Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.     

Self-report versus interview data of women's subjective theories of illness: Concordance and predictive validity in a psychosomatic-gynecological liaison service

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.     

Endometrioma undergoing laparoscopic ovarian cystectomy: its influence on the outcome of in vitro fertilization and embryo transfer (IVF–ET)

PURPOSE: To evaluate the effect of laparoscopic ovarian cystectomy for endometrioma on the clinical outcome of IVF treatment. METHODS: Patients who received IVF treatment were retrospectively classified into two groups. Group 1 included 95 patients who received IVF due to tubal occlusion. Group 2 included 127 patients who had received laparoscopic ovarian cystectomy for endometrioma(s) followed by IVF treatment. Clinical outcomes of IVF treatment were compared between two groups. RESULTS: More oocytes were harvested per retrieval in Group 1 than Group 2 (p < 0.05). The fertilization rate was higher in Group 1 than Group 2 (p < 0.05). Although the implantation rate was higher in Group 2 (p < 0.05), the clinical pregnancy rate revealed no statistically significant difference between the two groups. CONCLUSIONS: Women who received ovarian cystectomy for endometriomas have fewer oocytes harvested during IVF treatment. However, their chance of pregnancy was comparable to patients with tubal problems who underwent IVF treatment.     

The Effects of Danazol After Endometrial Resection: Results of a randomized, placebo-controlled, double-blind study

Summary: We report the results of a controlled, randomized, prospective, 'double blind' evaluation of the effect of danazol treatment in 120 patients after hysteroscopic endometrial resection. After endometrial resection, the women were allocated to 1 of 3 groups: Group A—placebo; Group B—high-dose danazol (600 mg daily); Group C—low-dose danazol (200 mg daily) plus placebo tablets. Tablets were specifically manufactured for the study, were identical in appearance, and were supplied in individual prepackaged boxes. The duration of treatment was 3 months and patients' compliance was noted. Amenorrhoea, dysmenorrhoea and premenstrual tension symptoms were assessed for each group by 1 or 2 independent gynaecologists at follow-up intervals of 6 weeks, 3, 6 and 12 months. A statistically-significant increased rate of amenorrhoea was found in patients who received treatment with the higher-dose danazol (600 mg day) following endometrial resection. While not statistically significant, the same trend was noted with the low-dose danazol. This result should influence our clinical management of women with menorrhagia, and the long-term results on the same cohort of patients are awaited with interest.     

Light and electron microscopic study of the effect of L-carnitine on the sperm morphology among sub fertile men

ObjectiveThis work was conducted to evaluate the effect of L-carnitine on sperm morphology in sub fertile patients who need enhance for intra cytoplasmic sperm injection (ICSI) as a method of infertility treatment.SettingAssisted Reproduction Unit, at the International Islamic Centre for Population Studies and Researchs (IICPSR), Al-Azhar University and Zoology Department Faculty of Science (Girl's Branch), Al-Azhar University.Materials and methodsAccording to the routine semen analysis, 85 patients were divided into:Group 1: Ten normal fertile men.Group 2: 25 oligozoospermic cases with sperm count less than 20 million/ml.Group 3: 25 athenozoospermic cases with reduced sperm motility <40%.Group 4: 25 teratozoospermic cases with more than >40% abnormal forms.L. carnitine therapy in the form of Carnivita forte 1gm /tab. b.i.d. for three months were given to groups 2, 3 and 4. All the patients underwent semen analysis before and 90 days after therapy. Group 1 was subjected to two semen analysis 3 months apart as a control. Smears were made on slides, fixed in absolute ethyl alcohol and stained with H&E and methyl green pyronin for light microscopic study. A second semen sample was processed for electron microscopic study.ResultsIn the fertile control group, there have not been any statistically significant differences among the patients at the beginning of the study and after 3 months regarding all the studied parameters. In Oligo group, highly significant decrease in the mean percent of head defects, cytoplasmic droplet and mitochondrial sheath defects were observed after treatment. In both atheno and terato groups, highly significant decrease in the mean percent of head defects, midpiece defects, cytoplasmic droplet and mitochondrial sheath defects were observed after treatment. The mean of DNA content of sperm heads demonstrated highly significant increase in oligo, atheno and terato-zoospermia groups as compared to the same groups before treatment.ConclusionThese results clearly show that L-carnitine treatment has ameliorative impact on the quality of spermatozoa in the infertile men, resulting in a decrease number in morphologically abnormal spermatozoa. These data indicated that this agent affects the quality of spermatozoa in infertile patients who need intra cytoplasmic sperm injection (ICSI) as a method for infertility treatment.     

