Parsanezhad Mohammad Ebrahim, Dadras Nasrin, Maharlouei Najmeh, Neghahban Leila, Keramati Peghah, Amini Madihe
Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran J Reprod Med. 2013 Nov;11(11):869-74.
Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes.
This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients.
This was a randomized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse.
The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17/114 (14.9%) vs. 6/103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701).
Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions. Registration ID in IRCT: IRCT2012082510657N1.
不明原因不孕症在病因、恰当管理及治疗方面仍是一个具有挑战性的问题。有证据表明早期胚胎病变或着床失败可能是其病因。
本研究旨在调查局部子宫内膜损伤对部分不明原因不孕患者妊娠率的影响。
这是一项在加迪尔医院设拉子大学不孕诊所进行的随机临床试验。通过区组随机化将217例年龄在23至35岁之间的不明原因不孕女性随机分为两个研究组。在使用枸橼酸氯米芬和促性腺激素进行超排卵且优势卵泡达到18至20毫米后，在排卵前几天（检测到自发性尿促黄体生成素峰时），患者被随机分配接受通过 Pipelle 子宫内膜取样对子宫后壁进行局部子宫内膜损伤（n = 114）或模拟 Pipette 活检（n = 103）。然后指导所有患者进行定时性交。
与对照组相比，子宫内膜损伤组的妊娠率显著更高[114例中有17例（14.9%） vs. 103例中有6例（5.8%）（OR：2.83，95%CI：1.07 - 7.49，p = 0.03]。两组的流产率相当（17.64% vs. 14.28%；p = 0.701）。
子宫内膜局部机械损伤可增强子宫容受性并促进胚胎着床。对于着床失败可能是不孕原因的部分不明原因不孕患者，在进行复杂治疗之前，这种简单、易行且具有成本效益的方法值得考虑。该方法可能有助于减轻心理压力以及此类干预带来的高额费用。伊朗临床试验注册中心注册号：IRCT2012082510657N1。
