卵巢储备功能与卵巢反应性评估

辅助生殖技术（ART）的成功率依赖于正确的卵巢刺激方案,而卵巢刺激方案的决定依靠准确的卵巢储备功能和卵巢反应性的评估,主要包括年龄、基础性激素水平、基础窦卵泡数（AFC）、抗苗勒管激素（AMH）等,但是目前尚无能够独立评价卵巢储备功能和卵巢反应性的特异性标志物,仍需联合应用评估。     

环境因素对卵巢储备功能的影响

卵巢储备功能反映了女性的生育潜能。大量流行病学调查和动物实验研究表明,环境中多种因素,如噪音、电离辐射、化学污染物、空气污染、社会压力等均可导致女性及其子代卵巢储备功能下降,甚至引起卵巢早衰。环境中各种因素对卵巢储备功能影响的研究分析,有利于卵巢早衰的预防、诊断和治疗。故就环境因素对卵巢储备功能的影响做一综述。     

宫颈评分B超尿LH试纸监测排卵60例分析

对６０例不孕症患者的８８个基础体温（ＢＢＴ）双相、卵泡期长短不同的月经周期，同时采用宫颈评分（ＣＳ）、Ｂ超、尿黄体生成素（ＬＨ）试纸、排卵痛、ＢＢＴ五项指标监测排卵。结果：ＣＳ、Ｂ超、尿ＬＨ试纸监测排卵的准确率分别为８１８％、９５５％、９３２％，无显著差异（Ｐ＞００５），且Ｂ超监测卵泡增大，ＣＳ增高，两者密切相关，减少了Ｂ超检查次数，８７８％排卵发生在尿ＬＨ峰出现后２４小时内，６０例的半年内妊娠率为７８３％。结论：ＣＳ调控Ｂ超、结合尿ＬＨ试纸是简便易行且准确可靠的监测排卵方法     

阴道B超结合尿LH试纸测定在不孕妇女卵泡生长及排卵与诱导排卵中的应用

目的采用阴道B超结合尿LH试纸测定方法对不孕患者卵泡生长、尿LH峰的监测,探讨该方法在不孕症的卵泡生长、预测排卵、促/超排卵掌握hCG使用时机及未破裂卵泡黄素化综合征(LUFS)的诊治中的应用价值.方法应用阴道B超结合尿LH试纸测定方法监测110例自然月经周期不孕患者(A组)及40例促/超排卵患者(B组)卵泡生长、尿LH峰、排卵情况.A组指导同房,B组19个周期指导同房,21个周期行宫腔内人工授精(IUI).比较两组卵泡生长速度、优势卵泡数、LUFS发生率、妊娠率,尿LH试纸预测排卵的准确性.结果A组尿LH试纸预测排卵的准确性达96.4%,峰后48 h内排卵达100%.B组过早LH峰发生率为12.5%.两组卵泡生长速度、优势卵泡数、LUFS发生率、妊娠率A组分别为1.6±0.4 mm/d;1.0个;4.5%;6.6%.B组分别为2.0±0.7 mm/d;2.8±2.1个;17.5%;32.5%.上述指标B组明显高于A组(P＜0.01).结论阴道B超结合尿LH试纸测定在监测卵泡生长、预测排卵、适时掌握诱导排卵时机等方面是有价值的.     

卵巢储备功能测定在体外受精(IVF)技术中的临床价值探讨

目的:探讨在体外受精-胚胎移植技术中对超促排卵最具临床价值的卵巢储备功能测定指标。方法:将2003.10-2004.10间,105例接受IVF-ET治疗的不孕患者的年龄、基础FSH值、基础窦卵泡数、卵巢体积和卵巢基质血流测定指标与IVF超排中卵巢的实际反应进行对比并作相关性分析。结果:年龄、FSH与获卵数呈非常显著负相关,与促性腺激素(Gn)注射支数呈显著正相关;窦卵泡数、卵巢体积与获卵数呈非常显著正相关,与Gn注射支数呈非常显著负相关;其中以基础窦卵泡数与卵巢反应关系最为密切。卵巢基质血流与卵巢反应无显著相关。结论:年龄、基础FSH值、阴道超声测量基础窦卵泡数和卵巢体积均能预测超排时卵巢对促性腺激素刺激的反应性,并有简便、经济之优点,其中以窦卵泡计数的预测价值最高,窦卵泡计数不仅可用于卵巢低反应的预测,还可预测卵巢反应过激,而年龄与基础FSH仅在预测卵巢低反应中较为敏感,卵巢基质血流对预测卵巢反应的意义有待进一步探讨。     

血清抑制素B水平预测卵巢储备功能的临床价值

目的:探讨血清基础抑制素B水平与卵巢储备功能的关系及其临床价值。方法:将158例观察对象分为3组,卵巢早衰(POF)组73例,卵巢储备功能下降(DOS)组55例,卵巢功能正常组30例,分别观测其血清基础抑制素B(INHB)、雌二醇(E2)、促卵泡素(FSH)、卵巢基质血流阻力指数(RI)、窦卵泡计数(OVF)、卵巢直径(OVD)、症状积分值。结果:INHB水平在POF组及DOS组与正常组相比均有极显著性差异(P<0.001),POF组与DOS组相比也有显著性差异(P<0.05),且POF组相似文献   

