Intervention Review

Ovulation suppression for endometriosis for women with subfertility

  1. Edward Hughes1,*,
  2. Julie Brown2,
  3. John J Collins3,
  4. Cindy Farquhar2,
  5. Donna M Fedorkow1,
  6. Patrick Vanderkerchove4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 19 APR 2009

DOI: 10.1002/14651858.CD000155.pub2

How to Cite

Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vanderkerchove P. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000155. DOI: 10.1002/14651858.CD000155.pub2.

Author Information

  1. 1

    McMaster University, Department of Obstetrics and Gynaecology, Hamilton, Ontario, Canada

  2. 2

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  3. 3

    The Children's Hospital at Westmead, Pain and Palliative Care Service, Westmead, NSW Australia, Australia

  4. 4

    Walsgrave Hospital, Department of Obstetrics and Gynaecology, Coventry, UK

*Edward Hughes, Department of Obstetrics and Gynaecology, McMaster University, 1200 Main St West, Room 4D14, Hamilton, Ontario, L8N 3Z5, Canada. hughese@mcmaster.ca.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 18 JUL 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and appears to be an oestrogen-dependent condition. This dependency has prompted the therapeutic use of ovulation suppression agents in an effort to improve subsequent fertility.

Objectives

To assess the effectiveness of ovulation suppression agents, including danazol, progestins and oral contraceptives, in the treatment of endometriosis-associated subfertility in improving pregnancy outcomes including live births.

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials (February 2009), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to February 2009), EMBASE (1980 to February 2009), and reference lists of articles.

Selection criteria

Randomised trials comparing an ovulation suppression agent with placebo or no treatment, a suppressive agent with danazol, or a gonadotropin-releasing hormone analogue (GnRHa) with oral contraception in women with endometriosis.

Data collection and analysis

Two review authors independently extracted data and assessed quality. We contacted study authors for additional information.

Main results

Twenty-five trials were included. Only two studies reported live births. The odds ratios (OR) for pregnancy following ovulation suppression versus placebo or no treatment was 0.97 (95% confidence interval (CI) 0.68 to 1.34, P = 0.8) for all women randomised, and 1.02 (95% CI 0.70 to 1.52, P = 0.82) for subfertile couples only despite the use of a variety of suppression agents. There was no evidence of benefit from the treatment. The common OR for pregnancy following all agents versus danazol was 1.38 (95% CI 1.05 to 1.82, P = 0.02) for all women randomised, and 1.37 (95% CI 0.94 to 1.99, P = 0.10) for subfertile couples only. When GnRHa and danazol were directly compared, the OR was 1.45 (95% CI 1.08 to 1.95, P = 0.01) for all women randomised, and 1.63 (95% CI 1.12 to 2.37, P = 0.01) for subfertile couples only, in favour of GnRHa. No effect was observed for GnRHa compared with oral contraception (OR 0.93, 95% CI 0.41 to 2.12, P = 0.86 for all women randomised; OR 0.83, 95% CI 0.34 to 2.05, P = 0.69 for subfertile couples only).

Authors' conclusions

There is no evidence of benefit in the use of ovulation suppression in subfertile women with endometriosis who wish to conceive.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Ovulation suppression for endometriosis

This review of 23 trials involving 3043 women with endometriosis has shown that there no evidence of benefit with the use of ovulation suppression for women with endometriosis and infertility. Endometriosis is caused by the lining of the uterus (endometrium) spreading to a site outside the uterus. It is associated with subfertility and can cause pain during both sexual intercourse and menstruation. The hormone oestrogen stimulates the growth of endometriosis. For many years, the use of drugs such as danazol to stop ovulation and the production of oestrogen has been standard practice in the treatment of pain and subfertility caused by endometriosis. This works well for pain, but does not appear to improve fertility. In fact, as ovulation and periods are stopped for the time of treatment, fertility may be reduced by this approach.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

針對子宮內膜異位症之排卵抑制

研究背景

子宮內膜異位症係在非子宮腔之位置發現子宮內膜腺體或基質之現象。子宮內膜異位症似乎是一種雌激素依賴型病症。此種荷爾蒙之依賴性促成了使用排卵抑制劑進行治療,以改善後續之生育力。

研究目的

判定a) 以danazol、medroxy progesterone acetate、gestrinone、組合之口服避孕藥及GnRH類似物進行排卵抑制,相對於安慰劑或無治療,b) 任何上述藥劑相對於danazol,以及c) GnRH類似物相對於口服避孕藥,對於治療子宮內膜異位症相關性生育力低下之有效性。

检索方法

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group's專科試驗登錄中心(搜尋時間為2007年10月5日)、Cochrane Register of Controlled Trials (Cochrane Library, Issue 3, 2007)、MEDLINE (1966年–2007年10月)、EMBASE (1980年–2007年10月) 及文章的參考文獻。

纳入标准

針對子宮內膜異位症之婦女,比較排卵抑制劑與安慰劑或無治療,或是比較排卵抑制劑與danazol,或是比較GnRH與口服避孕藥的隨機試驗。

数据收集与分析

由2位回顧作者獨立摘錄數據聘評估品質。茲連絡研究作者以取得額外之資訊。

主要结果

共收錄涉及3043名婦女之23項試驗。儘管使用各種不同之抑制劑,相對於安慰劑或無治療,進行排卵抑制後之懷孕率的勝算比,就所有隨機分派之婦女而言為0.79 (95% CI 0.54 − 1.14), P = 0.21,而僅就生育力低下之夫妻而言為0.80 (95% CI 0.51 − 1.24), P = 0.32。並無證據顯示治療具有效益。相對於danazol,在使用所有藥劑後之懷孕率的共有勝算比,就所有隨機分派之婦女而言為1.38 (95% CI 1.05 − 1.82), P = 0.02,而僅就生育力低下之夫妻而言為OR 1.37 (95% CI 0.94 − 1.99), P = 0.10。在直接比較GnRHa與danazol時,就所有隨機分派之婦女而言OR為1.45 (95% CI 1.08 − 1.95) P = 0.01,而僅就生育力低下之夫妻而言OR為1.63 (95% CI 1.12 − 2.37), P = 0.01,結果支持GnRH。在比較GnRH與口服避孕藥時並未觀察到任何效應;就所有隨機分派之婦女而言OR為0.99 (95% CI 0.52 − 1.89), P = 0.98,而僅就生育力低下之夫妻而言OR為0.79 (95% CI 0.37 − 1.69), P = 0.55。

作者结论

並無證據支持,針對希望懷孕之子宮內膜異位症婦女使用排卵抑制具有效益。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

針對子宮內膜異位症之排卵抑制

針對子宮內膜異位症之排卵抑制。本回顧係針對涉及3043名婦女之23項試驗而進行。其證據說明,針對具有子宮內膜異位症及不孕症之婦女使用排卵抑制並無效益。子宮內膜異位症係因為子宮內壁(子宮內膜)散播至子宮外之位置而造成。其會造成生育力低下,且可在性交及經期中造成疼痛。雌激素會刺激子宮內膜異位症之生長。多年來,使用藥物(諸如danazol)而使排卵及雌激素之生成停止,已是治療子宮內膜異位症之疼痛及生育力低下的標準實務。此種治療對於疼痛具有良好效果,但其似乎無法改善生育力。事實上,由於排卵及月經皆在治療時停止,此種方法反而可能降低生育力。

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