Coulam C B, Stern J J
Genetics & IVF Institute, Fairfax, VA 22031.
Clin Obstet Gynecol. 1994 Sep;37(3):730-44. doi: 10.1097/00003081-199409000-00024.
The role of endocrine factors as a cause of recurrent spontaneous abortion is controversial. Diabetes mellitus and thyroid disease do not represent a significant risk factor for recurrent pregnancy loss. Luteal-phase defect has been questioned because there are no accurate methods for diagnosis and no convincing evidence of correction with treatment exists. The corpus luteum is an unusual endocrine gland, highly diverse in function and important for successful reproduction in all mammalian species. Much controversy exists about the luteal function in humans and how defects in luteal function affects reproduction. Disagreement has been due to lack of accurate diagnosis and controlled studies to determine whether correction of the luteal-phase defect is worthwhile when treating female reproductive problems. The donor egg recipient model from assisted reproductive technology programs has shown that corpus luteum function can be replaced by estrogen and progesterone administration. The mechanism by which these steroids stimulate a uterus to be receptive to implantation of the embryo is not known. Several proteins produced by the endometrium are candidate markers for uterine receptivity. Further work needs to be done to correlate these markers with subsequent pregnancy outcome. A noninvasive marker for uterine receptivity is ultrasonographic evaluation of the endometrium. Although the sensitivity of this test is high (100%), its specificity is low (only 20% to 60%).
内分泌因素作为复发性自然流产病因的作用存在争议。糖尿病和甲状腺疾病并非复发性妊娠丢失的显著风险因素。黄体期缺陷一直备受质疑，因为尚无准确的诊断方法，且也没有令人信服的治疗后改善的证据。黄体是一种特殊的内分泌腺，功能高度多样，对所有哺乳动物物种的成功繁殖都很重要。关于人类黄体功能以及黄体功能缺陷如何影响生殖存在诸多争议。分歧源于缺乏准确的诊断和对照研究，无法确定在治疗女性生殖问题时纠正黄体期缺陷是否值得。辅助生殖技术项目中的供体卵接受者模型表明，通过给予雌激素和孕激素可以替代黄体功能。这些类固醇刺激子宫接受胚胎着床的机制尚不清楚。子宫内膜产生的几种蛋白质是子宫接受性的候选标志物。需要进一步开展工作，将这些标志物与后续妊娠结局相关联。子宫接受性的一种非侵入性标志物是子宫内膜的超声评估。尽管该检测的敏感性很高（100%），但其特异性较低（仅20%至60%）。
