慢性子宫内膜炎与试管婴儿：无声的子宫炎症是否会影响胚胎着床或导致流产？

今天我们聊聊慢性子宫内膜炎，这是一种可能在子宫里悄悄存在的炎症，它也许会影响胚胎着床、导致流产，还会影响生育治疗的效果。

Today we talk about chronic endometritis, the possible silent inflammation in the uterus that may be affecting implantation, miscarriage, and fertility treatment.

我是医生。

I'm Doctor.

阿莫尔斯，这里是TacoBoutFertility星期二。

Amols and this is TacoBoutFertility Tuesday.

你的子宫里会不会藏着一种看不见的感染，让你迟迟怀不上孩子呢？

Could there be a silent infection in your uterus keeping you from getting pregnant?

听起来挺吓人的。

Well, sounds scary.

这听起来也像是那种网上能传得沸沸扬扬，让大家觉得'所有人都得马上做这个检查'的事儿。

It also sounds like the kind of thing that can lead the internet to turn it into a everyone needs this test immediately type of thing.

但咱们先别急着慌，咱们再多聊一聊这个话题。

But before we hit the panic button, let's talk about this a little bit more.

我们来聊聊什么是慢性子宫内膜炎，它可能怎么影响你的生育能力，什么时候去做检查比较有意义，还有为什么你听说的那些不同的检查，并不总是回答同一个问题。

Let's talk about what chronic endometritis is, how it might affect your fertility, when testing may make sense, and why the different tests you hear about do not always answer the same question.

首先，慢性子宫内膜炎不是子宫内膜异位症。

First off, chronic endometritis is not endometriosis.

子宫内膜异位症是指类似于子宫内膜的组织长在子宫外面。

Endometriosis is tissue similar to the uterine lining growing on outside the uterus.

而慢性子宫内膜炎是子宫内壁本身的炎症。

Chronic endometritis is inflammation inside the lining of the uterus itself.

而且它通常不是人们一听到“感染”这个词就想象的那种严重感染。

And it's not usually the severe infection most people picture when they hear the word infection.

我们通常说的不是高烧、剧烈盆腔疼痛，或者看起来明显病得很重的情况。

We're not typically talking about high fever, severe pelvic pain, or someone looking obviously sick.

慢性子宫内膜炎通常是一种低度炎症。

Chronic endometritis is usually a low grade inflammation.

很多人有这个问题，但完全没有症状。

Many people have it and have no symptoms at all.

这就是今天要讲的重点。

And this is the big idea for today.

慢性子宫内膜炎可能是真的。

Chronic endometritis may be real.

甚至可能很重要。

It may even matter.

甚至可能可以治疗。

It may even be treatable.

但检测结果阳性并不自动就是导致不孕、试管婴儿失败或流产的铁证。

But a positive test is not automatically the smoking gun for infertility, failed IVF, or miscarriages.

而这种区别很重要，因为生育药物已经有足够多的烧钱陷阱了。

And that distinction matters because fertility medication has enough expensive rabbit holes already.

我们不需要再添一个，除非真有问题存在。

We only need another one without actually asking is the rabbit really there.

那么，什么是慢性子宫内膜炎呢？

So what is chronic endometritis?

慢性子宫内膜炎的标志是子宫内膜间质中出现浆细胞，也就是在组织内部。

Well, the hallmark of chronic endometritis is the presence of plasma cells in the endometrial stroma, that means inside the tissue.

这个组织就是子宫内膜的支持组织。

And this tissue is the supporting tissue of the uterine lining.

浆细胞是免疫细胞。

Plasma cells are immune cells.

当有炎症或其他炎症反应发生时，它们就会出现。

They show up when there are inflammation and other inflammatory processes going on.

那么，这为什么会和生育有关呢？

Now, why would that matter for fertility?

其实，胚胎着床并不是像飞机降落在机场那样，胚胎直接落在子宫里就行了。

Well, implantation is not just an embryo landing in the uterus like a plane at an airport.

子宫内膜首先得准备好接受胚胎。

The uterine lining first must become receptive.

它必须对孕激素反应正常，并且免疫信号要达到适当的平衡。

It has to respond properly to progesterone and it has to have the right balance of immune signaling.

