仿生物电刺激治疗薄型子宫内膜不孕症患者自然妊娠结局的回顾性分析

目的 分析薄型子宫内膜不孕症患者采用仿生物电刺激治疗的自然妊娠情况及其妊娠结局,为优化薄型子宫内膜治疗方案提供理论依据.方法 回顾性分析46例22～35岁采用仿生物电刺激治疗薄型子宫内膜不孕症计划内自然妊娠患者的临床资料.结果 相比治疗前,治疗后患者子宫内膜厚度明显增厚,子宫动脉血流阻力指数、搏动指数均明显下降,A型子...     

薄型子宫内膜的临床处理进展

有着床能力的胚胎、容受性良好的子宫内膜以及胚胎和母体的相互作用是胚胎成功种植的主要因素。子宫内膜厚度仍是目前临床评价子宫内膜容受性的重要指标。月经周期中子宫内膜厚度可以反映内膜功能状态,子宫内膜充分的增殖和向分泌期转化是胚胎成功着床的前提条件之一。目前一致认为,薄型子宫内膜显著降低胚胎种植率,此外,薄型子宫内膜也是导致女性不孕的重要原因之一。因此,探索薄型子宫内膜的病因并积极治疗、提高子宫内膜的容受性非常重要。对妨碍胚胎种植的子宫内膜进行预处理,通过治疗使子宫内膜增加至正常厚度,将有助于提高妊娠率及活产率。然而,目前薄型子宫内膜的治疗方法大多效果不理想。综述薄型子宫内膜的定义、病因及临床处理研究进展。     

补肾疏肝法对子宫内膜薄型不孕症患者的治疗效果

目的 探讨补肾疏肝法对不孕症中薄型子宫内膜的影响。方法 选取薄型子宫内膜不孕患者80例,以随机数字表法分为对照组和研究组,各40例。对照组采用西医治疗,研究组在上述基础上增加补肾疏肝法。比较两组治疗后有效率,治疗前后子宫内膜厚度、卵巢血流。结果 治疗后,研究组总有效率为95.00%,高于对照组的72.50%;与治疗前比,治疗后两组PI指数、RI指数均降低,且观察组低于对照组;内膜厚度则升高,观察组高于对照组,差异具有统计学意义（P<0.05）。结论 经补肾疏肝法治疗后,子宫内膜薄型不孕患者的子宫内膜容受性、卵巢血流参数均可改善,且疗效显著。     

麒麟丸联合芬吗通对薄型子宫内膜厚度、血流和妊娠率的影响

目的:观察麒麟丸联合芬吗通对薄型子宫内膜厚度及类型、血流和妊娠率的临床疗效。方法:前瞻性研究76例薄型子宫内膜不孕患者,随机分为对照组和研究组各38例,对照组经阴道给予芬吗通,研究组在对照组的基础上联合口服麒麟丸进行治疗。比较对照组和研究组治疗3个周期后子宫内膜厚度、类型、血流、血雌激素(E2)浓度情况和治疗半年后的自然妊娠率。结果:对照组和研究组治疗3个周期后的子宫内膜厚度、类型、血流、E2浓度情况均有明显改善(P0.05),且研究组子宫内膜厚度和血流优于对照组,差异均有统计学意义(P0.05);治疗半年后自然妊娠率研究组显著高于对照组(52.6%vs 28.9%),差异有统计学意义(P0.05);研究组和对照组中妊娠患者子宫内膜厚度、类型、血流分别与本组中未妊娠患者比较,差异均有统计学意义(P0.05)。结论:麒麟丸联合芬吗通治疗因子宫内膜薄而致的不孕,可有效改善子宫内膜厚度及血流,提高治疗半年后的自然妊娠率。     

辅助生殖技术中薄型子宫内膜的诊断标准与临床处理

薄型子宫内膜是指子宫内膜厚度＜7mm，病因可分为机能性、病理性及原因不明性，常见于药物副反应、宫腔粘连及子宫肌层病变。明确病因、修复子宫内膜是胚胎移植的实施条件，但对反复薄型子宫内膜尚难以统一病因诊断和针对性处理，故多建议联合治疗。     

粒细胞集落刺激因子对子宫内膜作用的研究

子宫内膜容受性(ER)是胚胎着床的重要因素,薄型子宫内膜(thin endometrium)是导致ER差的原因之一。薄型子宫内膜的发病机制、内膜厚度及血流灌注都与其胚胎移植的成功率息息相关,因此薄型子宫内膜的治疗显得尤为重要。近年来的一些研究证实了粒细胞集落刺激因子(G-CSF)在子宫内膜修复方面起到了积极的促进作用,探讨总结粒细胞集落刺激因子对子宫内膜的修复机制对胚胎移植适应症及临床应用具有重要意义。     