A comparison of the therapeutic efficacies of large loop excision of the transformation zone and hysterectomy for the treatment of cervical intraepithelial neoplasia III

Abstract. Kang S-B, Roh J-W, Kim J-W, Park N-H, Song Y-S, Lee H-P. A comparison of the therapeutic effects of large loop excision of the transformation zone (LLETZ) and hysterectomy for the treatment of cervical intraepithelial neoplasia III.
The technique of large loop excision of the transformation zone (LLETZ) came into vogue in the 1990s, and has been widely used in place of cold knife conization for diagnosis and treatment. Although its therapeutic efficacy for cervical intraepithelial neoplasia (CIN) has been confirmed and accepted in many countries, no direct comparison is available of the efficacies of LLETZ and hysterectomy for the treatment of CIN III, and unfortunately, hysterectomy is still widely used in many other countries. The aim of this analysis was to confirm the efficacy of LLETZ for the treatment of CIN III and to compare its results with those of hysterectomy. Between Jan. 1993 and De c . 1997, 380 patients with CIN III were treated in the Seoul National University Hospital. We defined group I ( n = 101) as those patients who underwent therapeutic LLETZ and follow-up only and group II ( n = 279) as those patients who underwent hysterectomy following LLETZ. Three patients in groups I (3.0%) and II (1.1%) developed persistent/recurrent CIN or vaginal intraepithelial neoplasia (VAIN). This result was not statistically significant. Group II contained more patients with positive resection margins and glandular extensions than group I ( P < 0.05), and these factors might have been confounding variables. However, when parameters influencing the rate of treatment failure were compared, no significant differences were found by logistic regression analysis ( P > 0.05). The results obtained show that the LLETZ is almost identical in terms of its therapeutic efficacy to hysterectomy and that it should be accepted as a standard treatment for CIN III.     

Evaluation of serum prolactin levels in patients with endometriosis and infertility.

The aim of this study was to clarify the significance of serum prolactin concentrations in patients with infertility and endometriosis. Forty patients with infertility and laparoscopically proven endometriosis were recruited into the study. Basal serum prolactin levels and prolactin levels after TRH administration were measured. The mean basal serum prolactin concentrations were 12.5, 16.5, 19.5, and 26.5 ng/ml and those after thyrotropin-releasing hormone (TRH) administration were 88.3, 114.2, 125.3 and 138.8 ng/ml in patients with stages I, II, III and IV endometriosis, respectively. A statistically significant relationship was found between the basal serum prolactin levels as well as those after TRH injection and the stage of the endometriosis. The patients were divided in two groups. Group I consisted of 20 patients who did not receive any treatment, while group II consisted of 20 patients who were initially treated with GnRH analogues for 24 week and subsequently with several therapeutic schemes in order to improve their fecundity. The pregnancy rate was not different between the two groups. The patients, however, who did not become pregnant had higher serum prolactin concentrations after TRH administration as compared to those who conceived. We conclude that occult hyperprolactinemia may be a cause of infertility in patients with endometriosis.     