也就是说，它得允许胚胎着床，然后支持早期胎盘发育。

That means it has to allow the embryo to implant and then support early placental development.

但慢性炎症确实可能干扰其中一些过程。

Well, chronic inflammation can interfere with some of those processes.

比如，它可能会改变蜕膜化过程，也就是子宫内膜为了支持着床的胚胎而发生的那种转化。

For example, it may alter decidualization, which is a transformational lining to help support the implanted embryo.

它还可能影响免疫信号、局部血流量以及整个子宫环境。

It may affect immune signaling, local blood flow, and the overall uterine environment.

所以从生物学角度看，这是说得通的。

So the biology makes sense.

但是，这里有个很重要的转折：在移植失败或流产后发现炎症，并不能证明是炎症导致了不良结果。

But, and this is an important but, finding inflammation after a failed transfer or miscarriage does not prove that the inflammation caused a bad outcome.

一个人可能长了息肉、怀孕后残留组织、粘连、靠近宫腔的肌瘤，或者有其他生育方面或子宫方面的问题，这些问题既会引起炎症，也会影响生育能力。

A person may have a polyp, retained tissue after a pregnancy, adhesions, a fibroid near the cavity, or another fertility or another uterine issue that both causes inflammation and affects fertility.

有时候，炎症可能只是信号，而不是全部原因。

Sometimes the inflammation may be the signal and not the entire explanation.

这就是为什么我们不应该对每一个只有一两个浆细胞的患者说‘我们找到你不孕的原因了’，因为那并不是真的。

And that is why we should not tell every patient with one or two plasma cells, ah, we have solved your infertility, because that's not true.

当然，我们确实发现了一些重要的东西。

Sure, we have found something important.

也许我们找到了一个重要线索，但线索并不总是元凶。

And maybe we have found a major clue, but the clue is not always the culprit.

如果并不是所有人都应该做检查，那什么时候应该考虑慢性子宫内膜炎呢？

So if everyone shouldn't be evaluated, what should make us think about chronic endometritis?

我觉得当出现某种模式或者有其他理由让人怀疑的时候，检查就变得更合理了。

I think testing becomes more reasonable when there is a pattern or another reason to be suspicious.

比如反复流产，或者反复着床失败，特别是移植了优质胚胎或整倍体胚胎之后。

For example, recurrent pregnancy loss, or repeated implantation failure, particularly after transferring good quality or euploid embryos.

或者像持续不规则的出血、长时间排液、经间期出血，或者不寻常的分泌物。

Maybe things like persistent irregular bleeding, prolonged spawning, or bleeding between periods or an unusual discharge.

或者宫腔镜检查发现微小息肉、水肿、片状发红，或者内膜呈草莓样外观，基本上就是宫腔内任何异常，比如息肉、残留组织或粘连。

Maybe it's a hysteroscopy showing micropolyps, edema, patchy redness, or a strawberry appearance in the lining, basically any abnormality in the uterine cavity such as polyps, retained tissue, and adhesions.

这些情况会让你开始想，这内膜里可能还有更多问题。

These are the situations where you start to say, maybe there's more going on in this lining.

但这并不意味着每次试管婴儿周期前都必须常规检查慢性子宫内膜炎。

But this does not mean that chronic endometritis testing should be automatic before every IVF cycle.

那如果移植了一个正常的胚胎但失败了呢？

What about after one failed euploid embryo transfer?

一般情况下，不用。

Well, usually not.

移植失败一次？

One failed transfer?

对，确实让人沮丧。

Yeah, frustrating.

但这并不能证明子宫里藏着什么异常。

But it's not proof that there's something unusual hiding in the uterus.

即使是基因正常的胚胎，也不是百分之百能着床的。

Even a genetically normal embryo does not implant one hundred percent of the time.

我们的目标不是忽视慢性子宫内膜炎。

Now the goal is not to ignore chronic endometritis.

我们的目标是在检测有可能改变决策的情况下使用它。

The goal is to use testing where it has a reasonable chance of changing a decision.

这里就变得有点让人困惑了，因为人们听到子宫内膜检测、微生物组检测，甚至感染检测，会以为它们可以互相替代，但实际上并不是这样。

And this is where things get a bit confusing because people hear endometrial tests, microbiome tests, maybe infection tests, and they assume they are interchangeable, but they are not.

