促排卵治疗对多囊卵巢综合征患者子宫内膜整合素αv、β3表达的影响

目的　了解促排卵药物对多囊卵巢综合征 (PCOS)患者黄体中期子宫内膜整合素αv、β3表达的影响。方法　应用单克隆抗体 ,采用免疫组织化学技术对 2 2例正常妇女、40例无排卵PCOS患者促排卵治疗后黄体中期的子宫内膜整合素αv、β3 进行测定。结果　正常妇女子宫内膜整合素αv、β3 表达在“着床窗口期”呈现强阳性 ;而氯米芬 (CC)及绝经期促性腺激素 (hMG)抑制αv、β3 的表达 ,使其表达呈弱阳性 ;而促性腺激素释放激素激动剂对整合素αv、β3 的表达无影响。结论　CC、CC/hMG促排卵周期的黄体中期子宫内膜容受性下降 ,整合素αv、β3 表达下降或缺失。     

多囊卵巢综合征患者应用孕激素后子宫内膜整合素αv β3的表达

本研究通过观察PCOS患者应用一定剂量孕酮后子宫内膜容受性标志物整合素αvβ3的表达,探讨影响子宫内膜容受性的可能机制,寻求提高子宫内膜容受性的最佳激素替代方案,以进一步提高辅助生育技术成功率。     

多囊卵巢综合征无排卵患者子宫内膜超声形态学及组织学变化

目的探讨多囊卵巢综合征(PCOS)无排卵患者子宫内膜超声形态学的变化特点,及组织学变化与激素水平的关系。方法采用B超观察76例PCOS无排卵患者(PCOS组)及32例排卵正常的不孕患者(对照组)的子宫内膜;按照Gonen等的分型方法,将子宫内膜分为A型(即低回声三线型)、B型(即均质中等回声)、C型(即强回声)3型;采用免疫组化技术,检测子宫内膜腺上皮细胞增殖相关核抗原Ki67及降钙素的表达;采用透射电镜观察子宫内膜超微结构;采用酶联免疫发光法,检测血清中黄体生成激素及孕酮等的水平。结果PCOS组子宫内膜为A型者23例,B型者34例、C型者17例,另2例患者因内膜厚度<5mm,未进行分型。A型患者的内膜间质发育异常比率为9%(2/23),B型和C型为43%(22/51)两者比较,差异有统计学意义(P<0·05)。PCOS组分泌期内膜腺上皮细胞Ki67表达为(14±6)%,对照组为(9±7)%,两组比较,差异有统计学意义(P<0·05)。PCOS组增生期子宫内膜腺上皮细胞中细胞器增多;分泌期显示分泌反应不良。结论PCOS无排卵患者子宫内膜呈现增生和分泌表现异常,其内膜超声形态学的强回声表现,可能与局灶性内膜间质发生异常组织学改变有关。     

多囊卵巢综合征临床内分泌代谢对子宫内膜病变的 …

目的 探讨多囊卵巢综合征（ＰＣＯＳ）患者临床内分泌代谢改变对子宫内膜病变的影响。方法 用组织学方法检测９４例ＰＣＯＳ患者子宫内膜病理改变,用放射免疫学方法测定血清泌乳素,黄体生成激素,卵泡刺激素,雌二醇,睾酮,雄烯二酮水平,８２ 时行糖耐量及胰岛素释放实验。结果 （１）７０例ＰＣＯＳ患者子宫内膜为无排卵型,其中增殖期内膜４５例,增殖症２５例（单纯增生２３例,不典型增生２例）;２４例为排卵型子宫内膜     

多囊卵巢综合征患者用克罗米酚促排卵结局与相关因 …

目的 探讨在多囊卵巢综合征（ＰＣＯＳ）患者中影响克罗米酚（ＣＣ）促排卵因素。方法 对９４例因多囊卵巢综合征不孕患者,用ＣＣ促排卵治疗。采用放射免疫方法测定卵泡刺激素（ＦＳＨ）,黄体生成素（ＬＨ）,雌二醇（Ｅ２）、睾酮（Ｔ）,雄烯二酮（Ａ）,泌乳素（ＰＲＬ）水平及胰岛素释放反应。分析了卵结局与年龄,基础激素水平、胰岛素抵抗（ＩＲ）、胰岛素反应曲线下面积（ＡＵＣ１）及体重指数（ＢＭＩ）之间的关系。结果     

