Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

Role of endometrial thickness in natural and stimulated cycles in infertility

Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate.

Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

Retrospective analysis of intrauterine granulocyte colony-stimulating factor in controlled ovarian stimulation with intrauterine insemination cycle

Background: Persistent thin endometrium affects <1% of patients. Various treatments have been proposed with no satisfactory results. GCSF is one such treatment modality which improves endometrial thickness and implantation. Aim of this study was to analyse the effects of dose and the site of instilling intrauterine G-CSF in COS IUI cycles in patients with unexplained infertility and to note the pregnancy rates among them.Methods: It is a 3-year retrospective study done in obstetrics and gynecology department of AJ Institute of Medical Sciences and Research Centre, that included all unexplained infertility cycles with controlled ovulation stimulation-IUI protocols where for a thin endometrium GCSF was used. The method of ovarian stimulation, the drug and dose used, the trigger for ovulation and the ovarian and endometrial response was noted. The day of the intrauterine GCSF and the dose and the site of instillation was noted. The endometrial response to GCSF the outcome for pregnancy was noted. All the data was analyzed statistically.Results: Significant endometrial response was seen with a dose of 100 mg,150 mg and 300 mg. Pregnancy outcome was better when GCSF was instilled just above the level of the os. GCSF instilled at the level of the fundus increases the possibility of ectopic pregnancy.Conclusions: Instillation of GCSF of 100 mg dosage just above the os; is a safe and effective method for improving the endometrial thickness and increasing pregnancy rate.

Abnormal uterine bleeding in perimenopausal women: sonographic and histopathological correlation and evaluation of uterine endometrium

Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.

Co-relation of endometrial thickness by transvaginal sonogram with histopathology pattern in abnormal uterine bleeding: a study from South India

Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.

Effect of autologous platelet rich plasma on thin endometrium in frozen thawed embryo transfer

Background: Endometrium is one of the main factors in implantation and pregnancy. Some of the assisted reproductive technology treatment (ART) cycles get cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of PRP (platelet rich plasma) in the treatment of thin endometrium and its outcome on pregnancy and live birth rates.Methods: This study was a prospective cohort which was conducted from January 2018 to December 2018 at Laxmi Narasimha Hospital, Warangal, Telangana State. 30 patients with history of inadequate endometrial growth in frozen thawed embryo transfer cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed.Results: 30 women were recruited in the study data of the 24 women were collected. Live birth was seen in 5 patients in the week range of 37±to 37±5 and average EMT in mm was 7.8, abortion was seen in 3 patients in the week range of 6 to 8±2 and average EMT in mm was 7.4 , chemical pregnancy was seen in 2 patients in the week range of 6 and average EMT in mm was 7.2 and number of women who were not pregnant were 14 and average EMT in mm was 7.0. Live birth was observed in 21% of the patients, abortion was observed in 13%, chemical pregnancy was seen in 9% and women who were not pregnant were 58%.Conclusions: Ability of autologous PRP to restore the endometrial receptivity of damaged endometrium has some aspects other than increasing the EMT.

Targeted treatments for dysfunctional uterine bleeding based on endometrial thickness

Background: Dysfunctional uterine bleeding is a common presentation to both general practitioner and gynaecologists which can have a significant effect on a woman’s quality of life. The aim of this study is to assess the effectiveness of treating dysfunctional uterine bleeding according to endometrial thickness.Methods: This study was a hospital based prospective study undertaken in gynecology outpatient clinic of Central Women’s Hospital, Mandalay, Myanmar for one-year period (2016). A total of 60 patients were recruited and divided into 3 groups based on endometrial thickness and offered targeted hormonal treatments. At the end of the one-month treatment, patients were asked to return for a follow-up visit and from their menstrual diaries, the number of bleeding days and bleeding scores were assessed and calculated.Results: Among sixty women with dysfunctional uterine bleeding, 55% of patients had endometrial thickness less than 6 mm, 25% had endometrial thickness 6-11 mm, with 20% of patients having endometrial thickness more than 11 mm. After one month of study period, treatment was found to be effective in 86.6% of the patients according to bleeding days and in 70% of the patients according to bleeding score.Conclusions: In women presenting with dysfunctional uterine bleeding, increased endometrial thickness was found to be associated with increased BMI. In the treatment of dysfunctional uterine bleeding, when the endometrial thickness of the patient was assessed and hormonal treatment was given according to the endometrial thickness, treatment was proven to be effective.

Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

Comparative evaluation of menstrual patterns and hormonal profiles in normal and abnormal perimenopause

Background: Currently there is only one marker to objectively establish perimenopause ie menstrual irregularities. Due to the wide variation in hormones like LH, FSH, estradiol, they become unreliable in predicting approaching menopause. This study was conducted to study and compare the patterns of LH, FSH and Estradiol in normal and abnormal perimenopause using the Stages of Reproductive Ageing Workshop (STRAW) criteria.Methods: A comparative evaluation was done after enrolling 200 patients out of which 100 women were in normal perimenopause (early-25 and late perimenopause-75, depending upon menstrual characteristics as defined by STRAW criteria) and 100 having AUB. Sociodemographic data, presence of menopausal symptoms were recorded. S. LH, S.FSH and S. estradiol we determined by adapted solid phase direct sandwich ELISA.Results: FSH was in menopausal ranges (>20IU/L) in early and late perimenopause. LH and FSH in women with AUB ranged from pre to post menopausal ranges. There was significant difference in LH and FSH between normal perimenopause and abnormal uterine bleeding. Estradiol levels showed a significant difference between late perimenopause and AUB p=0.015.Conclusions: This study shows that there is a progressive incremental trend in FSH and LH and decremental trend in Estradiol from early to late perimenopause due to decrease in ovarian follicular reserve, although the difference is not significant. Clinical symptoms present in 50% of late perimenopausal women showed that besides menstrual characteristics we can correlate these menopausal symptoms with raised FSH and low Estradiol. These women can be picked up and preventive therapy may be provided.

Efecto de la frecuencia de aplicación de estrógenos locales sobre el grosor endometrial en mujeres posmenopáusicas / Effect of local estrogen application frequency on endometrial thickness in postmenopausal women

Resumen Introducción: Los estrógenos conjugados vía vaginal para aliviar la atrofia y sequedad vaginales pueden producir cambios endometriales. Objetivo: Conocer el efecto de la frecuencia de aplicación de estrógenos conjugados vía vaginal en el grosor endometrial en mujeres posmenopáusicas. Método: Se estudiaron 70 mujeres posmenopáusicas con sequedad vaginal que recibieron estrógenos conjugados en crema (0.625 mg/1 g) durante 12 semanas divididas de la siguiente manera según la frecuencia de aplicación: grupo 1, dos veces por semana (n = 35) y grupo 2, tres veces por semana (n = 35). Al inicio y final del tratamiento se determinó el valor estrogénico en la citología vaginal y se realizó ultrasonido endovaginal para medir el grosor endometrial. La comparación entre los grupos se realizó con U de Mann-Whitney y entre los valores pre y postratamiento con prueba de Wilcoxon. Resultados: De 70 mujeres reclutadas solo se estudiaron 38 mujeres, 19 en cada grupo, pareadas por valor estrogénico inicial. No se encontró diferencia entre los grupos, ni antes ni después del tratamiento, en el índice de maduración, valor estrogénico ni grosor endometrial. Conclusión: No hubo diferencias en el grosor endometrial entre las distintas frecuencias de aplicación de estrógenos conjugados en crema.

Abstract Introduction: Conjugated estrogens, when used by the vaginal route for the relief of vaginal dryness and atrophy, can produce endometrial changes. Objective: To know the effect of vaginal conjugated estrogens application frequency on endometrial thickness in postmenopausal women. Method: Seventy postmenopausal women with vaginal dryness who received conjugated estrogen cream (0.625 mg/1 g) for 12 weeks were studied. The women were divided according to application frequency as follows: group 1, twice-weekly (n = 35), and group 2, thrice-weekly (n = 35). At baseline and at end-of-treatment, vaginal cytology was examined to determine the estrogenic value, and an endovaginal ultrasound was performed to measure endometrial thickness. The comparison between groups was carried out with Mann Whitney's U-test, and the comparison between baseline and post-treatment values, with Wilcoxon's test. Results: Of 70 recruited women, only 38 were studied, 19 in each group, paired by baseline estrogenic value. No difference was found between groups, neither at baseline nor after treatment, in the maturation index, estrogenic value or endometrial thickness. Conclusion: There were no differences in endometrial thickness between the conjugate estrogen cream different application frequencies.

