Sher G, Herbert C, Maassarani G, Jacobs M H
Department of Obstetrics/Gynecology, Pacific Presbyterian Medical Center, San Francisco, CA 94115.
Hum Reprod. 1991 Feb;6(2):232-7. doi: 10.1093/oxfordjournals.humrep.a137312.
This study reports on 330 women aged 29 to 45 years, who underwent 411 cycles of in-vitro fertilization and embryo transfer (IVF/ET). Vaginal sonograms were performed during the late proliferative phase of natural cycles and cycles of controlled ovarian hyperstimulation (COH) with gonadotrophins, to evaluate both the thickness and echogenicity of the endometrium. Findings classified as Grade I; characterized by homogeneous echogenicity of the endometrium, and Grade II; characterized by an outer peripheral layer of dense echogenicity surrounding a central sonolucent area (i.e. a 'halo pattern'). Grades I and II were subclassified on the basis of thickness into A (greater than or equal to 9 mm) and B (less than 9 mm). Grade IIA ('optimal') was associated with a clinical pregnancy rate per embryo transfer of 33% while Grades IA, IB and IIB ('poor') were associated with a rate of only 7%. Women aged 41-45 years experienced a 25% incidence of 'poor' sonographic grades while the incidence in women less than or equal to 40 years of age was 5%. The presence of various uterine pathologies was associated with 'poor' endometrial grades in 86% of cases while only 11% of normal uteri manifested 'poor' grades. 'Optimal' endometrial grades in natural cycles were consistently associated with 'optimal' grades in ensuing cycles of COH (96%). Women with 'poor' endometrial grades in natural cycles improved in 55% of cases during subsequent COH. The results of this study indicate that sonographic assessment of the endometrial lining in the late proliferative phase during both natural and COH cycles is a valuable method for screening and managing IVF/ET candidates.
本研究报告了330名年龄在29至45岁之间的女性，她们接受了411个周期的体外受精和胚胎移植（IVF/ET）。在自然周期以及使用促性腺激素进行控制性卵巢过度刺激（COH）的周期的增殖晚期进行阴道超声检查，以评估子宫内膜的厚度和回声性。检查结果分为I级，其特征为子宫内膜回声均匀；以及II级，其特征为中央无回声区周围有一层高回声外周层（即“晕圈模式”）。I级和II级又根据厚度细分为A（大于或等于9毫米）和B（小于9毫米）。IIA级（“最佳”）与每次胚胎移植的临床妊娠率33%相关，而IA级、IB级和IIB级（“不佳”）与仅7%的妊娠率相关。41至45岁的女性中“不佳”超声分级的发生率为25%，而年龄小于或等于40岁的女性中该发生率为5%。在86%的病例中，各种子宫病变的存在与“不佳”的子宫内膜分级相关，而只有11%的正常子宫表现为“不佳”分级。自然周期中“最佳”的子宫内膜分级与随后COH周期中的“最佳”分级始终相关（96%）。自然周期中子宫内膜分级“不佳”的女性在随后的COH期间，55%的病例情况有所改善。本研究结果表明，在自然周期和COH周期的增殖晚期对子宫内膜进行超声评估是筛选和管理IVF/ET候选者的一种有价值的方法。
