经阴道补充雌激素对促排卵期薄型子宫内膜的影响

目的:探讨经阴道补充雌激素对促排卵期薄型子宫内膜的影响。方法:将经B超监测有排卵发生但子宫内膜厚度7 mm的不孕患者随机分为对照组(CC组)和治疗组,治疗组又分成补佳乐组(CC+口服补佳乐)、芬吗通组(CC+芬吗通雌二醇片阴道用药)、联合用药组(CC+口服补佳乐及芬吗通雌二醇片阴道用药),观察内膜厚度增幅、类型、用药48 h后血雌激素浓度及妊娠率。结果:共纳入患者110例,对照组20例,治疗组90例,其中补佳乐组28例,芬吗通组28例,联合用药组34例。治疗组患者用药前、后子宫内膜增幅分别为2.3±0.3 mm、2.1±0.2 mm、2.9±0.2 mm;A型内膜比例分别为53.57%、46.43%、67.64%;用药48 h后血雌激素浓度分别为1 141.5±246.4 pmol/L、1 220.3±247.7 pmol/L、1 746.8±247.3 pmol/L;妊娠率分别为14.29%、17.86%、26.47%,均大于对照组,差异有统计学意义(P0.05)。用药48 h后直径15 mm的卵泡个数分别为1.1±0.5、1.2±0.5、1.2±0.5、1.1±0.5,对照组与治疗组间无统计学差异(P0.05)。联合用药组子宫内膜厚度、A型内膜比例、用药48 h后血雌激素浓度、妊娠率均大于补佳乐组和芬吗通组,差异有统计学意义(P0.05)。结论:经阴道补充雌激素可一定程度上提高血雌激素浓度,改变子宫内膜容受性,有助于胚胎着床,提高妊娠率,从而改善妊娠结局。

Effect of Vaginal Estrogens Administration on Proliferative Thin Endometrium in Ovulation Induction

Objective： To assess the vaginal administration of estrogens on the development of the thin endometrium. Methods： By the B ultrasound monitoring, the patients whos ovulation occurred but the endometrial thickness 〈7 mm were randomly divided into control group, treatment group： progynova group （estrogen supplement of oral progynova estrogen pills）, femonston group （estrogen supplement of femonston vaginal irrigation）, combination group （estrogen supplemental of oral progynova and femonston vaginal irrigation）, then observe the endometrial thickness, type, estrogen in 48 h, and pregnancy rate were observed. Results： A total of 110 patients were included 20 cases in the control, 90 cases in the treatment group, 28 cases in progynova group, 28 cases in femonston group, 34 cases in combined treatment group. The amplification of endometrial growth after the treatment （2.27 ± 0.33 mm, 2.14 ± 0.23 mm, 2.89 ± 0.22 mm）, the ratio of type A endometrium （53.57%, 46.43%, 67.64%）, the value of estrogen in 48 h （1 141.50 ± 246.41 pmol/L, 1 220.29 ± 247.73 pmol/L, 1 746.76 ± 247.28 pmol/L） and the pregnancy rate （14.29%, 17.86%, 26.47%） of the patients in treatment group were higher than those in the control, the data had significant differences （P〈0.05）. The endometrial thickness, the ratio of type A endometrium, the value of estrogen in 48 h, the pregnancy rate of combination group were more than progynova group and femonston group, there were significant differences （P〈0.05）. Conclusion： To a certain extent, the vaginal estrogen supplyment can improve the blood concentration of estrogen, and change the endometrial receptivity, so as to improve the outcome of pregnancy.