PDF(Pubmed)
Abstract：
OBJECTIVE: Does endometrial compaction (EC) help predict pregnancy outcomes in those undergoing ART?
CONCLUSIONS: EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR).
BACKGROUND: EC describes the progesterone-induced decrease in endometrial thickness, which may be observed following the end of the proliferative phase, prior to embryo transfer. EC is proposed as a non-invasive tool to help predict pregnancy outcome in those undergoing ART, however, published data is conflicting.
UNASSIGNED: A literature search was carried out by two independent authors using PubMed, Cochrane Library, MEDLINE, Embase, Science Direct, Scopus, and Web of Science from inception of databases to May 2023. All peer-reviewed studies reporting EC and pregnancy outcomes in patients undergoing IVF/ICSI treatment were included.
METHODS: The primary outcome is LBR. Secondary outcomes included other pregnancy metrics (positive pregnancy test (PPT), CPR, OPR, miscarriage rate (MR)) and rate of EC. Comparative meta-analyses comparing EC and no EC were conducted for each outcome using a random-effects model if I 2 > 50%. The Mantel-Haenszel method was applied for pooling dichotomous data. Results are presented as odds ratios (OR) with 95% CI.
RESULTS: Out of 4030 screened articles, 21 cohort studies were included in the final analysis (n = 27 857). No significant difference was found between LBR in the EC versus the no EC group (OR 0.95; 95% CI 0.87-1.04). OPR was significantly higher within the EC group (OR 1.61; 95% CI 1.09-2.38), particularly when EC ≥ 15% compared to no EC (OR 3.52; 95% CI 2.36-5.23). CPR was inconsistently defined across the studies, affecting the findings. When defined as a viable intrauterine pregnancy <12 weeks, the EC group had significantly higher CPR than no EC (OR 1.83; 95% CI 1.15-2.92). No significant differences were found between EC and no EC for PPT (OR 1.54; 95% CI 0.97-2.45) or MR (OR 1.06; 95% CI 0.92-1.56). The pooled weighted incidence of EC across all studies was 32% (95% CI 26-38%).
CONCLUSIONS: Heterogeneity due to differences between reported pregnancy outcomes, definition of EC, method of ultrasound, and cycle protocol may account for the lack of translation between CPR/OPR and LBR findings; thus, all pooled data should be viewed with an element of caution.
CONCLUSIONS: In this dataset, the significantly higher CPR/OPR with EC does not translate to LBR. Although stratification of women according to EC cannot currently be recommended in clinical practice, a large and well-designed clinical trial to rigorously assess EC as a non-invasive predictor of a successful pregnancy is warranted. We urge for consistent outcome reporting to be mandated for ART trials so that data can be pooled, compared, and concluded on.
BACKGROUND: H.A. was supported by the Hewitt Fertility Centre. S.G.P. and J.W. were supported by the Liverpool University Hospital NHS Foundation Trust. D.K.H. was supported by a Wellbeing of Women project grant (RG2137) and MRC clinical research training fellowship (MR/V007238/1). N.T. was supported by the National Institute for Health and Care Research. D.K.H. had received honoraria for consultancy for Theramex and has received payment for presentations from Theramex and Gideon Richter. The remaining authors have no conflicts of interest to report.
BACKGROUND: PROSPERO CRD42022378464.
CONCLUSIONS: EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR).
BACKGROUND: EC describes the progesterone-induced decrease in endometrial thickness, which may be observed following the end of the proliferative phase, prior to embryo transfer. EC is proposed as a non-invasive tool to help predict pregnancy outcome in those undergoing ART, however, published data is conflicting.
UNASSIGNED: A literature search was carried out by two independent authors using PubMed, Cochrane Library, MEDLINE, Embase, Science Direct, Scopus, and Web of Science from inception of databases to May 2023. All peer-reviewed studies reporting EC and pregnancy outcomes in patients undergoing IVF/ICSI treatment were included.
METHODS: The primary outcome is LBR. Secondary outcomes included other pregnancy metrics (positive pregnancy test (PPT), CPR, OPR, miscarriage rate (MR)) and rate of EC. Comparative meta-analyses comparing EC and no EC were conducted for each outcome using a random-effects model if I 2 > 50%. The Mantel-Haenszel method was applied for pooling dichotomous data. Results are presented as odds ratios (OR) with 95% CI.
