Impact of Luteinized Unruptured Follicles on Endometrial Receptivity

This study examined the impact of luteinized unruptured follicle （LUF） on endometrial receptivity. The menstrual cycle of 17 LUF patients （LUF group） and 13 ovulatory women （control group） was monitored by measuring LH level in urine and by ultrasonic examination. An endometrial biopsy at the sixth to tenth day after LH surge was taken in all the patients. The expressions of endometrial ER, PR and integrin ανβ3 were immunohistochemically determined. At the same time, the serum levels of E2 and P were detected by chemiluminescence. The results exhibited that （1） The mean serum P level in LUF group （7.32±2.56 ng/mL） was significantly lower than that in control group （11.17±3.17 ng/mL） （P0.01）. But there was no significant difference in the mean serum E2 levels between LUF group （179.35±81.60 pg/mL） and the control group （198.58±75.23 pg/mL） （P0.05）; （2） The mean expression intensities of ER, PR in endometrium of LUF group （183.86±2.43, 167.94±3.04） were significantly higher than those in control group （109.35±6.31, 105.98±4.07） （P0.01）; （3） The mean expression intensities of integrin ανβ3 in endomtrium of LUF patients （114.90±11.38） were significantly lower than those in control group （191.34±1.82） （P0.01）; （4） The change profile of integrin ανβ3 expression in the endometrium of LUF patients was in positive relation with serum P level （r=0.77, P0.01）, but bore no significant relationship with serum E2 level （r=0.01, P0.05）. It was concluded that the depression of serum P levels in LUF patients was closely related to the failure of the down-regulation of ER and PR, and the low expressions of integrin ανβ3 also suggested that the delayed implantation and the impaired endometrial receptivity had impact on embryonic implantation.

Value of Intrauterine Autologous Platelet-Rich Plasma Therapy on Endometrial Receptivity:A Literature Review

Endometrial receptivity is an important factor that influences embryo implantation.Thus,it is important to identify an applicable approach to improve endometrial receptivity in women undergoing assisted reproductive technology.Recently,growing evidence has indicated that intrauterine platelet-rich plasma(PRP)infusion is an effective method to obtain a satisfactory reproductive outcome by increasing endometrial thickness and improving endometrial receptivity.Therefore,the present review aims to outline the possible mechanisms of PRP on endometrial receptivity and summarize the present literature on the effects of PRP therapy in improving endometrial receptivity.

Network pharmacology-based prediction and verification of the mechanism for Bushen Chengyun granule on low endometrial receptivity

Objective:Bushen Chengyun granule(BCG)is an empirical treatment for female infertility(FI)caused by low endometrial receptivity(LER)involving a poorly understood mechanism.In this study,network pharmacology was used to explore the potential therapeutic mechanism of BCG on FI caused by LER.Methods:The corresponding herb targets were obtained by conducting a search in the Traditional Chinese Medicine Systems Pharmacology Database and PubMed-reported literature.Disease targets were obtained from the following databases:Comparative Toxicogenomics Database,Human Phenotype Ontology,and Therapeutic Target Database.Treatments for LER using BCG have used target matching(BCG e LER target).Then,the predicted targets were uploaded to the Search Tool for the Retrieval of Interacting Genes/Proteins database for gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses.Furthermore,triptorelin acetate for injection t menotrophin t chorionic gonadotropin for injection were used to establish a mouse model of blastocyst implantation disorder and to evaluate the in vivo effect of BCG on blastocyst implantation.Results:Overall,156 bioactive chemical components and 1092 targets of BCG were identified.The results indicated that 482 biological processes(FDR<0.01)and 15 pathways(FDR<0.01)related to BCG participated in the complex treatment effects and were associated with the endocrine system,inflammatory responses,metabolism,apoptosis,ovulatory performance,and angiogenesis.Moreover,16 hub nodes of BCG including estrogen receptor(ESR1),estrogen receptor beta(ESR2),progesterone receptor,et al,were recognized as potential treatment targets and might help clarify the underlying therapeutic mechanisms of BCG for female infertility.BCG significantly increased the protein expressions of estrogen receptors and progesterone receptors.Conclusions:These findings reveal the potential therapeutic mechanism of BCG for female infertility involves low endometrial receptivity,which should be evaluated further.

