Santamaria Xavier, Katzorke Nora, Simón Carlos
aDepartment of Obstetrics and Gynecology, Universidad de Valencia, Instituto Universitario IVI, INCLIVA, Valencia, Spain bDepartment of Obstetrics and Gynecology, Heinrich Heine University Medical Center, Duesseldorf, Germany cDepartment of Obstetrics and Gynecology, Stanford University, Stanford, California, USA.
Curr Opin Obstet Gynecol. 2016 Aug;28(4):242-9. doi: 10.1097/GCO.0000000000000279.
Since its first description in 2003, the endometrial scratching procedure has been the topic of over 1000 studies. This procedure, used to improve endometrial receptivity for assisted reproduction, is accessible - any gynecologist can easily perform it - and has been adapted into clinical routine by some reproductive units. However, the available data are controversial, and no biological plausibility exists to support the use of this intervention. This study aims to critically review the existing data, focusing on the last 2 years, regarding the efficiency of endometrial scratching.
A total of five randomized controlled studies, one meta-analysis, and a systematic review related to endometrial scratching/injury were published in 2014 and 2015. Considerable heterogeneity exists among these studies regarding the selected population, type of treatment, and even timing and devices used to perform the endometrial injury. Importantly, none of these studies reported improved reproductive outcomes in terms of live birth rates following endometrial scratching.
Overall, data from properly designed and powered randomized controlled studies demonstrate no beneficial effect of this intervention that is based on unknown biological effects. Endometrial scratching produces pain, costs money, and the side-effects of systematic scratching in the production of Asherman syndrome remain to be seen. Think before scratching.
自2003年首次被描述以来，子宫内膜搔刮术已成为1000多项研究的主题。该手术用于提高辅助生殖的子宫内膜容受性，易于实施——任何妇科医生都能轻松操作——并且一些生殖单位已将其纳入临床常规操作。然而，现有数据存在争议，且没有生物学合理性来支持这种干预措施的使用。本研究旨在严格审查现有数据，重点关注过去两年中有关子宫内膜搔刮术有效性的内容。
2014年和2015年共发表了五项与子宫内膜搔刮/损伤相关的随机对照研究、一项荟萃分析和一项系统评价。这些研究在所选人群、治疗类型，甚至实施子宫内膜损伤的时间和器械方面存在相当大的异质性。重要的是，这些研究均未报告子宫内膜搔刮术后活产率方面的生殖结局有所改善。
总体而言，来自设计合理且样本量充足的随机对照研究的数据表明，这种基于未知生物学效应的干预措施没有益处。子宫内膜搔刮会产生疼痛、花费金钱，而系统性搔刮导致阿谢曼综合征的副作用仍有待观察。搔刮之前需三思。
