Noci I, Borri P, Coccia M E, Criscuoli L, Scarselli G, Messeri G, Paglierani M, Moncini D, Taddei G
Department of Gynaecology and Obstetrics, University of Florence, Italy.
Eur J Obstet Gynecol Reprod Biol. 1997 Dec;75(2):215-20. doi: 10.1016/s0301-2115(97)00126-7.
The purpose of this contribution is to investigate the pathophysiology of the abnormal endometrial development in hyperstimulated IVF cycles.
In 12 IVF-patients who did not have embryo transfer because of failure of oocyte fertilization, serum values of 17 beta-estradiol, progesterone, FSH, LH, total and free testosterone, and androstenedione were measured on the pick-up day and were evaluated with respect to the values normally expressed in the day of ovulation; in the endometrial specimens collected 2 days later, at the time of embryo replacement, estrogen and progesterone receptors were immunohistochemically determined and dating by the Noyes method was performed.
17 beta-Estradiol values are constantly higher, and progesterone levels are, only in four cases, higher than expected for the day of ovulation in a natural cycle. These hormonal patterns can only partially explain the pattern of steroid receptors: progesterone receptors are expressed sparsely both in glands and stroma, while estrogen receptors are abundant in the glands and absent in the stroma. In 11 of 12 patients an abnormal endometrial development with stromal advancement was observed: this morphological picture of the endometrium could partially be explained only in the four cases presenting high progesterone levels by serum values and endometrial receptor content of estrogen and progesterone.
The abnormal endometrial development in hyperstimulated IVF cycles could only in part be explained by estrogen and progesterone, and other factors have to be considered.
本研究旨在探讨超促排卵试管婴儿周期中子宫内膜发育异常的病理生理学机制。
选取12例因卵母细胞受精失败而未进行胚胎移植的试管婴儿患者，在取卵日测定其血清中17β-雌二醇、孕酮、促卵泡生成素（FSH）、促黄体生成素（LH）、总睾酮、游离睾酮及雄烯二酮水平，并与自然周期排卵日的正常水平进行比较；在取卵2天后胚胎移植时收集子宫内膜标本，采用免疫组织化学方法检测雌激素和孕激素受体，并通过诺伊斯（Noyes）方法进行子宫内膜分期。
17β-雌二醇水平持续升高，仅4例患者的孕酮水平高于自然周期排卵日的预期值。这些激素水平变化仅能部分解释类固醇受体的表达情况：孕激素受体在腺体和间质中均稀疏表达，而雌激素受体在腺体中丰富表达，在间质中未表达。12例患者中有11例出现子宫内膜发育异常伴间质提前，这种子宫内膜形态学表现仅在4例血清孕酮水平升高且子宫内膜雌激素和孕激素受体含量正常的患者中得到部分解释。
超促排卵试管婴儿周期中子宫内膜发育异常仅部分可由雌激素和孕激素解释，还需考虑其他因素。
