Baracat Maria Candida P, Baracat Edmund C, Simões Ricardo S, Simões Manuel J, Maciel Gustavo A R, Azziz Ricardo, Soares José Maria
Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403 000, Brazil.
Department of Obstetrics & Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Diagnostics (Basel). 2023 Jan 19;13(3):382. doi: 10.3390/diagnostics13030382.
Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14-28 of the next cycle. A second EB was performed between days 21-24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. ( < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS.
激素和代谢因素可能会影响子宫内膜质量，并干扰孕酮的作用。因此，我们研究的目的是解决这个问题。参与者从一所学术性三级医疗中心的门诊生殖内分泌诊所招募。所有受试者在治疗前的月经周期卵泡期接受子宫内膜活检（EB）。此后，在下一个周期的第14 - 28天，他们接受微粉化孕酮治疗（400毫克/天，经阴道给药10天）。在月经周期的第21 - 24天（第二阶段）进行第二次EB。在着床窗口期评估代谢和激素血清水平。EB样本使用光学显微镜进行组织形态计量学分析。与对照组相比，多囊卵巢综合征（PCOS）女性在第二阶段的子宫内膜显示出表面上皮均匀，白细胞浸润较少且无凋亡细胞（<0.021）。PCOS组第二阶段表面上皮的厚度与游离和生物可利用睾酮值呈正相关。基质细胞数量随着胰岛素水平的升高而增加。我们的结果表明，尽管PCOS患者补充了孕酮，但子宫内膜的组织形态计量学异常仍然存在，并且与雄激素和胰岛素水平有关。