多囊卵巢综合征对子宫内膜的影响

多囊卵巢综合征(PCOS)是常见的内分泌代谢紊乱疾病,以稀发排卵或持续无排卵、雄激素过多症为特征,胰岛素抵抗和伴随而来的高胰岛素血症也常有发生;PCOS患者子宫内膜中雄激素受体和相应激动剂过度表达,植入窗期子宫内膜对受精卵容受性生物标志减少,上皮细胞的雌激素受体表达持续异常。PCOS患者内分泌和代谢异常对子宫内膜有复杂影响,引起子宫内膜周期紊乱、不孕、流产率增加和子宫内膜增生,甚至子宫内膜癌。其发生机制潜藏于以上症状中且极其复杂,有待跨学科研究使其得到更详尽的阐明。     

多囊卵巢综合征对子宫内膜容受性的影响

多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者不孕的原因主要有不排卵,卵母细胞质量差等。但经药物纠正不排卵因素后总体妊娠率仍不高。近年研究推测,PCOS患者体内复杂的内分泌和代谢环境影响了子宫内膜容受性,也可导致PCOS患者生育力减弱和不良妊娠结局。     

多囊卵巢综合征患者子宫内膜综合管理

多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科生殖内分泌疾病之一。PCOS患者存在排卵障碍、胰岛素抵抗、高胰岛素血症、代谢综合征等多种内分泌异常,可通过多种机制刺激子宫内膜增生,导致不同程度的子宫内膜疾病。对PCOS患者及时地进行子宫内膜规范管理,可有效避免子宫内膜疾病的发生发展,并降低因子宫内膜病变导致的器官切除及生育功能丧失。本文综述了PCOS患者子宫内膜管理的必要性及综合措施,以期为改善PCOS患者健康提供依据。     

生长激素在多囊卵巢综合征促排卵中的作用

目的　探讨生长激素(GH)在多囊卵巢综合征(PCOS)患者促排卵中的作用。方法　测定130例PCOS患者(PCOS组)及107例正常妇女(对照组)的血中生殖激素及GH和胰岛素样生长因子Ⅱ(IGF-Ⅱ)的基础水平,并应用GH辅助促排卵方案治疗7例对人绝经期促性腺激素(hMG)反应不良的PCOS患者,观察疗效。结果　PCOS患者血中GH水平明显降低,肥胖者更为明显,非肥胖与肥胖者分别为(2.50±1.33)μg/L及(1.04±0.47)μg/L,而对照组肥胖与非肥胖者分别为(2.95±1.49)μg/L、（5.30±2.26）μg/L（P均<0.05）;PCOS组肥胖者IGF-Ⅱ水平为（136±27）nmol/L,高于非肥胖者的（123±20）nmol/L,两者比较,差异有显著性（P<0.05）。应用GH辅助促排卵治疗,可以明显减少hMG用量1～12支,缩短hMG刺激时间3～12d,增加优势卵泡的数量。结论　PCOS患者存在GH分泌障碍,应用GH辅助促排卵可以提高排卵率。     

预测多囊卵巢综合征促排卵治疗结局的研究

目的 探讨影响多囊卵巢综合征（ＰＣＯＳ）患者促排卵治疗结局的相关因素,建立分类树分析（ＣＡＲＴ）模型。方法 采用放射免疫方法,测定１０３例ＰＣＯＳ患者及３１例正常妇女血清雌二醇（Ｅ２）、睾酮（Ｔ）、雄烯二酮（Ａ）、促卵泡激素（ＦＳＨ）、黄体生成素（ＬＨ）、垂体泌乳素（ＰＲＬ）水平,进行口服糖耐量试验及胰岛素释放试验,应用氯米芬（ＣＣ）／人绒毛膜促性腺激素（ｈＣＧ）、ＣＣ／人绝经期促性腺激素（ｈＭＧ     

Difference in alpha(v)beta3 integrin expression in endometrial stromal cell in subgroups of women with unexplained infertility

