未生育妇女卵巢早衰13例临床分析

目的:通过对未生育妇女卵巢早衰患者行激素周期治疗和促排卵治疗,评价其疗效,探讨可能有效的促排卵方案。方法:对13例患者行雌孕激素周期治疗3～6个周期,观察治疗前后患者临床症状、血清激素水平及盆腔超声相子宫的变化,并采用3种方案促排卵治疗。结果:13例患者经雌孕激素治疗3～6个周期后,血清卵泡刺激素(FSH)、黄体生成素(LH)水平明显下降(P<0.01),血清雌二醇(E2)与服药前相比差异无显著性(P>0.05),与治疗前比较B超子宫横切面的横径、前后径有增厚(P<0.05),但子宫纵切面的长径与治疗前相比差异无显著性(P>0.05),子宫内膜显著增厚(P<0.01)。以人绝经期促性腺激素(HMG)/人绒毛膜促性腺激素(HCG)方案和促性腺激素释放激素激动剂(GnRHa)/HMG/HCG方案促排卵治疗有成熟卵泡发育并各有1例妊娠。结论:卵巢早衰患者应尽可能查明病因,针对病因治疗,并尽早行激素周期治疗,有利于促排卵治疗成功,HMG/HCG和GnRHa/HMG/HCG这两种促排卵方案均有可行性。     

卵巢早衰

卵巢早衰的发病率为1％－3％,其病因尚不甚清楚。有许多因素尤其一些基因与之有关。其中以X染色体变异为最多见。在治疗上除传统的激素替代方法,又提出诱发排卵,辅助生殖及免疫治疗等方法。     

克龄蒙用于卵巢早衰30例临床观察

目的：分析卵巢早衰患者的临床特征及诊治措施。方法：回顾性分析2010年1月至2012年1月我院接受人工周期治疗的卵巢早衰患者30例的临床资料。结果：FSH、LH、E2三种激素在治疗前后比较均有显著性差异（P〈0．05）。治疗6个月后治愈13例（43．33％）、有疗14例（46．6％）,无效3例（10．O％）,总有效率为90．0％（27／30）。结论：卵巢早衰病因复杂,其中遗传因素占10％左右,免疫因素大约20％,还有激素受体异常,酶缺陷及异常、卵泡生成障碍及卵泡闭锁加速、外界因素等,尽早行激素替代治疗可改善临床症状,使血清FSH、LH水平降低。     

卵巢早衰

卵巢早衰是大多数难处理的家族性不育的原因之一。已知与其病因有关的因素有自身免疫、染色体异常、促性腺激素及其受体异常和放射损伤等。诊断的生化标准为ＦＳＨ〉４０ＩＵ／Ｌ或ＬＨ〉３０ＩＵ／Ｌ，Ｅ２〈２５ｐｇ／ｍｌ。治疗以激素替代治疗，诱导排卵，赠卵，免疫抑制剂应用为主。     

卵巢早衰的免疫学研究进展

卵巢早衰(POF)因病因复杂、机制不明,成为一个临床上难治的疾病.大部分卵巢早衰的发病机制不明,已知POF的病因包括医源性因素(如化疗、放疗及外科手术)、自身免疫性因素、遗传因素、感染因素、酶学障碍等.目前越来越多的研究表明,自身免疫是POF的一个重要致病因素,证据表明约20％的POF与自身免疫失调有关,包括HLA-DR抗原的异常表达、抗卵巢抗体等自身抗体等.认为血清抑制素水平、自身抗体可作为POF的预测指标,及时对其行 糖皮质激素和雄激素、调节性T细胞的免疫治疗,可以延缓甚至逆转POF.     

