The estrogen receptor polymorphisms and controlled ovulation hyperstimulation outcomes: a meta-analysis

Abstract

Objective: Several studies evaluated the relationship between estrogen receptor (ER) polymorphisms and the outcomes of controlled ovulation hyperstimulation (COH). However, the results remained obscure. The objective of this study was to perform a meta-analysis to investigate the links between ER polymorphisms and COH outcomes.Methods: Eligible studies were identified from the following electronic databases: PubMed, Embase and the Chinese CNKI till Nov. 2021. The odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous data and the weighted mean difference (WMD) with 95% confidence intervals (CIs) for continuous variables were used to calculate correlations between ER polymorphisms and COH outcomes. Based on the inclusion and exclusion criteria, a total of thirteen papers were eventually enrolled in the current meta-analysis.Results: The following were the key findings of this meta-analysis: (1) PvuII polymorphism had a significant relationship with IVF pregnancy outcome in all models, except the recessive model(CC VS TT: OR, 5.51, 95% CI, 1.13,26.84; CC + CT VS TT: OR, 3.73, 95% CI, 1.21,11.57; CT VS TT: OR, 3.19, 95% CI, 1.11,9.16;C VS T: OR, 2.19, 95% CI, 1.15, 4.19), with large or extreme heterogeneity; (2) XbaI polymorphism had a significant association with IVF risk in heterozygous and dominant models(AG VS GG: OR, 0.27, 95% CI, 0.12,0.61; AAAG VS GG: OR, 0.27, 95% CI, 0.12,0.59), with no heterogeneity; (3) (TA)n polymorphism was linked with IVF risk in the homozygous and recessive models(LL VS SS:OR = 3.74, 95%CI = 1.53,9.12;LL VS LS + SS:OR = 2.75, 95%CI = 1.18, 6.38), with no heterogeneity; (4) for Alul polymorphism and its association with POR risk, significant relationship was observed in the recessive model(AA VS AG + GG:OR = 2.27, 95%CI = 1.46, 3.54), with no heterogeneity;(5) PvuII T/C mutation did not predict the follicle number, oocyte number, ratio of follicles to oocytes and the risk of IVF;(6) for XbaI polymorphism and pregnancy outcome of IVF, no significant association was observed under all models; and (7) RsaI polymorphism does not increase the risk of POR under all models.Conclusion: In summary, our meta-analysis found evidence supporting that PvuII polymorphism may serve as a marker in predicting pregnancy rate in IVF-ET, XbaI and (TA)n polymorphisms may be related with infertility, and Alul polymorphism may predict the poor ovarian response to COH. More well-designed investigations are warranted to corroborate these findings.

摘要

目的

一些研究评估了雌激素受体（ER）多态性与控制性超促排卵（COH）结局之间的关系。然而, 结果仍不甚明了。本研究的目的是进行Meta分析, 探究ER多态性与COH结局之间的关系。

方法

从以下电子数据库中查找符合条件的研究： PubMed、Embase和中文CNKI, 截止时间为2021年11月。二分类数据的几率（OR）和95%的置信区间（CIs）以及连续变量的加权平均差（WMD）和95%的置信区间（CIs）被用来计算ER多态性与COH结局之间的相关性。根据纳入和排除标准, 共有13篇论文最终被纳入本次Meta分析。

结果

以下是该Meta分析的主要结果：（1）PvuII多态性在所有模型中都与IVF妊娠结果有显著关系, 除了隐性模型(CC VS TT: OR, 5.51, 95% CI, 1.13,26.84; CC+CT VS TT: OR, 3.73, 95% CI, 1.21,11.57; CT VS TT: OR, 3.19, 95% CI, 1.11,9.16;C VS T: OR, 2.19, 95% CI, 1.15, 4.19), 具有较大或极端的异质性；（2）XbaI多态性在杂合子和显性模型中与IVF风险有明显关联(AG VS GG: OR, 0.27, 95% CI, 0.12,0.61; AAAG VS GG: OR, 0.27, 95% CI, 0.12,0.59),没有异质性；（3）(TA)n多态性在纯合子和隐性模型中与IVF风险有关(LL VS SS:OR = 3.74, 95%CI = 1.53,9.12;LL VS LS+SS:OR = 2.75, 95%CI = 1.18, 6.38),没有异质性；（4）对于AluI多态性及其与POR风险的关系, 在隐性模型中观察到显著的关系(AA VS AG+GG:OR = 2.27, 95%CI = 1.46, 3.54),没有异质性；(5)PvuII T/C突变不能预测卵泡数、卵母细胞数、卵泡与卵母细胞之比以及IVF的风险；(6)对于XbaI多态性与IVF的妊娠结局, 在所有模型下都没有观察到明显的关联；(7)RsaI多态性在所有模型下都不会增加POR的风险。

结论

总之, 我们的Meta分析发现有证据支持PvuII多态性可作为预测IVF-ET妊娠率的标志, XbaI和(TA)n多态性可能与不孕症有关, AluI多态性可预测卵巢对COH的不良反应。有必要进行更多精心设计的调查来证实这些发现。

Keywords:

• estrogen receptor
• polymorphism
• meta-analysis
• COH

关键词:

• 雌激素受体
• 多态性
• Meta分析
• 控制性超促排卵

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The costs involved in the conduction of this systematic review and meta-analysis were borne by the authors themselves.