作者：Lensen S, et al.
译者：湖北省十堰市中医医院王家美
译者简介: 女，1971年出生，副主任医师，从事妇产科临床医疗20年，具有扎实理论基础和丰富的临床经验，手术技术娴熟，擅长各类妇产科各类疾病诊治，尤其擅长产科重症病人抢救和妇科内分泌疾病救治，曾先后在国家级核心期刊上发表专业论文十余篇，先担任十堰市计划生育委员会委员，十堰市妇产科专业委员会常务委员，十堰市围产医学专业委员会常务委员。
【摘要】
背景：子宫内膜刮伤(使用pipelle活检)是一种技术实验，以促进胚胎植入和增加怀孕的可能性的妇女接受体外受精(IVF)。
方法：我们进行了实用、多中心、开放标签、随机、对照试验。符合条件的妇女正在接受IVF(新鲜胚胎或冷冻胚胎移植),近期没有接触破坏性的宫内仪器(如子宫内镜检查)。参与者被随机分配为1:1的比例,以子宫内膜刮伤(在胚胎移植周期前的第3天和第3天之间的活检)或无干预。主要结果是活胎。
结果：共有1364名妇女进行了随机化。子宫内膜刮伤组：690名妇女中活产数为180人(26.08%)，对照组：674名妇女中活产数176人(26.1%)， 而持续妊娠、临床妊娠、多胎妊娠、异位妊娠或流产的发生率无显著差异。
子宫内膜刮伤疼痛的中位分数(在0到10,分数越高表示疼痛更严重)为3.5(四分位范围,1.9到6.0)。
结论: 接受IVF的妇女行子宫内膜刮伤没有导致活胎分娩率高于不干预组。
附原文
BACKGROUND：Endometrial scratching (with the use of a pipelle biopsy) is a technique proposed to facilitate embryo implantation and increase the probability of pregnancy in women undergoing in vitro fertilization (IVF).METHODS ：We conducted a pragmatic, multicenter, open-label, randomized, controlled trial. Eligible women were undergoing IVF (fresh-embryo or frozen-embryo transfer), with no recent exposure to disruptive intrauterine instrumentation (e.g., hysteroscopy). Participants were randomly assigned in a 1:1 ratio to either endometrial scratching (by pipelle biopsy between day 3 of the cycle preceding the embryotransfer cycle and day 3 of the embryo-transfer cycle) or no intervention. The primary outcome was live birth.RESULTS：A total of 1364 women underwent randomization. The frequency of live birth was 180 of 690 women (26.1%) in the endometrial-scratch group and 176 of 674 women (26.1%) in the control group (adjusted odds ratio, 1.00; 95% confidence interval, 0.78 to 1.27).
There were no significant between-group differences in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage. The median score for pain from endometrial scratching (on a scale of 0 to 10, with higher scores indicating worse pain) was 3.5 (interquartile range, 1.9 to 6.0).CONCLUSIONS：Endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF.
引自
Lensen S, Osavlyuk D, Armstrong S, et al. N Engl J Med(380): A Randomized Trial of Endometrial Scratching before In Vitro Fertilization.2019-01-24