血液病骨髓移植后卵巢早衰育龄女性激素补充治疗临床疗效

目的:探讨血液病骨髓移植(BMT)后卵巢早衰(POF)患者行激素补充治疗(HRT)的临床疗效。方法:选择2015年4月至2017年3月于苏州大学附属第一医院妇科门诊就诊的血液病BMT后POF行HRT的44例育龄女性的病例资料,比较其HRT前后月经情况、血管舒缩症状、症状自评量表(SCL-90)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)、抗苗勒管激素(AMH)、子宫大小、窦卵泡数量(AFC)、乳房钼靶或B超检查以及骨密度的变化情况,初步探讨HRT对这类患者的临床疗效。结果:血液病BMT后发生POF的患者行HRT后,月经复潮率95. 5%,治疗前有血管舒缩症状的患者治疗后症状均缓解(100%),治疗前后症状自评量表(SCL-90)总分和各因子分数差异有统计学意义(P0. 05)。治疗6个月后AMH数值增加、FSH和LH明显降低、子宫体积增大(P0. 05),但是AFC无明显变化。治疗1年后复查骨密度的9例患者,L1～L4骨密度无明显变化,双股骨骨密度数值增大(P0. 05);治疗1年以上的患者有11例随访乳房情况未发现明显变化。结论:血液病BMT后POF的育龄女性行HRT可有效缓解其雌激素缺乏相关症状,建议对这类患者行HRT。     

卵巢早衰与自身免疫紊乱的研究进展

卵巢早衰（POF）是一种高度异质性疾病,育龄期女性中其发生率约为3.7%。POF发病机制尚未完全阐明,但目前研究结果认为自身免疫紊乱在POF发生发展中起到重要作用,包括免疫细胞异常、抗卵巢抗体的高检出率、与自身免疫性疾病的高度关联,发现并治疗这些免疫紊乱为POF的预防和治疗提供了新方向,本文就POF与自身免疫紊乱的研究进展进行综述。     

受卵体外受精-胚胎移植治疗结局分析

目的:探讨受卵体外受精-胚胎移植(IVF-ET)治疗结局和疗效。方法:回顾分析2004年9月至2005年11月在本中心接受卵子赠送IVF-ET的患者共21周期的临床资料。赠卵组(20例)均采用长方案控制性超排卵行IVF-ET。受卵组(21例)采用激素替代治疗准备子宫内膜。赠卵者所赠卵子与受卵者丈夫精液行IVF-ET。选择同期常规IVF-ET患者55例做对照。结果:赠卵组种植率和临床妊娠率(7.3%,15.79%)明显低于受卵组(34.9%,52.38%)和同期IVF-ET组(21.19%,34.55%),P<0.05。结论:受卵IVF-ET是治疗卵巢功能不良和遗传原因不能生育健康后代妇女的有效方法;激素替代周期的种植率和临床妊娠率高于控制性超排卵周期。     

浅谈卵巢早衰的诊断与治疗

卵巢早衰是指妇女在青春期发育后至40岁前出现闭经、血雌激素水平低下、促性腺激素浓度过高，有时伴有潮热、出汗等绝经症状，与生理性绝经十分相似而命名，也称之为早期绝经或早发更年期。     

卵巢早衰

卵巢早衰的发病率为1%～3%,其病因尚不甚清楚.有许多因素尤其一些基因与之有关.其中以X染色体变异为最多见.在治疗上除传统的激素替代方法,又提出了诱发排卵,辅助生殖及免疫治疗等方法.     

Bone loss in young women with premature ovarian failure

Objective: To evaluate the effect of premature ovarian failure on bone mineral density. Materials and methods: Forty-five women with karyotypically normal spontaneous premature ovarian failure underwent hip and spinal bone density measurements by dual energy X-ray absorptiometry. Findings were compared with a control group of 61 women of similar age. Results: The median (range) age of the women with premature ovarian failure was 33 (18–39) years. The median (range) time since diagnosis of premature ovarian failure was 2 years (0.5–7). Forty-one of the women (91%) had sought medical advice previously and had taken a variety of estrogen and progestin replacement regimens at least intermittently. Both the femoral neck bone mineral density measurements and the spinal bone mineral density measurements were significantly lower than measurements of the control group (P<0.05). Conclusion: Our study shows that premature ovarian failure has significantly lower levels of bone mineral density than the control group of normal women. We suggest that hormone replacement therapy should be substituted early and consistently in affected patients. Our data also raise questions about whether preservation of bone mass in these patients will require replacement of additional gonadal steroids.     

Genetic abnormalities in Turkish women with premature ovarian failure

Objective

To identify the distribution of cytogenetic abnormalities among Turkish women with premature ovarian failure (POF).