Selective estrogen receptor modulator: efficacy in abnormal uterine bleeding in perimenopausal women

Background: Abnormal uterine bleeding affects 50% women of perimenopausal age group. The use of ormeloxifene (SERMS) in management of AUB is well known. The objective of the present study was aimed to see the effects of ormeloxifene on different types of endometrium.in the medical management of Abnormal Uterine Bleeding (AUB).Methods: It was Prospective, interventional study. A total of 90 women who attended Outpatient Gynaecology Department, Guwahati with complain of AUB in perimenopausal age group (37-48) were prescribed 60mg ormeloxifene twice weekly for 3 months followed by once weekly for next 3 months after preliminary D and C.Results: Ormeloxifene was found to be more effective in reducing PBAC score and ET in patients with proliferative and secretory endometrium The reduction in mean PBAC score with ormeloxifene (175.3 to 20.93)(p value 0.0001) and ET (9.6 to 2.9 mm) (p value 0.0001) in proliferative endometrium, (179.2 to 14.8 (p value 0.0001) ) and ET 11.1 to 1.9 mm (p value 0.0003)in secretory endometrium was observed after 6 months. However, it was found not to be effective in reducing PBAC score and ET in patients with atrophic endometrium. Change in PBAC SCORE from 176.4 to 150.8 (p value 0.08) and in ET from 2.8 to 2.1mm( p value 0.3) was observed. No major side effects were reported.Conclusions: Ormeloxifene is effective in AUB with proliferative and secretory endometrium.

Role Of Ormeloxifene In Management Of Symptomatic Uterine Leiomyoma In Reproductive Age Group

Introduction : Abnormal uterine bleeding due to leiomyoma is commomn problem in the reproductive age group and was found to be third most common cause of hysterectomies in teaching hospital of India1. The search for ideal drug for medical management of fioid is still on so that we can avoid operative interventions in symptomatic women of reproductive age group. Ormeloxifene is Selective Estrogen Receptor Modulator developed at CDRI, Luckhnow. It has proven to be an important drug in treatment of AUB, but its utility in fioid is yet to be defined. Through this study, we have explored its role in AUB due to leiomyoma. Aim and objective: To assess decrease in menstrual blood loss (MBL) by pictorial blood loss assessment chart to assess increase in hemoglobin level, to assess change in endometrial thickness, to assess change in fioid size in patients of AUB with leiomyoma treated with Ormiloxifene. Materials and Methods: Subjects were given tablet ormeloxifene 60 mg biweekly for 3 months, followed by 60mg weekly for next 3 months. Subjects were assessed after 3 months and 6 months for MBL, endometrial thickness, fioid volume and hemoglobin level. Observation: There was statistically significant decrease in MBL, endometrial thickness, (p=0.0334 and p=0.0096) , increase in hemoglobin(p=0.0001) and no change in fioid volume. after 3 months and 6 months respectivelyConclusion: SERM such as ormeloxifene in standard biweekly dosage is effective in providing symptomatic relief in a patient of AUB-L when prescribed for a short period of 6 months

Pregnancy of unknown location: the value of frozen section analysis and its relation to Beta-hCG levels and endometrial thickness

