超声监测子宫内膜预测排卵障碍妇女促排卵疗效

Sonographic Mornitoring of Endometrium to Predict the Efficacy of Ovulation Induction Therapy in Anovulatory Women

目的：评估阴道超声监测排卵前子宫内膜厚度及回声类型，对排卵障碍妇女促排卵疗效的预测价值。方法：研究对象为６８例排卵障碍妇女。３９例采用促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）＋人绝经期促性腺激素（ＨＭＧ）超短方案，２９例采用常规ＨＭＧ方案作促排卵治疗。阴道超声监测卵泡发育及注射人绒毛膜促性腺激素（ＨＣＧ）日子宫内膜厚度和回声类型。注射ＨＣＧ后每例均行宫腔内人工授精（ＩＵＩ）。以妊娠情况评定促排卵疗效。结果：完成促排卵治疗共５６例，其中ＧｎＲＨ－ａ超短方案组３１例，常规ＨＭＧ组２５例，子宫内膜厚≤１０ｍｍ者分别为２例和４例，均未妊娠；≥１５ｍｍ者分别为５例和２例，持续妊娠率均为０；１１．０～１４．９ｍｍ者分别为２４例和１９例，持续妊娠率分别为４１．７％和３６．８％。子宫内膜回声呈三线型者各有２１例和１７例，持续妊娠率分别为４７．６％和３５．３％；同质型者各有１０例和８例，持续妊娠率分别为０和１２．５％。结论：排卵障碍妇女促排卵治疗时，注射ＨＣＧ日阴道超声检测子宫内膜的厚度及回声类型，可以成功地预测ＩＵＩ的妊娠率，当子宫内膜厚≤１０ｍｍ或≥１５ｍｍ或为同质型回声时，预示妊娠率低下。

Objective:To judge the value of predicting the effects of ovulation induction therapy on anovulatory women by transvaginal sonography to measure periovulatory endometrial thickness and echo pattern.Methods:Sixty eight anovulatory women were included in the study.Ovulation was induced in 39 patients with ultrashort protocol of GnRH a+HMG and in 29 patients with HMG alone.With transvaginal sonography the follicular development and endometrial thickness and echo pattern were mornitored on the day of HCG injection.The effect of treatment was evaluated by pregnant rate.Results:Fifty six infertile women completed the ovulation induction cycles.Thirty one patients were stimulated with ultra short GnRH a+HMG regimen and twenty five with conventional HMG regimen.On the day of HCG administration,the cases with endometrial thickness ≤10 mm were two and four in two regimen respectively.None of them was pregnant.The cases with endometrial thickness ≥15 mm were five and two respectively.None of them was successful in ongoing pregnancy.The cases with endometrial thickness between 11.0 mm and 14.9 mm were twenty four and nineteen respectively.The ongoing pregnancy rates(PRs) were 41.7% and 36.8% respectively.The ongoing PRs were significantly higher in those endometrium with trilaminar patterns than in those homogeneous patterns (47.6% and 35.3% versus 0 and 12.5%, P <0.05).Conclusion:Induction therapy for anovulatory women in ovulation measuring endometrial thickness and echo patterns by transvaginal sonography on the day of HCG administration is successful in prediction of pregnant possibility.Endometrial thickness ≤10 mm or ≥15 mm or homogeneous pattern predicts a lower PRs.