多囊卵巢综合征患者达英-35治疗后不同间隔启动促排卵的妊娠结局

Pregnancy outcomes of ovarian stimulation in PCOS patients with different intervals after Diane 35 treatment

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)高雄激素血症不孕患者应用达英-35(炔雌醇醋酸环丙孕酮)降低雄激素后,不同间隔启动HMG促排卵对妊娠结局以及子宫内膜血管体积百分比的影响。方法33名高雄激素PCOS不孕患者,在给予达英-35治疗至血睾酮正常后,启动HMG促排卵。根据促排卵前停用达英-35的时间不同分为短间隔组和长间隔组。统计组间HCG日子宫内膜厚度、妊娠率等差异。再选择实验组5名高雄激素PCOS患者,停用达英-35月经来潮第3天开始应用人工周期诱导胚胎种植窗子宫内膜;对照组为5名因男性不孕就诊,月经周期正常的女性患者,尿LH峰值后7～9d取子宫内膜。病理证实为分泌中期子宫内膜后,CD34免疫组织化学染色内膜组织,计数血管内皮细胞体积百分比。结果入选病例的一般情况、HCG日内膜厚度等组间差异无统计学意义。短间隔组(20.83%)的临床妊娠率较长间隔组(54.2%)显著降低(P<0.05)。达英-35后月经来潮当月胚胎种植窗的子宫内膜血管内皮细胞体积百分比中位数(4.82%)较对照组(6.35%)显著降低(P<0.05)。结论PCOS不孕患者停用达英-35后月经来潮当月启动促排卵的临床妊娠率较停用至少一个月经周期的患者显著降低。达英-35治疗后月经来潮当月的胚胎种植窗子宫内膜血管较正常月经周期患者明显稀疏。

Objective To compare ultrasound data on endometrial endothelial cell volume fraction and pregnancy outcomes in different intervals between Diane 35 treatment and HMG administration. Methods Thirty three infertile patients with PCOS were enrolled in this study. They were all pre - treated with Diane35 due to hyperandro- genism, and once the total testosterone level dropped to normal, HMG stimulation was randomly started in short or long intervals. General data, ultrasound data and pregnancy outcomes were compared. Five PCOS patient＇s endometrial samples at implantation window were collected in the first HRT cycle after Diane cessation. Five mid - secretory endometrial samples were collected as controls from infertile women because of male factors. The volume fraction of endometrial endothelial cell was counted with CD34 immunohistochemical staining. Results No difference was found in general status, endometrial thickness on HCG day and number of 〉 15mm follicles between the two groups. The pregnancy rate of long interval group was higher than short interval group （54.2% vs. 20. 83%, P〈 0.05）. the median volume fraction of endothelial cell in Diane pretreated group was less than the control group （4. 82% vs. 6.35%, P〈0.05）. Conclusions Short free interval after Diane 35 leads lower pregnancy rate compared with long interval. In addition, the volume fraction of endometrial endothelial cell decreased significantly in the first cycle after Diane35 withdrawing.