Comparison of tolerance of combination carboplatin and paclitaxel chemotherapy by age in women with ovarian cancer

OBJECTIVE: The objective of this study was to compare tolerance of treatment of ovarian cancer patients > or = 70 years to those < or =55. MATERIALS AND METHODS: A retrospective review of all data relevant to comparison of clinical course in 31 women > or =70 years (Study Group) and 44 women < or =55 (Control Group), who received primary therapy for ovarian cancer between 1996 and 2001 was performed. The tolerance of the entire treatment plan was then compared using SAS 8.1 (Gary, IN), chi(2) test with Yates correction or Fischer's exact test, and the Student t test as appropriate. RESULTS: The mean age for the study group was 73, and for the control group 49. Statistically significant differences were as follows: the study group had a lower hemoglobin and serum albumin, higher performance status postoperatively, and received lower carboplatin dose and dose intensity. The groups were similar in stage at presentation, medical comorbidities, estimated blood loss, optimal cytoreduction rates, dose intensity of paclitaxel, completed number of chemotherapy cycles, time intervals from surgery to completion of therapy, and posttreatment performance status and nutritional status. The rate of grade 3 and 4 toxicities was low in both groups, and did not hinder delivery of therapeutic dose of chemotherapy. CONCLUSION: Women in the study group tolerated aggressive cytoreductive surgery and therapeutic doses of chemotherapy, despite poorer nutritional status and general health at time of diagnosis. Although older women are more likely to have chemotherapy dose reduction, the treatment remained within the recommended standard dosage.     

Characteristics of patients with small-volume residual ovarian cancer unresponsive to cisplatin-based ip chemotherapy: lessons learned from a Gynecologic Oncology Group phase II trial of ip cisplatin and recombinant alpha-interferon.

The Gynecologic Oncology Group conducted a phase II trial of intraperitoneal (ip) cisplatin plus recombinant human alpha-interferon in patients with small-volume persistent/recurrent ovarian cancer. This study was based on the known single agent activity of the drugs administered by the ip route and experimental evidence of cytotoxic synergy between the agents. In 18 evaluable patients, only 1 partial response was observed (5.5% response rate). In an effort to explain these disappointing findings, patients were retrospectively divided into two groups; those with favorable disease (documented response to systemic platinum and absence of surgical findings of diffuse carcinomatosis at laparotomy prior to initiation of ip therapy) or unfavorable disease (no evidence of response to systemic platinum and/or laparotomy findings of diffuse carcinomatosis before ip treatment). The favorable patient population would be predicted to have a far greater chance of responding to local therapy, but only 3 of the evaluable patients fell into this category. In the 15 unfavorable patients, only 1 partial response was observed (7% response rate). We conclude that patients who have failed to demonstrate a response to systemic cisplatin or carboplatin or who have diffuse carcinomatosis at second-look laparotomy are poor candidates for second-line ip cisplatin-based therapy, even if they are considered to have small-volume residual disease (each individual tumor nodules less than 0.5-1 cm). Such patients should be considered for alternative therapeutic strategies.     

Clinical efficacy analysis of different therapeutic methods in patients with cesarean scar pregnancy

ObjectiveThe purpose of this study was to analyze the clinical efficacy of five therapeutic strategies in patients with CSP.Materials and methodsA total of 135 CSP patients were included and divided into five groups based on the treatment they received, including transvaginal resection (Group A), laparoscopic resection (Group B), uterine arterial embolization (UAE) combined with hysteroscopic curettage (Group C), UAE combined with uterine curettage (Group D), and hysteroscopic curettage (Group E). To investigate the clinical efficacy of these strategies, intraoperative bleeding, serum β-hCG levels and recovery time, menstruation recovery time, hormone levels at 1 month after treatment.ResultsPatients in group A had the lowest postoperative serum β-hCG levels, and the shortest recovery times of both serum β-hCG and menstruation, followed by patients in group B. Group C and D had small amount of blood loss. The hospital stays and costs were low in group E. In addition, the sex hormone levels showed no significant difference among the five groups.ConclusionOur results indicated that resection surgery and UAE have good curative effects, but high hospital costs in CSP treatment. The selection of an optimal treatment regimen for CSP should be carried out based on specific conditions of the patients.     