OBJECTIVE: The aim of the study was to evaluate the endometrial receptivity by using alpha(v)beta3 expression in the midsecretory phase in different endometrial compartments in women with unexplained infertility. STUDY DESIGN: A prospective controlled clinical trial in a setting of a university teaching hospital was performed. Thirty-three fertile and 33 infertile women were included in the study. Midluteal endometrial biopsies of the endometrium were carried out during the implantation window. Immunohistochemical staining was performed for the expression of alpha(v)beta3 in endometrial samples. Alpha(v)beta3 expression was measured using the HSCORE scoring system in the endometrial glandular and luminal epithelium and in the endometrial stroma. Serum levels of estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, total testosterone and dehydroepiandrosterone sulphate were measured in the early follicular phase and in the midluteal phase. RESULTS: The average alpha(v)beta3 integrin expression at different sites of the endometrium was not different in the infertile and fertile controls. However, the stromal alpha(v)beta3 integrin was found to be expressed significantly less in a subgroup of women with lower than average alpha(v)beta3 integrin expression in luminal epithelium than in fertile controls and significantly more in a subgroup of women with higher than average alpha(v)beta3 integrin expression in luminal epithelium. There was no difference in stromal alpha(v)beta3 integrin expression in the lower or higher glandular alpha(v)beta3 integrin expression subgroups. CONCLUSIONS: Alpha(v)beta3 integrin expression in endometrial stromal cells may be different in subgroups of women with unexplained infertility.     

Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome

Objective

To study the role of a phyto-oestrogen, Cimicifuga racimosa extract (Klimadynon^®, Bionorica, Neumarkt i.d.OBf., Germany), in ovulation induction in women with polycystic ovarian syndrome (PCOS).

Study design

Prospective randomized controlled trial in Minia University Hospital, Minia, Egypt. One hundred women with PCOS were allocated into one of two groups: one group (n = 50) received clomiphene citrate 100 mg daily for 5 days, and the other group (n = 50) received C. racimosa 20 mg daily for 10 days. Both groups received medication starting from the second day of the cycle for three consecutive cycles, during which changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), FSH/LH ratio, progesterone, endometrial thickness and pregnancy rate were measured.

Results

The groups were similar in terms of age, clinical presentation and hormonal levels before treatment. Following treatment, significant favourable changes in LH level and FSH/LH ratio (p = 0.007 and 0.06, respectively) were seen in the Klimadynon group. In this group the progesterone level was higher from the first treatment cycle, indicating better ovulation (p = 0.0001), and endometrial thickness was greater (p = 0.0004). The pregnancy rate was higher in the Klimadynon group but the difference between the groups was not significant (p = 0.1).

Conclusion

Phyto-oestrogen can be used as an alternative to clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome.     

多囊卵巢综合征患者子宫内膜增生相关因素的分析

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者子宫内膜增生(endometrial hyperplasia,EH)的发生率及相关预测因素。方法:以160例PCOS患者为研究对象,以80例因输卵管因素或男方因素不孕的非PCOS患者为对照组。研究P-COS诊断要素在EH中的作用;比较两组EH的发生率及不同亚型PCOS患者EH的发生率;研究PCOS患者临床特征与EH的关系。结果:月经稀发和高雄激素血症组的EH发生率明显增高(P均<0.05);PCOS组EH发生率明显高于对照组(18.75%vs 7.5%,P=0.021)。PCOS患者月经周期>59天或超声子宫内膜回声异常时,EH发生率显著升高(P=0.005,P=0.003)。结论:月经稀发和高雄激素血症在EH中发挥重要作用,只存在月经稀发或高雄激素血症的可疑PCOS患者亦应重视其子宫内膜病变。PCOS患者EH发生率增高,尤其是月经周期>59天或存在子宫内膜回声异常者,应高度警惕子宫内膜病变。     

Alterations in expression of endometrial endothelial nitric oxide synthase and alpha(v)beta(3) integrin in women with endometriosis

