Check J H, Dietterich C, Lurie D
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, USA.
Obstet Gynecol. 1995 Sep;86(3):341-5. doi: 10.1016/0029-7844(95)00165-N.
To determine whether successive cycles of clomiphene citrate affect endometrial thickness.
Thirty-four women presenting for treatment of anovulation, oligoovulation, or follicle maturation defects were given the smallest dose of clomiphene citrate necessary to attain a mature follicle. If no pregnancy ensued, the same dose was continued if a follicle 18-24 mm in diameter and a serum estradiol (E2) level greater than 200 pg/mL were achieved. Ethinyl E2 was supplemented for poor cervical mucus only. Endometrial thickness and echo patterns were measured each cycle at peak follicular maturation.
There was no difference in mean endometrial thickness during the first six cycles of therapy, nor was there a trend for thickness to increase or decrease with successive cycles with or without the addition of ethinyl E2. There was no change in the distribution of echo patterns with successive cycles of clomiphene citrate. Post-treatment measures of thickness and echo pattern did not differ from baseline pre-treatment values. The homogeneous hyperechogenic pattern was the rarest. Mean serum E2 and progesterone levels at mid-cycle did not change with successive cycles.
One proposed mechanism for the dichotomy between ovulation and pregnancy rates after clomiphene citrate therapy is that the drug adversely affects the endometrium. If clomiphene citrate does affect implantation adversely, the mechanism does not seem to be related to thinning the endometrium or causing an echo pattern that indicates a poor prognosis. The data also suggest that estrogen supplementation does not influence endometrial thickness and would best be used exclusively for hostile cervical mucus.
确定枸橼酸氯米芬连续周期治疗是否会影响子宫内膜厚度。
34名因无排卵、排卵稀少或卵泡成熟缺陷前来治疗的女性，给予能使卵泡成熟所需的最小剂量枸橼酸氯米芬。若未妊娠，当卵泡直径达到18 - 24 mm且血清雌二醇（E2）水平大于200 pg/mL时，继续使用相同剂量。仅在宫颈黏液不佳时补充乙炔雌二醇。在每个卵泡成熟高峰期测量子宫内膜厚度和回声模式。
治疗的前六个周期中，平均子宫内膜厚度无差异，无论是否添加乙炔雌二醇，随着连续周期的进行，厚度也无增加或减少的趋势。随着枸橼酸氯米芬连续周期治疗，回声模式分布无变化。治疗后厚度和回声模式的测量值与治疗前基线值无差异。均匀高回声模式最为罕见。周期中期平均血清E2和孕酮水平在连续周期中无变化。
枸橼酸氯米芬治疗后排卵率与妊娠率二分法的一种推测机制是该药物对子宫内膜有不利影响。如果枸橼酸氯米芬确实对着床有不利影响，其机制似乎与使子宫内膜变薄或产生提示预后不良的回声模式无关。数据还表明，补充雌激素不会影响子宫内膜厚度，最好仅用于宫颈黏液不良的情况。