Alternative indications for pulsatile gonadotropin-releasing hormone therapy in infertile women

Three groups of women with different types of ovulatory dysfunction who had failed to conceive on conventional therapy were treated with pulsatile gonadotropin-releasing hormone (GnRH). Group A consisted of nine patients with luteal phase defect; group B included four patients with apparently normal menstrual cycles but disordered folliculogenesis seen by serial ultrasound examinations; and group C consisted of eight patients who exhibited anovulation or irregular ovulation. GnRH was administered subcutaneously or intravenously in dosages varying from 5 micrograms to 20 micrograms, with pulse frequency of 2 to 3 hours in 53 cycles. Forty-one cycles were ovulatory. Four pregnancies resulted, one ending in miscarriage at 12 weeks' gestation. Our results indicate that GnRH may be used as an alternative to the prevalent therapeutic methods for ovulatory dysfunction. Only those women who had anovulation and abnormal basal levels of serum luteinizing hormone were resistant to GnRH therapy.     

Advanced primary carcinoma of the Bartholin gland: report of 18 patients

Conservative surgery plus radiotherapy for vulvar cancer has been established as a therapeutic alternative to extensive radical surgery and produces a similar cumulative 5-year survival. We retrospectively analyzed the cases of 18 patients with advanced primary carcinoma of the Bartholin gland treated with wide local excision (WLE) or radical vulvectomy and lymphadenectomy followed by radiotherapy (RT) at the University of Texas M. D. Anderson Cancer Center from January 1978 through December 1990. All patients have been observed for a minimum of 7 months (maximum follow-up, 15 years; median follow-up, 9 years). Of the 18 patients, 7 were treated with wide local excision (WLE) followed by radiation therapy (RT) (Group 1), 9 had radical vulvectomy (RV) followed by RT to the vulvar and inguinal-femoral and pelvic node areas (Group II), and 2 were treated with RT alone after biopsy of the tumor (Group III). The 5-year disease-free survival rates were 86%, 78%, and 50% for groups I, II, and III, respectively, and 83% for the whole group. Of 2 patients treated with RT alone, one lived for 6 years with no evidence of disease, and the other lived for 20 months. The rate of local tumor control was 100% for all three treatment groups. There were no significant differences among the treatment groups in rate of primary tumor control or 5-year disease-free survival rate (p=0.1300). The present study demonstrated WLE followed by RT is the best treatment for advanced primary carcinoma of the Bartholin gland. Less radical surgery plus RT produces good long-term survival and has fewer complications.     

Laminaria digitata in saline abortions

Laminaria tents were used in addition to the technique of saline abortion in an attempt to shorten the injection-abortion interval. 142 second trimester therapeutic abortion patients, aged 13 to 40 years, agreed to participate in the study and were assigned to 1 of 4 groups. 72.2% were single, 27.8% were married, and the gestational age was from 13 to 20 weeks. Group 1 (26 primigravid patients) served as the control group (no oxytocin or laminaria tent used). Group 2 (25 primigravid patients) received an intravenous infusion of 20 units oxytocin/500 ml of 5% dextrose in water (beginning 12 hours after saline injection). Group 3 (50 primigravid patients) likewise received an infusion of 20 units oxytocin/500 ml of 5% dextrose in water (beginning 12 hours after saline injection), and in addition, a single medium, sterile laminaria tent was inserted at the time of the saline injection and removed 12 hours after insertion. Group 4 (41 multigravid patients) received treatment identical to that of Group 3. The mean interval time from injection to delivery in Group 1 was 41.26 hours. The mean injection-abortion time was 30.67 hours for Group 2, 26.84 hours for Group 3, and 22.96 hours for Group 4. The complication rate was significantly higher for both the oxytocin plus saline group (Group 2) as well as the laminaria plus saline groups (Groups 3 and 4). Group 3 experienced a 22% febrile rate, and 18% of patients required uterine curettage, while the figures for Group 4 were 12.2% and 24.4%, respectively. The laminaria tents did result in an 11% to 15% increase in complications in Groups 3 and 4, respectively, as compared with Group 2.     