EFFECT OF MIFEPRISTONE (RU486)ON MARKERS OF ENDOMETRIAL RECEPTIVITY

Objective To study the effect of single and low dose of RU486 on endometrial receptivity of healthy women. Methods A total of 5 healthy women were followed for one control and one treatment cycle. In the treatment cycle, a dose of 10 mg RU486 was administered on day luteinizing hormone (LH)-2. In both the control and treatment cycle, an endometrial biopsy was obtained on LH+7. These biopsies were assessed by immunohistochemical analysis to find the difference in expression of integrins and progesterone receptor (PR) between the control and treatment cycle. Results The treatment with RU486 increased the expression of α 1 and α 4 subunits of integrin in glandular epithelial cells, but did not influence β 3 subunit. Moreover, the normal down regulation of PR in epitherial cell nuclei was inhibited by 10 mg RU486. Conclusion Single dose of 10 mg RU486 impairs the establishment of endometrial receptivity on time.

Study of Endometrial Receptivity during Implantation in Implantation Dysfunction Mouse

Objective To establish the mice model of implantation dysfunction and to study the endometrial receptivity during implantation in implantation dysfunction mouse. Methods Sexually mature female virgin, Kunming mice were randomly assigned to the control group and the model group postcoitally. The model mice at 9 ： 00 AM on d 4 of pregnancy（d 4） were injected subcutaneously with mifepristone. All animals were sacrificed at 9 ：00 PM on d 4 and their uterine horns were examined for the presence of implanted embryos. Histopathology of uterine endometrium was observed by light-microscope. The endometrial expressions of estrogen receptor （ER） and progesterone receptor （PR） assessed by immunnohistochemical SP method. The endometrial expressions of ER mRNA and PR mRNA were assessed by semi-quantitative reverse transcriptase polymerase chain reaction （RT-PCR）. Results Compared with control group, implantation rates and average embryo num- ber significently decreased in model group, the development of endometrium was inhibited. In model group, absorbency and area rate of ER and PR in the gland and stroma were lower than those in control group （P〈0.05）. Expressions of ER mRNA and PR mRNA in model uterus were significantly lower than those in the control. Conclusion The endometrial receptivity and implantation decreased in mifepristoneinduced implantation dysfunction mouse.

A meta-analysis on the improvement of endometrial receptivity of PCOS by Bushen recipe combined with Clomiphene

Objective: To systematically evaluate the efficacy and safety of Bushen Recipe combined with clomiphene compared with clomiphene in improving endometrial receptivity of polycystic ovary syndrome. Methods: The time limit is from the establishment of the database to January 2, 2020. A randomized controlled trial was conducted to compare the effects of Bushen Recipe combined with clomiphene and clomiphene on the endometrial receptivity of polycystic ovary syndrome (PCOS). Meta analysis was performed with RevMan5.3 software. Results: A total of 13 RCTS were included, with a total of 797 PCOS patients. The results of this meta-analysis show: there were statistically significant differences in the improvement of endometrial thickness [WMD=1.62,95%CI(1.22, 2.01), P <0.00001], endometrial type[RR=1.51,95%CI(1.28, 1.78), P <0.00001], uterine artery pulse index(PI) [WMD=-0.18,95%CI(-0.27, -0.09) , P <0.0001], uterine artery resistance index(RI)[WMD=-0.08,95%CI(-0.11, -0.05) , P <0.00001], pregnancy rate [RR=2.18,95%CI(1.55, 3.05), P <0.00001], TCM syndrome score[WMD=-6.97,95%CI(-8.97, -4.97) , P <0.00001], effective rate [RR=1.25, 95%CI (1.13, 1.37), P < 0.00001]. Conclusion: Compared with clomiphene alone, Bushen Recipe combined with clomiphene can effectively increase the thickness of endometrium and improve the type of endometrium, promote the blood perfusion of endometrium, improve the pregnancy rate, improve the clinical symptoms, reduce the TCM syndrome score, improve the total efficiency of treatment, with high clinical application value.