Abstract Objective Frozen section examination is a rapid method for identifying products of conception in endometrial curetting, yet its accuracy is inconclusive. The purposes of this study is to determine the accuracy of frozen section analysis of endometrial curetting in pregnancies of unknown location, and to verify the relation of β-human chorionic gonadotrophin (hCG) level and endometrial thickness to the assessed accuracy. Methods We reviewed data from January 2009 to December 2014 of diagnostic curettages from women with suspected ectopic pregnancies sent for frozen section examination at a medical center. A frozen section diagnosis was considered accurate if it concurred with the final pathologic diagnosis. Results Of 106 frozen section studies, the diagnosis was accurate in 94 (88.7%). Of 79 specimens interpreted as negative on frozen sections (no products of conception noted), 9 (11.4%) were positive on final pathologic review. Three of the 27 (11.1%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 72.7%, specificity 95.9%, positive predictive value 88.9%, negative predictive value 88.6%, and accuracy 88.6%. A statically significant correlation was found between β-hCG level and high accuracy of the frozen section technique (p< 0.001). No correlation was found between endometrial thickness and the accuracy of the frozen section technique. Conclusion The accuracy of frozen section examination was high and was found to correlate with β-hCG level, but not with endometrial thickness.

Effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the fresh IVF/ICSI cycle-a retrospective multicenter study / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of endometrial thickness(EMT)on the day of hCG administration on preg⁃nancy outcome in the fresh in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycle.METHODS:A retrospec⁃tive analysis was conducted of 3601 IVF/ICSI-ET cycles between January 1,2015 and December 31,2015 in eight repro⁃ductive centers.The endometrial thickness was measured on hCG injection day and the distribution of endometrial thick⁃ness and pregnancy outcome was drawn.Patients were divided into two groups based on the EMT:group A(289 cycles,EMT<8 mm),group B(3312 cycles,EMT≥duration of pregnancy and birth weight of single gestation were compared.RESULTS:Group A had significantly lower clini⁃cal pregnancy rate(46.0% vs.55.9%,P=0.001),live birth rates(35.3% vs. 47.0%,P=0.000)and higher pregnancy loss rate(23.3% vs.15.8%,P=0.024)compared with group B,while there was no significant difference in duration of pregnan⁃cy or birth weight of single gestation.Logistic regression analyses showed that clinical pregnancy rate(aOR=1.492,P=0.001)and live birth rate(aOR=1.621,P=0.000)increased in group B compared with group A,when correcting for the women age,BMI and transfer embryo numbers.CONCLUSION:The endometrial thickness on the day of hCG administra⁃tion affects the pregnancy outcome in the fresh IVF/ICSI cycle.When EMT<8 mm,the clinical pregnancy rate and live birth rate of IVF-ET are lower,and the patient should be well informed before making the decision of em⁃bryo transfer.However,endometrial thickness on the day of hCG administration does not affect the duration of preg⁃nancy and the birth weight of the fetus.

Effects of metformin combined with clomiphene on endothelial function, endocrine indicators and clinical outcomes in infertile women with polycystic ovary syndrome / 中国基层医药

