控制性超促排卵对黄体期子宫内膜胶原纤维表达的影响

Effects of Controlled Ovarian Hyperstimulation on Collagen Fibril Expression in Endometrium at Luteal Phase

目的:探讨IVF-ET妇女控制性超促排卵(COH)时着床窗期子宫内膜胶原纤维(collagen fibril,CF)对子宫内膜容受性(ER)的影响。方法:共对25个刺激周期(SC)和20个自然周期(NC)妇女分别在取卵后或排卵后的第7±1日行外周血雌、孕激素水平检测和子宫内膜活检术,常规HE染色确定组织学分期,采用透射电子显微镜观察CF增生情况和改良Masson染色进行CF定量分析。结果:SC组外周血雌、孕激素水平均显著高于NC组(P<0.05)。SC组分泌期较NC组提前1～2 d,内膜腺体扩张和间质水肿明显。SC组分泌早、中和晚期内膜间质中的CF较NC组显著升高(P<0.01,P<0.05和P<0.05),且SC组分泌早期SC明显高于分泌中期(P<0.05)。结论:COH过程中过高的雌、孕激素水平可使子宫内膜分泌期提前并刺激内膜CF的过度增生,这可能是导致COH周期ER下降和着床失败的原因。

Objective： To analyze the effects of controlled ovarian hyperstimulation（COH） on the endometrial expression of collagen fibril（CF） during the peri-implantation period in patients undergoing IVF,and its relation to endometrial receptivity（ER）.Methods： Peripheral blood and endometrial biopsies were obtained from infertile women on day 7 ± 1 after oocytes retrieval or ovulation in 25 stimulated cycles（SC） and 20 natural cycles（NC）,respectively.Serum levels of E2 and progesterone were measured with chemiluminescence analysis.All endometrial samples were stained with HE for histological dating.CF was assayed by transmission electron microscope and quantified by modified Masson staining.Results： Serum levels of both E2 and progesterone were significantly higher in the peripheral blood in SC than in NC（P0.05）.The development of endometrium in SC was advanced 1-2 d,and had more significant gland expansion and edema in stroma than that in NC.The expression of CF in the stroma at early,mid and late secretory phase was increased significantly in SC than in NC（P0.01,P0.05 and P0.05）.Furthermore,expression levels of CF in the SC group dropped significantly between the early and mid secretory phase（P0.05）,but not in the NC group.Conclusion： High E2 and progesterone secreted by COH may advance the development of sectory phase and overstimulate expression of CF,this may be one of the causes of defective ER and implantation failure in some IVF patients.