控制性超排卵周期的子宫内膜容受性研究

The effects of controlled ovarian hyperstimulation on endometrial receptivity

目的 研究控制性超排卵 (COH)对子宫内膜容受性的影响。方法 扫描电镜观察COH后子宫内膜胞饮突的变化和免疫组化法检测整合素 β3、TGFβ1的表达 ;以正常月经周期分泌中期子宫内膜作对照。 结果 COH周期 ,完全发展的胞饮突出现在月经周期的第 18～ 19d ,较正常周期提前 1～ 2d出现和消失 ;整合素 β3、TGFβ1在正常月经周期第 2 1～ 2 3d的子宫内膜腔上皮和腺上皮细胞的细胞质高表达 ,而COH周期在第 18～ 2 0d高表达。COH周期和正常周期 ,整合素 β3和TGFβ1在子宫内膜上皮细胞的高表达与完全发展胞饮突的出现在时期上存在着一致性。结论 COH可能通过改变子宫内膜与着床密切相关的粘附分子、细胞因子和超微结构的时序性表达来影响子宫内膜的容受性 ,使子宫内膜着床窗的开放与胚泡的发育不同步 ,这可能是影响IVF妊娠率的重要原因。

Objective To investigate the effects of controlled ovarian hyperstimulation on endometrial receptivity.Methods The possible relationship between pinopodes,integrinβ3 and TGFβ1 in endometrial during IVF donor oocyte cycles was analyzed.Endometrial biopsies were examined by scanning electron microscopy for the detection of pinopodes,by immunohistochemistry for the expression of integrinβ3 and TGFβ1.Take endometrium in mid secretion stage in normal menstrual cycles as control.Results Pinopode formation was observed 1~2 days earlier in COH cycles than in the natural menstrual cycles.The positive integrin β3 and TGFβ1 immunostaining in the apical part of the luminal and glandular epithelium was highest when fully developed pinopodes were present in day 18~19 of COH cycles;while in day 21~23,integrinβ3 and TGFβ1 less intense immunoreactivity concomitant with the disappearance of the pinopodes.In contrast,in day 21~23 of the natural menstrual cycles,intense ingetrinβ3 and TGFβ1 immunostaining of endometrial epithelium cell was concomitant with developed pinopodes.Intense apical integrinβ3 and TGFβ1 immunoreactivity in endometrial epithelial cells coincides with the presence of pinopodes.Conclusion COH may affect endometrial receptivity through transforming implantation related adherins,cytokines and suprastructure,leading to embryo endometrial asynchrony.This may be an important factor in influencing pregnancy rate in in vitro fertilization.