Multiomics approaches to uncover endometrial receptivity in embryo implantation:a mini-review

Successful implantation requires concerted interactions during the apposition,adhesion,and invasion of the embryo into a receptive endometrium.However,the embryo implantation rate for assisted reproduction remains low despite the transfer of good quality embryos.Changes in endometrial transcriptomics,proteomics,lipidomics,and even microbiota all play important roles in embryo implantation.Specifically,the expression of steroid hormone-regulated adhesive and anti-adhesive molecules during the embryo implantation window is becoming an area of increasingly intense research.This review(a)summarizes the different molecules expressed in the receptive endometrium and(b)proposes the use of surface protein markers to predict pregnancy outcomes from assisted reproduction.

Acupuncture-induced improvement of endometrial receptivity of rats with polycystic ovary syndrome treated by Clomiphene for ovarian stimulation

Objective To observe acupuncture effects on endometrial receptivity of the rats with polycystic ovary syndrome （PCOS） treated by ovarian stimulation with Clomiphene to explore its mechanisms. Methods eGOS rat model was experimentally induced by subcutaneous injection of oil solution of dehydroepiandrosterone （DHEA） in immature （24-day-old） female rats for continuous 20 days. The same dose of oil was given for an equivalent length of time to animals in a control group （Group Con）. The rats with PCOS were randomly divided into a model group （group M）, a Clomiphene treatment group （group C）, a Clomiphene plus acupuncture group （group C＋ A）. The treatments were given for 5 days since 80 days after birth. Half of the rats were killed by decapitation after treatment finished, and the serum, uteri and endometria were obtained. The other half mated with male rats, and they were killed at the 8th day of pregnancy. We observed the implantation number and condition of pregnant uteri. Results Compared with group C, the animals in group C＋A had higher implantation rate and more average implanted embryos （P〈0. 01 ）, higher serum estradiol （E2） level （P〈0.01 ）, better development of endometrium, and increased mRNA and protein expressions of molecular markers of endometrial receptivity （P〈0.01）, which were closer to those in the control group. Conclusion Acupuncture could improve poor endometrial receptivity of PCOS rats with ovarian stimulation by citrated Clomiphene and promote implantation. The effects may be related with its up-regulation of serum E2 level, mRNA and protein expressions of molecular markers of endometrial receptivity.

Effect of electroacupuncture combined with ginger-isolated moxibustion on endometrial receptivity in infertile patients with polycystic ovarian syndrome

Objective:To observe the effect of the combined therapy of electroacupuncture(EA) and ginger-isolated moxibustion on endometrial receptivity in the patients with polycystic ovarian syndrome(PCOS).Methods:A total of 70 subjects of PCOS were randomized into two groups,35 cases in each one.In the western medication group,letrozole and human chorionic gonadotropin(HCG) were administered.In the combined therapy group,on the base of the treatment as the western medication group,the artificial cycle therapy with EA and ginger-isolated moxibustion was provided.The treatment duration was 3 menstrual cycles in two groups.After treated for 3 menstrual cycles,the symptom score of traditional Chinese medicine(TCM),endometrial thickness,the number of ovulation cycle,endometrial morphology,bilateral uterine artery pulsatility index(PI),resistance index(RI),the sum of peak systolic velocity/end diastolic velocity(S/D) and pregnancy were compared in the patients between two groups.Results:(1) After treatment,the endometrial thickness was better(0.21 ± 0.13 vs 0.14 ± 0.08,P <0.01),TCM symptom score reducing range was larger(5.00 ± 2.24 vs 0.52 ± 1.66,P <0.01),the reducing degrees of bilateral uterine artery PI,RI and S/D sum were better(0.62 ± 0.26 vs 0.04 ± 0.15,0.08± 0.05 vs0.01±0.05,0.61±0.33 vs 0.07±0.17,0.11±0.05 vs 0.01 ± 0.05,4.80±1.14 vs 0.15 ± 0.89,all P <0.01) in the combined therapy group respectively as compared with the western medication group.After treatment,the number of ovulation cycle and the proportion of A+B type of endometrial morphological were higher in the combined therapy group(2.09 ± 0.78 vs 1.27 ± 0.84,87.5% vs 60.61%,P <0.01,P <0.05) as compared with the western medication group respectively.(2) The clinical pregnancy rate was56.25% in the combined therapy group,better than 30.30% in the western medication group(P <0.05).The early abortion rate was 10.53% in the combined therapy group,lower than 50.00% in the western medication group(P <0.05).Conclusion:The combined treatment of electroacupuncture and ginger-isolated moxibustion with western medication effectively improves endometrial receptivity,increases clinical pregnancy rate and reduces early abortion rate in the patients with PCOS.

