| Objective:To discuss the influence of the pathological changes of endometrium to infertility.Method:Thirty infertility cases were randomly selected among those who visited Gynaecological Clinic of NO.2 Hospital of Jinlin University during the period of Nov. 2004– Mar. 2007. According to their medical records, symptoms, sign and other check-ups, they are accordant with following diagnosis:(1)Non-ovulatory functional bleeding ,( 2 ) Infertility accompany with over-hyperplastic endometrium. Simple endometrium hyperplasia were prescribed Marvelon 1 tablet daily, continually taking for 2-3 courses.Complex endometrium hyperplasia were prescribed progestin 30mg daily for 3 months; during the treatment, the patients were given Gynecatoptron together with B mode supersound recheck-ups once per month to observe the status of endometrium; The pathological tests were also curried out in the mean time. According to different response after 3 months Progestin treatment, the patients were distinguished to 2 different types: (1) For those who changed to secretive period, on the fifth of their catamenia, were prescribed Clomiphene 50mg daily for 5 days to help ovulation. The same treatment was curried out at each catamenia for 3 cycles. (2) For those who transformed to hyperplastic period, were firstly prescribed Marvelon 1 tablet daily, continually taking for 2 -3 courses, each course last for 21 days. And then they were given Clomiphene, the same dosage as the first team did for another 2-3 courses to help ovulation. All the patients were given the blood test before treatment and at the end of the second catamenia period which is regular pattern after treatment to measure blood serum, PRL,FSH,LH,P,E2,T. Also the data such as procreation hormone level, the result of pathological test and Gynecatoptron Test for endometrium, the status of catamenia and gravidity before and after medication treatment were also kept recording. All datas were inputted into table accordingly, and then were dealt with statistically by employing T-test and variance analysis methods.Findings:1,The level of blood serum before and after treatment After treatment, there is no obvious change on blood serum FSH,LH,PRL,E2,T (p>0.05) in comparison with before treatment,there is obvious change on blood serum progestogen (p<0.01).2,The result of pathological test of endometrium before and after treatmentAmong these 30 patients, there were 7 of them were belong to complicated over–hyperplasia endometrium, 2 of among these 7 cases transformed to secretive-period type of endometrium, 2 of them transformed to simple hyperplasia endometrium, and the rest 3 transformed to hyperplasitic type of endometrium; there were 23 patients belong to simple hyperplasia endometrium among those 30 cases, 15 of these 23 patients transformed to hyperplastic-period type of endometrium, and another 8 transformed to secretive-period type of endometrium. During the treatment, the blood pressure were in normal range; before and after treatment, liver and kidneys were functionally normal. 3 patients had the side effect of vomiting and 4 had painful breast.3,follow-up visit Thirty infertility cases were follow-up for 6 months after the treatment. Among these 30 patients,the longest course of treatment is 9 months, the shortest course of treatment is 3 months.Beside 2 cases which are complex endometrium hyperplasia still show too longer catamenia period, endometrium still show simple hyperplasia,all the cases show regular catamenia.There are two cases who conceived after treatment.Conclusion:1,Procreation hormone level test is a good method for monitoring the quality of treatments for gynaecological incretion problems.2,The pathological changes of endometrium is one of un-neglectable causations for infertility. The gynecatoptron test is a distinct method to diagnose the pathological change of endometrium. During the hormonal treatment and medication treatment for abnormally hyperplastic endometrium that caused by non-ovulation, it can be used for monitoring the quality and the process of the treatments. Therefore, the dosage of the medicine can be adjusted accordingly in time, It, hence is irreplaceable by other equipments till now.3,The infertility which is caused by non-ovulatory functional bleeding, because the patients are lack of progestin antagonists, in the long term, estrogen results in abnormal hyperplasia of endometrium. For this problem, large dosage of progesterone will be used in the treatment. Progesterone leads to the decrease of the estrogen level, consequently, the metabolizable process of estrogen will be fastened, in the meantime, the decidual change on endometrium will be stimulated, subsequently, the endometrium will be protected in this process. This not only stops the progress of the problem, bus also helps to keep the conceivable ability for young women.4,Marvelon gives a good result for dealing with non-ovulation functional bleeding. it is a kind of safe and effective medication for treating non-ovulation functional bleeding problem. |
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