Objective@#To investigate the effects of metformin combined with clomiphene on endocrine index, vascular endothelial function, pregnancy rate and ovulation rate in infertile women with polycystic ovary syndrome(PCOS).@*Methods@#From January 2018 to January 2019, 60 cases of PCOS with infertility treated in Zhuji People's Hospital were studied.According to the random number table, they were divided into control group and study group, with 30 cases in each group.The control group was treated with clomiphene, while the study group was treated with metformin and clomiphene.The levels of endocrine indicators including follicle stimulating hormone (FSH), luteinizing hormone (LH), pituitary prolactin (PRL), testosterone (T) and estradiol (E2) were compared between the two groups before and after treatment.The levels of fasting insulin (FIN), fasting plasma glucose (FPG) and insulin resistance index (HOM-IR) were compared between the two groups before and after treatment.The pregnancy rate, ovulation rate and abortion rate were observed and compared between the two groups after treatment.@*Results@#In the comparison of endocrine indicators, the levels of LH, PRL, T, E2, FIN and FPG in the control group[(8.84±1.13)IU/L, (18.57±2.13)μg/L, (2.75±0.54)nmol/L, (62.49±5.73)ng/L, (16.55±7.84)IU/mL, (5.16±0.74)mmol/L] were improved after treatment compared with before treatment[(16.32±1.26)IU/L, (20.48±3.29)μg/L, (3.88±0.64)nmol/L, (59.13±4.95)ng/L, (21.33±5.32)IU/mL, (5.67±0.81)mmol/L; t=24.207, 2.669, 7.391, 2.431, 2.763, 2.546, P=0.000, 0.005, 0.000, 0.009, 0.004, 0.007], while the levels of FSH and HOM-IR were not significantly improved after treatment[(5.32±1.53)IU/L, (3.19±1.41)] compared with before treatment[(5.44±1.69)IU/L, (3.64±2.15); t=0.288, 0.959, P=0.387, 0.171]. The levels of LH, PRL, T, E2, FIN, FPG and HOM-IR in the study group[(6.25±1.47)IU/L, (16.24±2.16)μg/L, (3.79±0.83)nmol/L, (68.82±4.67)ng/L, (12.69±6.24)IU/mL, (4.63±0.71)mmol/L, (2.55±1.43)] were significantly improved after treatment compared with before treatment (t=24.576, 5.437, 9.277, 6.779, 5.479, 5.621, 2.018, P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000, 0.020), and the decrease of FSH was not significant after treatment[(5.17±1.55)IU/L, (5.21±1.54)IU/L]. After treatment, the levels of LH, PRL, T, FIN, FPG and HOM-IR in the study group decreased significantly, while the level of E2 increased significantly compared with those in the control group[(6.25±1.47)IU/L, (16.24±2.16)ug/L; t=7.651, 4.207, P=0.000, 0.000]. After treatment, CIMT in both two groups[(0.075±0.018)mm, (0.067±0.016)mm]was lower than before treatment[(0.088±0.028)mm, (0.088±0.022)mm], and the improvement in the study group was better than the control group(t=1.819, P=0.037). The body mass index (BMI) and endometrial thickness of the two groups were decreased after treatment[(24.53±3.11)kg/m2, (23.15±3.17)kg/m2, (9.46±0.72)mm, (8.89±0.67)mm] compared with before treatment[(26.91±4.02)kg/m2, (27.03±3.85)kg/m2, (12.03±0.45)mm, (11.92±0.53)mm], and the improvement degree of the study group was significantly better than that of the control group(t=1.702, 3.174, P=0.047, 0.001). As to clinical outcomes, the ovulation rate and pregnancy rate of the study group (50.00%, 76.67%) were higher than those of the control group (20.00%, 50.00%)(χ2=5.034, χ2=4.593, all P<0.05), and the abortion rate of the study group (3.33%) was lower than that of the control group (13.33%), but there was no statistically significant difference (χ2=1.964, P>0.05).@*Conclusion@#Metformin combined with clomiphene can effectively improve the level of endocrine indicators, regulate insulin resistance, improve BMI, reduce endometrial thickness, correct hyperandrogenic status, effectively promote ovulation, improve pregnancy rate and achieve obvious therapeutic effect in PCOS patients with infertility.

Effect of Stage-based Acupuncture-moxibustion on Endometrial Thickness After Repeated Implantation Failure in IVF-ET / 上海针灸杂志

Objective To observe the effect of stage-based acupuncture-moxibustion therapy on the endometrial thickness in patients suffering from repeated implantation failure in IVF-ET (in vitro fertilization and embryo transfer). Method Seventy-two patients suffering from repeated implantation failure in IVF-ET were randomized into two groups. Thirty-six cases in the treatment group were intervened by stage-based acupuncture-moxibustion therapy plus oral administration of Estradiol valerate tablets; the other 36 cases in the control group were prescribed with oral administration of Estradiol valerate tablets alone. The implantation result of IVF-ET was analyzed 3 cycles later. The endometrial thickness was compared before and after the intervention. Result The endometrial thickness of the non-pregnant women increased after the treatment in both groups (P<0.05), and the increase in the treatment group was more significant than that in the control group (P<0.05). The clinical pregnancy rate in the treatment group was significantly higher than that in the control group (P<0.05). Conclusion Stage-based acupuncture-moxibustion therapy can improve the endometrial thickness, promote the growth of endometrium, benefit the implantation of embryo, and enhance the clinical pregnancy rate.

