子宮內膜刺激手術 2016 最新 國際認證 證明 是可以增加試管嬰兒成功率胚胎著床率，但是大部分病人會痛However, the endometrial injury procedure does appear to cause some pain, although this is short lived. 內置圖片 1 ​像農夫春耕犁田，子宮內膜刺激術可以增加子宮著床成功率， 就像​農夫春耕犁田，在春天的時候會犁田， 把田裡面深層刮出來讓它吸收氧氣， 而子宮內膜刺激術 從最早前的加拿

2016.08.12

 

 
 
 
子宮內膜刺激手術 2016 最新 國際認證 證明 是可以增加試管嬰兒成功率胚胎著床率，但是大部分病人會痛However, the endometrial injury procedure does appear to cause some pain, although this is short lived.

內置圖片 1

 

​像農夫春耕犁田，子宮內膜刺激術可以增加子宮著床成功率，

就像​農夫春耕犁田，在春天的時候會犁田，

把田裡面深層刮出來讓它吸收氧氣，

而子宮內膜刺激術

從最早前的加拿大，

以色列的研究，

到最近的2016年芬蘭舉行的歐洲生殖醫學會的一個14份研究系統性整理(COCHRAE  REVIEW)，

大部份的研究都證實的確可以增加胚胎著床率，怎麼個做法?

通常在試管嬰兒前植入胚胎前7天，有的是說植入胚胎前1~3個月，

不過有一份研究比較奇怪的是在取卵手術的時候進行手術，

endometrial 切片injury

它的原理都是因為子宮內膜刺激

做了讓子宮內膜受傷我們稱為EBI，E：子宮內膜，B：切片，I：就是受傷，

Endometrial injury


以前的做法有在子宮內膜刮3條在子宮底部，
而就在胚胎著床的位置，
當受傷的時候之後此部分研究泌生長激素，
也因此帶來胚胎著床的機會，
可是博元婦產科根據林口長庚的黃錦榮醫師的那個研究，
他那份研究子宮內膜雌激素是在胚胎的著床位置做一個點狀的切片，
那博元婦產科很早很早很早以前改用林口長庚醫院黃錦榮的那份研究，

Site-specific endometrial 切片injury improves implantation and pregnancy in patients with repeated implantation failures

    • Shang Yu Huang†,
    • Chin-Jung Wang†,
    • Yung-Kuei Soong,
    • Hsin-Shih Wang,
    • Mei Li Wang,
    • Chieh Yu Lin and
    • Chia Lin ChangEmail author
†Contributed equally
Reproductive Biology and Endocrinology2011



那份研究發表在Reproductive Biology and Endocrinology20119:140得到100%的懷孕成功率，

為甚麼會增加成功率到百分之百呢?

根據香港中國大學陳小章教授的研究是，
而最近一份的研究是國際性的大規模研究，

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques

把全球14篇子宮內膜雌激素的研究做系統性的研究，芬蘭舉行的歐洲生殖醫學會的年會2016年六月份發表https://www.eshre2016.eu/Media/Press-releases_/Lensen.aspx，

他們的證據率是一級的，
而且提出來，沒有做子宮內膜雌激素懷孕率是26%，
有做的話呢?成功率從26%增加到28%到48%，

當然在那一份系統性的研究他也提到，
難免在做完手術的時候病人會喊痛，

不過因為他只有在胚胎的著床位置小區域小部位的切片，
進行子宮內膜的切片，
BIOpSY

所以妳如果把子宮想成一個教室或是一個防空洞

Site-specific endometrial injury

只是一個在胚胎著床的位置教室的地板好像是切片一個小小的刮，
在那個區域產生會復原的過程，
所以基本上這個切片的面積占整個子宮是幾乎不到千分之一萬分之一的。

===========================







醫學上任何研究會做一個研究、兩個研究，越做越多，等到一定研究數目，就有專家出面會把它整理叫做系統性整理(COCHRAE  REVIEW)的回顧，最近有一份發表在英國的COCHRANE REVIEW，

