目的 分析比较体外受精-胚胎移植中子宫内膜形态不良的两种不同预处理方式。方法 自然周期阴道彩超监测卵泡及子宫内膜,卵泡晚期彩超提示子宫内膜形态非三线征者共265例,随机分组：药物组(90例)给予口服地屈孕酮片、10mg／次、2次／日、10天；机械刺激组(87例)行子宫内膜搔刮术；对照组(88例)子宫内膜不予处理。入组患者均采用黄体期短效长方案促排卵,排卵后一周(垂体降调日)使用子宫内膜取样器留取子宫内膜用于子宫内膜ER、PR、HOXA-10mRNA表达的测定。分别在自然周期卵泡晚期及HCG日检测子宫内膜厚度、形态、血流。比较三组患者的一般临床资料及结局。结果 三组患者临床资料(年龄、不孕因素及年限、Gn用量、Gn天数、获卵数、移植优质胚胎数等)比较,差异无统计学意义。子宫内膜经预处理,药物组和机械刺激组的胚胎种植率(33.41%、34.18%)、临床妊娠率(53.13%、56.71%)明显高于对照组。治疗后,药物组、机械刺激组HCG日A型内膜(32.2%、34.5%)及A型血流(34.4%、39.1 )比率均明显高于卵泡晚期；药物组、机械刺激组HCG日A型内膜(32.2%、

Objective To analyze and compare two different pretreatment methods of endometrial malformation in IVF-ET.Methods A total of 265 patients with endometrium non-third line signs revealed by color ultrasonography in late stage of follicles were randomly divided into two groups: drug group (n = 90) was given dydrogesterone tablet, 10mg/time, 2 times/day, 10 days; Endometrial curettage was performed in mechanical stimulation group (n = 87). The endometrium of the control group (88 cases) was not treated. All the enrolled patients were ovulated with a short-effect and long-duration scheme in luteal phase. Endometrium sampling device was used to collect endometrium one week after ovulation (pituitary lowering day) for the determination of mRNA expression of ER, PR and HOXA-10 in endometrium. The endometrial thickness, morphology and blood flow were measured at late follicular stage and HCG day. The general clinical data and outcomes of the three groups were compared. Results There was no statistical significance in the comparison of clinical data (age, infertility factors and years, Gn dosage, Gn days, number of eggs obtained and number of high-quality embryos transferred) among the three groups. The implantation rate (33.41%, 34.18%) and clinical pregnancy rate (53.13%, 56.71%) in the drug group and mechanical stimulation group were significantly higher than those in the control group after endometrial pretreatment. After treatment, the rates of type A endometrium (32.2%, 34.5%) and type A blood flow (34.4%, 39.1%) on HCG day in drug group and mechanical stimulation group were significantly higher than those in late follicular stage. The rates of type A endometrium (32.2%, 34.5%) and type A blood flow (34.4%, 39.1%) on HCG day in drug group and mechanical stimulation group were significantly higher than those in control group, and there was no significant difference between drug group and mechanical stimulation group. The mRNA expression levels of ER, PR and HOXA-10 in endometrium of pituitary hyporegulation day in drug group and mechanical stimulation group were significantly higher than those in control group, while those in drug group were slightly lower than those in mechanical stimulation group, with no statistical difference. Conclusions Pretreatment with oral progesterone or scratch curettation during IVF-ET treatment can transform endometrial morphology, improve endometrial blood flow, increase the mRNA expression of ER, PR and HOXA-10, improve endometrial receptivity, and then increase the clinical pregnancy rate. Medicinal curettage via progesterone is a new and better treatment alternative to mechanical stimulation of curettage.

]内蒙古自治区自然科学(2019MS08088)；内蒙古医科大学科技百万工程联合项目(YKD2018KJBW(LH)062)