Molloy D, Martin M, Speirs A, Lopata A, Clarke G, McBain J, Ngu A, Johnston I H
Fertil Steril. 1987 Mar;47(3):450-5. doi: 10.1016/s0015-0282(16)59054-2.
It is now possible to identify and study the performance of different subgroups of patients in in vitro fertilization (IVF) programs. Patients with severe pelvic adhesions due to pelvic inflammatory disease (PID) or endometriosis were classed as having a frozen pelvis if less than or equal to 20% of total ovarian surface was visible and if the rest of the ovary was bound down with significant adhesions. IVF offers the only hope of pregnancy for these patients. Fifty-one treatment cycles in 23 such patients were matched against 51 cycles in 48 patients with adhesion-free ovaries. The study group had a significantly higher number of cancelled oocyte retrievals because of poor estradiol (E2) response. They also had a significantly lower rate of E2 rise and a lower peak value of E2 before and after the administration of human chorionic gonadotropin. These patients took longer to respond to a hyperstimulation regime, and when a response occurred they formed fewer follicles, as measured with the use of ultrasound. Lower numbers of oocytes were obtained from this group, but the fertilization rate of oocytes was the same for both groups. One pregnancy occurred in the study group and 11 in the control group. It is possible that disruption of ovarian blood supply or mechanical factors due to the pressure of significant adhesions prevent a good follicular response in patients with a frozen pelvis.
现在已经能够识别和研究体外受精（IVF）项目中不同亚组患者的表现。因盆腔炎（PID）或子宫内膜异位症导致严重盆腔粘连的患者，如果可见的卵巢总面积小于或等于20%，且卵巢其余部分被大量粘连束缚，则被归类为患有“冰冻骨盆”。体外受精为这些患者提供了唯一的怀孕希望。对23例此类患者的51个治疗周期与48例卵巢无粘连患者的51个周期进行了匹配。研究组因雌二醇（E2）反应不佳而取消取卵的次数明显更多。他们的E2上升率也显著更低，在注射人绒毛膜促性腺激素前后E2的峰值也更低。这些患者对超促排卵方案的反应时间更长，而且当出现反应时，通过超声测量发现他们形成的卵泡更少。该组获得的卵母细胞数量较少，但两组卵母细胞的受精率相同。研究组有1例妊娠，对照组有11例妊娠。卵巢血液供应中断或由于大量粘连的压迫导致的机械因素可能会妨碍“冰冻骨盆”患者产生良好的卵泡反应。
