest plot	3	339	Mean Difference (IV, Fixed, 95% CI)	0.41 [‐0.04, 0.85]

4 Cancellation rate Show forest plot	1	122	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.42, 2.33]

Comparison 1. Cyst aspiration versus conservative management

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