120例早发型子痫前期孕妇解痉抗凝治疗的临床分析

目的:探讨早发型子痫前期患者应用硫酸镁合并低分子肝素及丹参期待治疗的临床效果和安全性。方法:将2008年10月至2011年5月来我院就诊的早发型子痫前期孕妇随机分为4组(共120例)。A组:硫酸镁常规治疗;B组:硫酸镁+丹参(20ml/d)治疗;C组:硫酸镁+低分子肝素(4100U/d)治疗;D组:硫酸镁+丹参(20ml/d)+低分子肝素(4100U/d)治疗。通过临床症状、体征及辅助检查的变化判断各组的治疗效果及其对母婴的影响。结果:4组患者在治疗前临床各项指标差异无统计学意义(P>0.05);4组治疗后平均动脉压均较治疗前下降(P<0.05),24小时尿蛋白治疗前后差异无统计学意义;治疗后B、C、D3组的新生儿窒息率较A组显著降低(P<0.05),而在B、C、D各组间比较差异无统计学意义(P>0.05)。结论:硫酸镁联合低分子肝素或丹参治疗可改善早发型子痫前期患者新生儿的预后,安全有效。     

Effect of anesthesia for repeat cesarean section on postoperative infectious morbidity

It has been suggested that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 206 women who underwent repeat cesarean delivery at Duke University Medical Center was conducted. Group 1 consisted of 106 patients whose repeat cesarean section was performed with regional anesthesia, and group 2 included 100 patients whose repeat cesarean section was performed with general anesthesia. Group 2 patients were more likely to be of low socioeconomic status. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, does not increase the risk of infectious morbidity after repeat cesarean delivery.     

A validation study of the new revised FIGO staging system to estimate prognosis for patients with stage IIIC endometrial cancer

Objective

The aim of this study was to validate the role of the new FIGO staging system for estimating prognosis for patients with stage IIIC endometrial cancer.

Methods

A total of 93 cases with stage IIIC were entered in this study and classified into three groups: one group of patients who underwent pelvic lymphadenectomy (PLX) and para-aortic lymphadenectomy (PALX) and who were for positive for pelvic node metastasis (PLNM) and negative for para-aortic node metastasis (PANM) (Group 1), one group of patients who underwent PLX alone and were positive for PLNM (Group 2) and one group of patients who underwent PLX and PALX and were positive for PANM (Group 3). Information on clinicopathologic findings and treatments was obtained from medical charts. Cox regression analysis was used to select prognostic factors.

Results

The 5-years survival rates were 89.3% in Group 1, 46.5% in Group 2 and 59.9% in Group 3. The overall survival rate in Group 1 was significantly better than that in Group 2 (p = 0.0001) and Group 3 (p = 0.0016). No significant difference in overall survival was found between Group 2 and Group 3. Age, number of metastatic lymph nodes, type of lymphadenectomy and type of adjuvant therapy were significantly and independently related to overall survival. Only when patients received PALX, PANM was a prognostic risk factor.

Conclusion

Sub-classification of stage IIIC would be functional for estimating prognosis in the revised FIGO staging system. Systematic lymphadenectomy including PALX has therapeutic significance for patients with stage IIIC endometrial cancer. Prognosis of patients with stage IIIC endometrial cancer would depend much more on application of lymphadenectomy including PALX than nodal status.     