宫腔镜检查是看子宫腔内部。

A hysteroscopy looks inside the uterine cavity.

它可以发现息肉、粘连、残留组织，以及一些视觉上的变化，这些变化可能会让人怀疑有慢性子宫内膜炎。

It can identify things like polyps, adhesions, retained tissue, and visual changes that can raise suspicion of chronic endometritis.

但是仅凭宫腔镜检查并不能确诊。

But hysteroscopy alone does not prove it.

传统的子宫内膜活检是看组织本身。

A traditional endometrial biopsy looks at the tissue itself.

CD138染色是一种额外的病理染色，有助于识别浆细胞。

And a CD138 staining is an additional pathology stain that helps identify plasma cells.

这可能是目前诊断慢性子宫内膜炎最成熟的检测方法，因为它寻找的是该疾病的特征性炎症细胞。

That is probably the most established test for chronic endometritis because it looks for the inflammatory cells that defines the condition.

现在他们在培养细胞时，是试图让细菌生长起来。

Now when they culture the cells, they are attempting to grow bacteria.

如果能培养出有意义的细菌，那可能有助于指导抗生素治疗。

And if it grows something meaningful, it may help direct antibiotic treatment.

但培养法会漏掉那些在实验室里长得不好的细菌，而且容易受到污染的影响。

But culture misses bacteria that do not grow well in the lab, and they can be affected by contamination.

然后还有一些检测，比如ALICE和EMMA。

Then you have tests like ALICE and EMMA.

ALICE检测的是与慢性子宫内膜炎相关的特定细菌的DNA，而EMMA则分析目标细菌谱，并与该公司认为更健康的子宫内膜微生物模式进行比较，通常特别看重乳酸杆菌。

ALICE looks for DNA from selected bacteria that are associated with chronic endometritis, whereas EMMA looks at targeted bacterial profiles and compares it to what the company considers a more favorable endometrial microbial pattern, often with a lot of emphasis on lactobacillus.

另外还有阴道微生物组检测，是从阴道取样。

And then there are vaginal microbiome tests, which take a sample from the vagina.

这里简单总结一下。

So here is the simple version.

CD138检测看的是子宫内壁中是否存在炎症相关的浆细胞。

CD138 test says, are plasma cells which are inflammatory present in uterine lining.

ALICE测试问的是：是否存在某些特定细菌的DNA？

The ALICE test asks is DNA from certain bacteria present?

EMMA测试问的是：根据这个检测，细菌谱看起来是否有利？

The EMMA test asks does the bacterial profile look favorable according to this assay?

而阴道拭子则问：阴道里发生了什么？

And the vaginal swab says what's happening in the vagina?

这些问题可能相关，但它们不是同一个问题。

Now those questions may be related, but they are not the same question.

CD138可能是医生在评估慢性子宫内膜炎时最常想到的测试。

CD138 is probably the test most physicians think of when they're evaluating chronic endometritis.

它很有用，因为浆细胞在标准病理切片上可能很难识别，所以CD138让它们更容易看到。

And it's useful because plasma cells can be hard to identify on a standard pathology slide, so CD138 makes them easier to see.

但有一个问题。

But there is a problem.

对于什么是阳性，目前还没有公认的统一标准。

There is no universal agreed upon cutoff for what counts as positive.

一个浆细胞就够了吗？

Is one plasma cell enough?

两个呢？

Two?

五个呢？

Five?

十个呢？

10?

那每个显微镜视野下有一定数量才算呢？

What about a certain number per microscopic field?

还是整个样本中达到一定数量才算？

A certain number across the entire sample?

不同的研究用的定义不一样。

And different studies use different definitions.

不同的病理医生对临界病例的解读也可能不同。

Different pathologists may interpret borderline cases differently.

活检是从一个很大的器官上取非常小的一块组织。

A biopsy is a very small sample of a very large organ.

所以月经周期的时机、组织质量以及标本的处理方式都会影响结果。

So timing of the cycle, tissue quality, and how the specimen is processed can affect the answer.

一项系统性综述给了我们一个有用但并非最终定论的参考。

One systematic review gives us a useful but not final anchor.

如果以每10个高倍视野中至少5个浆细胞为标准，慢性子宫内膜炎与较高的流产率相关。

Using a threshold of at least five plasma cells across 10 high power fields, chronic endometritis was associated with a higher miscarriage rate.