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques


http://rbej.biomedcentral.com/articles/10.1186/1477-7827-9-140


有一個系統性整理(COCHRAE  REVIEW)在評估子宮內膜刺激術

endometrial 切片injury

的臨床效益，

共有14篇研究

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques

這14篇裡面有1篇是在取卵的時候做內膜刺激手術，

其他13天都在植入月經週期前七天做內膜刺激，

但這個研究裡面再沒有做子宮內膜刺激術的平均臨床懷孕率是26%，

做子宮內膜刺激術的平均懷孕率從28%~48%，大大有增加的，

但是唯一一篇沒有增加懷孕率就是那篇，

在取卵的時候順便做內膜刺激手術，因為太靠近胚胎植入的時間血淋淋的當然會失敗，



這篇系統性整理(COCHRAE  REVIEW)研究，也在今年芬蘭舉行的歐洲生殖醫學會的年會2016年六月份發表https://www.eshre2016.eu/Media/Press-releases_/Lensen.aspx，而且他提出證據力是中等，


但研究也提到子宮內膜刺激術故意讓子宮內膜受傷，


大部分病人會在手術的時候病人會喊痛。However, the endometrial injury procedure does appear to cause some pain, although this is short lived.












(2)子宮後壁特殊區域的，也就是胚胎著床的

​位置做小部位!的​
子宮內膜刺激術EBI 

Site-specific endometrial injury


    

 

子宮內膜上皮細胞上的鈉離子通道；

中文大學最近破解了人類胚胎成孕之謎。中大發現了上皮細胞的鈉離子通道在胚胎著床（或胚胎植入子宮）過程中不可或缺的作用，開展診斷不孕症的新路向。中文的研究剛於國際醫學界其中一份最具影響力的期刊《自然醫學》上刊登。 採訪：靜態組

有關研究由中大李嘉誠生理學講座教授兼上皮細胞生物學研究中心主任陳小章教授領導的研究團隊負責。

  陳小章表示，研究團隊的發現，不僅揭開了長期以來關於胚胎植入子宮的啟動過程的謎團，並闡述了流產或試管嬰兒成功率低下的一個重要原因，同時，研判亦為診斷不孕及進行避孕提供了新的方法。

    先決條件可創造：子宮內膜刺激術
胚胎附著子宮內膜後，引起滋養層細胞分化的「蛻膜化」過程是成功懷孕的先決條件。但胚胎最初只接觸到子宮內膜表層的上皮細胞，而來自胚胎的物理或化學的訊號，是如何傳遞到子宮內膜下面的滋養層細胞，從而引發 「蛻膜化」反應呢？這個問題一直找不到答案。 
    陳教授說：「我們發現表達在子宮內膜上皮細胞上的鈉離子通道，可以被胚胎釋放的蛋白質激活，讓上皮細胞釋放出可以誘導滋養層細胞『蛻膜化』的重要份子—前列腺素E2（PGE2）。」

 

    她補充說：「我們亦發現曾接受輔助生殖技術卻未能成孕的婦女，其子宮內膜的上皮細胞鈉離子通道的表達水平，明顯比通過此技術成功受孕的婦女要低。」 


    上皮細胞生物學研究中心一直引領人類生育相關的上皮細胞生物學研究，曾多次發表有關控制生育的份子機制和不育成因的重大發現。這些貢獻為她帶來多個重要獎項榮譽，包括兩次國家自然科學獎（1997年及2008年）和「長江學者成就獎」（2007年）。

 

    


因此在ESHRE歐洲生殖醫學會2015是把子宮內膜刺激術EBI對於增加試管嬰兒成功率、
增加胚胎著床率列為具有一級證據力的有效醫學方法，

子宮內膜刺激就可以增加多少個懷孕率，

子宮內膜刺激有可以增加胚胎的著床率呢？
以一份研究，
這一份研究是2013年報告,


Site-specific endometrial injury

在做試管嬰兒 前一個月，月經第6天到第12天,
發現這樣刮或不刮，這個研究裡面有89個病人，其中有40個子宮內膜刺激術49個不子宮內膜刺激術，子宮內膜刺激術的這一組可以得到從不子宮內膜刺激術的12.2%的
臨床懷孕率增加到37.5%，
胚胎著床率從6.3%增加到23.6%，
繼續懷孕率8.2%增加到25%，


你會說怎麼會這麼低??

