三维能量多普勒超声监测子宫内膜容受性在促排卵治疗中的应用

Application of three-dimensional ultrasonographic measurement for assessment of endometrial receptivity in ovulation induction therapy

目的探讨三维能量多普勒超声监测子宫内膜容受性在促排卵治疗中的临床意义。方法选取不孕患者70例88个周期,采取4种不同促排卵方案:枸橼酸氯米芬促排卵(CC组)、CC+注射用尿促性腺激素促排卵(CC+HMG组)、HMG促排卵(HMG组)、来曲唑促排卵(LE组);依据是否确诊临床妊娠将研究对象分为妊娠组和未妊娠组,随访妊娠结局。分析各促排卵方案组间的妊娠情况、子宫内膜血流情况及妊娠组非妊娠组间的子宫内膜血流情况。结果(1)HMG、CC+HMG组妊娠率较CC组高(均P<0.05),其他各组间比较均无统计学意义(均P>0.05);(2)HMG组子宫内膜容积(VOL)高于CC组、LE组(均P<0.01);LE、HMG、CC+HMG组的血管指数(VI)均高于CC组(均P<0.05);各组间血流指数(FI)比较无统计学差异(均P>0.05);(3)妊娠组VOL、VI、FI均明显高于未妊娠组,差异均有统计学意义(均P<0.05或0.01)。结论(1)针对不同患者需选择不同的促排卵方案,相较于CC方案,使用LE、HMG促排卵可以使子宫内膜血流灌注丰富。(2)三维能量多普勒超声在评估子宫内膜容受性方面有重大意义,应继续进行三维能量多普勒超声参数在不孕临床诊治意义的研究。

Objective To investigate the application of three-dimensional(3-D)ultrasonographic measurement for assessment of endometrial receptivity in ovulation induction therapy.Methods Seventy infertility patients with 88 cycles were recruited in the study.Patients were divided into 4 groups according the methods applied for stimulating ovulation:Clomifene Citrate group(CC group),human menopausal gonadotropin group(HMG group),CC+HMG group and letrozole group(LE group).The parameters of endometrial receptivity were measured by 3-D ultrasonography,and the relationship between endometrial receptivity and pregnancy outcomes was analyzed in all groups.Results Compared to CC group,the pregnancy rate in HMG,CC+HMC group were significantly increased(all P<0.05),there was no significant difference among the other groups(P>0.05).Compared to the CC,LE groups,the VOL was higher in HMG groups(all P<0.01).The VI of LE,HMG,CC+HMG groups were higher than that of CC group(all P<0.05).There was no significant difference in FI among the groups.The VOL,VI and FI in the pregnant group were significantly higher than those in non-pregnant group,and the P<0.05 or 0.01.Conclusion HMG,LE may make the endometrial receptivity better in ovulation induction,which may improve the embryo implantation rate.