但更低的水平，比如每10个视野中少于5个细胞，并不能可靠地预测不良的妊娠结局。

But lower level findings, fewer than five cells per 10 fields, did not reliably predict worse pregnancy outcomes.

但这并不意味着5个细胞就是普遍适用的神奇分界线。

Now that does not make the five cells the magical universal line.

这些研究之间差异较大，活产率的差异在统计上也不够明确。

Their studies were heterogeneous, and the live birth differences were not statistically clear.

但这确实支持了一个实际的观点。

But it does support a practical point.

少量散在的浆细胞可能和整个样本里明显的炎症不是一回事。

A few scattered plasma cells may not mean the same thing as substantial inflammation throughout the sample.

所以CD138在找浆细胞方面确实很厉害。

So CD138 is good at finding plasma cells.

更难的问题在于，它找到的那个数量是否足以解释生育问题，尤其是当结果处于临界状态的时候，这一点特别重要。

The harder question is whether the number it finds is enough to explain a fertility problem, and this is especially important when someone gets a borderline result.

极少量的浆细胞可能意义不大，不像更明显的炎症那样。所以我不会因为一个很轻微的发现，就让患者开始六个疗程的抗生素冒险。

A tiny number of plasma cells may not carry the same meaning as more substantial inflammation, and that's why I would be cautious about turning a very mild finding into a six month antibiotic adventure.

接下来讲到EMMA和ALICE，这两个测试非常有意思。

Now when comes to EMMA and ALICE, they're very interesting tests.

技术本身很厉害，但技术和临床价值的证据，这两者不一定是等同的。

The technology is very impressive, but technology and proof of clinical value are not automatically the same thing.

这些分子测试检测细菌的DNA，具体来说，它们寻找的是这些细菌所特有的某段DNA。

These molecular tests look for bacterial DNA, and to be specific, they look for a very specific portion of DNA that are found in these bacteria.

这就是它们能区分人体细胞和细菌细胞的原因。

This is how they're able to distinguish between human cells and bacterial cells.

这也让他们能够检测到可能无法在培养中生长的微生物，这可能是很有用的信息。

This also allows them to detect organisms that might not grow in a culture, and that can be useful information.

但是，发现细菌DNA不一定意味着存在活动性感染。

But finding bacterial DNA does not necessarily mean there is an active infection.

这甚至不意味着这些细菌是活的。

It doesn't even mean that the bacteria are alive.

也不一定意味着这些细菌导致了不孕。

It does not necessarily mean that those bacteria caused infertility.

而且绝对不自动意味着服用抗生素能提高活产的机会。

And it definitely does not automatically mean that taking antibiotics will improve the chances of a live birth.

另一个挑战是，子宫是一个低生物量环境。

Another challenge is that the uterus is a low biomass environment.

用通俗的话说，就是那里的细菌物质不像阴道、口腔或肠道那么多。

In plain English, that means there's not much bacterial material compared with places like the vagina, the mouth, or the gut.

当你要测量一个微弱的信号时，污染就显得更加重要了。

When you are trying to measure a tiny signal, contamination now matters more.

一点点来自阴道、宫颈、导管、采集装置，甚至实验室试剂或处理环境的DNA，都可能影响结果。

A little DNA from the vagina, cervix, the catheter, the collection device, maybe even lab reagents, or processing environment, can potentially influence the results.

这并不意味着这些检测毫无价值。

That does not mean the tests are worthless.

而是说我们必须诚实地看待它们目前能告诉我们什么，不能告诉我们什么。

It means we have to be honest about what they can and cannot tell us right now.

分子检测在检测细菌DNA方面可能非常出色，但仍然无法告诉我们治疗这些DNA是否真的能帮助某人带宝宝回家。

A molecular test can be incredibly good at detecting bacterial DNA, and still not tell us whether treating the DNA helps someone take home a baby.

这就是差距所在。

That is the gap.

现在我们来谈谈很多患者在移植说明中会看到的内容——胚胎移植前使用抗生素。

Now let's talk about something many patients see in transfer instructions, antibiotics before embryo transfer.

诊所为什么这么做？

Why do clinics do that?