原本子宮內膜薄的懷孕率原本就不高，因此這個成績算是有統計差異性的進步。




































Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures





內置圖片 1






內置圖片 2內置圖片 4內置圖片 3

Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures
    • Shang Yu Huang†,
    • Chin-Jung Wang†,
    • Yung-Kuei Soong,
    • Hsin-Shih Wang,
    • Mei Li Wang,
    • Chieh Yu Lin and
    • Chia Lin ChangEmail author
†Contributed equally
Reproductive Biology and Endocrinology20119:140

DOI: 10.1186/1477-7827-9-140

©  Huang et al; licensee BioMed Central Ltd. 2011

Received: 3 June 2011

Accepted: 21 October 2011

Published: 21 October 2011

Abstract

Background

To test whether a site-specific hysteroscopic biopsy-induced injury in the endometrium during the controlled ovarian hyperstimulation cycle improves subsequent embryo implantation in patients with repeated implantation failure, a total of 30 patients who have had good responses to controlled ovulation stimulation but have failed to achieve pregnancy after two or more transfers of good-quality embryos were recruited in this prospective study.

Methods

A single, site-specific hysteroscopic biopsy-induced injury was generated on the posterior endometrium at midline 10-15 mm from the fundus during the D4-D7 period of the ongoing controlled ovarian hyperstimulation cycle in six patients.

Results

Patients received endometrial biopsy protocol achieved a pregnancy rate of 100%. By contrast, only 46% of patients with similar clinical characteristics (N = 24) achieved pregnancy without the hysteroscopic biopsy-induced endometrium injury (p < 0.05).

Conclusions

Our proof-of-concept study demonstrates that a site-specific hysteroscopic endometrium injury performed during the ongoing in vitro fertilization (IVF) cycle, instead of injuries received during prior cycles, significantly improves clinical outcomes in patients with repeated implantation failure.

Keywords

hysteroscopy endometrium biopsy IVF repeated implantation failure pregnancy

Endometrial injury in women undergoing assisted reproductive techniques

Review question

To assess the safety and efficacy of performing an endometrial injury (such as endometrial biopsy) on reproductive outcomes in women undergoing ART.

Background

Couples who have trouble getting pregnant may seek fertility treatments to help them conceive. These treatments are known as assisted reproductive techniques (ART), such as in vitro fertilisation (IVF). In ART, eggs are collected from the woman and are combined with semen in the laboratory to create embryos. Embryos are transferred back into the womb in the hope that they will establish a pregnancy. Implantation is the process by which an embryo is embedded in the lining of the womb; it is the first step toward establishing a successful pregnancy. It has been suggested that the chances of implantation are increased by intentional endometrial scratching, such as by endometrial biopsy or curettage, before replacement of the embryo.

Study characteristics

Cochrane authors included 14 clinical trials (2128 women) evaluating the effects of endometrial injury on outcomes of ART. Thirteen of these trials studied endometrial injury during the menstrual cycle before embryo transfer. One trial studied endometrial injury on the day of oocyte retrieval, which is just a few days before the day the embryo is transferred into the womb. Whether participants had undergone previous embryo transfers varied among the included studies. The evidence is current to January 2015.

Key results

The included studies suggest that endometrial injury performed sometime during the month before the start of ovarian stimulation as part of ART improves the chances that a woman will achieve live birth and clinical pregnancy. Moderate-quality evidence suggests that if 26% of women achieve live birth without endometrial injury, between 28% and 48% will achieve live birth with thisintervention. Contrary to this, endometrial injury performed on the day the eggs are picked up reduces the chances of pregnancy.

We are still uncertain about the effect of endometrial injury on adverse events such as miscarriage, multiple pregnancy or vaginal bleeding.However, the endometrial injury procedure does appear to cause some pain, although this is short lived.

