A Preliminary Exploration of Laboratory Diagnosis and IVF Improvement Protocol on Endometriosis
|School||Zunyi Medical College,|
|Course||Obstetrics and Gynaecology|
|Keywords||endometriosis carbohydrate antigen-125 vascular endothelial growth factor endometrium antibody laboratory diagnosis treatment protocol in vitro fertilization and embryo transfer|
Objective:To detect the serum levels of CA125,VEGF and EMAb in patients with endometriosis and adenomyosis,and for further evaluate the clinical diagnostic values for endometriosis and adenomyosis by combination three markers maintimed above.Methods:The 53 patients who were pathologically diagnosised as endometriosis or adenomyosis after laparotomy or laparoscopy surgery set as study group,on the other hand,23 infertile women with tubal problems confirmed of not endometriosis after laparoscopy surgery were recruited into the control group. The chemiluminescence assay and the enzyme-linked immunosorbent assay were employed to detect the serum concentrations of CA125,VEGF and EMAb, followed by the drawing of the ROC curves of them and the area under the curves were calculated and the critical points of diagnosis were explored.Results:①The serum CA125 levels in patients from the ovarian endometriosis (OEM) group at stageⅡ,ⅢandⅣ,and the ones from both the adenomyosis and the combined disease group were all significantly higher compared with that of the control group (P<0.01),moreover,significant differences between stageⅡ,ⅣandⅠOEM groups(P<0.05), also significant differences of that were found between adenomyosis and the combined disease group when compared with that of the OEM group(P<0.01).②The serum VEGF levels in patients from the OEM group at stageⅠ,Ⅱ,ⅢandⅣ, and the ones from both the adenomyosis and the combined disease group were all significantly higher compared with that of the control group(P<0.01),moreover,significant differences of that were found between stageⅠandⅣOEM groups(P<0.05),but significant differences of that were not found between stageⅡandⅢOEM groups(P>0.05).③The serum EMAb levels in patients from the OEM group,and the ones from both the adenomyosis and the combined disease group were all significantly higher compared with that of the control group (P<0.01).④The areas under the ROC curves were respectively 0.897,0.766 and 0.877 for serum CA125,VEGF and EMAb. The sensitivity, specificity, positive predictive value and the negative predictive value for serum CA125 is respectively 87.6%,88.9%,91%and 84.2%.those for serum EMAb is respectively81.4%,85.2%,87.7%and 78%.and those for serum VEGF is respectively 84.3%,68.5%,77.9%and 78.7%.Conclusion:Serum CA125,VEGF,EMAb levels are increased significantly higher in patients with endometriosis and adenomyosis,which will be conductive to the auxiliary diagnosis of the diseases,what’s more,the combined detection of the above three markers will be contributed to diagnosis. Objective:To explore the influence of two improved overlength protocols to treatment outcomf of infertile patients with endometriosis that they will receive IVF-ET treatment, and to evaluate the application value of the improved protocols.Methods:28 infertile patients with endometriosis that they will receive IVF-ET treatment were enrolled into the present study group, and randomly divided into two groups. The long acting triptorelin was injected 1 time at the first 1-5 days during the menstrual cycle, with the second time injected after a 28-day interval and the total injection 2 times. Patients from group A were injected respectively at 3.75 mg and 1.5mg dosage; while patients from group B were injected respectively at a 1.5 mg and 1.5mg. IVF-ET treatment was carried out after 20 day to 29 days of the second injection. The peripheral venous blood was collected, the gynecological examination and B ultrasonic examination were carried out before injecting triptorelin, after injecting triptorelin and in the process of IVF-ET treatment. The serum concentrations of CA125, E2, FSH, LH and VEGF were detected by chemiluminescence assay and the enzyme-linked immunosorbent assay, and the changes of endometriotic lesion and drug side effects were observed, the other laboratory and clinical parameter were recorded.Results:①The IVF-ET treatment of 6 patients and 12 patients were achieved respectively in the group A and B, and the cycle clinical pregnancy rate all reached 50%. No difference was observed in the endometrium thinkness at the injecting hCG day, in serum E2 level at the injecting hCG day, in the duration time and dosage of using Gn, in the average oocyte retrieval numbers, in the fertilization rate, in the cleavage rate, in the implantation rate, in the clinical pregnancy rate between group A and B.②The symptoms of dysmenorrhea were reduced, the nodes of uterosacral ligament were shrinked, and the numbers of ovaria cyst were decreased in patients from group A and B after long acting triptorelin treatment. The serum levels of CA125. VEGF were decreased gradually following the increasing of treatment times. There was difference in the serum level of CA125 in the group A after the first and the secong treatment(P<0.05). The serum level of CA125 was reduced in the group B after the first treatment, but no difference compared with before the pre-treanment(P>0.05). There was difference in the serum level of CA125 between the pre-treatment and after the secong treatment(P<0.05). The serum level of VEGF was reduced in patients from group A and B after the treatment(P<0.05).③The small number of patients expressed the low level estrogen status after the treatment of two improved overlength protocols, no cases of OHSS were found. The serum E2 level was reduced after the treatment in the group A and B(P<0.05), but maintained in the level of window period.Conclusions:①The improved overlength protocol may have effect on the raising of fertility efficiency of infertile patients with endometriosis.②The two improved protocols show similar therapeutic effects on the infertile patients with endometriosis before IVF-ET, but thinking of cost and utility, B protocol may have better application value.