中药直肠滴入联合温针灸治疗肾虚血瘀型薄型子宫内膜不孕症的效果分析

目的 评价中药直肠滴入联合温针灸治疗肾虚血瘀型薄型子宫内膜不孕症的效果。方法 选取232例肾虚血瘀型薄型子宫内膜不孕症患者,依据双色球法将其分为治疗组与对照组,每组116例。对照组采用西药治疗,治疗组采用中药直肠滴入联合温针灸治疗。比较两组患者子宫内膜厚度、子宫动脉指标及中医证候评分。结果 治疗组治疗后子宫内膜厚度（9.53±1.71）mm明显厚于对照组的（7.92±1.64）mm(P<0.05)。治疗组治疗后子宫动脉搏动指数、子宫动脉阻力指数均低于对照组（P<0.05）。治疗组治疗后中医证候评分低于对照组（P<0.05）。结论 中药直肠滴入联合温针灸治疗有助于改善肾虚血瘀型薄型子宫内膜不孕症患者子宫动脉指标及子宫内膜厚度,缓解临床症状,值得临床推广与应用。     

薄型子宫内膜性不孕的诊治进展

子宫内膜容受性是妊娠成功的重要影响因素,子宫内膜过薄会影响胚胎着床,进而导致不孕。薄型子宫内膜的发病机制尚未完全明确,其病因主要包括年龄、内分泌因素及子宫内膜损伤等。临床针对此类疾病的治疗方法多种多样,本文就薄型子宫内膜性不孕的诊治进展进行综述。     

富血小板血浆促子宫内膜增殖对妊娠结局的影响

目的:探讨富血小板血浆(PRP)促子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的应用价值。方法:选择薄型子宫内膜患者94例,其中53例予PRP治疗(PRP组),于冷冻胚胎移植周期中给予PRP宫腔内灌注治疗,另41例未予PRP治疗(对照组)。ELISA法检测PRP组中PRP与全血中血小板计数(PLT)、血小板源生长因子(PDGF)-AB、PDGF-BB及转化生长因子β(TGF-β)的表达量,并比较PRP组与对照组黄体酮日子宫内膜厚度、胚胎种植率、生化妊娠率、临床妊娠率,同时采用Logistic多变量逻辑回归分析变量因素与妊娠结局的相关性。结果:153例行PRP宫腔内灌注的患者术后均未出现不良反应,制备的PRP中PLT、PDGF-AB、PDGF-BB及TGF-β表达量均较全血中明显升高(P0.01)。2PRP组黄体酮日子宫内膜可达7.56±0.38 mm,较对照组6.41±0.36 mm明显升高,差异有统计学意义(P0.05)。PRP组生化妊娠率、临床妊娠率、胚胎种植率均比对照组明显升高(P0.05)。3Logistic回归分析结果示,子宫内膜厚度与妊娠率有关(OR 1.48,95%CI 1.04~2.21,P0.05);PRP与妊娠率有关(OR 3.16,95%CI 1.48~6.74,P0.05)。结论:制备的PRP达到治疗标准,结果满意。PRP具有促进子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的临床效果,可作为菲薄子宫内膜的临床治疗中一种安全、有效的方法。     

辅助生殖技术周期中薄型子宫内膜的相关机制及临床对策

在人类辅助生殖技术(ART)周期中,子宫内膜容受性是胚胎植入并获得妊娠的关键条件,然而临床工作中,ART周期中子宫内膜薄、子宫内膜反应不良的问题一直困扰着众多临床医生。其病因需结合患者年龄、促排方案及完善宫腔镜检查排除宫腔粘连等综合考虑。同时,参阅众多文献报道的相关方案,考虑在大剂量雌激素治疗的基础上结合其他相关改善局部微循环药物联合用药,如阿司匹林、维生素E、枸橼酸西地那非及集落刺激因子等,供临床总结、参考,以改善ART周期中内膜反应不良的状态、提高临床妊娠率。但目前薄型子宫内膜的临床处理疗效仍欠满意,单纯子宫内膜薄、子宫内膜反应不良的机制及其临床方案的优化等相关问题仍需要进一步的深入探讨。     

The thin endometrium in assisted reproductive technology: An ongoing challenge

Thin endometrium is identified to adversely affect reproductive success rates after assisted reproductive technology (ART). Several treatment modalities have been presented to patients with thin endometrium, to improve endometrial thickness and the subsequent endometrial receptivity. These approaches comprising hormonal management by estradiol, tamoxifen, human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (GnRH) agonist, vasoactive agents such as aspirin, vitamin E, pentoxifylline, nitroglycerin and sildenafil, intra-uterine infusion of growth factor such as Granulocyte Colony Stimulating Factor (G-CSF) and the latest application of platelet-rich plasma, electrical stimulation, regenerative medicine and presentation of endometrial receptivity array. In spite of the large variety of treatment, most of the choices achieve only minor modification in the endometrium thickness and have not been validated so far. Treatment of thin endometrium remains a challenge and future enormous investigations are required to further clarification and ideal management of patients with thin endometrium.     