Quality of the evidence

Evidence that endometrial injury performed in the cycle before ART increases theprobability of live birth and clinical pregnancy is of moderate quality. For all other outcomes the evidence is of low or very low quality. The quality of the evidence is reduced because insufficient participants were included in the studies, and because a large proportion of the included studies have important limitations in the methods that they used.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


內置圖片 1

 

​像農夫春耕犁田，子宮內膜刺激術可以增加子宮著床成功率，

就像​農夫春耕犁田，在春天的時候會犁田，

把田裡面深層刮出來讓它吸收氧氣，

而子宮內膜刺激術

從最早前的加拿大，

以色列的研究，

到最近的2016年芬蘭舉行的歐洲生殖醫學會的一個14份研究系統性整理(COCHRAE  REVIEW)，

大部份的研究都證實的確可以增加胚胎著床率，怎麼個做法?

通常在試管嬰兒前植入胚胎前7天，有的是說植入胚胎前1~3個月，

不過有一份研究比較奇怪的是在取卵手術的時候進行手術，

endometrial 切片injury

它的原理都是因為子宮內膜刺激

做了讓子宮內膜受傷我們稱為EBI，E：子宮內膜，B：切片，I：就是受傷，

Endometrial injury


以前的做法有在子宮內膜刮3條在子宮底部，
而就在胚胎著床的位置，
當受傷的時候之後此部分研究泌生長激素，
也因此帶來胚胎著床的機會，
可是博元婦產科根據林口長庚的黃錦榮醫師的那個研究，
他那份研究子宮內膜雌激素是在胚胎的著床位置做一個點狀的切片，
那博元婦產科很早很早很早以前改用林口長庚醫院黃錦榮的那份研究，

Site-specific endometrial 切片injury improves implantation and pregnancy in patients with repeated implantation failures

    • Shang Yu Huang†,
    • Chin-Jung Wang†,
    • Yung-Kuei Soong,
    • Hsin-Shih Wang,
    • Mei Li Wang,
    • Chieh Yu Lin and
    • Chia Lin ChangEmail author
†Contributed equally
Reproductive Biology and Endocrinology2011



那份研究發表在Reproductive Biology and Endocrinology20119:140得到100%的懷孕成功率，

為甚麼會增加成功率到百分之百呢?

根據香港中國大學陳小章教授的研究是，
而最近一份的研究是國際性的大規模研究，

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques

把全球14篇子宮內膜雌激素的研究做系統性的研究，芬蘭舉行的歐洲生殖醫學會的年會2016年六月份發表https://www.eshre2016.eu/Media/Press-releases_/Lensen.aspx，

他們的證據率是一級的，
而且提出來，沒有做子宮內膜雌激素懷孕率是26%，
有做的話呢?成功率從26%增加到28%到48%，

當然在那一份系統性的研究他也提到，
難免在做完手術的時候病人會喊痛，

不過因為他只有在胚胎的著床位置小區域小部位的切片，
進行子宮內膜的切片，
BIOpSY

所以妳如果把子宮想成一個教室或是一個防空洞

Site-specific endometrial injury

只是一個在胚胎著床的位置教室的地板好像是切片一個小小的刮，
在那個區域產生會復原的過程，
所以基本上這個切片的面積占整個子宮是幾乎不到千分之一萬分之一的。

===========================







醫學上任何研究會做一個研究、兩個研究，越做越多，等到一定研究數目，就有專家出面會把它整理叫做系統性整理(COCHRAE  REVIEW)的回顧，最近有一份發表在英國的COCHRANE REVIEW，

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques


http://rbej.biomedcentral.com/articles/10.1186/1477-7827-9-140


有一個系統性整理(COCHRAE  REVIEW)在評估子宮內膜刺激術

endometrial 切片injury

的臨床效益，

共有14篇研究

http://www.cochrane.org/CD009517/MENSTR_endometrial-injury-in-women-undergoing-assisted-reproductive-techniques