RESULTS: Out of 4030 screened articles, 21 cohort studies were included in the final analysis (n = 27 857). No significant difference was found between LBR in the EC versus the no EC group (OR 0.95; 95% CI 0.87-1.04). OPR was significantly higher within the EC group (OR 1.61; 95% CI 1.09-2.38), particularly when EC ≥ 15% compared to no EC (OR 3.52; 95% CI 2.36-5.23). CPR was inconsistently defined across the studies, affecting the findings. When defined as a viable intrauterine pregnancy <12 weeks, the EC group had significantly higher CPR than no EC (OR 1.83; 95% CI 1.15-2.92). No significant differences were found between EC and no EC for PPT (OR 1.54; 95% CI 0.97-2.45) or MR (OR 1.06; 95% CI 0.92-1.56). The pooled weighted incidence of EC across all studies was 32% (95% CI 26-38%).
CONCLUSIONS: Heterogeneity due to differences between reported pregnancy outcomes, definition of EC, method of ultrasound, and cycle protocol may account for the lack of translation between CPR/OPR and LBR findings; thus, all pooled data should be viewed with an element of caution.
CONCLUSIONS: In this dataset, the significantly higher CPR/OPR with EC does not translate to LBR. Although stratification of women according to EC cannot currently be recommended in clinical practice, a large and well-designed clinical trial to rigorously assess EC as a non-invasive predictor of a successful pregnancy is warranted. We urge for consistent outcome reporting to be mandated for ART trials so that data can be pooled, compared, and concluded on.
BACKGROUND: H.A. was supported by the Hewitt Fertility Centre. S.G.P. and J.W. were supported by the Liverpool University Hospital NHS Foundation Trust. D.K.H. was supported by a Wellbeing of Women project grant (RG2137) and MRC clinical research training fellowship (MR/V007238/1). N.T. was supported by the National Institute for Health and Care Research. D.K.H. had received honoraria for consultancy for Theramex and has received payment for presentations from Theramex and Gideon Richter. The remaining authors have no conflicts of interest to report.
BACKGROUND: PROSPERO CRD42022378464.
摘要：
目的：子宫内膜致密化（EC）是否有助于预测接受ART的患者的妊娠结局？
结论：EC与更高的临床妊娠率（CPR）和持续妊娠率（OPR）相关，但这并不能转化为活产率(LBR)。
背景：EC描述了孕酮诱导的子宫内膜厚度减少，这可以在增殖期结束后观察到，在胚胎移植之前。建议将EC作为一种非侵入性工具来帮助预测接受ART的患者的妊娠结局。然而,发布的数据是相互矛盾的。
