Cortínez Armando, De Carvalho Iara, Vantman David, Gabler Fernando, Iñiguez Germán, Vega Margarita
Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
Fertil Steril. 2005 Jan;83(1):110-5. doi: 10.1016/j.fertnstert.2004.05.099.
To evaluate the clinical response and endometrial morphology during the implantation window on ovarian hyperstimulation with the aromatase inhibitor letrozole in infertile ovulatory women.
Prospective trial in infertile patients.
Tertiary care hospital.
PATIENT(S): Eight ovulatory infertile patient candidates for ovarian superovulation.
INTERVENTION(S): Subjects were monitored in one control cycle. In the next cycle, they received letrozole 5.0 mg daily on days 3 through 7 after menses.
MAIN OUTCOME MEASURE(S): Number of ovulatory follicles; dominant follicle diameter; endometrial thickness; hormonal profile of FSH, LH, E(2), A, T, and P; endometrial histological dating; and pinopode formation assessed by scanning electron microscopy.
RESULT(S): Cycles stimulated with letrozole resulted in more ovulatory follicles than did natural cycles (mean +/- SD 2.0 +/- 0.9 vs. 1.0 +/- 0.0), which attained a greater preovulatory diameter (mean +/- SD 23.8 +/- 2.7 vs. 19.3 +/- 2.1 mm), with similar endometrial thickness at midcycle compared with spontaneous cycles. Endocrine profile of medicated cycles was characterized on day 7 by increased levels of LH (5.9 +/- 0.8 vs. 3.5 +/- 0.4 IU/mL), reduced E(2) (98.4 +/- 11.4 vs. 161.5 +/- 14.7 pmol/L), and elevated androgens. Preovulatory and midsecretory E(2) were similar to spontaneous cycle, and P levels during midluteal phase were significantly elevated (44.2 +/- 4.6 vs. 27.7 +/- 4.6 pmol/L). Endometrial morphology during the implantation window in letrozole-stimulated cycles was characterized by in-phase histological dating and pinopode expression on scanning electron microscopy.
CONCLUSION(S): Letrozole induces moderate ovarian hyperstimulation in ovulatory infertile patients with E(2) levels similar to spontaneous cycles and higher midluteal P, leading to both a normal endometrial histology and development of pinopodes, considered to be relevant markers of endometrial receptivity.
评估芳香化酶抑制剂来曲唑对排卵功能正常的不孕女性进行卵巢过度刺激时，植入窗期的临床反应及子宫内膜形态。
针对不孕患者的前瞻性试验。
三级护理医院。
八名排卵功能正常且准备接受卵巢超促排卵的不孕患者。
受试者在一个对照周期内接受监测。在下一个周期，月经来潮后第3至7天，她们每天服用5.0毫克来曲唑。
排卵卵泡数量；优势卵泡直径；子宫内膜厚度；促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E₂）、雄烯二酮（A）、睾酮（T）和孕酮（P）的激素水平；子宫内膜组织学分期；以及通过扫描电子显微镜评估的微绒毛形成情况。
来曲唑刺激的周期比自然周期产生更多的排卵卵泡（平均±标准差：2.0±0.9 vs. 1.0±0.0），且卵泡在排卵前直径更大（平均±标准差：23.8±2.7 vs. 19.3±2.1毫米），与自然周期相比，周期中期的子宫内膜厚度相似。用药周期的内分泌特征在第7天时表现为LH水平升高（5.9±0.8 vs. 3.5±0.4 IU/mL）、E₂水平降低（98.4±11.4 vs. 161.5±14.7 pmol/L）以及雄激素水平升高。排卵前和分泌中期的E₂与自然周期相似，黄体中期的P水平显著升高（44.2±4.6 vs. 27.7±4.6 pmol/L）。来曲唑刺激周期的植入窗期子宫内膜形态表现为组织学分期同步，且扫描电子显微镜下有微绒毛表达。
来曲唑可使排卵功能正常的不孕患者产生中度卵巢过度刺激，E₂水平与自然周期相似，黄体中期P水平更高，从而使子宫内膜组织学正常且出现微绒毛，微绒毛被认为是子宫内膜容受性的相关标志物。
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