OBJECTIVE: To determine the expression of endometrial endothelial nitric oxide synthase (eNOS) protein and alpha(v)beta(3) integrin in patients with and without endometriosis. DESIGN: Case-control cohort study. SETTING: University-based tertiary care center. PATIENT(S): Endometrial biopsy samples were obtained from 9 fertile women with regular cycles and 30 infertile women with varying severity of endometriosis. Peritoneal fluid levels of nitric oxide were determined in 13 infertile women with a normal pelvis and 12 infertile women with endometriosis. MAIN OUTCOME MEASURE(S): Expression of eNOS and alpha(v)beta(3) integrin protein in the endometrium and peritoneal fluid levels of nitric oxide. RESULTS: In patients with endometriosis, expression of eNOS was significantly increased in the glandular and luminal epithelium, with no significant changes in the stroma. Peritoneal fluid levels of nitric oxide were unchanged, and expression of alpha(v)beta(3) integrin expression in glandular and luminal epithelium was significantly decreased compared with controls. A significant negative correlation was observed between luminal expression of eNOS and alpha(v)beta(3) integrin and between glandular expression of eNOS and luminal expression of alpha(v)beta(3) integrin. CONCLUSION(S): The nitric oxide pathway may play a role in the pathogenesis of endometriosis.     

Optimizing ovulation induction in women with polycystic ovary syndrome

Recent developments in our understanding of the pathophysiology of polycystic ovary syndrome led to the introduction of new therapeutic approaches. It is apparent that a significant proportion of women with polycystic ovary syndrome have insulin resistance and compensatory hyperinsulinemia. Growing evidence indicates that elevated serum insulin induces hyperandrogenism, which in turn leads to anovulation and infertility. Hyperinsulinemia also contributes to the increased risk for cardiovascular disorders and type 2 diabetes mellitus. These concepts provide rationale for therapies focused on treatments of insulin resistance. In particular, weight loss and exercise have been shown to increase insulin sensitivity and improve ovulatory function. Metformin, an insulin-sensitizing agent, is particularly effective in women with polycystic ovary syndrome who have significant insulin resistance. Metformin use leads to a decrease in serum insulin and androgen levels as well as an improvement in ovulatory function. Moreover, it appears to ameliorate cardiovascular risk factors. Other approaches to ovulation induction in women with polycystic ovary syndrome include traditional therapies using clomiphene citrate or gonadotropins. In clomiphene-resistant subjects, one can consider laparoscopic ovarian drilling and other forms of partial ovarian resection or destruction.     

Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome

Clomiphene citrate (CC) is the most commonly used oral agent for the induction of ovulation. It is a nonsteroidal selective estrogen receptor modulator that has predominant antiestrogenic action resulting in long-lasting estrogen receptor depletion. Side effects include antiestrogenic effects systemically and on the endometrium and cervical mucous. Letrozole is a potent, nonsteroidal, aromatase inhibitor, originally used for postmenopausal breast cancer therapy, at present its only registered indication. We hypothesized that letrozole could mimic the action of CC without depletion of estrogen receptors. As there is no estrogen receptor antagonism, antiestrogenic effects such as poor cervical mucus and thin endometrium are not expected with aromatase inhibitor treatment. In addition, because estrogen receptors in the brain are not depleted, normal negative feedback occurs with letrozole and generally results in monoovulation. We and others have demonstrated the success of aromatase inhibition in inducing ovulation in women with polycystic ovarian syndrome. Letrozole may be very effective for ovulation induction and pregnancy in cases of CC resistance. When used together with follicle-stimulating hormone (FSH) injections, letrozole resulted in a significant reduction in the FSH dose needed for controlled ovarian hyperstimulation. Aromatase inhibitors likely increase ovarian sensitivity to FSH, and may be useful in poor responders and in women undergoing ovarian stimulation for in vitro fertilization. The safety of letrozole in pregnancy outcome studies has been demonstrated by examination of spontaneous pregnancy loss, multiple pregnancy rates, and congenital anomalies compared with a control group of infertility patients treated with CC. In addition, new data suggest that CC may result in cardiac anomalies and other birth defects and in low birth weight babies. We believe aromatase inhibitors are acceptable alternatives to CC as first line oral agents for ovulation induction or controlled ovarian stimulation.     

