Evidence mapPaperPMID 41299568Full record

SynthesisBMC medicine2025

Assisted reproductive technology and reproductive, perinatal, and maternal outcomes: evidence from an umbrella review of systematic reviews with meta-analyses of randomized controlled trials.

Dong-Dong Wang, Ming-Li Sun, Xin-Jian Song, Ke-Xin Liu, Xing Chen, Dong-Run Li, Ying Wang, Ming-Hui Sun, Rui Yang, Zan-Fei Feng and 13 more

Abstract readSystematic Review
In one paragraph

Synthesis in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Dong-Dong Wang *Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Ming-Li Sun *Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Xin-Jian Song *Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Ke-Xin Liu *Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Xing ChenDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Dong-Run LiDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Ying WangDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
Ming-Hui SunDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Rui YangDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Zan-Fei FengDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
Xi-Yang ChenDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Fang-Hua LiuDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Yi-Zi LiDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Fan CaoDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Wei-Yi XingDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Jia-Nan SunDepartment of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Rui-Han BaoDepartment of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Ze XingCenter of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China. anneontheway@163.com.
Qi-Peng MaDepartment of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Qi ZhouEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Da LiCenter of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China. leeda@sina.cn.
Qi-Jun WuDepartment of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China. wuqj@sj-hospital.org.
Ting-Ting GongDepartment of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China. gongtt@sj-hospital.org.

Funding

Outstanding Scientific Fund of Shengjing Hospital M1150the Natural Science Foundation of China 82071607the Natural Science Foundation of China 82073647the Natural Science Foundation of China 82103914
6 · The paper itself

Abstract

backgroundThe expanding global use of assisted reproductive technology (ART) warrants rigorous evidence synthesis. This umbrella review (UR) evaluated the strength and validity of evidence on ART effects on reproductive, perinatal, and maternal outcomes.

methodsWe searched five databases and reference lists (Inception to 15 June 2025) to identify systematic reviews with meta-analyses of randomized controlled trials (RCTs). For each extracted association, we performed a reanalysis using random-effects models, calculated the 95% prediction interval, heterogeneity, small-study effect, and evaluated excess significance bias. The quality of systematic reviews was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR). The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system, and the strength of evidence was also evaluated on a grading scale. This study is registered with PROSPERO (CRD42024563290).

resultsThe UR included 23 meta-analyses (200 associations from 109 RCTs), with 69.6% rated high quality. Regarding reproductive outcomes, high credibility of evidence showed that frozen embryo transfer (ET), compared with fresh ET, was associated with a reduced risk of ectopic pregnancy. Sequential ET significantly improved ongoing pregnancy rates relative to single blastocyst or cleavage-stage ET. Single ET, compared with double ET, reduced multiple births, but decreased live birth rate. Regarding perinatal and maternal outcomes, high-credibility evidence indicated that frozen ET, compared with fresh ET, was associated with increased birth weight of singletons, and a higher rate of large for gestational age infants and miscarriage, but a lower rate of small for gestational age infants in cumulative measures and ovarian hyperstimulation syndrome. While frozen ET significantly reduced the risk of preterm delivery, it paradoxically increased the rate of neonatal hospitalization.

conclusionsThis UR delineates trade-offs between ART and reproductive, perinatal, and maternal outcomes. Clinical decisions should balance effectiveness against potential risks, with future research focusing on personalized treatment strategies.

Indexed as

Pregnancy OutcomeReproductive Techniques, AssistedFemaleHumansInfant, NewbornMeta-Analysis as TopicPregnancyRandomized Controlled Trials as TopicSystematic Reviews as TopicAssisted reproductive technologyMaternal-health outcomePerinatal-health outcomeReproductive outcomeUmbrella review

Identifiers

PMID41299568
PMCPMC12659476

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.