E J Fraser1, D A Grimes, K F Schulz. 1. Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
Abstract
OBJECTIVE: To determine the efficacy of immunotherapy as treatment for recurrent spontaneous abortion (three or more consecutive abortions without an intervening pregnancy of more than 20 weeks' gestation) using meta-analysis. DATA SOURCES: The search began with MEDLINE and was supplemented by reference lists from original research, review articles, and textbooks. We also corresponded with investigators and consulted experts in the field of infertility. METHODS OF STUDY SELECTION: We identified four randomized controlled trials and 19 case-series reports that examined the use of immunotherapy for recurrent spontaneous abortion. DATA EXTRACTION AND SYNTHESIS: A meta-analysis performed on four randomized controlled trials of leukocyte immunotherapy or trophoblast membrane infusion revealed a fixed-effects model odds ratio of 1.3 (95% confidence interval [CI] 0.77-2.3) and a random-effects model odds ratio of 1.3 (95% CI 0.44-3.8). CONCLUSION: The quality of evidence regarding this treatment is class I (best), and the strength of recommendation is D (fair evidence against its use). Unless its efficacy can be established through other randomized controlled trials, this treatment should be abandoned.
OBJECTIVE: To determine the efficacy of immunotherapy as treatment for recurrent spontaneous abortion (three or more consecutive abortions without an intervening pregnancy of more than 20 weeks' gestation) using meta-analysis. DATA SOURCES: The search began with MEDLINE and was supplemented by reference lists from original research, review articles, and textbooks. We also corresponded with investigators and consulted experts in the field of infertility. METHODS OF STUDY SELECTION: We identified four randomized controlled trials and 19 case-series reports that examined the use of immunotherapy for recurrent spontaneous abortion. DATA EXTRACTION AND SYNTHESIS: A meta-analysis performed on four randomized controlled trials of leukocyte immunotherapy or trophoblast membrane infusion revealed a fixed-effects model odds ratio of 1.3 (95% confidence interval [CI] 0.77-2.3) and a random-effects model odds ratio of 1.3 (95% CI 0.44-3.8). CONCLUSION: The quality of evidence regarding this treatment is class I (best), and the strength of recommendation is D (fair evidence against its use). Unless its efficacy can be established through other randomized controlled trials, this treatment should be abandoned.