二甲双胍在多囊卵巢综合征促排卵治疗中的作用

目的　评估二甲双胍在多囊卵巢综合征 (PCOS)患者促排卵治疗中的作用。方法　以40例PCOS患者 (PCOS组 )为研究对象 ,其中 2 0例口服二甲双胍治疗 12周 ,治疗后 17例未孕者加用高纯度促卵泡激素 (FSH HP)治疗 1个周期 (A组 ) ,另 2 0例单用FSH HP治疗 1个周期 (B组 ) ;同时 ,以体重和月经周期均正常的 2 0例门诊患者为对照组。观察各组及A组患者口服二甲双胍前后血清FSH、黄体生成激素 (LH)、睾酮、瘦素、空腹血糖及空腹胰岛素水平 ;比较A、B两组促排卵治疗结果。结果　空腹胰岛素和瘦素水平 ,PCOS组显著高于对照组 (P <0 .0 5) ,PCOS肥胖者高于PCOS非肥胖者(P <0 .0 5) ,但PCOS非肥胖者与对照组相比 ,差异无显著性 (P >0 .0 5)。二甲双胍治疗后 ,LH、空腹胰岛素、睾酮及瘦素水平明显下降 (P <0 .0 5～ 0 .0 1)。PCOS组患者中有 3例服二甲双胍治疗期间妊娠 ,另外 3 7例行FSH HP促排卵治疗后有 7例妊娠 (A组 4例 ,B组 3例 ) ,总妊娠率为 19% ( 7 3 7) ;A组的排卵率 ( 88% ,15 17)和妊娠率 ( 2 4% ,4 17)虽高于B组 ( 70 % ,14 2 0 ;15% ,3 2 0 ) ,但差异无显著性 (P >0 .0 5)。结论　二甲双胍能降低胰岛素和瘦素水平 ,逆转PCOS患者性激素异常 ,使部分患者恢复排卵和妊娠 ,可增强PCOS患者对促性腺素的敏感     

Induction of ovulation with purified urinary follicle-stimulating hormone in patients with polycystic ovarian syndrome

Purified urinary follicle-stimulating hormone was used to induce ovulation in 18 patients with polycystic ovarian syndrome. Each ampule contained 75 IU of follicle-stimulating hormone and less than 0.11 IU of luteinizing hormone. Initial doses were 150 to 225 IU/day, later increased to a maximum of 375 IU, according to daily clinical controls and estradiol values. After 12 to 16 days, follicle-stimulating hormone treatment was suspended. Within 36 to 48 hours each patient received 5000 or 10,000 IU of human chorionic gonadotropin, rarely more. Ovulation occurred in 39 of 43 treatment cycles and hyperstimulation in nine. Seven patients had normal pregnancies with viable fetuses, including one pair of twins. Two had abortions. Analysis of the endocrine situation during therapy does not permit either pregnancy or hyperstimulation to be predicted. However, hyperstimulation is frequently accompanied by endogenous luteinizing hormone peaks and greater estradiol increases during the final phase of induction. Purified follicle-stimulating hormone has thus demonstrated its validity in inducing ovulation in patients with polycystic ovarian syndrome, apparently with equal or lower risks of hyperstimulation than with other gonadotropin preparations.     

多囊卵巢综合征患者用克罗米酚促排卵结局与相关因素的探讨

目的　探讨在多囊卵巢综合征 (PCOS)患者中影响克罗米酚 (CC)促排卵因素。方法　对 94例因多囊卵巢综合征不孕患者 ,用CC促排卵治疗。采用放射免疫方法测定卵泡刺激素 (FSH)、黄体生成素 (LH)、雌二醇 (E2 )、睾酮 (T)、雄烯二酮 (A)、泌乳素 (PRL)水平及胰岛素释放反应。分析了排卵结局与年龄、基础激素水平、胰岛素抵抗 (IR)、胰岛素反应曲线下面积 (AUCI)及体重指数 (BMI)之间的关系。结果　用克罗米酚促排卵 94个周期中排卵率为 5 5 2 % (5 2 / 94) ,未排卵组的基础血雄激素、LH、AUCI 和BMI均较排卵组高。结论　PCOS患者的高雄激素、高LH血症、IR、高BMI对促排卵的结局产生负影响。