Keng Feng, Ling Wu, Zhao Zhang, Yudi Luo, Xiang Li, Derong Li, Junjie Zhong, Liuping Lan, Lingling Zhu
Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China.
Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Endocrinol (Lausanne). 2025 Aug 20;16:1575248. doi: 10.3389/fendo.2025.1575248. eCollection 2025.
The incidence of thin endometrium in assisted reproductive technology (ART) is between 1% and 2.5%, yet its treatment options are varied and often show limited efficacy. There is an urgent need to delineate the relative effectiveness of various interventions to guide clinical practice.
This study aims to systematically compare the efficacy of different interventions for treating thin endometrium via a network meta-analysis, focusing on improvements in endometrial thickness and clinical pregnancy rates.
A systematic search was conducted in PubMed, The Cochrane Library, EMBASE, CBM, and CNKI databases, covering literature until December 31, 2024. Randomized controlled trials (RCTs) evaluating treatments for thin endometrium were included and assessed for quality using the Cochrane Risk of Bias Tool. Stata 17.0 software was used for the network meta-analysis, employing Bayesian methods to construct network diagrams and calculate the surface under the cumulative ranking curve (SUCRA).
Eighteen RCTs involving six interventions (oral aspirin, Ding Kun Dan, intrauterine infusion of platelet-rich plasma [PRP], intrauterine infusion of granulocyte-macrophage colony-stimulating factor [G-CSF], intramuscular injection of recombinant human growth hormone [rhGH], and neuromuscular electrical stimulation [NMES]) were included. The network meta-analysis revealed: 1) Endometrial thickness: All intervention groups showed varying degrees of effectiveness in increasing thickness compared to the control group. The top three ranked in effectiveness were G-CSF (SUCRA = 78.48%), aspirin (SUCRA = 70.89%), and PRP (SUCRA = 68.14%). 2) Clinical pregnancy rate: PRP ranked highest in improving pregnancy rates (SUCRA = 80.12%), followed by aspirin (SUCRA = 70.29%) and Ding Kun Dan (SUCRA = 62.79%). Overall, PRP showed significant advantages in both increasing endometrial thickness and improving clinical pregnancy rates, making it the most promising intervention.
PRP demonstrates the best clinical application potential in treating thin endometrium, particularly in improving clinical pregnancy rates. Future high-quality RCTs are necessary to further validate and optimize intervention strategies.
辅助生殖技术（ART）中薄型子宫内膜的发生率在1%至2.5%之间，但其治疗方案多样且疗效往往有限。迫切需要明确各种干预措施的相对有效性以指导临床实践。
本研究旨在通过网络荟萃分析系统比较不同干预措施治疗薄型子宫内膜的疗效，重点关注子宫内膜厚度和临床妊娠率的改善情况。
在PubMed、The Cochrane Library、EMBASE、CBM和CNKI数据库中进行系统检索，涵盖截至2024年12月31日的文献。纳入评估薄型子宫内膜治疗方法的随机对照试验（RCT），并使用Cochrane偏倚风险工具评估质量。使用Stata 17.0软件进行网络荟萃分析，采用贝叶斯方法构建网络图并计算累积排名曲线下面积（SUCRA）。
纳入了18项RCT，涉及六种干预措施（口服阿司匹林、定坤丹、宫腔内输注富血小板血浆[PRP]、宫腔内输注粒细胞巨噬细胞集落刺激因子[G-CSF]、肌肉注射重组人生长激素[rhGH]和神经肌肉电刺激[NMES]）。网络荟萃分析显示：1）子宫内膜厚度：与对照组相比，所有干预组在增加厚度方面均显示出不同程度的有效性。有效性排名前三的是G-CSF（SUCRA = 78.48%）、阿司匹林（SUCRA = 70.89%）和PRP（SUCRA = 68.14%）。2）临床妊娠率：PRP在提高妊娠率方面排名最高（SUCRA = 80.12%），其次是阿司匹林（SUCRA = 70.29%）和定坤丹（SUCRA = 62.79%）。总体而言，PRP在增加子宫内膜厚度和提高临床妊娠率方面均显示出显著优势，是最有前景的干预措施。
PRP在治疗薄型子宫内膜方面显示出最佳的临床应用潜力，尤其是在提高临床妊娠率方面。未来需要高质量的RCT进一步验证和优化干预策略。
