Application Of Clomiphene Combined With Low-dose Estrogen In The Treatment Of Ovulatory Infertility

Objective To investigate the effect of clomiphene citrate(CC)combined with lowdose estrogen on endometrial receptivity in patients with ovulatory infertility and its effect on pregnancy outcome.Methods From December 2016 to December 2018,110 cases of ovulation-impaired infertility patients admitted to the third clinical hospital of Inner Mongolia medical university were selected as the study subjects.They were divided into three groups,namely,38 cases in group A treated with CC directly induced ovulation.In group B,42 patients were treated with low dose estrogen while taking CC orally.On the basis of the application of CC,30 cases in group C were treated with oral low dose estrogen when the follicle reached 14 mm by vaginal ultrasound.To stimulate ovulation treatment three groups of patients at the same time,the transvaginal ultrasound in the day of HCG monitoring endometrial blood flow parameters of pulse index(PI),resistance index(RI),blood flow velocity in peak ratio(S/D),endometrial thickness of endometrium and endometrial blood flow distribution types,comparison between the three groups of related parameters of endometrium,ovulation rate and clinical pregnancy rate difference,comparing pregnancy group and non pregnancy lining related index difference between the two groups.Results(1)Endometrial thickness: There were significant differences between the groups of group A,group B and group C in the endometrial thickness group(P<0.01).The endometrial thickness of group A was lower than that of group B and C.Significant difference(P<0.05),the intima thickness of group C was lower than that of group B,there was significant difference(P<0.05);the intima thickness of pregnant group was higher than that of non-pregnant group,there was a significant difference(P<0.01).(2)Intimal blood flow parameters: There were significant differences in blood flow parameters PI,RI and S/D between groups A,B and C(P<0.01);PI,RI of group A,Compared with group B and group C,the S/D value was significantly higher in group A than in group B and group C(P<0.05),but there was no significant difference in blood flow parameters between group B and group C(P>0.05);the intimal blood flow parameters of pregnant patients were lower than those of non-pregnant patients,and there was a significant difference(P<0.05).(3)Type of endometrium: There were significant differences between the three groups of patients with endometrial types(P<0.01).The A-type rate of group A was significantly lower than that of group B and C,with significant difference(P<0.05).There was no significant difference in the rate of type A between group B and group C(P>0.05).There was a significant difference between the two groups in the pregnancy group and non-pregnant group(P<0.01).The rate of type A was higher than that of non-pregnant group,and there was a significant difference(P<0.01).(4)Distribution of endometrial blood flow: There was no significant difference in the distribution of endometrial blood flow between the three groups(P>0.05).There was significant difference in the distribution of endometrial blood flow between the pregnant group and the non-pregnant group.The difference was(P<0.05).The rate of type III in the distribution of endometrial blood flow in the pregnant group was higher than that in the non-pregnant group(P<0.05).(5)Ovulation rate: There was no significant difference in ovulation rate between group A,group B and group C(P>0.05).There were significant differences in pregnancy rate between group A,group B and group C.(P<0.05);The pregnancy rate of group A was significantly lower than that of group B and group C(P<0.05).There was no significant difference in pregnancy rate between group B and group C(P>0.05).(6)There was a negative correlation between endometrial thickness and endometrial blood flow parameters,and there was a significant difference(P<0.05).Conclusions(1)The addition of small doses of estrogen in the early and middle follicular phase during CC ovulation induction can reverse the adverse effects of CC on endometrial development,improve endometrial perfusion and improve pregnancy rate,but early follicular phase small dose The addition of estrogen is more pronounced.(2)Comprehensive analysis of endometrial blood flow parameters,endometrial blood flow distribution,endometrial thickness and type,to evaluate endometrial receptivity in infertile patients,and to better predict clinical pregnancy outcomes.