Risk Of Thrombosis Induced By 17?-estradiol,A Clinical Study

Objective:To investigate serum estrogen levels?Antithrombin ? and Coagulation factor X in different populations.different 17?-estradiol dose,time and route of administration,and explore the risk of estrogen-induced thrombosis and its mechanism,which in estrogen replacement therapy of the period of frozenembryo transfer(FET)in the field of Assisted Reproductive Technology(ART).Methods:Patients were involved from November 2015 to August 2016 in The reproductive medicine center of Fuzhou General Hospital for frozen-thawed embryo transfer,A total of 195 cases.Preoperative examination to exclude high blood pressure,diabetes and other serious medical illness,age 22-40 years old.And endometrial preparation program is divided into the natural cycle.micro-stimulation program and hormone replacement program.control group of 30 patients with natural or micro stimulating cycles,research group of 165 patients with estrogen replacement therapy(ERT).The basic risk factors of thrombosis,such as Methylenetet rahydrofolater eductase?homocysteine and anticardiolipin,were detected.The expression of the methylenetet rahydrofolater eductase type CC,homocysteine normal level and anticardiolipin negative were the control group?research group A(low risk of thrombosis),one of which was one or more items are the research group B(high risk of thrombosis).In the control group,E2,AT? and FX were detected before injection of HCG on HCG injection(LH peaking day).In the research group,E2,AT? and FX were measured before the first day and the third day before using 17?-estradiol.Patient medication 12 days after taking the doctor to decide whether to continue or increase vaginal estrogen according to endometrial thickness,until progesterone conversion day.Results:1.E2 levels and medication timeResearch group(Research group A and Research group B):The levels of E2 in estrogen for 12 days,15 days and 17 days were significantly higher than those before administration(P<0.05);The level of E2 in estrogen for 15 days was more than 12 days(P<0.05);The level of E2 in estrogen for 17 days was more than 15 days(P<0.05).The data show that serum E2 levels increase with medication time.2.The level of estrogen between the control group and the research group each medication timeResearch group A:The level of E2 in the control group(LH peak day)was greater than that in estrogen for 12 days(P<0.05),but less than 15 days and 17 days.Research group B:in contrast to research group A,there was no statistically significant difference between the level of E2 of estrogen for 15 days and the control group(P>0.05).The data show that estrogen levels in estrogen for 12 days are smaller than those in the control group(LH peak day),but also in normal mature follicle estrogen levels;After the increase in estrogen vaginal medication,estrogen levels fluctuate range widely.3.AT? levels and medication timeResearch group(Research group A and Research group B):The levels of AT? in estrogen for 12 days,15 days and 17 days were significantly higher than those before administration(P<0.05);but there was no significant difference among the estrogen for 12 days,15 days and 17 days(P>0.05).The data show that AT III levels increase with medication time,but in the platform period after increasing vaginal administration.4.The level of ATIII between the control group and the research group each medication timeResearch group(Research group A and Research group B):The level of AT? in the control group was greater than that in estrogen for 12 days,15 days and 17 days(P<0.05),but there was no significant difference between the control group and those before administration(P>0.05).The data show that there is no significant consumption of the natural cycle and the basic in AT?level.5.FX levels and medication timeResearch group(Research group A and Research group B):The levels of FX in estrogen for 12 days was significantly higher than those for 15 days and before administration(P<0.05);but there was no significant difference among the estrogen for 15 days,17 days,before administration(P>0.05).The data showed that FX levels increased first and then decreased with the time of administration.6.The level of FX between the control group and the experimental group A each medication timeResearch group(Research group A and Research group B):The level of FX in the control group was greater than that in estrogen for 15 days,before administration(P<0.05),but there was no significant difference among the control group and those for 12 days and 17 days(P>0.05).7.Research group(Research group A and Research group B):There were no significant differences in E2,A? and FX among estrogen for 12 days,15 days,17 days and before treatment(P>0.05),which Suggests Thrombosis risk factors prompted this study did not increase the risk of abnormal coagulation.conclusion:1.In the exclusion of patients aged(>40 years old),smoking,obesity,diabetes,primary hypertension,pregnancy-induced hypertension,history of pulmonary embolism and family history,hyperlipidemia,valvular disease,varicose veins,cardiovascular disease and have a history of venous thrombosis(or)when family history,high homocysteine,that the methylenetet rahydrofolater eductase behaves abnormal.homocysteine is high and anticardiolipin behaves positive were not the risk factors of thrombosis risk,which causes by ERT.BUT these three groups maybe still have synergistic effects when other risk factors for thrombosis exist.2.That oral 17?-estradiol making serum E2 increase causes AT? consumption too much,FX increased to promote the F?a,which may be one of the mechanisms of thrombosis risk caused by ERT.3.Serum E2 levels were positively correlated with medication time.When absorbed through the vagina,it can make the blood circulating E2 levels increased dramatically.4.On the basis of oral estrogen,when added to the vaginal route,did not observe the further AT ? consumption and increase in FX,which prompt the vaginal route did not further increase the risk of thrombosis.