Reproductive Biology, Toronto Centre for Advanced Reproductive Technology, the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, and the Department of Obstetrics and Gynecology, the Institute of Medical Sciences, and the Division of Reproductive Sciences, University of Toronto, Toronto, Ontario, Canada.
Obstet Gynecol. 2012 Aug;120(2 Pt 1):348-54. doi: 10.1097/AOG.0b013e31825ec2ee.
To estimate whether there is any association of long-term use of combined oral contraceptive pills (OCP) with adverse endometrial growth.
We reviewed the charts of 137 patients with history of OCP use undergoing endometrial preparation with estrogen for frozen embryo transfer. Endometrial thickness was measured by transvaginal ultrasonography on day 10 after menses and patients were divided into two groups (less than 7 mm and 7 mm or more).
Thirty patients had endometrial thickness less than 7 mm and 107 had thickness of 7 mm or more. Mean years of combined OCP use in each group were 9.8±4.54 and 5.8±4.52, respectively (P<.001). With 10 years of combined OCP use as the threshold, the difference between the two groups (63.35% users in less than 7 mm group compared with 28.04% in the 7 mm or more thickness group) was highly significant (P<.001 by Fisher exact test), with an odds ratio of 4.43 (95% confidence interval 1.89-10.41). Past use of 5 years of OCPs was also associated with a significant (P=.002) difference in endometrial thickness. The mean endometrial thicknesses on cycle day 10 in patients using combined OCP for less than 10 years and 10 years or more were 9.54±1.88 mm and 8.48±2.33 mm, respectively, with P=.007. The mean endometrial thickness was 9.72±1.69 mm in less than 5 years and 8.81±2.23 mm in 5 or more years of use, respectively (P=.008). Cycle cancellation rates in the less than 7 mm group and 7 mm or greater endometrial thickness group were 23% and 4%, respectively (P=.002), but there was no difference in the clinical pregnancy rates between the two groups (13% compared with 27%, respectively; P=.15).
Long-term combined OCP use (5 years or more) can potentially affect optimal endometrial growth, leading to a higher cancellation rate and longer stimulation in frozen embryo transfer cycles. These findings suggest a previously unidentified adverse effect of long-term combined OCP use in women who are anticipating future fertility.
II.
评估长期使用复方口服避孕药（OCP）是否与不良子宫内膜生长有关。
我们回顾了 137 名有 OCP 使用史的患者的图表，这些患者在进行冷冻胚胎移植前使用雌激素进行子宫内膜准备。在月经后第 10 天通过阴道超声测量子宫内膜厚度，并将患者分为两组（<7mm 和≥7mm）。
30 名患者的子宫内膜厚度<7mm，107 名患者的子宫内膜厚度≥7mm。每组 OCP 使用的平均年数分别为 9.8±4.54 和 5.8±4.52（P<.001）。以 10 年联合 OCP 使用为界，两组之间的差异（<7mm 组中 63.35%的使用者与≥7mm 组中 28.04%的使用者）具有高度显著性（Fisher 确切检验 P<.001），优势比为 4.43（95%置信区间 1.89-10.41）。OCP 过去使用 5 年也与子宫内膜厚度显著相关（P=.002）。使用 OCP 少于 10 年和 10 年或更长时间的患者在周期第 10 天的平均子宫内膜厚度分别为 9.54±1.88mm 和 8.48±2.33mm，P=.007。使用 OCP 少于 5 年的平均子宫内膜厚度为 9.72±1.69mm，使用 OCP 5 年或更长时间的平均子宫内膜厚度为 8.81±2.23mm，P=.008。<7mm 组和≥7mm 子宫内膜厚度组的周期取消率分别为 23%和 4%（P=.002），但两组的临床妊娠率无差异（分别为 13%和 27%；P=.15）。
长期（5 年或以上）联合 OCP 使用可能会影响子宫内膜的最佳生长，导致冷冻胚胎移植周期的取消率更高，刺激时间更长。这些发现提示长期联合 OCP 使用对计划未来生育的女性存在以前未识别的不良影响。
II。