Intrauterine hyperglycemia impairs endometrial receptivity via up-regulating SGK1 in diabetes

Diabetes is a complex metabolic disorder which can adversely affect reproductive function. SGK1 is found to be up-regulated in multiple tissues of diabetic patients. However, the effects of diabetes on endometrial SGK1 expression and endometrial receptivity remain unknown. In this study, we established a streptozotocin-induced diabetic mouse model and observed reduced implantation sites, retarded development of pinopodes, increased SGK1, and aberrant expression of LIF and MUC1 in the endometrial epithelium. We injected the uterine lumen of normal mice with high-glucose solution and cultured endometrial cells in high-glucose medium to mimic intrauterine hyperglycemia. Both studies provided compelling evidence that hyperglycemia could lead to diminished embryo implantation and dysregulated SGK1, LIF and MUC1. Additionally, through over-expression of SGK1 in vivo and in vitro, we found that enhanced SGK1 also decreased LIF expression, increased MUC1 expression, and attenuated embryo implantation rate. We further identified that hyperglycemia-activated SMAD2/3 might be responsible for the enhancement of SGK1 and verified directly the interaction between SMAD3 and corresponding SMAD binding elements within SGK1 promoter. Taken together, our study confirmed the association between diabetes-related hyperglycemia and endometrial receptivity defects. Hyperglycemia-induced SGK1 has a tremendous role in this pathological process, rendering it as an attractive therapeutic target for diabetes-related reproductive disorders.

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound examination performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1-3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B （P〈0.05） and group C （P〈0.01）. The implantation rate of group A was significantly lower than than of group C （P〈0.01）. There was no significant difference of the rate of pregnancy and implantation between group B and group C （P〉0.05）. Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.

Rhizoma Drynariae Improves Endometrial Receptivity in a Mus Model of Dysfunctional Embryo Implantation

Background: Rhizoma drynariae is a traditional Chinese medicine used in orthopedics and traumatology, but its effect on endometrial receptivity remains unknown. Aims and Objectives: To observe effect of Rhizoma drynariae and its main components on endometrial receptivity in a mus model of dysfunctional embryo implantation. Materials and Methods: Mus models were established by the Gn RHa+HMG+HCG method. Normal mus receiving saline were used as controls and the remaining six groups were: model receiving saline, progynova, aspirin, Rhizoma drynariae, osteopractic total flavone, and naringin. Pinopodes in uterine endometrium were examined by scanning electron microscopy. Stem cell factor(SCF) m RNA expressions was determined by real-time RT-PCR, and estrogen receptor α(ERα), progesterone receptor(PR) by immunohistochemistry. Results: In the model group, surface morphology of endometrium was heterogeneous, without obvious pinopodes. In the Rhizoma drynaria and progynova groups, pinopodes were abundant. Compared with the blank group, model group had lower levels of SCF(-47%), ERα(-63%) and PR(-50%)(all P<0.05). In comparison, Rhizoma drynariae group had higher levels of SCF(+73%), ERα(+118%) and PR(+101%)(all P<0.01). The individual main components of Rhizoma drynariae had variable efficacy. Conclusion: Rhizoma drynariae could improve endometrial receptivity of mouse models of dysfunctional embryo implantation as shown by increased numbers of pinopodes and higher levers of SCF, ERα, PR compared with the model group.

Use of biological and chemical molecules in regulating embryo implantation and endometrial receptivity

This review summarizes the drugs and chemicals that may modulate embryo implantation.Non-hormonal molecules,including aspirin,improved endometrial blood flow,while low molecular weight heparin,vitamin E,sildenafil,and atosiban modulated the expression of endometrial genes.Hormonal factors,including human chorionic gonadotropin and growth hormones,can regulate the expression of endometrial receptivity markers.Other immunomodulatory molecules,including granulocyte colony-stimulating factor,peripheral blood mononuclear cells,autologous platelet-rich plasma,and intralipid and intravenous immunoglobulins,may improve implantation rate by modulating endometrial immune functions.Medicinal extracts of the Chinese herbs Paeonia lactiflora and Perilla frutescens increased the expression of leukemia inhibitory factors in endometrial epithelial cells.Recently,the use of the commercially available Library of Pharmacologically Active Compounds with a high-throughput screening method has provided an approach to screen for compounds that may potentially enhance or suppress embryo implantation.Whether these biomedical findings translate into clinical effects that enhance or suppress embryo implantation requires further investigation.

