Assisted Conception Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
Reprod Biomed Online. 2012 Oct;25(4):345-54. doi: 10.1016/j.rbmo.2012.06.012. Epub 2012 Jun 26.
A systematic review was conducted of the influence of local endometrial injury (LEI) on the outcome of the subsequent IVF cycle. MEDLINE, EMBASE, the Cochrane Library, National Research Register, ISI Conference Proceedings, ISRCTN Register and Meta-register were searched for randomized controlled trials to October 2011. The review included all trials comparing the outcome of IVF treatment in patients who had LEI in the cycle preceding their IVF treatment with controls in which endometrial injury was not performed. The main outcome measures were clinical pregnancy and live birth rates. In total, 901 participants were included in two randomized (n=193) and six non-randomized controlled studies (n=708). The quality of the studies was variable. Meta-analysis showed that clinical pregnancy rate was significantly improved after LEI in both the randomized (relative risk, RR, 2.63, 95% CI 1.39-4.96, P=0.003) and non-randomized studies (RR 1.95, 95% CI 1.61-2.35, P<0.00001). The improvement did not reach statistical significance in the one randomized study which reported the live birth rate (RR 2.29, 95% CI 0.86-6.11). Robust randomized trials comparing a standardized protocol of LEI before IVF treatment with no intervention in a well-defined patient population are needed.
系统评价了局部子宫内膜损伤（LEI）对随后的试管婴儿周期结局的影响。检索了 MEDLINE、EMBASE、Cochrane 图书馆、国家研究注册处、ISI 会议录、ISRCTN 登记处和 Meta 注册处，以获取截至 2011 年 10 月的随机对照试验。本综述纳入了所有比较试管婴儿治疗前周期中存在 LEI 的患者与未行子宫内膜损伤的对照组患者的试管婴儿治疗结局的随机对照试验。主要结局指标为临床妊娠率和活产率。共有 901 名患者纳入了两项随机研究（n=193）和六项非随机对照研究（n=708）。研究质量各不相同。Meta 分析显示，LEI 后临床妊娠率在随机研究中显著提高（相对风险，RR，2.63，95%置信区间 1.39-4.96，P=0.003）和非随机研究中也显著提高（RR 1.95，95%置信区间 1.61-2.35，P<0.00001）。但一项报告活产率的随机研究中，这种提高没有达到统计学意义（RR 2.29，95%置信区间 0.86-6.11）。需要开展比较 LEI 标准化方案与 IVF 治疗前无干预措施的、针对明确患者人群的、严格设计的随机试验。