Effects of acupuncture on pregnancy outcomes of ovarian induction period with clomiphene citrate: a retrospective analysis / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy and action mechanism of acupuncture for ovulatory disorder infertility of ovarian induction period with clomiphene citrate (CC).</p><p><b>METHODS</b>Through retrospective analysis, 36 patients with ovulatory disorder infertility were divided into CC group (16 cases) and acupuoture group (20 cases) by method. The patients in the CC group were treated with oral administration of CC (50 mg) for 5 days from the 5th day of menstruation; based on the treatment of CC, patients in the acupuncture group were treated with acupuncture; the group A of acupoint was mainly consisted of acupoints of the conception vessel and the three meridians and front- acupoints in abdomen; the group B of acupoint was mainly consisted of acupoints of the governor vessel and back- acupoints. The two groups of the acupoints were selected alternately, combined with the -guan points (Taichong (LR 3)、Hegu (LI 4)) and five- points. The needles were inserted with flying needling method, and the needles were retained for 30 min per treatment; acupuncture was given once every other day. All the patients were treated for 2 months, and treatment stopped if pregnancy occurred. The pregnancy rate, cycle ovulation rate, maximum diameter of follicle, endometrial thickness and adverse effects were compared between the two groups.</p><p><b>RESULTS</b>The pregnancy rate of the acupuncture group was 75.0% (15/20), which was superior to 37.5% (6/16) in the CC group (<0.05). The cycle ovulation rates of two groups were 70.4% (19/27, >0.05). The maximum diameter of follicle and the endometrium thickness in the acupuncture group were superior to those in the CC group (both <0.05). The incidence of adverse effects in the acupuncture group was 0% (0/20), which was lower than 18.8% (3/16) in the CC group (<0.05).</p><p><b>CONCLUSION</b> acupuncture combined with CC could improve the quality of follicle and the receptivity of endometrium in patients with ovulatory disorder infertility, so as to improve the pregnancy rate, which could be used as a safe and effective means to cooperate with modern assisted reproductive technology.</p>

Effects of Fuzheng Xiaoai decoction joint tamoxifen on serum sex hormone and endometrial thickness with breast cancer / 中国生化药物杂志

Objective To analyze the effects of Fuzheng Xiaoai decoction joint tamoxifen on serum sex hormone and endometrial thickness with breast cancer.Methods 124 patients with breast cancer were divided into control group and research group by lot drawing method, all as 62 cases, treated with the same surgery, control group was treated with tamoxifen, research group was treated with Fuzheng Xiaoai decoction based on control group, the sex hormones, endometrial thickness, tumor markers, immune function and complications were compared between two groups.Results The prolactin (PRL), progesterone (P), estradiol (E2) of research group were all lower than control group, the difference were statistically significant (P<0.05).The endometrial thickness of research group [(8.61+1.07) mm]was lower than the control group [(9.74+1.21) mm](P<0.05).The tumor markers, immune function of research group were better than that of control group (P<0.05).The complications was no difference between two groups. Conclusion Fuzheng Xiaoai decoction joint tamoxifen can regulation the serum levels of sex hormone, relieve tamoxifen-induced endometrial thickening, can improve tumor markers and immune function .

Prediction of endometrial pathology by measuring endometrial thickness with TVS in women with breast cancer on tamoxifen.

Background: Tamoxifen is given in women with breast cancer who underwent surgery and is receptor positive. As Tamoxifen increases the risk of endometrial carcinoma to 2% a screening technique such as transvaginal sonography is essential to identify women at risk of endometrial cancer. Aim: To identify endometrial pathology in women using tamoxifen after surgery for breast cancer Material and methods: Fifty women on tamoxifen for breast cancer attending the department of radiotherapy were screened once in six months by history taking, clinical examination and measuring endometrial thickness with TVS. Endometrial biopsy for histology was performed in women with endometrial thickness more than 11 mm Observation: Endometrial biopsy was performed in ten women who were found to have endometrial thickness > 11 mm. Out of ten, four had normal endometrium, three had simple hyperplasia one was found to have complex endometrial hyperplasia without atypia and two were reported to have inadequate endometrium. Conclusion: Routine screening with TVS is not a cost effective measure as tamoxifen induces subepithelial stromal hypertrophy resulting in minimal tissue yield on endometrial biopsy. Therefore bleeding should remain the primary trigger for investigation of women on tamoxifen.