Chu Micheline C, Sauer Mark V
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH 16-29, New York, NY 10032, USA.
Arch Gynecol Obstet. 2005 Feb;271(2):184-6. doi: 10.1007/s00404-004-0677-z. Epub 2004 Oct 9.
A 31-year-old nulligravid woman seeking fertility treatment with in vitro fertilization and intracytoplasmic sperm injection failed to achieve pregnancy. Supernumerary embryos were cryopreserved for future use. In preparation for the transfer of the frozen embryos, the patient was prescribed hormones, which included pituitary down-regulation with leuprolide acetate, followed by oral micronized estradiol (E2) and vaginal progesterone (P4) suppositories. At the time of embryo transfer (ET) it was noted that the patient had misunderstood her instructions and was administering both her estrogen and progesterone vaginally. Ultrasound examination revealed a well-developed endometrium adequate for ET so the procedure was performed, and at that point she was instructed to use E2 orally as originally prescribed. Two weeks later, her beta-hCG was elevated, and subsequent ultrasound examinations revealed a twin gestation. The pregnancy progressed normally.
This patient's hormones were adequately replaced despite vaginal placement of oral medication. Although not commonly prescribed, oral E2 tablets may be administered vaginally in functionally agonadal women preparing for ET, and may serve as an alternative route for women who experience difficulties with oral formulations.
一名31岁未孕女性寻求体外受精和卵胞浆内单精子注射的生育治疗但未成功受孕。多余的胚胎被冷冻保存以备将来使用。在准备移植冷冻胚胎时，给患者开了激素药物，包括用醋酸亮丙瑞林进行垂体降调节，随后口服微粒化雌二醇（E2）和阴道用黄体酮（P4）栓剂。在胚胎移植（ET）时，注意到患者误解了医嘱，将雌激素和黄体酮都经阴道给药。超声检查显示子宫内膜发育良好，适合进行胚胎移植，于是进行了该操作，此时指示她按原医嘱口服E2。两周后，她的β - 人绒毛膜促性腺激素（β - hCG）升高，随后的超声检查显示为双胎妊娠。妊娠进展正常。
尽管口服药物经阴道给药，但该患者的激素得到了充分替代。虽然不常用，但对于准备进行胚胎移植的功能性腺功能减退女性，口服E2片可经阴道给药，对于口服制剂有困难的女性可作为一种替代途径。