通常，他们的考量不外乎以下三种之一。

Usually the thought process is one of three things.

首先，可能有一种低水平的宫颈或子宫感染是我们没发现的。

First, maybe there is a low level cervical uterine infection that we are not detecting.

其次，可能是在移植过程中，细菌通过导管被带了上去。

Second, maybe bacteria could be carried upward during the transfer process on the catheter.

或者第三，可能抗生素是一种低风险的方法，在把宝贵的胚胎放进子宫之前，先覆盖可能存在的问题。

Or third, maybe antibiotics are a low risk way to cover a possible problem before putting a very valuable embryo inside the uterus.

这个逻辑是可以理解的。

That logic is understandable.

并不是荒谬的。

It's not absurd.

而且研究表明，抗生素可以减少从胚胎移植导管培养出的细菌。

And studies have shown that antibiotics can reduce bacteria cultured from embryo transfer catheters.

所以，在移植时，可能检测到的细菌污染会更少。

So there may be less detectable bacterial contamination at the time of the transfer.

但关键问题不是，我们能不能减少导管上的细菌？

But the key question is not, can we reduce bacteria on the catheter?

关键问题是，这能带来更多健康的宝宝吗？

The key question is does it lead to more healthy babies?

这不仅仅是我个人的理解。

And this is not just my interpretation.

ASRM的胚胎移植指南认为，现有的随机试验有充分证据表明，在胚胎移植周期使用莫西沙星，并不能提高怀孕率。

ASRM's embryo transfer guidelines concluded that there is fair evidence from the available randomized trial that moxicillin hominate, given the round embryo transfer, does not improve pregnancy rates.

因为没有更多证据显示有益处，ASRM不建议常规使用预防性抗生素进行胚胎移植来改善结果。

Because there is not additional evidence showing a benefit, ASRM does not recommend routine prophylactic antibiotics and embryo transfers to improve outcomes.

对于已知感染、疑似严重慢性子宫内膜炎或有其他特定指征的患者，使用抗生素可能完全合适。

Now, for a patient with a known infection, suspected significant chronic endometritis, or another specific indication, antibiotics may be entirely appropriate.

但常规为每次移植使用抗生素并未被证明能提高试管婴儿成功率。

But routine coverage for every transfer has not been shown to improve IVF success.

而且确实是这样。

And it's true.

抗生素也不是完全无害的。

Antibiotics are not completely harmless.

它们确实会引起肠胃不适、酵母菌感染，以及破坏阴道或肠道里的正常菌群。

They do cause things like GI symptoms, yeast infections, and disruption of normal bacteria such as in the vagina or in the bowels.

话虽如此，我们还是会在移植时使用抗生素吗？

Now that being said, do we still do it?

当然会用。

Of course, we do.

因为就像你一样，我们也想尽一切可能来提高你的成功率，而且相对于因为轻度子宫内膜炎而导致不怀孕的担忧，产生症状甚至细菌耐药的风险相对较低。

Because just like you, we wanna do everything possible to help improve your chances, and the small risk of creating symptoms or even bacteria resistance is low compared to the thought that you won't get pregnant due to a mild case of endometritis.

这样做未必是对的，但这就是科学和医学之间的差别。

It doesn't make it right, but it's just the difference between science and medicine.

如果你最近有留意，会发现有很多关于阴道菌群的新检测方法。

Now if you noticed recently, there are a lot of tests coming out looking at the vaginal biome.

但阴道离子宫那么远，真的重要吗？

But the vagina is so far away from the uterus, does it really matter?

简单的答案是正确的，因为它们是相连的。

Well, the simple answer is yes, because they're connected.

阴道微生物组对阴道健康绝对有影响。

And the vaginal microbiome can absolutely matter for vaginal health.

细菌性阴道病、性传播感染、宫颈炎和反复出现的阴道症状都需要适当的评估和治疗。

Bacterial vaginosis, sexually transmitted infection, cervicitis, and recurrent vaginal symptoms deserve appropriate evaluation and treatment.

而且有些研究表明，阴道的细菌模式与试管婴儿的结果和早期妊娠的结果有关。

And some studies show that vaginal bacterial patterns are associated with IVF outcomes and early pregnancy outcomes.

