BACKGROUND: As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of these steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies.
OBJECTIVES: To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART) procedures.
METHODS: Published Cochrane systematic reviews of couples undergoing ART procedures (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The primary outcome of the overview was live birth or the composite outcome live birth or ongoing pregnancy, as reported by the included reviews. Our secondary outcomes were clinical pregnancy, multiple pregnancy, miscarriage, and ovarian hyperstimulation syndrome. We excluded studies of intrauterine insemination and ovulation induction.We undertook selection of systematic reviews, data extraction, and quality assessment in duplicate. We assessed review quality by using the AMSTAR tool. We organised reviews by their relevance to specific stages in the ART cycle. We summarised their findings in the text and reported data for each outcome in 'Additional tables'.
MAIN RESULTS: We included 68 systematic reviews published in the Cochrane Library up to May 2018. All were of high quality. These reviews identified 38 interventions that were effective (n = 23) or promising (n = 15), and they identified 19 interventions that were ineffective (n = 2) or possibly ineffective (n = 17). For 15 interventions, review authors were unable to draw conclusions owing to lack of evidence.We identified an additional 11 protocols and four titles for future inclusion in this overview.
AUTHORS' CONCLUSIONS: This overview provides the most up-to-date evidence on ART cycles from systematic reviews of randomised controlled trials. Fertility treatments are costly, and the stakes are high. Using the best available evidence to optimise outcomes is best practice. Evidence from this overview could be used to develop clinical practice guidelines and protocols that can be applied in daily clinical practice to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation, and ovarian hyperstimulation syndrome.
JUSTIFICATIVA: A co-mórbidas sintomas (por exemplo, dor crônica, depressão, ansiedade e fadiga) são particularmente comuns em caças militares que retornam dos conflitos atuais, que sofreram traumas físicos e / ou psicológicos. Estas condições se sobrepõem atravessam as fronteiras da mente, cérebro e corpo, resultando em um espectro sintomática e funcional dos físicos, efeitos cognitivos, psicológicos e comportamentais que se refere como o "espectro de resposta Trauma" (TSR).Embora a acupuntura foi mostrado para tratamento de alguns desses componentes de forma eficaz, a literatura corrente é muitas vezes difícil de interpretar, inconsistente ou de qualidade variável. Assim, para avaliar de forma abrangente a eficácia da acupuntura em componentes TSR, uma revisão sistemática de opiniões foi realizado utilizando de Avaliação do Instituto Samueli da Prova Rápida da Literatura (REAL (C)) metodologia. MÉTODOS: PubMed / MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycInfo foram procurados desde o início de setembro de 2011, para revisões sistemáticas / meta-análises. Avaliação da qualidade foi rigorosamente realizada utilizando o escocês Rede de Diretrizes Intercolegial (SINAL 50) lista de verificação e da classificação da metodologia Recomendação Desenvolvimento, Avaliação e Avaliação (GRADE). Aderência aos Padrões de Relatórios Intervenções em ensaios clínicos em Acupuntura (STRICTA) critérios também foi avaliada. RESULTADOS: Das 1.480 citações identificadas por nossas pesquisas, 52 revisões sistemáticas / meta-análises, todos de alta qualidade com exceção de um, se reuniram critérios de inclusão para cada componente TSR exceto pós-traumático (TEPT) e função sexual. A maioria dos comentários dirigida componentes mais stricta, mas não descrevem segurança. CONCLUSÕES: Com base nos resultados de nossa revisão, a acupuntura parece ser eficaz para o tratamento de dores de cabeça e, embora mais pesquisa é necessária, parece ser uma opção de tratamento promissora para a ansiedade, distúrbios do sono, depressão e dor crônica. Isso não significa, no entanto, demonstrar qualquer benefício substancial do tratamento de abuso de substâncias. Porque não havia comentários sobre PTSD ou função sexual que corresponde aos nossos critérios pré-definidos de inclusão, não podemos comentar sobre a eficácia da acupuntura no tratamento destas condições. Mais dados de qualidade também são necessários para determinar se a acupuntura é adequada para o tratamento de problemas de fadiga ou cognitiva. Além disso, enquanto a acupunctura tem sido mostrado para ser geralmente seguro, a segurança não foi descrito, na maioria dos estudos, o que torna difícil proporcionar quaisquer recomendações fortes, pesquisas futuras devem tratar relatórios de segurança, em detalhe, a fim de aumentar a nossa confiança na eficácia da acupuntura em todo o identificou componentes TSR.
As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of these steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies.
OBJECTIVES:
To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART) procedures.
METHODS:
Published Cochrane systematic reviews of couples undergoing ART procedures (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The primary outcome of the overview was live birth or the composite outcome live birth or ongoing pregnancy, as reported by the included reviews. Our secondary outcomes were clinical pregnancy, multiple pregnancy, miscarriage, and ovarian hyperstimulation syndrome. We excluded studies of intrauterine insemination and ovulation induction.We undertook selection of systematic reviews, data extraction, and quality assessment in duplicate. We assessed review quality by using the AMSTAR tool. We organised reviews by their relevance to specific stages in the ART cycle. We summarised their findings in the text and reported data for each outcome in 'Additional tables'.
MAIN RESULTS:
We included 68 systematic reviews published in the Cochrane Library up to May 2018. All were of high quality. These reviews identified 38 interventions that were effective (n = 23) or promising (n = 15), and they identified 19 interventions that were ineffective (n = 2) or possibly ineffective (n = 17). For 15 interventions, review authors were unable to draw conclusions owing to lack of evidence.We identified an additional 11 protocols and four titles for future inclusion in this overview.
AUTHORS' CONCLUSIONS:
This overview provides the most up-to-date evidence on ART cycles from systematic reviews of randomised controlled trials. Fertility treatments are costly, and the stakes are high. Using the best available evidence to optimise outcomes is best practice. Evidence from this overview could be used to develop clinical practice guidelines and protocols that can be applied in daily clinical practice to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation, and ovarian hyperstimulation syndrome.