這14篇裡面有1篇是在取卵的時候做內膜刺激手術，

其他13天都在植入月經週期前七天做內膜刺激，

但這個研究裡面再沒有做子宮內膜刺激術的平均臨床懷孕率是26%，

做子宮內膜刺激術的平均懷孕率從28%~48%，大大有增加的，

但是唯一一篇沒有增加懷孕率就是那篇，

在取卵的時候順便做內膜刺激手術，因為太靠近胚胎植入的時間血淋淋的當然會失敗，



這篇系統性整理(COCHRAE  REVIEW)研究，也在今年芬蘭舉行的歐洲生殖醫學會的年會2016年六月份發表https://www.eshre2016.eu/Media/Press-releases_/Lensen.aspx，而且他提出證據力是中等，


但研究也提到子宮內膜刺激術故意讓子宮內膜受傷，


大部分病人會在手術的時候病人會喊痛。However, the endometrial injury procedure does appear to cause some pain, although this is short lived.












(2)子宮後壁特殊區域的，也就是胚胎著床的

​位置做小部位!的​
子宮內膜刺激術EBI 

Site-specific endometrial injury


    

 

子宮內膜上皮細胞上的鈉離子通道；

中文大學最近破解了人類胚胎成孕之謎。中大發現了上皮細胞的鈉離子通道在胚胎著床（或胚胎植入子宮）過程中不可或缺的作用，開展診斷不孕症的新路向。中文的研究剛於國際醫學界其中一份最具影響力的期刊《自然醫學》上刊登。 採訪：靜態組

有關研究由中大李嘉誠生理學講座教授兼上皮細胞生物學研究中心主任陳小章教授領導的研究團隊負責。

  陳小章表示，研究團隊的發現，不僅揭開了長期以來關於胚胎植入子宮的啟動過程的謎團，並闡述了流產或試管嬰兒成功率低下的一個重要原因，同時，研判亦為診斷不孕及進行避孕提供了新的方法。

    先決條件可創造：子宮內膜刺激術
胚胎附著子宮內膜後，引起滋養層細胞分化的「蛻膜化」過程是成功懷孕的先決條件。但胚胎最初只接觸到子宮內膜表層的上皮細胞，而來自胚胎的物理或化學的訊號，是如何傳遞到子宮內膜下面的滋養層細胞，從而引發 「蛻膜化」反應呢？這個問題一直找不到答案。 
    陳教授說：「我們發現表達在子宮內膜上皮細胞上的鈉離子通道，可以被胚胎釋放的蛋白質激活，讓上皮細胞釋放出可以誘導滋養層細胞『蛻膜化』的重要份子—前列腺素E2（PGE2）。」

 

    她補充說：「我們亦發現曾接受輔助生殖技術卻未能成孕的婦女，其子宮內膜的上皮細胞鈉離子通道的表達水平，明顯比通過此技術成功受孕的婦女要低。」 


    上皮細胞生物學研究中心一直引領人類生育相關的上皮細胞生物學研究，曾多次發表有關控制生育的份子機制和不育成因的重大發現。這些貢獻為她帶來多個重要獎項榮譽，包括兩次國家自然科學獎（1997年及2008年）和「長江學者成就獎」（2007年）。

 

    


因此在ESHRE歐洲生殖醫學會2015是把子宮內膜刺激術EBI對於增加試管嬰兒成功率、
增加胚胎著床率列為具有一級證據力的有效醫學方法，

子宮內膜刺激就可以增加多少個懷孕率，

子宮內膜刺激有可以增加胚胎的著床率呢？
以一份研究，
這一份研究是2013年報告,


Site-specific endometrial injury

在做試管嬰兒 前一個月，月經第6天到第12天,
發現這樣刮或不刮，這個研究裡面有89個病人，其中有40個子宮內膜刺激術49個不子宮內膜刺激術，子宮內膜刺激術的這一組可以得到從不子宮內膜刺激術的12.2%的
臨床懷孕率增加到37.5%，
胚胎著床率從6.3%增加到23.6%，
繼續懷孕率8.2%增加到25%，


你會說怎麼會這麼低??