但是，阴道拭子采样并不等同于对子宫内膜的采样。

But the vaginal swab is not the same as sampling the uterine lining.

虽然阴道环境和子宫内膜环境有重叠，但它们并不完全相同。

Although the vaginal and endometrial environments overlap, they are not identical.

阴道检测可能会给我们提供一些有用的线索。

A vaginal test may give us useful clues.

它可能帮助我们诊断细菌性阴道病或其他真正的临床问题。

It may help us diagnose bacterial vaginosis or another real clinical issue.

但是，目前它还不能作为一个经过验证的捷径，来判断你的子宫内膜是否有慢性子宫内膜炎，或者移植前是否需要使用抗生素。

But it is not yet a validated shortcut for saying your uterine lining has chronic endometritis or you need antibiotics before transfer.

对患者最好解释的方式是这样的。

The best patient friendly explanation is this.

阴道微生物组可能会给我们一些关于生殖道的线索，但它还不能可靠地反映子宫内膜是否有炎症。

The vaginal microbiome may give us clues about the reproductive tract, but there's not yet a reliable window into whether the uterine lining is inflamed.

现在，当慢性子宫内膜炎按常规诊断时，治疗通常包括抗生素，常见的是多西环素，以及其他各种方案。

Now, when chronic endometritis is conventionally diagnosed, treatment often includes antibiotics, commonly doxycycline, and other various regimens.

如果有息肉、残留组织、粘连或其他结构问题，这些也需要处理。

If there is a polyp, retained tissue, adhesions, or another structural issue, that needs attention too.

有时候最好的治疗不只是抗生素。

Sometimes the best treatment is not simply antibiotics.

可能是要去除那个持续刺激内膜的东西。

It might be removing the thing that is continuing to irritate the lining.

最有趣的数据往往来自那些研究表明，慢性子宫内膜炎得到治愈的患者比炎症持续存在的患者预后更好。

The most interesting data are often from studies showing that patients whose chronic endometritis resolves do better than patients whose inflammation persist.

但我们要小心解读这一点。

But be careful how we interpret that.

那可能说明治疗起作用了。

It may mean treatment worked.

也可能意味着那些炎症持续存在的人，原本就有更复杂或更棘手的基础问题。

It also may mean the people who persistently had inflammation had a different or more difficult underlying problem.

但这并不能证明，所有边缘性结果都需要抗生素、重复抗生素、益生菌，或者再做一次活检，然后再加一个分子检测才放心。对于确实有慢性子宫内膜炎、又准备做胚胎移植的患者，治疗后复查一次活检可能是合理的，特别是当初发现问题比较严重，而是否移植又取决于炎症有没有消退。

What it does not prove is that every borderline result needs an antibiotic, or repeat antibiotics, or probiotics, or another biopsy, or then a second molecular test for good measure, For someone with clear chronic endometritis and an upcoming embryo transfer, repeating a biopsy after treatment may be reasonable, especially when the original finding was significant and the transfer decision depends on whether inflammation has resolved.

但如果是那种只发现一个罕见浆细胞，又没有其他警示信号的患者，追查这个结果的意义就小得多了。

Whereas the patient with one rare plasma cell and no other warning signs, the value of chasing the result is much less clear.

顺便说一下，这方面目前有很多研究正在进行中。

Just so you know, there is a lot of research ongoing in this area.

研究人员正在研究正常的子宫内膜菌群，以及如何在没有污染的情况下取样，阴道和子宫的细菌情况是否真的有相关性，还有抗生素、益生菌或其他治疗手段，是否真的能改善特定患者的预后。

Researchers are studying the normal endometrial microbiome and how to collect samples without contamination, whether vaginal and uterine bacterial profiles meaningfully correlate and whether antibiotics, probiotics, or other treatments can even improve the outcomes in selected patients.

但我们真正需要的研究其实很简单。

But the studies we really need are pretty straightforward.

我们需要的，是慢性子宫内膜炎一个标准化的定义。

We need a standardized definition of chronic endometritis.

到底多少个浆细胞才是真的预示预后不好呢？

What number of plasma cells actually predict worse outcome?

我们需要在明确分组的人群中做随机对照试验，比如反复胚胎移植失败但用的是整倍体胚胎的患者。

We need randomized trials in clearly defined groups, such as patients with recurrent embryo transfer failures with eupoid embryos.