藏西北绒山羊子宫内膜容受性相关基因和可变剪接事件的综合分析

背景:藏西北绒山羊子宫内膜容受性是胚胎植入的关键因素,目前对于藏西北绒山羊子宫内膜容受性相关基因表达及可变剪接的认识还未明确。目的:分析并挖掘藏西北绒山羊子宫内膜容受性相关的基因和可变剪接事件。方法:在妊娠第5天和第15天(分别代表容受前子宫内膜组和容受性子宫内膜组),分别随机选取3只藏西北绒山羊,采集子宫内膜组织,苏木精-伊红染色观察组织形态,免疫组织化学检测子宫内膜容受性标志蛋白白血病抑制因子、血管内皮生长因子的表达水平;提取子宫内膜组织总RNA,质量检测合格后进行转录组测序,寻找差异表达的mRNA、长链非编码RNA、环状RNA和miRNA,进行功能预测,并分析与子宫内膜容受性相关的可变剪接mRNA和长链非编码RNA。结果与结论:(1)与容受前子宫内膜组比较,容受性子宫内膜组子宫内膜组织中白血病抑制因子和血管内皮生长因子蛋白的表达水平明显升高;(2)测序结果显示,差异表达基因多为mRNA和长链非编码RNA,包括250个上调的mRNA、193个上调的长链非编码RNA、135个下调的mRNA和123个下调的长链非编码RNA,显著富集于Wnt、Hedgehog和Hippo信号通路;(3)可变剪接事件分析显示有8个差异表达的可变剪接转录本,均为mRNA分子,其中2个下调、6个上调,与血管内皮生长因子受体信号、细胞运动和胚胎发育有关。

补肾调轴方治疗体外受精-胚胎移植反复胚胎着床失败伴慢性子宫内膜炎症的临床研究

目的观察补肾调轴方对体外受精-胚胎移植(IVF-ET)反复胚胎着床失败并且合并慢性子宫内膜炎症病人内膜容受性、胚胎种植率、子宫免疫微环境和妊娠结局的影响。方法选择于黄河三门峡医院生殖医学中心治疗的150例IVF-ET反复胚胎着床失败并且合并慢性子宫内膜炎症病例,治疗时间为2018年2月至2021年2月,采用随机数字表法分组。75例对症组,于IVF-ET失败后第1个月经周期行抗感染治疗,经期停药,经净后继续服药,共服用14 d,75例病人为补肾调轴方组,给予自拟中药补肾调轴方治疗,连续服用30 d。治疗前、后检测两组病人肿瘤坏死因子α(TNF-α)、谷胱甘肽过氧化物酶(GSHPx)、白细胞介素4(IL-4)、超氧化物歧化酶(SOD)、白细胞介素-1β(IL-1β)、抗超氧阴离子自由基(抗O_(2)^(−))活力水平及CD138阳性率,检测病人CD56^(+)表达情况,检测子宫内膜厚度、子宫动脉的血流指数、搏动指数、阻力指数,治疗前、后给予病人Salle及中医证候评分,记录对症组、补肾调轴方组临床妊娠率、移植胚胎数、早期流产率、胚胎种植率及活产率。结果补肾调轴方组病人TNF-α、IL-1β、CD56^(+)含量、CD138阳性率较对症组明显低(P<0.05),补肾调轴方组病人IL-4含量较对症组明显高(P<0.05),补肾调轴方组病人SOD、抗O_(2)^(−)活力、GSH-Px含量较对症组明显高(P<0.05);补肾调轴方组病人子宫内膜厚度、子宫动脉的血流指数较对症组高(P<0.05),补肾调轴方组病人子宫动脉的搏动指数、阻力指数较对症组低(P<0.05),补肾调轴方组中医证候评分较对症组明显低(P<0.05),补肾调轴方组Salle评分较对症组明显高(P<0.05),补肾调轴方组胚胎种植率、临床妊娠率、活产率较对症组高(33.33%、42.67%、41.33%)比(22.36%、26.67%、22.67%)(P<0.05),两组早期流产率比较差异无统计学意义(P>0.05),结论补肾调轴方治疗IVF-ET反复胚胎着床失败伴慢性子宫内膜炎症病人,可抑制机体炎症,调节子宫免疫微环境,减少氧化应激损伤,改善子宫内膜容受性,缓解病人临床症状,改善病人妊娠结局。