甲氨蝶呤联合子宫动脉栓塞术后定点吸胚术治疗剖宫产术后子宫瘢痕妊娠51例临床分析

目的:探讨甲氨蝶呤(MTX)预处理联合子宫动脉栓塞术(UAE)后超声引导下定点吸胚术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效和最佳给药方法。方法:回顾性分析首都医科大学附属朝阳医院2011年1月—2014年12月收治的采用MTX预处理联合UAE后超声引导下定点吸胚术治疗的51例CSP患者资料,按MTX不同给药方式分为3组。A组(23例):MTX全身用药后行UAE,然后行定点吸胚术;B组(11例):MTX子宫动脉灌注化疗栓塞(UACE)后行定点吸胚术;C组(17例):MTX全身用药联合UACE,再行定点吸胚术。比较各组患者的基本信息、治疗前情况和术中情况,并评估治疗效果指标。结果:3组患者均一次性手术成功,无需腹腔镜手术等二次处理,无膀胱损伤、子宫穿孔和子宫切除等并发症发生。3组患者出血量、手术时间、血清人绒毛膜促性腺激素β亚单位(β-hCG)转阴时间、包块吸收时间、手术成功率和并发症发生率比较,差异无统计学意义(均P>0.05)。B组的住院时间和住院费用较另2组减少,差异有统计学意义(均P<0.05)。孕囊或包块最大直径在Logistic回归模型中有统计学意义(OR=1.094,95%CI:1.012～1.183,P=0.024)。结论:MTX预处理联合UAE后定点吸胚术疗效确切、手术难度小、创伤小且花费少,可广泛用于治疗内生型和外生型CSP,推荐UACE作为术前预处理的首选方式,该方法对于病灶最大直径<4.3 cm的患者更安全。     

The Use of a Combined Regimen of GnRH Agonist Plus a Low-Dose Oral Contraceptive Improves the Spontaneous Pulsatile LH Secretory Characteristics in Patients with Polycycstic Ovary Disease After Discontinuation of Treatment

Purpose: The fertility rate in women with polycystic ovarydisease (PCOD) is influenced by the type of treatmentreceived. The present study evaluated the possiblecorrelation between treatment and pulsatile release ofgonadotropins. Methods: Spontaneous episodic secretion of luteinizinghormone (LH) and follicle-stimulating hormone (FSH) andhormonal parameters were monitored before and after 1, 3, and6 months after treatments suspension. Twenty-four PCODpatients were randomnly divided into two groups of 12subjects. Group A was treated with gonadotropin-releasinghormone (GnRH)-analogue plus oral contraceptive (OC).Group B was treated only with OC. Both groups were treatedfor 6 months and followed up for 6 months. Results: In all subjects the therapeutic regimens reducedthe androgenic milieau and the gonadotropin plasma levels.Spontaneous pulsatile secretion of LH and FSH wassignificantly modified in both groups, but patients who receivedthe combined regimen showed a significantly greaterreduction of LH plasma levels and a significantly greater decreaseof LH pulse amplitude throughout the 6 months aftertreatment suspension. Ferriman=nGallway score and ovarianvolumes were significantly reduced in patients who receivedthe combined treatment than in the OC-treated patients. Conclusions: These data support the evidence of a higherefficacy of the combination of GnRH-a + OC than OC alonein restoring a normal and adequate spontaneous episodicgonadotropin discharge and in decreasingFerriman—Gallway score and ovarian volumes in patients with PCOD.     

黄体期个体化雌激素补充方案对IVF-ET治疗结局的影响

目的:探讨黄体期个体化添加不同剂量雌激素对体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响。方法:回顾性分析104个长方案控制性促排卵(COH)IVF-ET周期,根据其移植日血清E2水平下降幅度分为4组,A组:E2下降<30%,12个周期,单用黄体酮进行黄体期支持;B组:E2下降30%-39%,18个周期,黄体期支持采用黄体酮+3mg/d雌激素;C组:E2下降40%-49%,16个周期,D组:E2下降≥50%,58个周期,C组、D组患者黄体期支持采用黄体酮+4mg/d雌激素。结果:各组的取卵数目、受精率、卵裂率、优质胚胎数、内膜厚度和移植胚胎数相比差异均无显著性(P>0.05)。A组、B组、C组间胚胎种植率和临床妊娠率无统计学差异;而D组与其余3组比,胚胎种植率和临床妊娠率显著下降(P<0.05)。结论:①在长方案COH的IVF-ET中,当移植日血清E2水平下降幅度≥30%时黄体期支持补充雌激素可以改善胚胎种植率和临床妊娠率;②E2下降幅度大的患者可能需要增加雌激素的添加剂量。