原本子宮內膜薄的懷孕率原本就不高，因此這個成績算是有統計差異性的進步。




































Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures





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Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures

    • Shang Yu Huang†,
    • Chin-Jung Wang†,
    • Yung-Kuei Soong,
    • Hsin-Shih Wang,
    • Mei Li Wang,
    • Chieh Yu Lin and
    • Chia Lin ChangEmail author
†Contributed equally
Reproductive Biology and Endocrinology20119:140

DOI: 10.1186/1477-7827-9-140

©  Huang et al; licensee BioMed Central Ltd. 2011

Received: 3 June 2011

Accepted: 21 October 2011

Published: 21 October 2011

Abstract

Background

To test whether a site-specific hysteroscopic biopsy-induced injury in the endometrium during the controlled ovarian hyperstimulation cycle improves subsequent embryo implantation in patients with repeated implantation failure, a total of 30 patients who have had good responses to controlled ovulation stimulation but have failed to achieve pregnancy after two or more transfers of good-quality embryos were recruited in this prospective study.

Methods

A single, site-specific hysteroscopic biopsy-induced injury was generated on the posterior endometrium at midline 10-15 mm from the fundus during the D4-D7 period of the ongoing controlled ovarian hyperstimulation cycle in six patients.

Results

Patients received endometrial biopsy protocol achieved a pregnancy rate of 100%. By contrast, only 46% of patients with similar clinical characteristics (N = 24) achieved pregnancy without the hysteroscopic biopsy-induced endometrium injury (p < 0.05).

Conclusions

Our proof-of-concept study demonstrates that a site-specific hysteroscopic endometrium injury performed during the ongoing in vitro fertilization (IVF) cycle, instead of injuries received during prior cycles, significantly improves clinical outcomes in patients with repeated implantation failure.

Keywords

hysteroscopy endometrium biopsy IVF repeated implantation failure pregnancy

Endometrial injury in women undergoing assisted reproductive techniques

Review question

To assess the safety and efficacy of performing an endometrial injury (such as endometrial biopsy) on reproductive outcomes in women undergoing ART.

Background

Couples who have trouble getting pregnant may seek fertility treatments to help them conceive. These treatments are known as assisted reproductive techniques (ART), such as in vitro fertilisation (IVF). In ART, eggs are collected from the woman and are combined with semen in the laboratory to create embryos. Embryos are transferred back into the womb in the hope that they will establish a pregnancy. Implantation is the process by which an embryo is embedded in the lining of the womb; it is the first step toward establishing a successful pregnancy. It has been suggested that the chances of implantation are increased by intentional endometrial scratching, such as by endometrial biopsy or curettage, before replacement of the embryo.

Study characteristics

Cochrane authors included 14 clinical trials (2128 women) evaluating the effects of endometrial injury on outcomes of ART. Thirteen of these trials studied endometrial injury during the menstrual cycle before embryo transfer. One trial studied endometrial injury on the day of oocyte retrieval, which is just a few days before the day the embryo is transferred into the womb. Whether participants had undergone previous embryo transfers varied among the included studies. The evidence is current to January 2015.

Key results

The included studies suggest that endometrial injury performed sometime during the month before the start of ovarian stimulation as part of ART improves the chances that a woman will achieve live birth and clinical pregnancy. Moderate-quality evidence suggests that if 26% of women achieve live birth without endometrial injury, between 28% and 48% will achieve live birth with thisintervention. Contrary to this, endometrial injury performed on the day the eggs are picked up reduces the chances of pregnancy.

We are still uncertain about the effect of endometrial injury on adverse events such as miscarriage, multiple pregnancy or vaginal bleeding.However, the endometrial injury procedure does appear to cause some pain, although this is short lived.

Quality of the evidence

Evidence that endometrial injury performed in the cycle before ART increases theprobability of live birth and clinical pregnancy is of moderate quality. For all other outcomes the evidence is of low or very low quality. The quality of the evidence is reduced because insufficient participants were included in the studies, and because a large proportion of the included studies have important limitations in the methods that they used.