超声评估在子宫内膜容受性判定中的应用

目的 探讨经阴道三维超声在子宫内膜容受性判定中的应用价值。方法 回顾性选取昆明市妇幼保健院2022年4月至2023年6月106例拟行辅助生殖者,所有辅助生殖者在妊娠前均接受经阴道三维超声检测,根据临床妊娠与否分为妊娠组(n=48)和未妊娠组(n=58),运用经阴道三维容积探头,记录2组子宫内膜类型、子宫内膜血流分型、子宫内膜容积、妊娠率、子宫内膜及内膜下血流参数[血流指数(flow index,FI)、血管化指数(vascularization index,VI)、及血管-血流指数(vascular fiow index,VFI)]情况。结果 2组在子宫内膜类型、子宫内膜血流分型、子宫内膜容积方面比较,差异有统计学意义(P <0.05);子宫内膜形态A型妊娠率高于C型,子宫内膜血流分型Ⅲ级妊娠率高于型Ⅰ级,差异有统计学意义(P <0.05);2组在子宫内膜及内膜下FI、VI以及VFI方面比较,差异有统计学意义(P <0.05)。结论 经阴道三维超声技术能够有效评估子宫内膜容受性,预测妊娠结局,为临床治疗方案提供重要依据。

维生素D与女性生育力及生殖系统疾病的研究进展

维生素D受体在女性生殖器官中广泛表达,维生素D与维生素D受体结合调节体内骨和钙稳态,参与炎症、细胞介导免疫、细胞周期和凋亡等多种信号通路。维生素D对卵泡发育和卵巢储备、子宫内膜容受性有调节作用;维生素D缺乏与多囊卵巢综合征病理进程有关;补充维生素D对预防卵巢早衰、子宫肌瘤、子宫内膜异位症和卵巢癌有重要意义;体内维生素D水平与体外受精结局也有一定相关性。维生素D缺乏是一个主要公共卫生问题,合理补充维生素D,有益于维护女性生殖健康。

粒细胞集落刺激因子联合他达拉非对薄型子宫内膜患者子宫内膜容受性和妊娠结局的影响

目的探究粒细胞集落刺激因子(G-CSF)联合他达拉非(TD)对薄型子宫内膜(TE)患者子宫内膜容受性和妊娠结局的影响。方法选取2020年5月至2023年3月秦皇岛市第一医院生殖医学科TE患者为研究对象。根据治疗方案不同分为试验组(G-GSF联合TD)和对照组(G-GSF)。比较治疗前和治疗后(内膜转化日)TE患者子宫内膜容受性[子宫内膜厚度(EMT)、子宫内膜容积(EMV)、子宫内膜血流收缩期峰值流速/舒张末期流速(EBF-S/D)、子宫内膜分型、子宫内膜血流分型、子宫动脉搏动指数(AUPI)、子宫动脉阻力指数(AURI)和子宫动脉收缩期峰值流速/舒张末期流速(AU-S/D)];比较两组患者内膜转化日子宫内膜容受性、治疗后妊娠结局[胚胎种植率(EIR)、临床妊娠率(CPR)和早期流产率(ABR)]及治疗期间不良反应发生情况。结果研究共纳入60例患者,每组30例。治疗前,两组患者子宫内膜容受性差异无统计学意义(P>0.05)。与治疗前比较,治疗后两组患者内膜转化日EMT、EMV、A型子宫内膜比例和II型+III型子宫内膜血流比例显著增加(P<0.05),而EBF-S/D、AUPI、AURI和AU-S/D显著下降(P<0.05)。试验组EMT和EMV大于对照组(P<0.05),而EBF-S/D、AUPI、AURI和AU-S/D小于对照组(P<0.05)。与对照组相比,试验组子宫内膜形态、子宫内膜血流分型、EIR、CPR、ABR差异均无统计学意义(P>0.05)。两组患者在治疗期间均未发生不良反应。结论G-CSF联合TD可改善TE患者子宫内膜容受性,安全性较高,但对妊娠结局尚无影响。

