Mrosk Paolina, Sandi-Monroy Nathallie, Gagsteiger Friedrich, Friedl Thomas Wolfram Paul, Hancke Katharina, Bundschu Karin
Kinderwunschzentrum Ulm, Ulm, Germany.
Department of Urology, University Hospital of Ulm, Ulm, Germany.
Front Reprod Health. 2024 Nov 27;6:1505842. doi: 10.3389/frph.2024.1505842. eCollection 2024.
Endometrial scratching (ES) and/or intravenous intralipid therapy (in cases of increased uterine natural killer cells, uNKs) are still conducted in several fertility centers as "add-on" treatments in patients undergoing ART, although convincing evidence for beneficial effects is lacking.
In this retrospective study, associations between ES treatment or additional intralipid therapy and pregnancy and live birth rates of 1,546 patients undergoing 2,821 IVF-/ICSI-treatment cycles with fresh or frozen embryo transfers in a German fertility-center between 1st January 2014 and 31th May 2017 were analyzed.
Overall pregnancy and live birth rates for all 2,821 treatment cycles (468 cycles with ES) were 32.8% and 23.5%. There were no statistically significant differences in pregnancy or live birth rates between first treatment cycles with and without ES ( = 0.915 and = 0.577) or between second cycles following an unsuccessful first cycle with and without ES ( = 0.752 and = 0.623). These results were confirmed using multivariable generalized estimating equations (GEE) models accounting for non-independency of multiple treatment cycles per patients that included all cycles and showed no significant effect of ES on pregnancy ( = 0.449) or live birth rates ( = 0.976). Likewise, a GEE model revealed no significant effect of intralipid treatment on pregnancy ( = 0.926) and live birth rates ( = 0.727).
Our results reveal no evidence that ES increases the pregnancy or live birth rates in women undergoing their first or further IVF cycle with fresh or frozen embryo transfer. Intralipid treatment was also not beneficial. Even if patients explicitly ask for it, these procedures are not recommended outside of clinical studies.
子宫内膜搔刮术（ES）和/或静脉输注脂肪乳剂治疗（针对子宫自然杀伤细胞，即uNK细胞增多的情况）在一些生育中心仍作为辅助治疗应用于接受辅助生殖技术（ART）的患者，尽管缺乏其有益效果的确凿证据。
在这项回顾性研究中，分析了2014年1月1日至2017年5月31日期间，德国一家生育中心1546例患者接受2821个新鲜或冷冻胚胎移植的体外受精/卵胞浆内单精子注射（IVF-/ICSI）治疗周期中，ES治疗或额外的脂肪乳剂治疗与妊娠率和活产率之间的关联。
所有2821个治疗周期（其中468个周期接受了ES治疗）的总体妊娠率和活产率分别为32.8%和23.5%。首次治疗周期中，接受ES治疗和未接受ES治疗的患者在妊娠率（P = 0.915）或活产率（P = 0.577）方面无统计学显著差异；首次周期未成功后的第二次周期中，接受ES治疗和未接受ES治疗的患者在妊娠率（P = 0.752）或活产率（P = 0.623）方面也无统计学显著差异。使用多变量广义估计方程（GEE）模型对每位患者多个治疗周期的非独立性进行校正后，纳入所有周期的分析结果证实，ES对妊娠率（P = 0.449）或活产率（P = 0.976）无显著影响。同样，GEE模型显示脂肪乳剂治疗对妊娠率（P = 0.926）和活产率（P = 0.727）也无显著影响。
我们的结果表明，没有证据显示ES能提高接受首次或后续新鲜或冷冻胚胎移植IVF周期的女性的妊娠率或活产率。脂肪乳剂治疗也无益处。即使患者明确要求，在临床研究之外也不建议进行这些操作。