Evaluation of granulocyte colony-stimulating factor on the treatment of thin endometrium during frozen-thawed embryo transfer cycles: a retrospective cohort study

Abstract

The aim of this study was to evaluate the effect of granulocyte colony-stimulating factor (G-CSF) on thin endometrium (≤7?mm) in women undergoing frozen-thawed embryo transfer (FET). This retrospective cohort study includes 271 infertile patients with thin endometrium. 117 patients who received intrauterine perfusion of G-CSF before the day of administration of progesterone were defined as G-CSF group, whereas 154 patients who refused to use G-CSF treatment were defined as control group. In the G-CSF group, significantly higher endometrial thickness was observed after G-CSF perfusion (p?<?.001). When we divided the G-CSF group into two subgroups according to whether they conceived, the endometrial thickness increased from 6.02?±?0.92?mm to 6.98?±?1.20?mm in the conception group (p?<?.001) and from 6.21?±?0.96?mm to 6.87?±?1.16?mm in the non-conception group (p?<?.001). However, there were no significant differences between the two subgroups in respect to the endometrial thickness both before and after G-CSF perfusion. The implantation rate, hCG positive rate and clinical pregnancy rate were similar between G-CSF group and control group. Thus, our study fails to demonstrate that G-CSF has the potential to improve pregnancy outcome but has the potential to increase endometrial thickness of the women with thin endometrium in FET cycles.     

Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF)

The texture and the thickness of the endometrium as assessed by transvaginal sonography were prospectively evaluated in 123 patients undergoing IVF treatment. Three different types of endometrial patterns could be distinguished: (A) an entirely homogeneous, hyperechogenic endometrium; (B) an intermediate type characterized by the same reflectivity of ultrasound as the myometrium, with a nonprominent or absent central echogenic line; and (C) a multilayered endometrium consisting of prominent outer and midline hyperechogenic lines and inner hypoechogenic regions. On the day before oocyte retrieval, endometrial thickness was significantly greater in the group of patients who achieved pregnancy than in the group who did not (8.7±0.4 vs 7.5±0.2 mm, respectively; P<0.01) and significantly more patients had multilayered, pattern C, endometrium (75% in pregnant women vs 42.4% in nonpregnant women; P<0.01). No pregnancy occurred when the endometrial thickness was less than 6 mm. When type C endometrium >-6 mm thick was seen, the pregnancy rate per embryo transfer was 39%. When type A or B endometrial pattern was seen, the negative predictive value for the occurrence of pregnancy was 90.5%. Our results suggest that transvaginal sonographic evaluation of endometrial texture and thickness may be an indicator of the likelihood of achieving pregnancy.     

Management of thin endometrium in assisted reproduction: a clinical practice guideline from the Canadian Fertility and Andrology Society

The impact and management of thin endometrium is a common challenge for patients undergoing assisted reproduction. The objective of this Canadian Fertility and Andrology Society (CFAS) guideline is to provide evidence-based recommendations using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework on the assessment, impact and management of thin endometrium in assisted reproduction. The effect of endometrial thickness on pregnancy and live birth outcomes in ovarian stimulation and IVF (fresh and frozen cycles) is addressed. In addition, recommendations on the use of adjuvants to improve endometrial thickness and pregnancy outcomes are provided.     

The dynamics of endometrial growth and the triple layer appearance in three different controlled ovarian hyperstimulation protocols and their influence on IVF outcomes

The impact of endometrial growth to the triple layer, endometrial thickness, and echogenicity on IVF outcomes was investigated in the study. A retrospective analysis of 583 ICSI patients was conducted: 385 with a long GnRH agonist protocol, 114 with a short GnRH agonist, and 84 with a GnRH antagonist protocol. The progression of endometrial growth to the appearance of the triple layer, endometrial thickness, and echogenicity was compared between protocols. At least one high quality blastocyst was transferred in a double embryo transfer. The time of the appearance of the endometrial triple layer was statistically significant for the pregnancy rate only in the GnRH antagonist protocol. The endometrial thickness on the day of the appearance of the triple layer had a statistically significant influence on the pregnancy rate in the GnRH antagonist and in the long GnRH agonist protocols. The highest pregnancy rate for the long GnRH agonist and the GnRH antagonist protocols was observed when the endometrium thickness was 12–13?mm (61.6% and 58.8%, respectively). The endometrial echogenicity had a significant influence on the pregnancy rate only in the long GnRH agonist protocol. Endometrial features could be helpful parameters in IVF outcomes in particular controlled ovarian hyperstimulation protocols.     