Method

A karyotype analysis was performed at the Medical Genetics Department of Zekai Tahir Burak Women's Hospital, Ankara, Turkey, for 75 women younger than 40 years found to have POF over a 5-year period.

Results

There were 18 familial cases (24%), 1 of which involving an abnormality of the X chromosome [46,X,del(X)(q22)]. Sixteen patients (21.3%) had chromosomal abnormalities such as Xq and Xp deletions, translocations, and numerical aberrations; 2 had Swyer syndrome; 2 were fragile X premutation carriers; and 1 had galactosemia.

Conclusion

A genetic cause of POF was identified in 39 (52%) of 75 patients. A thorough genetic evaluation of women with POF should be performed regardless of clinical features suggestive of chromosomal abnormality.     

Hormone replacement therapy and successful pregnancy in a patient with premature ovarian failure

Premature ovarian failure (POF), premature ovarian insufficiency, premature menopause or hypergonadotropic hypogonadism, a serious life-changing condition that affects young women, remains an enigma and the researcher's challenge. In the present article we described a case of singleton pregnancy in a 33-year-old patient, presenting with POF and treated with hormone replacement therapy. Twenty months later this therapy led to maturation of one follicle, recruitment and fertilisation of the residual oocyte and spontaneous pregnancy ensued. A normal infant was delivered by cesarean section.     

The lived experience of premature ovarian failure

OBJECTIVE: To describe the lived experience of women who have been diagnosed with idiopathic premature ovarian failure (POF). DESIGN: Phenomenology was used to achieve the purpose. Women were asked to share their experiences in living with premature ovarian failure during an approximately 1-hour interview. The interviews were tape-recorded, transcribed, and analyzed for emergent themes. SETTING: Interviews were conducted in the participants' homes and in a conference room in a hospital. PARTICIPANTS: The six participants were drawn from a multicultural sample of women with idiopathic POF. RESULTS: The women in this study expressed anger at their health care providers for their perceived lack of quality care they had experienced and at the insurance industry for its lack of reimbursement for fertility interventions; they expressed depression and sadness at the prospective outcome of the diagnosis, mixed emotions regarding their significant others, and sadness and resignation about their menopausal symptoms. CONCLUSIONS: Health care providers who create an environment in which women and their significant others will feel supported in asking questions, be assured that their concerns are taken seriously, and be provided with the physical and emotional resources they need can help these women to continue to build and live their lives.     

卵巢早衰治疗策略探讨

目的　评价性激素替代治疗 (hormonereplacementtreatment,HRT)对卵巢早衰 (prematureovarianfail ure ,POF)患者的疗效 ,探讨卵巢早衰可能有效的促排卵方案。方法　采用前瞻性研究方法对 19例卵巢早衰患者 ,行HRT共 3～ 6个周期 ,观察服药前后临床症状、盆腔超声相、血清生殖激素变化及停药后卵泡发育情况 ,并对个别患者行促排卵治疗观察疗效。结果　 19例患者经HRT临床症状明显缓解。与服药前比较 ,血清卵泡刺激素 (FSH)水平明显下降 (P <0 0 1) ,血清黄体生成素 (LH)水平显著下降 (P <0 0 5 )。双侧卵巢及子宫体积无显著变化 (P >0 0 5 ) ,子宫内膜明显增厚 (P <0 0 1)。停药后 1例自然妊娠 ,1例自发排卵 ,1例用促性腺激素释放激素激动剂 (GnRHa) /绝经期促性腺激素 (HMG) /绒毛膜促性腺激素 (HCG)治疗有排卵。服药期间无肝功能损伤及其它副反应。结论　性激素替代治疗卵巢早衰 3～ 6个周期 ,可使临床症状缓解 ,血清FSH、LH明显下降 ,利于促排卵治疗成功。     

Psychological assessment of patients with premature ovarian failure

Objective.?The objective of the present work was to perform an overall psychological assessment of patients diagnosed with premature ovarian failure, with the aim of studying personality traits and assessing anxiety, depression and psychosocial stress among women suffering from this physical condition.