■由两名独立作者使用PubMed进行了文献检索，科克伦图书馆,MEDLINE,Embase,科学直接，Scopus,和WebofScience从数据库开始到2023年5月。纳入了所有报告接受IVF/ICSI治疗的患者的EC和妊娠结局的同行评审研究。
方法：主要结果是LBR。次要结局包括其他妊娠指标（妊娠试验阳性（PPT），CPR,OPR,流产率(MR))和EC率。如果I2>50%，使用随机效应模型对每个结果进行比较EC和无EC的比较荟萃分析。Mantel-Haenszel方法用于汇集二分数据。结果以比值比(OR)和95%CI表示。
结果：在4030篇筛选的文章中，21项队列研究纳入最终分析（n=27857）。EC与非EC组的LBR之间没有发现显着差异（OR0.95；95％CI0.87-1.04）。OPR在EC组中显著升高(OR1.61;95%CI1.09-2.38),特别是当EC≥15%时，与无EC相比(OR3.52；95%CI2.36-5.23)。CPR在研究中的定义不一致，影响调查结果。当定义为宫内妊娠<12周时，EC组的CPR显著高于无EC组(OR1.83;95%CI1.15-2.92).在PPT（OR1.54;95％CI0.97-2.45）或MR（OR1.06;95％CI0.92-1.56）的EC和无EC之间没有发现显着差异。所有研究中合并的EC加权发生率为32%（95%CI26-38%）。
结论：由于报告的妊娠结局之间的差异，EC的定义，超声方法，和周期协议可能是CPR/OPR和LBR结果之间缺乏翻译的原因；因此，应谨慎查看所有合并数据。
结论：在此数据集中，使用EC的显著较高的CPR/OPR不能转化为LBR。尽管目前在临床实践中不推荐根据EC对女性进行分层，有必要进行一项大型且精心设计的临床试验,以严格评估EC作为成功妊娠的非侵入性预测因子.我们敦促强制要求ART试验进行一致的结果报告，以便可以汇集数据，比较,并得出结论。
背景：H.A.由休伊特生育中心支持。S.G.P.和J.W.得到了利物浦大学医院NHS基金会信托基金的支持。D.K.H.得到了妇女福利项目赠款（RG2137）和MRC临床研究培训研究金（MR/V007238/1）的支持。N.T.得到了国家健康与护理研究所的支持。D.K.H.已获得Theramex咨询酬金，并已收到Theramex和GideonRichter的演示文稿付款。其余作者没有利益冲突需要报告。
背景：PROSPEROCRD42022378464。
结论：EC与更高的临床妊娠率（CPR）和持续妊娠率（OPR）相关，但这并不能转化为活产率(LBR)。
背景：EC描述了孕酮诱导的子宫内膜厚度减少，这可以在增殖期结束后观察到，在胚胎移植之前。建议将EC作为一种非侵入性工具来帮助预测接受ART的患者的妊娠结局。然而,发布的数据是相互矛盾的。
■由两名独立作者使用PubMed进行了文献检索，科克伦图书馆,MEDLINE,Embase,科学直接，Scopus,和WebofScience从数据库开始到2023年5月。纳入了所有报告接受IVF/ICSI治疗的患者的EC和妊娠结局的同行评审研究。
方法：主要结果是LBR。次要结局包括其他妊娠指标（妊娠试验阳性（PPT），CPR,OPR,流产率(MR))和EC率。如果I2>50%，使用随机效应模型对每个结果进行比较EC和无EC的比较荟萃分析。Mantel-Haenszel方法用于汇集二分数据。结果以比值比(OR)和95%CI表示。
结果：在4030篇筛选的文章中，21项队列研究纳入最终分析（n=27857）。EC与非EC组的LBR之间没有发现显着差异（OR0.95；95％CI0.87-1.04）。OPR在EC组中显著升高(OR1.61;95%CI1.09-2.38),特别是当EC≥15%时，与无EC相比(OR3.52；95%CI2.36-5.23)。CPR在研究中的定义不一致，影响调查结果。当定义为宫内妊娠<12周时，EC组的CPR显著高于无EC组(OR1.83;95%CI1.15-2.92).在PPT（OR1.54;95％CI0.97-2.45）或MR（OR1.06;95％CI0.92-1.56）的EC和无EC之间没有发现显着差异。所有研究中合并的EC加权发生率为32%（95%CI26-38%）。
结论：由于报告的妊娠结局之间的差异，EC的定义，超声方法，和周期协议可能是CPR/OPR和LBR结果之间缺乏翻译的原因；因此，应谨慎查看所有合并数据。
结论：在此数据集中，使用EC的显著较高的CPR/OPR不能转化为LBR。尽管目前在临床实践中不推荐根据EC对女性进行分层，有必要进行一项大型且精心设计的临床试验,以严格评估EC作为成功妊娠的非侵入性预测因子.我们敦促强制要求ART试验进行一致的结果报告，以便可以汇集数据，比较,并得出结论。
背景：H.A.由休伊特生育中心支持。S.G.P.和J.W.得到了利物浦大学医院NHS基金会信托基金的支持。D.K.H.得到了妇女福利项目赠款（RG2137）和MRC临床研究培训研究金（MR/V007238/1）的支持。N.T.得到了国家健康与护理研究所的支持。D.K.H.已获得Theramex咨询酬金，并已收到Theramex和GideonRichter的演示文稿付款。其余作者没有利益冲突需要报告。
背景：PROSPEROCRD42022378464。
