Tesarik Jan, Hazout André, Mendoza Carmen
MAR&Gen, Molecular Assisted Reproduction and Genetics, Gracia 36, 18002 Granada, Spain.
Reprod Biomed Online. 2003 Jul-Aug;7(1):59-64. doi: 10.1016/s1472-6483(10)61729-4.
Previous studies have suggested that LH, in addition to its well-known effects on the ovary, may exert direct effects on the uterus. This study evaluated the effects of mid-cycle administration of human chorionic gonadotrophin (HCG), which signals through the LH receptor, on endometrial thickness and uterine receptivity in two groups of women lacking ovarian activity and receiving embryos from an oocyte donation programme. Patients in one group still had ovulatory cycles, but their ovarian function was suppressed by pituitary down-regulation with a gonadotrophin-releasing hormone (GnRH) agonist in the embryo transfer cycle, resulting in low endogenous LH concentrations. Patients in the other group were menopausal women whose pituitary function was not down-regulated in the embryo transfer cycle and whose endogenous LH concentrations were thus high. Patients in each of the two groups were randomized into two subgroups. Patients in one subgroup were given 5000 IU of HCG 2 days before oocyte recovery in the corresponding donor. Patients in the other subgroup received placebo at the same time. Oocytes from each donor were randomly distributed between one patient from the HCG subgroup and one patient from the placebo subgroup in each patient group. Endometrial growth and secretory transformation were stimulated by sequential treatment with oestradiol valerate and progesterone. In women with low endogenous LH receiving placebo, endometrial thickness stopped increasing at the beginning of secretory transformation. Mid-cycle HCG administration resulted in a continuous increase in endometrial thickness through this period, improved the implantation rate after embryo transfer in these women (30.6 versus 20.7%) and augmented the number of multiple pregnancies. No similar stagnation of endometrial thickness and no effects of mid-cycle HCG administration on endometrial thickness, the implantation rate and the number of multiple pregnancies were found in women with high endogenous LH. It is concluded that endometrial maturation is disturbed in women with low endogenous LH but can be rescued by mid-cycle stimulation of LH receptor with exogenous HCG in the absence of ovarian activity.
先前的研究表明，促黄体生成素（LH）除了对卵巢有众所周知的作用外，可能还对子宫有直接影响。本研究评估了在两组缺乏卵巢活性且接受卵母细胞捐赠计划胚胎的女性中，通过促黄体生成素受体发挥信号作用的人绒毛膜促性腺激素（HCG）在月经周期中期给药对子宫内膜厚度和子宫容受性的影响。一组患者仍有排卵周期，但在胚胎移植周期中，其卵巢功能通过使用促性腺激素释放激素（GnRH）激动剂进行垂体降调节而受到抑制，导致内源性LH浓度较低。另一组患者为绝经后女性，其垂体功能在胚胎移植周期中未被降调节，因此内源性LH浓度较高。两组中的每一组患者又被随机分为两个亚组。一个亚组的患者在相应供体卵母细胞回收前2天给予5000 IU的HCG。另一个亚组的患者在同一时间接受安慰剂。每个供体的卵母细胞在每个患者组中随机分配给HCG亚组的一名患者和安慰剂亚组的一名患者。通过戊酸雌二醇和孕酮的序贯治疗刺激子宫内膜生长和分泌转化。在内源性LH水平低且接受安慰剂的女性中，子宫内膜厚度在分泌转化开始时停止增加。月经周期中期给予HCG导致在此期间子宫内膜厚度持续增加，提高了这些女性胚胎移植后的着床率（30.6%对20.7%），并增加了多胎妊娠的数量。在内源性LH水平高的女性中，未发现子宫内膜厚度有类似的停滞现象，且月经周期中期给予HCG对子宫内膜厚度、着床率和多胎妊娠数量均无影响。结论是，内源性LH水平低的女性子宫内膜成熟受到干扰，但在无卵巢活性的情况下，通过月经周期中期用外源性HCG刺激LH受体可使其得到挽救。
