Network Meta-Analysis on the Efficacy of Different Interventions for Treating Thin Endometrium

Keng Feng¹zhao zhang²ling ling zhu¹di yu luo¹xiang li¹rong de li¹jie jun zhong¹ping liu lan¹ling wu^3*

• ¹Yulin Maternal and Child Health Hospital, Yulin City, China
• ²Qinzhou Maternity and Child Health Care Hospital, Guangxi, China
• ³People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Region, China

Background: 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.Objective: 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.Methods: 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).Results: 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. Conclusion: 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.