黄体酮对子宫内膜异位症在位内膜预处理与IVF治疗结局关系

摘要 目的：研究黄体酮对子宫内膜异位症在位内膜预处理改善IVF结局。方法：男性因素并卵巢子宫内膜异位囊肿168例，分两组：（1）实验组：IVF前自然周期月经第12天地屈孕酮30 mg/日、14天，3个月；（2）对照组：IVF前无干预。IVF前测血CA125，黄体期长方案促排卵，排卵后一周（垂体降调日）再测CA125并取子宫内膜行ER、PR、HOXA-10mRNA检测。HCG日测子宫内膜厚度、形态、血流。比较临床资料及结局、症状疼痛评分。结果：实验组胚胎种植率、临床妊娠率高于对照组（P<0.05）；HCG日对照组子宫内膜厚于实验组。实验组子宫内膜A型血流比率高于对照组（P<0.05）。实验组A型子宫内膜比率高于对照组，但无明显差异（P>0.05）；IVF前两组CA125均高于参考值，但无明显差异（P>0.05）。垂体降调日复查CA125，实验组明显低于对照组，实验组治疗后低于治疗前；实验组子宫内膜ER、PR、HOXA-10 mRNA表达量高于对照组，实验组分泌期子宫内膜比率高于对照组（P<0.05）；治疗后两组各项症状疼痛评分均较治疗前改善，且实验组优于对照组（P<0.05）。结论：IVF治疗中合并卵巢子宫内膜异位囊肿用黄体酮预处理在位内膜，可以降低血CA125，有利于转变子宫内膜组织类型、减小子宫内膜厚度、增加子宫内膜血流、增加子宫内膜ER、PR、HOXA-10 mRNA表达，改善在位内膜容受性，缓解症状疼痛，提高临床妊娠率。

Relationship between Progesterone on Endometrial Preconditioning and IVF Treatment Outcome in Endometriosis

ABSTRACT Objective: To investigate whether the treatment outcome of IVF can be improved by progesterone pretreatment of endometriosis. Methods: 168 cases with male factors and ovarian endometriosis cysts were divided into two groups: (1) experimental group: 12 days of natural cycle menstruation before IVF dystogesterone, 30 mg/day, 14 days, 3 months; (2) Control group: no intervention before IVF. Blood CA125 was measured before IVF, ovulation was induced by long luteal phase program, and CA125 was measured again one week after ovulation (pituitary hyporegulation day), and the endometrium was taken for ER, PR, HOXA-10 mrna detection and pathological examination. Endometrial thickness, morphology and blood flow were measured by HCG daily. Clinical data and outcomes were compared. Results: The embryo implantation rate and clinical pregnancy rate were higher in the experimental group than in the control group (P<0.05); The endometrium was thicker in the control group than in the experimental group on HCG day. The ratio of endometrial type A blood flow in the experimental group was higher than that in the control group(P<0.05). The endometrial ratio of type A in the experimental group was higher than that in the control group, but there was no difference (P>0.05); CA125 was higher than the reference value in both groups before IVF, but there was no difference(P>0.05). The CA125 was lower in the experimental group than in the control group when the pituitary gland was retested on the day of pituitary downregulation, and lower in the experimental group than before the intervention; the expression of ER, PR and HOXA-10 mRNA in the endometrium was higher in the experimental group than in the control group, and the ratio of endometrium in the secretory phase was higher in the experimental group than in the control group (P<0.05); The pain scores of all symptoms were improved in both groups after treatment than before treatment, and the experimental group was better than the After treatment, the pain scores of both groups improved compared with those before treatment, and the experimental group was better than the control group(P<0.05). Conclusion: In IVF treatment of ovarian endometriosis cysts, preconditioning the endometrium with progesterone can reduce blood CA125, facilitate the transformation of endometrial tissue types, reduce endometrial thickness, increase endometrial blood flow, increase endometrial ER, PR, HOXA-10 mRNA expression, and improve endometrial receptivity, relieve symptoms and pain, Improve the clinical pregnancy rate.