Summary of findings 1. GM‐CSF‐supplemented culture media compared to culture media not supplemented with GM‐CSF for women undergoing assisted reproduction.
| GM‐CSF‐supplemented culture media compared to culture media not supplemented with GM‐CSF for women undergoing assisted reproduction | |||||
| Patient or population: women undergoing assisted reproduction Setting: fertility clinics Intervention: GM‐CSF‐supplemented culture media Comparison: culture medium not supplemented with GM‐CSF | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with culture media not supplemented with GM‐CSF | Risk with GM‐CSF‐supplemented culture media | ||||
| Live birth or ongoing pregnancy | Study population | OR 1.19 (0.93 to 1.52) | 1432 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| 223 per 1000 | 254 per 1000 (210 to 303) | ||||
| Miscarriage | Study population | OR 0.75 (0.41 to 1.36) | 1432 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 | |
| 36 per 1000 | 27 per 1000 (15 to 48) | ||||
| Clinical pregnancy | Study population | OR 1.16 (0.93 to 1.45) | 1532 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 4 | |
| 263 per 1000 | 293 per 1000 (250 to 342) | ||||
| Multiple gestation | Study population | OR 1.24 (0.73 to 2.10) | 1432 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 | |
| 36 per 1000 | 44 per 1000 (26 to 72) | ||||
| Preterm birth | Study population | OR 1.20 (0.70 to 2.04) | 1432 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 | |
| 36 per 1000 | 43 per 1000 (25 to 70) | ||||
| Birth defects | Study population | OR 1.33 (0.59 to 3.01) | 1432 (2 RCTs) | ⊕⊕⊝⊝ LOW3 | |
| 14 per 1000 | 18 per 1000 (8 to 40) | ||||
| Aneuploidy | Study population | OR 0.34 (0.03 to 3.26) | 1432 (2 RCTs) | ⊕⊕⊝⊝ LOW 5 | |
| 3 per 1000 | 1 per 1000 (0 to 9) | ||||
| Stillbirth | Study population | ‐ | 1432 (2 RCTs) | ‐ | |
| See comment6 | See comment6 | ||||
| *The risk in the intervention group (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; RCT: randomised controlled trial | |||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
1Downgraded once for inconsistency, as the included studies report differing directions of point estimates: one supports the intervention, and one does not support the intervention. 2Downgraded once for imprecision as broad confidence intervals and a low number of included studies, at least one of which is very small. 3Downgraded twice for imprecision as very broad confidence intervals and a low number of included studies. 4Downgraded once for risk of bias. One included study had an unclear risk of selection bias, performance bias, and detection bias due to limited information available from published abstract. 5Downgraded twice for imprecision as included studies had so few reported incidences of aneuploidy that the point estimate is not precise and has very broad confidence intervals.
6No stillbirths occurred in either arm of the included studies, therefore the result is inestimable.