Fertility Plus, National Women's Hospital Auckland, New Zealand.
Centre for Biostatistics, Division of Population Health, Health Services Research, and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK.
Reprod Biomed Online. 2022 Feb;44(2):316-323. doi: 10.1016/j.rbmo.2021.10.008. Epub 2021 Oct 24.
Does endometrial scratching improve the chance of a live birth in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction and trying to conceive?
An international, multicentre, randomized, sham-controlled trial across six fertility clinics in three countries (New Zealand, UK and Brazil). Women with a diagnosis of PCOS who were planning to commence ovulation induction cycles (at least three cycles) in order to conceive were randomly assigned to receive the pipelle (scratch) procedure or a sham (placebo) procedure in the first cycle of ovulation induction. Women kept a diary of ovulation induction and sexual intercourse timing over three consecutive cycles and pregnancies were followed up to live birth. Primary outcome was live birth and secondary outcomes were clinical pregnancy, ongoing pregnancy, multiple pregnancy, adverse pregnancy outcomes, neonatal outcomes, bleeding following procedure and pain score following procedure.
A total of 117 women were randomized; 58 to the scratch group and 59 to the sham group. Live birth occurred in 11 (19%) women in the scratch group and 14 (24%) in the sham group (odds ratio 0.76, 95% confidence interval [CI] 0.30-1.92). Secondary outcomes were similar in each group. Significantly higher pain scores were reported in the scratch group (adjusted mean difference 3.2, 95% CI 2.5-3.9) when measured on a visual analogue scale.
No difference was detected in live birth rate for women with PCOS who received an endometrial scratch when trying to conceive using ovulation induction; however, uncertainty remains due to the small sample size in this study.
在接受排卵诱导并试图怀孕的多囊卵巢综合征（PCOS）女性中，子宫内膜搔刮是否能提高活产率？
这是一项在六个生殖中心（新西兰、英国和巴西各有两个）进行的国际性、多中心、随机、假手术对照试验。诊断为 PCOS 的女性计划开始排卵诱导周期（至少三个周期）以怀孕，随机分配接受 pipelle（搔刮）程序或假手术（安慰剂）程序在排卵诱导的第一个周期。女性在三个连续周期中记录排卵诱导和性交时间，并随访妊娠至活产。主要结局是活产，次要结局是临床妊娠、持续妊娠、多胎妊娠、不良妊娠结局、新生儿结局、手术后出血和手术后疼痛评分。
共有 117 名女性被随机分配；58 名进入搔刮组，59 名进入假手术组。搔刮组中有 11 名（19%）女性活产，假手术组中有 14 名（24%）女性活产（比值比 0.76，95%置信区间[CI]0.30-1.92）。每个组的次要结局相似。在视觉模拟量表上测量时，搔刮组报告的疼痛评分明显更高（调整平均差异 3.2，95%CI2.5-3.9）。
在接受排卵诱导并试图怀孕的 PCOS 女性中，接受子宫内膜搔刮并没有检测到活产率的差异；然而，由于本研究的样本量较小，不确定性仍然存在。
