Sauer M V, Miles R A, Dahmoush L, Paulson R J, Press M, Moyer D
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033.
J Assist Reprod Genet. 1993 Jan;10(1):47-52. doi: 10.1007/BF01204440.
Our objective was to characterize the endometria of women of various ages placed on similar estrogen/progesterone replacement regimens prior to attempted donor embryo transfer using histologic, ultrasonographic, and steroid receptor markers in order to determine if advancing age has a detrimental effect on uterine responsiveness to pharmacologic sex steroid replacement therapy.
This was a prospective open clinical trial. Functionally agonadal women aged 25 to 60 years receiving hormone replacement therapy underwent transvaginal ultrasound examination of the uterus followed by a timed endometrial biopsy on artificial cycle day 21. Endometrial histology and estrogen and progesterone receptors were analyzed from biopsy material. Subjects were assigned to three groups according to age: Group I, aged 25 to 39 years (n = 48); Group II, aged 40 to 49 years (n = 61); and Group III, aged 50 to 60 years (n = 13). Endometrial preparation was accomplished in all patients using the same sequential regimen consisting of oral micronized estradiol and intramuscular progesterone.
Similar histologic, ultrasonographic, and steroid receptor characteristics were noted in all groups of patients regardless of age. A normal appearing midluteal secretory endometrium was demonstrated histologically in 85% of biopsies. However, 15% of biopsies exhibited intraluminal papillary excrescences within the glands and/or increase in the normal gland-to-stroma ratio. Three patients, one from each group, did not initially respond to replacement therapy and required further treatment.
Functionally agonadal women exhibit normal or near-normal endometrial responses to sex steroid replacement therapy designed to imitate the natural cycle through the sixth decade of life.
我们的目的是，在尝试进行供体胚胎移植之前，使用组织学、超声检查和类固醇受体标记物，对接受相似雌激素/孕激素替代方案的不同年龄女性的子宫内膜进行特征分析，以确定年龄增长是否会对子宫对药物性甾体激素替代疗法的反应产生不利影响。
这是一项前瞻性开放性临床试验。年龄在25至60岁之间接受激素替代疗法的功能性性腺功能减退女性接受经阴道子宫超声检查，然后在人工周期第21天进行定时子宫内膜活检。对活检材料进行子宫内膜组织学以及雌激素和孕激素受体分析。根据年龄将受试者分为三组：第一组，年龄25至39岁（n = 48）；第二组，年龄40至49岁（n = 61）；第三组，年龄50至60岁（n = 13）。所有患者均采用相同的序贯方案进行子宫内膜准备，该方案包括口服微粒化雌二醇和肌肉注射黄体酮。
无论年龄大小，所有患者组的组织学、超声检查和类固醇受体特征均相似。组织学检查显示，85%的活检标本中出现外观正常的黄体中期分泌期子宫内膜。然而，15%的活检标本显示腺腔内有乳头状赘生物和/或正常腺-间质比增加。每组各有一名患者最初对替代疗法无反应，需要进一步治疗。
功能性性腺功能减退女性对旨在模拟自然周期直至60岁的甾体激素替代疗法表现出正常或接近正常的子宫内膜反应。
