促排卵治疗后子宫内膜厚度及妊娠率的临床分析

Clinical analysis of the endometrial thickness and pregnancy rate after ovarian stimulation treatment

目的 探讨不同促排卵治疗后子宫内膜厚度及妊娠率。方法 采用宫颈粘液评分(CMS)、放射免疫法测定雌激素(E2)水平,阴道超声观察用克罗米芬(CC)、CC/戊酸雌二醇(CC/E)、CC联合绝经期促性腺激素(CC/HMG)及促性腺激素激动剂联合HMG(GnRH-a/HMG)促排卵方案治疗后的卵泡成熟情况,并测量注射HCG日的子宫内膜厚度,分析不同促排卵方案子宫内膜的厚度及其受孕率。结果 子宫内膜厚度≥7 mm者,周期妊娠率为17.1％,明显高于子宫内膜<7 mm者(3.45％)(P<0.05);应用CC、CC/E促排卵方案注射HCG日子宫内膜厚度≥7 mm的比率明显小于CC/HMG及GnRH—a/HMG方案;CC及CC/E促排卵方案注射HCG日,子宫内膜厚度差异无显著性(P>0.05);GnRH—a/HMG方案LH值小于CC、CC/E及C/HMG方案,而E2值明显大于CC及CC/E方案,小于CC/HMG方案,CC及CC/E的E2水平差异无显著性(P>0.05)。结论 CC对子宫内膜的周期性增殖具有不良影响。而GnRH—a及HMG的使用则可提高子宫内膜的厚度,增加受孕能力。

Objective To study the relationships between the thickness of endometrium and pregnancy rate after different stimulation protocols.Methods The sera estradiol were measured by RIA and cervical mucus score (CMS) . The endometrial thickness was examined by transvaginal ultrasonography on the day of human chorionic gonadotropin (HCG) injection after clomi-phen citrate (CC) alone, CC and estradiol (E2), CC and human menopausal gonadotropin (HMG), gonadotropin - releasing hormone agonist ( GnRH - a ) and HMG regimens . Results The pregnancy rate was 17.1% when endometrial thickness was ≥ 7 mm, and 3.45% when the thickness was < 7 mm. The endometrial thickness on the day of HCG administration in CC alone, CC/E2 regimens were less than that in CC/HMG and GnRH-a/HMG regimens. There was no difference between the endometrial thickness in CC and CC/E2 regimens. The sera LH on the day of HCG administration in GnRH-a/HMG regimens was less than that in CC, CC/E2 and CC/HMG regimens; the sera eastradiol in GnRH-a/HMG was more than that in CC and CC/E2, but less than that in CC/HMG regimens. There was no difference between the sera estradiol in CC and CC/E2 regimen. Conclusions There is an adverse effect of CC on the endometrial proliferation, while GnRH-a and HMG could thicken the endometrium and improve the pregnancy rate.