我们需要对比查和不查的差异。

We need to compare testing versus no testing.

我们需要对比针对性治疗和安慰剂或常规治疗的效果。

We need to compare targeted treatment versus placebo or usual care.

而且最重要的是，最终要看活产率。

And most importantly, we need live birth as the endpoint.

不是只看细菌谱有没有改善。

Not just did the bacterial pattern improve?

不是只看复查结果是不是转阴了。

Not just did the repeat test turn negative?

也不是只看这次验孕是不是阳性。

And not just did we get a positive pregnancy test this time?

这些事情可能有意思。

Those things may be interesting.

但患者真正关心的是能不能生个健康的宝宝。

But the outcomes patients care about is the healthy baby.

那我们怎么总结呢？

So where do we land?

慢性子宫内膜炎不是假的。

Chronic endometritis is not fake.

它确实存在，而且可能是一种可以治疗的问题，尤其是在合适的临床情况下，比如反复种植失败、反复流产、可疑出血、宫腔镜检查异常，或者子宫结构异常。

It can be a real and potential treatable issue, particularly in the right clinical situation, such as recurrent implantation failure, recurrent loss, suspicious bleeding, abnormal hysteroscopy, or a structural uterine finding.

但这不是解释所有胚胎移植失败、流产或者不明原因不孕的万能答案。

But it's not a universal explanation for every cell transfer, every miscarriage, or every unexplained infertility diagnosis.

CD138是一种炎症检测。

CD138 is an inflammation test.

ALICE是一种细菌DNA检测。

ALICE is a bacterial DNA test.

EMMA是微生物组图谱检测。

EMMA is a microbiome profile test.

阴道拭子在合适的场景下有用，但它不等同于子宫诊断。

A vaginal swab is useful in the right setting, but it's not the same as a uterine diagnosis.

每次胚胎移植前常规使用抗生素，理论上听起来有道理，感觉也不错，但我们还是没有看到确凿的证据表明它能改善最关键的结局。

And routine antibiotics before every embryo transfer may make theoretical sense and feel good, but we still have not seen convinced proof that it improved the outcome that matters most.

负责任的中间路线是：在合适的患者中筛查慢性子宫内膜炎。

The responsible middle ground is to look for chronic endometritis in the right patient.

要弄清每项检测实际测的是什么，合理治疗明确的疾病，同时抵制把每个细微的化验结果都变成生育诊断的冲动。

Understand what each test actually measures, treat clear disease thoughtfully, and resist the urge to turn every subtle lab finding into a fertility diagnosis.

如果你经历过反复流产、反复移植失败，或异常出血，或者被告知CD138、EMMA或ALICE检测阳性，不妨问医生一个简单的问题。

If you've had repeated losses, repeated cell transfers, or unusual bleeding, or you've been told you have a positive CD138, EMMA, or ALICE test, ask your physician a simple question.

这项检测到底发现了什么？你有多大把握它对我是有影响的？

What exactly did the test find and how confident are you that it matters for me?

治疗又会如何改变我活产的机会？

And how would treatment change my chances of a live birth?

这样的对话比单纯问要不要吃抗生素要好得多。

That conversation is much better than simply asking, should I take antibiotics?

在未来的节目中，我非常想和这些测试的公司坐下来聊聊，让你能深入了解他们的测试，希望到时候能有更多的研究帮我们指导该怎么处理这些信息。

In a future episode, I really like to sit down with the company that makes these tests so you can have a deep understanding of their test, and hopefully at that future time, we'll have more research studies helping guide us on what to do with that information.

如果这期节目帮你理解了这些被推荐的测试，或者你想到某个正在做不孕治疗的人，就把这期节目转发给他们吧。

And if this episode helped you understand the tests you have been offered, or maybe think of someone who's in infertility treatment right now, send this to them.

如果你还没订阅并且喜欢这个播客，请在你常用的平台上给我们五星好评，并且告诉你的朋友们。

And if you haven't already and you like this podcast, give us a five star review on your favorite medium and tell your friends about us.

和往常一样，非常感谢大家的收听，期待下周的TacoBout Fertility周二再聊。

As always, I greatly appreciate everyone listening to this and I look forward to talking to again next week on TacoBout Fertility Tuesday.