Alteration of sonographic texture of the endometrium in post-menopausal bleeding. A guide to further management

BACKGROUND: The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling. METHODS: Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology. RESULTS: Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm. CONCLUSION: This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.     

The validity of transvaginal ultrasound measurement of endometrial thickness: a comparison of ultrasound measurement with direct anatomical measurement

OBJECTIVES: To compare transvaginal ultrasound measurements of endometrial thickness with direct anatomical measurements and consider the implications of these findings on clinical practice. DESIGN: Prospective observational study using two modalities blinded to each other's findings. SETTING: Singleton Hospital, Swansea, a medium-sized District General Hospital. SAMPLE: Forty-seven women admitted for hysterectomy. METHODS: All women underwent transvaginal ultrasound scan to measure the endometrial thickness within 16 hours of surgery. Anatomical measurement of the fresh specimen was carried out immediately after surgery. MAIN OUTCOME MEASURES: Agreement between ultrasound and anatomical measurements of the endometrial thickness. RESULTS: No ultrasound measurement was possible in 15% of patients. When both values were obtained, transvaginal ultrasound measurements were > 2 mm different from the ruler measurement in 13/40 (33%) with an obvious tendency of the ultrasound scan to over-estimate the endometrial thickness. The mean difference between the two measurements was -0.8 mm (limits of agreement -7.1 to +5.5 mm). The discrepancy was greater in women with endometrial thickness < or = 5 mm (-1.6 mm, limits of agreement -5.7 to +2.6 mm) compared with that in women with endometrial thickness > 5 mm (-0.2 mm, limits of agreement -7.6 to +7.2 mm). Kappa statistics showed good agreement between the two measurements in discriminating between thin and thick endometrium in 77% (kappa = 0.55). Transvaginal ultrasound misdiagnosed a thick endometrium as thin in 3/40 (8%) and misdiagnosed a thin endometrium as thick in 6/40 (15%). CONCLUSIONS: Transvaginal ultrasonography is of limited value as a screening test for abnormal endometrium in patients with postmenopausal bleeding if the only parameter of normality is an endometrial thickness of 5 mm or less.     

First case successful twin pregnancy by transdermal therapy for patients with 5.0 mm thick endometrium during frozen-thawed embryo transfer: a case report

Abstract

We reported the first case of thin endometrium patient with twin conceived via transdermal therapy during frozen-thawed embryo transfer (FET). The patient used Progynova administration to preparate endometrium in the first FET cycle. The endometrial thickness was 5.0?mm after 10 days of Progynova administration, the cycle was cancelled. In the second FET cycle, the transdermal therapy was used to support the endometrial development. The endometrial thickness reached 7.6?mm, two embryos were transferred on the day 4 of progesterone intramuscularly. The patient was carrying twins for nine months. There is a speculation that transdermal therapy may be effective for patients with thin endometrium during FET and provide a new method of clinical treatment.     

Endometrial evaluation with transvaginal ultrasound during hormone therapy: a prospective multicenter study

OBJECTIVE: To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium. DESIGN: Prospective multicenter study. SETTING: University and general hospitals outpatient centers. PATIENT(S): Postmenopausal women (702) on HT. INTERVENTION(S): Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding. MAIN OUTCOME MEASURE(S): Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness >4.5 mm (precision scale 0.5 mm). RESULT(S): Endometrial thickness >4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding. CONCLUSION(S): Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium.     

Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

AIM: To assess the role of measuring endometrial thickness by transvaginal ultrasonography (TVS) as a screening tool for abnormal uterine bleeding triage in premenopausal women. METHODS: Between November 2002 and October 2004, endometrial thickness was measured by TVS in 111 premenopausal women with non-cyclic abnormal uterine bleeding before dilatation and curettage. RESULTS: Of the 111 women, 31 (27.9%) had an abnormal endometrium (hyperplasia 13.5%, polyps 5.4%, submucous myoma 5.4%, and adenocarcinoma 3.6%). An endometrial thickness of 8 mm showed optimal sensitivity and specificity (83.9% and 58.8%, respectively) and 90.4% negative predictive value (NPV) for an abnormal endometrium. When submucous myoma was excluded, the sensitivity, specificity, and NPV were 80%, 53.8%, and 89.6%, respectively. CONCLUSION: Endometrial thickness of 8 mm or less is less likely to be associated with malignant pathologies in premenopausal uterine bleeding.