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体外受精前进行子宫内膜轻微吸刮术的随机试验
A Randomized Trial of Endometrial Scratching before In Vitro Fertilization


Sarah Lensen ... 妇产科和儿科 • 2019.01.24
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子宫内膜轻微吸刮术未提高体外受精的活产率

 

黄佳,杨冬梓*

中山大学孙逸仙纪念医院生殖医学专科

*通讯作者

 

IVF(体外受精)已问世40多年,但以活产衡量的成功率仍不到一半。为提高其成功率,已有多种辅助手段应用于临床,然而很多技术并未经过高质量临床试验的评判。

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摘要


背景

子宫内膜轻微吸刮术(借助pipelle法子宫内膜针吸活检)的目的是促进胚胎植入,提高接受体外受精(IVF)女性的妊娠概率。

 

方法

我们开展了一项实用性、多中心、开放标签、随机、对照试验。试验的纳入条件为正在接受IVF(新鲜胚胎或冷冻胚胎移植),并且最近未暴露于破坏性宫内器械操作(例如宫腔镜检查)的女性。以1∶1的比例将参与者随机分组,接受子宫内膜轻微吸刮术(在胚胎移植周期前一周期的第3日至胚胎移植周期的第3日接受pipelle法子宫内膜针吸活检)或未接受干预。主要结局为活产。

 

结果

共有1,364名女性被随机分组。子宫内膜轻微吸刮术组和对照组的活产率分别为180/690名女性(26.1%)和176/674名女性(26.1%)(校正比值比,1.00;95%置信区间[CI],0.78~1.27)。持续妊娠、临床妊娠、多胎妊娠、异位妊娠或流产发生率无显著组间差异。子宫内膜轻微吸刮术的中位疼痛评分(评分范围为0~10分,较高的评分表示较严重的疼痛)为3.5分(四分位距,1.9~6.0)。

 

结论

在接受IVF的女性中,与无干预相比,子宫内膜轻微吸刮术未获得较高的活产率(由奥克兰大学[University of Auckland]等资助;PIP在澳大利亚新西兰临床试验注册号为ACTRN12614000626662)。





作者信息

Sarah Lensen, Ph.D., Diana Osavlyuk, M.Sc., Sarah Armstrong, M.B., Ch.B., M.R.C.O.G., Caroline Stadelmann, M.D., Aurélie Hennes, M.Sc., Emma Napier, B.Sc., Jack Wilkinson, Ph.D., Lynn Sadler, M.P.H., Devashana Gupta, C.R.E.I., Annika Strandell, M.D., Ph.D., Christina Bergh, M.D., Ph.D., Kugajeevan Vigneswaran, M.R.C.O.G., Wan T. Teh, F.R.A.N.Z.C.O.G., Haitham Hamoda, M.D., F.R.C.O.G., Lisa Webber, M.R.C.O.G., Sarah A. Wakeman, M.B., Ch.B., Leigh Searle, F.R.A.N.Z.C.O.G., Priya Bhide, M.D., F.R.C.O.G., Simon McDowell, C.R.E.I., Karen Peeraer, Ph.D., Yacoub Khalaf, M.D., F.R.C.O.G., and Cynthia Farquhar, F.R.A.N.Z.C.O.G., M.P.H.
From the Department of Obstetrics and Gynaecology, University of Auckland (S.L., D.O., C.F.), and Women’s Health (L. Sadler) and Fertility Plus (D.G., C.F.), Auckland District Health Board, Auckland, Fertility Associates, Christchurch (S.A.W.), and Fertility Associates, Wellington (L. Searle, S.M.) — all in New Zealand; Bath Fertility Centre, Bath (S.A., E.N.), the Department of Medical Statistics, Manchester University NHS Foundation Trust, Manchester (J.W.), and the Department of Obstetrics and Gynaecology, King’s College Hospital (K.V., H.H.), University College Hospital (L.W.), Homerton Fertility Centre, Homerton University Hospital NHS Foundation Trust (P.B.), and Guy’s Hospital (Y.K.), London — all in the United Kingdom; the Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (C.S., A.S., C.B.); Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium (A.H., K.P.); and Reproductive Services, Royal Women’s Hospital, Melbourne, VIC, Australia (W.T.T.). Address reprint requests to Dr. Lensen at s.lensen@auckland.ac.nz. A list of trial investigators and staff is provided in the Supplementary Appendix, available at NEJM.org.

 

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