子宫内膜种植窗检测结合个体化胚胎移植对反复种植失败患者的临床应用分析

目的:探讨子宫内膜种植窗检测(ERT)结合个体化胚胎移植(ET)改善反复种植失败患者的妊娠结局有效性。方法:回顾性分析2019年3月至2022年8月于中山大学附属第六医院生殖医学中心诊断为反复种植失败患者的临床资料,行ERT的428例作为ERT组,运用SPSS 26.0软件的倾向性评分匹配分析选择不行ERT的396例为对照组。比较两组的临床特征和妊娠结局,并比较子宫内膜种植窗(WOI)正常、延迟1 d、延迟2 d患者个体化ET后的妊娠结局。结果:ERT组临床妊娠率(47.73%vs.12.79%)和活产率(38.97%vs.9.76%)显著高于对照组,差异有统计学意义(P<0.05);并且ERT组的不孕因素中子宫内膜异位症(EMT)和多囊卵巢综合征(PCOS)因素占比较对照组高(P<0.05)。428例行ERT患者中发现有316例(73.83%)为WOI正常,有112例(26.17%)为WOI移位。WOI正常、WOI延迟1 d和WOI延迟2 d患者妊娠结局间差异无统计学意义(P>0.05)。结论:ERT技术结合个体化移植方案可以改善反复种植失败患者助孕结局,尤其是WOI移位患者,ERT技术具有应用前景和临床应用价值。

超声引导下高强度聚焦超声治疗联合亮丙瑞林治疗子宫肌瘤的临床疗效

目的分析超声引导下高强度聚焦超声(HIFU)治疗联合亮丙瑞林治疗子宫肌瘤的临床疗效。方法前瞻性选取2021年5月至2023年5月枣庄市妇幼保健院妇产科收治的子宫肌瘤患者112例,按照住院号奇偶数法分为观察组(n=56)与对照组(n=56)。对照组采用单一HIFU治疗,观察组在对照组基础上联合亮丙瑞林皮下注射治疗。随访6个月,观察两组的临床疗效、月经量、痛经情况[视觉模拟评分法(VAS)]、子宫体积、子宫内膜容受性[血管搏动指数(PI)、阻力指数(RI)、收缩期峰值血流速度(PSV)]、卵巢功能[血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、雌激素受体(ER)]以及不良反应、肌瘤残留率。结果观察组显效率为57.14%,总有效率为91.07%,均显著高于对照组(35.71%、76.79%),差异均有统计学意义(P<0.05)。观察组治疗后月经量评分为(95.32±16.43)分,月经量过多率为8.93%,均低于对照组[(117.71±19.64)分、23.21%],差异均有统计学意义(P<0.05)。观察组治疗后6个月的痛经VAS评分为(2.58±0.43)分,低于对照组[(3.45±0.58)分],差异有统计学意义(P<0.05)。观察组治疗后6个月的子宫体积、PSV分别为(85.37±7.84)cm^(3)、(36.88±4.59)cm/s,均低于对照组[(96.32±6.32)cm^(3)、(40.82±6.31)cm/s],PI、RI分别为0.97±0.06、2.79±0.20,均高于对照组(0.88±0.08、2.63±0.15),差异均有统计学意义(P<0.05)。观察组治疗后6个月的FSH、LH、雌二醇、ER水平分别为(12.26±1.15)IU/L、(7.36±1.66)IU/L、(173.45±35.27)pmol/L、0.81±0.22,均低于对照组[(14.89±1.18)IU/L、(9.85±1.73)IU/L、(188.63±41.38)pmol/L、1.06±0.21],差异均有统计学意义(P<0.05)。观察组患者总不良反应发生率为7.69%,低于对照组(21.43%),内肌瘤残留率为5.36%,低于对照组(16.07%),差异均有统计学意义(P<0.05)。结论HIFU联合亮丙瑞林治疗子宫肌瘤的临床效果较单一治疗效果佳,能显著改善患者临床症状,且更安全,可能与其改善患者子宫内膜容受性、卵巢功能有关。