Shaaban M M, Segal S, Salem H T, Ghaneimah S A, Khalifa E A, Ahmed A G
Department of Obstetrics and Gynecology, School of Medicine, Assiut University, Egypt.
Fertil Steril. 1993 May;59(5):998-1002. doi: 10.1016/s0015-0282(16)55917-2.
To study the probability of ovulation and subclinical abortion during long-term use of Norplant and to assess the concomitant endometrial development.
This was a prospective nonrandomized comparative study. The ovaries and endometrium were assessed daily by ultrasonography during 59 menstrual cycles in 50 women who were using Norplant for > 1 year. Serum concentrations of E2, P, FSH, LH, pregnancy specific beta 1 glycoprotein (Sp1), and hCG were also daily measured. The findings were compared with those in 35 ovulatory cycles in normal fertile women not using contraception.
Clients of the Family Planning Clinic of Assiut University Hospital (Norplant users) and the hospital women staff (controls).
Sonographic and hormonal evidence of ovulation were observed in one third of Norplant users; two of them resulted in conception. However, the majority of these ovulatory cycles showed low midcycle peaks of E2, FSH, and LH and evidence of luteal phase defect (LPD). Excessive follicular enlargement was observed in 46% of the cycles. Norplant users had significantly thinner endometrium that did not exhibit the normal phasic changes in sonographic texture. Apart from conceptive cycles, no rise in Sp1 or hCG was observed.
Norplant acts mainly by inhibiting ovulation, but when this occurs, it is associated with LPD and subnormal endometrial development. Subclinical abortion does not contribute to the contraceptive effect.
研究长期使用左炔诺孕酮皮下埋植剂期间排卵及亚临床流产的概率，并评估同期子宫内膜的发育情况。
这是一项前瞻性非随机对照研究。对50名使用左炔诺孕酮皮下埋植剂超过1年的女性在59个月经周期中每天进行超声检查以评估卵巢和子宫内膜情况。同时每天测定血清雌二醇（E2）、孕酮（P）、促卵泡生成素（FSH）、促黄体生成素（LH）、妊娠特异性β1糖蛋白（Sp1）和人绒毛膜促性腺激素（hCG）的浓度。将结果与35名未使用避孕措施的正常育龄妇女的排卵周期结果进行比较。
阿斯尤特大学医院计划生育门诊的患者（左炔诺孕酮皮下埋植剂使用者）和医院女性工作人员（对照组）。
三分之一的左炔诺孕酮皮下埋植剂使用者有超声和激素方面的排卵证据；其中2人怀孕。然而，这些排卵周期中的大多数显示E2、FSH和LH的周期中期峰值较低，并有黄体期缺陷（LPD）的证据。46%的周期观察到卵泡过度增大。左炔诺孕酮皮下埋植剂使用者的子宫内膜明显更薄，且超声图像纹理未呈现正常的阶段性变化。除怀孕周期外，未观察到Sp1或hCG升高。
左炔诺孕酮皮下埋植剂主要通过抑制排卵起作用，但当发生排卵时，会伴有黄体期缺陷和子宫内膜发育异常。亚临床流产对避孕效果无贡献。
