| Objective: Implantation is one of the most importance step of reproduction , which involves two major participants~embryos and endometrium . This study focused on endometrial preparation for implantation . Endometrial development in the follicular phase of IVF cycles is driven by E2 produced by the ovaries and is followed up clinically by the thickness and the type of echogenicity of endometrium , which are indicators of its receptivity. The main controlled parameters at this stage of treatment are follicular growth and E2 output,and these parameters govern decision~making in regard to hormonal stimulation according to well~defined criteria . In contrast , hormonal treatment during the luteal phase usually is conducted empirically . This is because of a lack of clearly defined treatment goals , either morphologic or hormonal , that relate to appropriate endometrial preparation for implantation during the luteal phase of IVF treatment cycles .Serum levels of E2 and progesterone decline from the midluteal phase in IVF~ET cycles in which pituitary suppression is used for controlled ovarian hyperstimulation(COH) and granulose cells loss in the oocyte pick~up procedure . This decline has been found adversely affect implantation . Progesterone supplementation in the luteal phase after pituitary down~regulation is known to improve implantation rates and therefore is widely used in IVF treatment .The importance of E2 levels during the luteal phase or of luteal E2 supplementation in IVF cycles in which a GnRH analog(GnRHa) is used is controversial .The latest studys have shown that luteal E2 supplement may improve pregnant rate.Therefore,this prospective , randomized study aimed to evaluate the effect of adding E2 to the luteal support protocol on serumE2 and progestrone levels and pregnancy rates in patients treated with IVF in whom GnRHa down~regulation is used in the COH protocol and expect a good result clinically .Endometrium receptivity exibit specific cells and molecules produced in turn which controlled and regulated by some facters. Estridiol and progesterone act as original signals.Under the effect of embryo,cytokines,adhesion molecules and growth factors conduct the conmunicate between cell and cell,cell and extracellular matrix which adjust endometrium receptivity and make embryo implant successful..Recently some progess have been gained about adhesion molecules in the prosess of implanting and some test have shown that intercellular adhesion molecule~1(ICAM-1) involove in the process that embryo interact with endometrium . But most study foucus on the role of ICAM-1 in endometrium tissues . Soluble intercellular adhesion molecule~1(SICAM-1) is a immune marker which exist in normal serum . We test in serum SICAM-1 level in luteal phase in COH cycles in order to find some evidence about the role of SICAM-1 in implanting.Methods: Sixty patient undergoing IVF~ET in the second hospital of hebei medical university are enrolled.Patient indications for IVF include the following diagnoses : tubal factor infertility(n=48) , male factor infertility(n=10) , endometriosis(n=1) and Pcos(n=1) . The patients allocate into two groups for the luteal phase support .The treatment receive progesterone and hCG and E2 valerate(2mg/d taken orally) ; the control only receive progesterone and hCG . The average ages of the two groups is similar , in the range of 20~40 years.Protocol for ovulation induction is long GnRHa protocol . It is, GnRHa /FSH~HP or Gonal~F/HMG/hCG protocol . From ET day , patients are randomly allocated to one of the following protocols : 30 patients received IM injections of P and hCG (the controls) . The other 30 patients received together with Pand hCG support additional oral tablets of E2 valerate , 2mg/d till we know the cycle outcome.Blood samples for the measurement of E2 and P serum levels be taken on the day of hCG injection , and 8 , 13 days after hCG injection .SICAM-1 be taken 13 days after hCG injection too.The statistical package SPSS 10.0 is used for data ana... |
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