The Incidence And Treatment Of Luteinized Unruptured Follicle Syndrome

Objective:Luteinized unruptured follicle syndrome,LUFS,is the process of the ovarian follicle growing and maturing is quite normal,but it does not break,the ovum does not emit while the in-situ becoming luteinizing.LUFS can produce the corresponding estrogen and progestin.It makes the effect organ appears a system of change like ovulation cycle,which is a particular type of menstruation without ovulation.It is one of the reasons why the woman is not pregnant and belongs to ovary infertility.There are 9%-55%normal woman and 6%-83%women who are sterile have such problem.But many women who are sterile frequently happen to such problem without knowing its reason.The incidence of such disease is so high that the research of it is not only an important theory problem in Reproductive Medicine but also an important applied subject in birth,infertility and family planning.In recent years,the broad and intensive study is made in the incidence, manifestation,diagnosis and treatment.But the relating pathogeny of LUFS is quite complicated,it is still not clear about the reason of such incidence and there is no effective method to cure it.Generally speaking,qualities of researches shows that the reasons of LUFS are divided into mechanical element MF and endocrine element and iatrogenic element.The endocrine element is the common reason.This search is designed taking the samples of follicular fluid and blood in normal women and LUFS women 36 hours after the onset of endogenous LH surge or hCG adminstration and testing the LH,FSH,E2,P by enhanced chemiluminescence immunoassay,and looking for the possible endocrine factor of the LUFS.This research is made according to the endocrine element possibly happened to LUFS to reduce the frequencies of the incidence of LUFS by adopting gonadotrophin-releasing hormone agonist to avoid the appearance of LH waves.In addition,it discuss the treatment effect and afford the reliable basis for the therapeutical treatment.This research not only can afford the theory basis for the treatment of the infertility caused by LUFS but also find the new ways to research and produce the new contraceptives.Research method:一depart one:1 Selection of cases of illness:Choose 60 patients from all visited in our center from Jan.2006 to July 2007 and devide into three groups,control groupA,regular menstruation,no LUFS history,laparoscopic approch.group B and group C who are suitable to the followings:the size and the form of the womb is normal by hysterosalpingography uterosalpingography and the bilateral fallopian tube is open, or the womb and the fallopian tube connected with other tissue,two years after decomposition with a laparoscope,the check of her husband's semen at least two times and the result is normal by WHO standard,antisperm antibody,anticardolipin antibodies,endometrium antibodies of couple are normal,the check by B supersound in excessive at least two weeks appears LUF.There are no significant different in the three groups in the age and time of infertility.2 Method:In group A punct to take follicular fluid when the diameter of dominant follicle≥18 mm and 36 hours after the onset of endogenous LH surge in the laparoscopic approch,at the same time draw venous blood to test.In group B monitor the follicles and LH surge,draw the blood and follicular fluid to test LH,P,FSH,E2 when there is no ovulation sign after 36 hours of the onset of LH surge or no LH surge when the diameter of dominant follicle≥30 mm.In group C, All patients had their IVF-ET in controlled ovary hyperstimulation cycles(COH) because of LUFS using Triptorelin to drop accommodation.Take blood and follicular fluid 36 hours after HCG administration.二depart two:1 Selection of cases of illness:Choose patients from all visited in our center from Jan.2006 to July 2007.All patients are suitable to the conditions eaqual to depart one.2 All the patients accept the treatment of controlled ovary stimulation.The patients in group A and B have the injection of HMG75-150U two days from the five days after the menstruation.From the eight days,the ovum is mornitored by the transvagina supersound.The dose is adjusted according to the growth of the follicle. When the follicle size reach to 18mm or E2> 200pg/ml,the venous blood is taken out and checked by LH,P.at the same time,the patients in group A accept the injection of HCG10000U while group B Triptorelin 0.1 mg.the patients in group C accept the injection of Triptorelin 0.1 mg from the five days after the menstruation, and at the sixth day HMG 75U one day.From the eight days,the follicle is momitored by the trans vagina supersound.When the dominant follicle size reaches to 18mm or E2> 200pg/ml,then they accept HCG 10000U adminstration.All the patients in three groups observe the rupture of follicles,the venous blood is again taken out and checked by LH,P from the seven days after the menstruation.Result:(1) The LH,FSH,P in the blood in three groups are no significance after 36 hours of LH surge or HCG administration.The LH,FSH,E2 in follicular fluid are no significance at the same time.while the P in the follicular fluid at this time in group B is significantly lower than in group A and in group C.(2) There is a difference in statistics of the frequency of the ovulation of three treatment(P＜0.05).the difference in the results in group A and B is no significance (P＜0.01),the difference between group C and group A,B(P＜0.01) is signifecant.The the ovulation rate of group C is much higher than group A and B.while the pregnancy rate among three groups has no significant differences.The venous blood of all the patients is again taken out and checked by LH,P from the three days after the Triprelin/hCG administration.The LH in blood is no significance in groupA and group B,while group C is lower than group A and group B.The P in blood is no significance in three groups,there is a difference in blood number P in statistics after 7 days of the ovulation(P＜0.05).There is obvious differences between group A and B,and group B and C,group A is higher than C and group C is higher than B.Conelusion:①after 36 hours of LH surge or HCG administration The progesterone in follicular fluid of LUFS patients is significantly lower than control group.This shows that one of the possible reasons of ovulation drawback is the lower of progesterone.Progesterone may be an important role of ovulatory event.②The reformed plan is able to restrain effectively the praecox endogenous LH surge and improve effectively the ovulation rate.But the pregnancy rate has no differences in statistics of three groups.