Unit for Human Reproduction, Medical School, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia, 56430, Thessaloniki, Greece.
Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia.
Reprod Biol Endocrinol. 2023 Oct 2;21(1):89. doi: 10.1186/s12958-023-01141-2.
To evaluate the role of endometrial scratching performed prior to an embryo transfer cycle on the probability of pregnancy compared to placebo/sham or no intervention.
A computerized literature (using a specific search strategy) search was performed across the databases MEDLINE, EMBASE, COCHRANE CENTRAL, SCOPUS and WEB OF SCIENCE up to June 2023 in order to identify randomized controlled trials (RCTs) evaluating the effect of endometrial scratching prior to an embryo transfer cycle on the probability of pregnancy, expressed either as live birth, ongoing pregnancy or clinical pregnancy (in order of significance) compared to placebo/sham or no intervention. Data were pooled using random-effects or fixed-effects model, depending on the presence or not of heterogeneity. Heterogeneity was assessed using the I statistic. Subgroup analyses were performed based on the population studied in each RCT, as well as on the timing and method of endometrial biopsy. Certainty of evidence was assessed using the GRADEPro tool.
The probability of live birth was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (relative risk-RR: 1.12, 95% CI: 1.05-1.20; heterogeneity: I=46.30%, p<0.001, 28 studies; low certainty). The probability of ongoing pregnancy was not significantly difference between the two groups (RR: 1.07, 95% CI: 0.98-1.18; heterogeneity: I=27.44%, p=0.15, 11 studies; low certainty). The probability of clinical pregnancy was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (RR: 1.12, 95% CI: 1.06-1.18; heterogeneity: I=47.48%, p<0.001, 37 studies; low certainty). A subgroup analysis was performed based on the time that endometrial scratching was carried out. When endometrial scratching was performed during the menstrual cycle prior to the embryo transfer cycle a significantly higher probability of live birth was present (RR: 1.18, 95% CI:1.09-1.27; heterogeneity: I=39.72%, p<0.001, 21 studies; moderate certainty). On the contrary, no effect on the probability of live birth was present when endometrial injury was performed during the embryo transfer cycle (RR: 0.87, 95% CI: 0.67-1.15; heterogeneity: I=65.18%, p=0.33, 5 studies; low certainty). In addition, a higher probability of live birth was only present in women with previous IVF failures (RR: 1.35, 95% CI: 1.20-1.53; heterogeneity: I=0%, p<0.001, 13 studies; moderate certainty) with evidence suggesting that the more IVF failures the more likely endometrial scratching to be beneficial (p=0.004). The number of times endometrial scratching was performed, as well as the type of instrument used did not appear to affect the probability of live birth.
Endometrial scratching during the menstrual cycle prior to an embryo transfer cycle can lead to a higher probability of live birth in patients with previous IVF failures.
PROSPERO CRD42023433538 (18 Jun 2023).
评估胚胎移植周期前进行子宫内膜搔刮术与安慰剂/假手术或无干预相比，对妊娠概率的影响。
通过特定的搜索策略，对 MEDLINE、EMBASE、COCHRANE 中央、SCOPUS 和 WEB OF SCIENCE 数据库进行计算机检索，以确定评估胚胎移植周期前进行子宫内膜搔刮术对妊娠概率（以活产、持续妊娠或临床妊娠表示，按重要性顺序排列）的随机对照试验（RCT），与安慰剂/假手术或无干预相比。使用随机效应或固定效应模型对数据进行汇总，具体取决于是否存在异质性。使用 I 统计量评估异质性。根据每个 RCT 研究的人群、子宫内膜活检的时间和方法进行亚组分析。使用 GRADEPro 工具评估证据的确定性。
与安慰剂/假手术或无干预相比，胚胎移植周期后行子宫内膜搔刮术可显著提高活产概率（相对风险-RR：1.12，95%置信区间：1.05-1.20；异质性：I=46.30%，p<0.001，28 项研究；低确定性）。两组间持续妊娠概率无显著差异（RR：1.07，95%置信区间：0.98-1.18；异质性：I=27.44%，p=0.15，11 项研究；低确定性）。与安慰剂/假手术或无干预相比，胚胎移植周期后行子宫内膜搔刮术可显著提高临床妊娠概率（RR：1.12，95%置信区间：1.06-1.18；异质性：I=47.48%，p<0.001，37 项研究；低确定性）。根据子宫内膜搔刮术的时间进行了亚组分析。当在胚胎移植周期前的月经周期中进行子宫内膜搔刮术时，活产概率显著提高（RR：1.18，95%置信区间：1.09-1.27；异质性：I=39.72%，p<0.001，21 项研究；中等确定性）。相反，在胚胎移植周期中进行子宫内膜损伤时，对活产概率没有影响（RR：0.87，95%置信区间：0.67-1.15；异质性：I=65.18%，p=0.33，5 项研究；低确定性）。此外，只有在 IVF 失败的女性中才存在活产概率升高的情况（RR：1.35，95%置信区间：1.20-1.53；异质性：I=0%，p<0.001，13 项研究；中等确定性），并且证据表明 IVF 失败次数越多，子宫内膜搔刮术获益的可能性越大（p=0.004）。子宫内膜搔刮术的次数以及使用的器械类型似乎都不会影响活产概率。
在 IVF 失败的患者中，在胚胎移植周期前的月经周期中进行子宫内膜搔刮术可提高活产概率。
PROSPERO CRD42023433538（2023 年 6 月 18 日）。
