膳食补充剂对女性不孕的影响，包括子宫内膜厚度、妊娠、活产和流产：系统综述和荟萃分析

摘要(中文译文)

尽管现有研究表明膳食补充剂对女性不孕症具有有益作用，但现有证据往往不一致且确定性有限。本系统综述与荟萃分析旨在探讨膳食补充剂对女性不孕症的影响，从子宫内膜厚度、妊娠、活产和流产方面与安慰剂进行比较（主要目的），以及与安慰剂或无治疗对照进行比较（次要目的）。检索了PubMed、Embase和CENTRAL数据库，截止至2025年3月。纳入评估膳食补充剂与安慰剂或无治疗对照在不孕女性中效果的随机对照试验。筛选、数据提取、偏倚风险及证据确定性评估由两名独立评审员完成。数据采用随机效应限制最大似然模型进行定量合成。共纳入20项安慰剂对照研究和20项无治疗对照研究。大多数研究在偏倚风险方面存在一些担忧。主要分析显示，与安慰剂相比，补充N-乙酰半胱氨酸后子宫内膜厚度有所改善，而未发现补充剂对妊娠相关结局有影响。主要分析的证据确定性为低。次要分析表明，与安慰剂和无治疗相比，补充不同补充剂后在子宫内膜厚度和妊娠相关结局方面存在阳性差异。本综述未发现高确定性证据表明膳食补充剂与安慰剂相比能改善女性不孕症结局。结合安慰剂对照和无治疗对照研究的次要分析为肌醇、N-乙酰半胱氨酸、维生素D、维生素E以及含≥3种成分的膳食补充剂提出了假设，但这些研究偏倚风险较高，需要在以活产为主要结局、有足够把握度的安慰剂对照试验中加以证实。

Abstract

: Although current research suggests beneficial effects of dietary supplements on female infertility, existing evidence is often inconsistent and of limited certainty. This systematic review and meta-analysis aimed to investigate the effect of dietary supplements on female infertility in terms of endometrial thickness, pregnancy, live birth, and miscarriage compared to placebo (primary objective) and compared to placebo or a no-treatment comparator (secondary objective). : PubMed, Embase, and CENTRAL were searched up to March 2025. Randomized controlled trials assessing the effect of dietary supplements compared to placebo or a no-treatment comparator among infertile women were included. Screening, data extraction, risk of bias, and certainty of evidence assessments were conducted by two independent reviewers. Data was synthesized quantitatively using random effects restricted maximum likelihood models. : Twenty placebo-controlled and 20 no-treatment comparator studies were included. Most studies had some concerns in risk of bias. Primary analyses showed an improvement in endometrial thickness following N-acetyl-cysteine supplementation compared to placebo, while no effect was found for supplements on pregnancy-related outcomes. Certainty of evidence of primary analyses was low. Secondary analyses indicated positive differences in endometrial thickness and pregnancy-related outcomes following supplementation with different supplements compared to placebo and no treatment. : This review found no high-certainty evidence that dietary supplements improve female infertility outcomes when compared with placebo. Secondary analyses combining placebo and no-treatment comparator studies generated hypotheses for myo-inositol, N-acetyl-cysteine, vitamin D, vitamin E, and ≥3 substance dietary supplements, but these are at higher risk of bias and require confirmation in adequately powered placebo-controlled trials with live birth as the primary outcome.

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