【摘要】 目的：探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）中，供卵者胚胎和受卵者子宫内膜同步化的激素治疗，以使受卵者的内膜发育适合胚胎着床。方法：ＩＶＦ－ＥＴ按照我院常规进行。采用患者丈夫的精液。受卵者共７例，包括：（１）过早绝经３例；（２）染色体核型异常者及代孕母亲４例，均有正常月经周期。过早绝经者于供卵者月经来潮日前３～５天开始口服恒量、小剂量雌二醇（Ｅ２），每日２～４ｍｇ；于供卵者注射ｈＣＧ日开始加用孕酮（Ｐ），每日肌内注射３０ｍｇ，取卵日开始每日５０ｍｇ，移植胚胎日后每日１００ｍｇ，尿β－ｈＣＧ阳性后每日１５０ｍｇ，直到妊娠９０天左右逐步减量，到１００天停药。在此期间口服Ｅ２每日４ｍｇ。隔１～２周测定血清Ｅ２及Ｐ水平，并与未用药的正常妊娠者比较。对月经周期正常的受卵者应用促性腺激素释放激素类似物（ＧｎＲＨ－Ａ），调节垂体性激素释放或造成暂时性人工去势，使受卵者闭经２～３个月后，Ｂ超下见子宫内膜及卵巢处于静止状态。于估计供卵者月经来潮日前３～５天加用Ｅ２，激素治疗同过早绝经者。ＧｎＲＨ－Ａ于供卵者注射ｈＣＧ日停用。结果：应用激素治疗时血清Ｅ２水平大都和正常妊娠时相似，Ｐ水平则为正常妊娠的３～５倍。３例已绝经者妊娠并?更多还原

【Abstract】 Objective:Toevaluatetheeficacyofhormonaltherapyfortheestablishmentofen-dometriumsynchronouswiththeembryoinanoocytedonationandsurogacyfertilizationinvitro-embryotransfer(IVF-ET)program.Methods:TheIVF-ETroutineoftheBeijingMedicalUniversi-tywasemployed.Therecipientsincludedcaseswith(1)prematuremenopauseand(2)abnormalchromosomalkaryotypes;surogatemothers.For(1)surogatemother,lowconstantdosesofestradiol(E2)(17-βestradiol-EstraceorE2valerate)2～4mgwasstarted3～5daysbeforetheex-pectedmenstruationofthedonor;progesterone(P)wasstartedintramuscularly30mgdailyfromthedayofhCGinjection,50mgfromthedayofoocytepick-up,100mgfromthedayofembryotransferand150mgfromthedayofpositiveurinaryβ-hCG;E2wasmaintainedatthe4mgdose.BothE2andPwerecontinueduntilaftertheluteo-placentalshift-about90to100daysofpregnancywithgradualtaperingdoses.TheserumE2andPlevelsweremeasuredbyradioimmunoasayandcomparedwiththoseofnormalpregnancy.For(2)womenwithnormalmenstrualperiods,theChinesemadego-nadotropin-releasinghormone-A(GnRH-A)400～600μgwasgivenfordown-regulationofpituitaryandartificialagonadismwhenatleastamenorheaoftwomonthswasachievedandaquiescentstateoftheendometriumandovarieswasascertainedbyvaginalultrasonography.ThentheE2andPtherapywasstartedasdescribedabove.GnRH-AwasstoppedonthedayofhCGinjection.Results:Inthehormonaltherapygroup,theserumE2levelswerequitesimilartothoseofthenormalpregnancy,whilethePlevelswereabout3～5timeshigher.Twofultermdeliveriesofnormalfemalebabiesandoneinher36thwekofpregnancywereachievedintheprematuremenopausegroup.Inthenormalmenstrua-tiongroup,onewasinher15thwekofpregnancyandthesurogatemotherwasinher41/2monthsofpregnancy.Conclusion:TheproposedhormonaltherapytosynchronizethedonorandtherecipientmaybeusedwithsatisfactoryclinicaloutcomeinanoocytedonationandsurrogacyIVF-ETprogram.更多还原