不明原因不孕患者着床窗期子宫内膜形态结构与性激素及其受体表达

目的:研究着床窗期子宫内膜形态结构与性激素及其受体表达判断不明原因不孕患者的子宫内膜条件及黄体功能。方法:活检不明原因不孕55例及正常生育16例着床窗期子宫内膜行组织学天数及组织学分型;内膜扫描电镜观察胞饮突。检测黄体功能缺陷8例及子宫内膜反应不良6例着床窗期内膜性激素及其受体。结果:不孕组内膜的发育同步率(63.6%)明显低于正常生育组(93.8%),差异有统计学意义(P<0.05)。不孕组子宫内膜胞饮突数量少,且发育明显滞后于正常生育组。黄体功能缺陷患者着床窗期子宫内膜孕激素受体表达与正常生育组无统计学差异(P>0.05);子宫内膜反应不良患者孕激素受体表达明显低于正常生育组,差异有统计学意义(P<0.05)。结论:着床窗期子宫内膜发育同步性差,内膜容受性欠佳可能是部分不明原因不孕的病因之一。鉴别由黄体功能缺陷抑或子宫内膜反应不良引起的分泌期子宫内膜发育不良,是临床选择治疗方案的关键。

Study on endometrial morphologic changes, sex hormone and sex hormone receptors at the implantation window of the unexplained infertile women

Objective:To study the relationship between endometrial morphologic changes,sex hormone and sex hormone receptors at the implantation window of the unexplained infertile women,in order to explore the condition of endometrium and luteal function.Methods:Fifty five infertile women and sixteen normal women underwent endometrial biopsy to explore the histological dating and histological type,and explore pinopode by scanning electron microscope at the implantation window.Estrogen receptors and progesterone receptors in the endometrium were determined in 8 cases of luteal phase deficiency(LPD) and 6 cases of inadequate endometrial response(IER).Results:The infertile group(63.6% is synchronism) of glandular-stromal development showed worse than the the normal group(93.8% is synchronism).Compared with the normal women,the pinopode coverage in infertile women was deficient,and the pinopode development was delayed.There was no difference of progesteron receptor expression at the implantation window between LPD group and normal group(P>0.05).Progesteron receptor expression in IER group was significantly lower than that of normal group(P<0.05).Conclusion:The deficiency of endometrial synchronism and endometrial receptivity may be factors resulting in of the unexplained infertile women.Identification of the causes of the poor endometrial development at implantation window is the key point for clinical treatment.