Methods.?We surveyed 21 patients between 18 and 39 years old. We psychologically assessed the patients with the following techniques: semi-structured interview, Beck Depression Inventory, State-Trait Anxiety Inventory for Adults, Millon Index of Personality Styles, Psychosocial Stress Severity Scale, Human Figure Drawing Test, Two Person Drawing Test, and Rorschach Inkblot Test. The Pearson moment correlation statistic was utilized to appreciate correlation between the variables. To compare the results obtained we used the χ² test, the Kolmogorov–Smirnov test and Student's t test. Significance level was set at α = 0.05.

Results.?We found that these patients did not show high levels of depression, but they did show high values of anxiety. Psychosocial stress was higher throughout the year before they lost their menstrual cycles, than during the year before the psychological evaluation. Regarding personality profiles, the following scales stood out from the rest: Actively Modifying, Self-Indulging, Internally Focused, Realistic/Sensing, Feeling-Guided, Dominant/Controlling and Dissatisfied/Complaining.     

Poland's syndrome and premature ovarian failure

A 19-year-old female with Poland's Syndrome with associated left amastia, scoliosis, and left Sprengel deformity developed secondary amenorrhea from premature ovarian failure. Her menarche was at 13 years of age, and periods were regular and monthly until 15 years of age when her periods suddenly stopped. Her hormonal evaluation was significant for elevated FSH (46.5 mIU/ml) and LH (28.5 mIU/ml), and low estradiol (23 pg/ml). Anti-ovarian antibody level was less than 2 units (normal < 4 units). Her chromosomes were 46XX, by both standard karyotype and by fluorescence in situ hybridization. On transabdominal and transvaginal ultrasonography, ovaries were not visualized, the uterus was of normal size and anteverted and both kidneys were normal. The patient began hormone replacement therapy with conjugated estrogen (Premarin) 0.625 mg po daily and progestin (Provera) 5 mg on days 20 to 25. Because of menopausal symptoms, she was switched to a combination oral contraceptive (OC) with 20 mcg ethinyl estradiol that was eventually increased to 30 mcg. Her menopausal symptoms (hot flashes and sweating) improved on the continuous 30 mcg ethinyl estradiol combination OC. Following a comprehensive review of the literature, this is the first reported case of Poland's Syndrome associated with premature ovarian failure; however, this association may be coincidental.     

Xanthogranulomatous inflammation: a rare cause of premature ovarian failure

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We report an unusual presentation of xanthogranulomatous inflammation of the genital tract in a young female presenting with premature ovarian failure. A 25-year-old unmarried female presented to the gynecology OPD with amenorrhea and lump abdomen for one and half years with weight loss and mucoid discharge per rectum for 2 months. On investigating, CECT showed a heterogeneously enhancing mass lesion with solid cystic components in pelvis. Cystic components showed enhancing walls and air fluid levels. Uterus and ovaries were not seen separately. There were multiple lymph nodes in retroperitoneum. Both LH and FSH were raised to post menopausal levels (FSH-69.35, LH-64.53). A provisional diagnosis of ovarian malignancy was made and a differential diagnosis of genital tuberculosis was kept and a decision for laparotomy was taken. Intraoperatively, there was a mass arising from the right side of fundus stuck to rectum. There was a pus pocket in the tumor. The final histopathological report was suggestive of endometrioma with xanthogranulomatous inflammation involving adjacent ovary and fallopian tube.     

Factors associated with bone density in young women with karyotypically normal spontaneous premature ovarian failure

Objective  To evaluate bone density and associated factors in women with premature ovarian failure (POF) compared to age-matched women with normal ovarian function. Methods  A cross-sectional study of 50 patients with POF undergoing bone mineral densitometry was conducted, compared to 50 women paired by age who menstruated regularly. Results  In women with POF, the mean bone mineral density measured was 1.22 g/cm² at the spine and 0.92 g/cm² at the femur, values which were significantly lower than in the control group (P < 0.0001). Factors directly associated with bone density of the lumbar spine were age and with bone density of the femur were BMI and reproductive age. Conclusion  Young women with POF have a decrease in lumbar spine and femoral bone density. Age, reproductive age and BMI were the factors associated with BMD. These women need early investigation and treatment to prevent bone loss and minimize fracture risk in the future.