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目的:探讨IVF-ET妇女控制性超促排卵(COH)时着床窗期子宫内膜胶原纤维(collagen fibril,CF)对子宫内膜容受性(ER)的影响。方法:共对25个刺激周期(SC)和20个自然周期(NC)妇女分别在取卵后或排卵后的第7±1日行外周血雌、孕激素水平检测和子宫内膜活检术,常规HE染色确定组织学分期,采用透射电子显微镜观察CF增生情况和改良Masson染色进行CF定量分析。结果:SC组外周血雌、孕激素水平均显著高于NC组(P<0.05)。SC组分泌期较NC组提前1～2 d,内膜腺体扩张和间质水肿明显。SC组分泌早、中和晚期内膜间质中的CF较NC组显著升高(P<0.01,P<0.05和P<0.05),且SC组分泌早期SC明显高于分泌中期(P<0.05)。结论:COH过程中过高的雌、孕激素水平可使子宫内膜分泌期提前并刺激内膜CF的过度增生,这可能是导致COH周期ER下降和着床失败的原因。
Objective: To investigate the effect of endometrial collagen (CF) on the endometrial receptivity (ER) in the window of implantation during controlled ovarian hyperstimulation (COH) in IVF-ET women. Methods: Peripheral blood serum estrogen and progesterone levels and endometrial biopsy were performed on 25 days (SC) and 20 cycles of natural (NC) women after ovulation or 7 days after ovulation respectively. Histopathological staging was determined by routine HE staining. CF proliferation was observed by transmission electron microscopy and modified Masson staining was used for CF quantitative analysis. Results: The levels of estrogen and progesterone in peripheral blood of SC group were significantly higher than those of NC group (P <0.05). The secretory phase of SC group was 1 ~ 2 days earlier than NC group, and the endometrial gland expansion and interstitial edema were obvious. Compared with NC group, CF of early, middle and late endometrial stromal of SC group was significantly higher than that of NC group (P <0.01, P <0.05 and P <0.05) ). CONCLUSION: Excessive levels of estrogen and progesterone during COH may lead to the advance of endometrial secretion and stimulate the hyperplasia of endometrial CF, which may be responsible for the decline of ER in COH and the failure of implantation.