经阴道超声在年轻不孕症患者卵巢储备功能评估及排卵预测中的应用价值

目的 探讨经阴道超声在年轻不孕症患者卵巢储备功能评估及排卵预测中的应用价值。方法 选择80例年轻不孕症患者为研究对象,均采用阴道超声检查,并将患者按照卵巢储备功能分为正常组(n=43)和异常组(n=37),比较两组超声检测结果、基础激素水平、卵巢储备功能超声参数及预测排卵指标。结果 异常组颈动脉收缩期最大流速(PSV)、颈动脉舒张末期血流速度(EDV)、窦卵泡计数(AFC)以及卵巢体积(OV)均小于正常组(P<0.05);异常组卵泡刺激素(FSH)、FSH/黄体生成素(LH)水平高于正常组,LH和雌二醇(E₂)水平低于正常组(P<0.05)。卵巢储备功能超声参数及预测排卵指标显示EDV、OV、AFC、PSV截断值分别为4.163、3.582、4.512、13.681,各项指标特异度均高于90.00%。结论 经阴道超声检查年轻不孕症患者卵巢储备功能以及在排卵预测中的应用效果较好,具有较高的应用价值,值得临床推广与应用。     

PCOS患者卵巢打孔对卵巢储备功能的影响

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)不孕患者促排卵的首选方法是使用氯米芬,然而对于氯米芬抵抗的PCOS患者,手术是一种有效的治疗方法。卵巢楔形切除术在1935年就开始被运用于PCOS的治疗,但由于手术创伤大、术后盆腔粘连等副反应,目前已基本被腹腔镜下卵巢打孔术     

卵母细胞线粒体DNA(mtDNA)拷贝数在卵巢储备功能下降中的研究

目的:初步探讨卵母细胞线粒体DNA(mtDNA)拷贝数对卵巢储备功能下降患者生育潜能的影响。方法:选取IVF-ET治疗的不孕症患者80例,按照卵巢储备功能状态分为卵巢储备功能下降(DOR)组和卵巢储备功能正常(NOR)组,胚胎移植日收集患者自愿捐赠的未受精的废弃MII期卵母细胞,Real-timePCR方法定量检测比较卵母细胞mtDNA拷贝数。结果:共收集到废弃的MII期卵母细胞110个,其中DOR组46个,NOR组64个。DOR组卵母细胞mtDNA拷贝数下降(9.96×104±5.21×104vs1.77×105±7.27×104),组间具有显著性差异(P<0.05)。结论:卵巢储备功能下降患者卵母细胞mtDNA拷贝数减少,可能与其卵母细胞发育潜能下降相关。     

基础FSH/LH比值对预测年轻不孕患者IVF-ET周期卵巢反应性的影响

目的:探讨基础FSH和LH比值预测基础FSH水平正常且年轻不孕患者卵巢反应性的临床价值。方法:回顾分析2004年6月至2005年5月因男方因素或输卵管因素行体外受精-胚胎移植(in-vitrofertilization-embryotransfer,IVF-ET)治疗的年轻(年龄≤35岁)且基础FSH水平正常(≤8.5IU/L)不孕患者237例的临床资料,共计237个治疗周期,依据FSH/LH不同比例分为3组,A组(n=44)FSH/LH<1;B组(n=143)FSH/LH12;C组(n=50)FSH/LH>2。比较各组间的年龄、激素水平、卵巢反应、IVF的实验室结果以及妊娠情况。结果:3组患者的年龄、窦卵泡数、基础E2值、受精率、卵裂率和妊娠率两两相比无统计学差异(P>0.05),但A、B两组间的基础FSH值、基础LH值、E2峰值和成熟卵泡数差异有统计学意义(P<0.05);A、C两组间基础FSH值、基础LH值、E2峰值、促性腺激素(gonadotropin,Gn)总用量、Gn平均每日用量、Gn用药时间及获卵数和成熟卵泡数的差异有统计学意义(P<0.05);B、C两组间基础LH值、E2峰值、促性腺激素总用量、Gn平均每日用量和Gn用药时间比较也有明显差异(P<0.05)。结论:FSH正常的年轻妇女,FSH/LH>2的卵巢反应性明显低于FSH/LH<1者;FSH/LH比值是预测基础FSH正常且年轻不孕者卵巢反应性的一项较好指标。     

The predictive value of five different urinary LH kits in detecting the LH surge in regularly menstruating women

OBJECTIVES: To compare the predictive value of five different urinary LH kits at detecting the LH surge in regularly menstruating, reproductive-age women. DESIGN: Single center, prospective study. SETTING: University of Tennessee, Obstetrics and Gynecology department. INTERVENTION: Eleven regularly menstruating women collected urine daily from cycle days 10 through 18. Urinary LH was quantitated by radioimmunoassay. Transvaginal sonography was performed to document ovulation. Three different lots of Clear Plan Easy, OvuKit, OvuQuick, Sure Step, and EZ LH were evaluated. MAIN OUTCOME MEASURE: Correlation of urinary LH test kit results with urine LH value determined by RIA. RESULTS: Peak urinary LH values by RIA ranged from 13.5 mIU/mL to 73.0 mIU/mL. The lowest level detected as positive by LH kits ranged from 25.5 mIU/mL to 48.7 mIU/mL. Lot-to-lot variations were rare. Follicular collapse occurred within 24 hours of the urinary LH peak in 8 of 10 (80%) and by 48 hours in the remaining 2 subjects. CONCLUSIONS: The percentage of LH surges detected by urinary LH kits ranged from 50% to 100%. The lowest LH value detected as positive varied almost twofold between different kits. Manufacturers should indicate the detection limit of their kits in mIU/mL.     

Prognostic value of some ovarian reserve tests in poor responders

Background The objective of this study was to determine the prognostic value of the basal estradiol (E₂) and inhibin-B levels, the antral follicle count (AFC), and the clomiphene citrate challenge test (CCCT) of ovarian response in controlled ovarian hyperstimulation (COH), in an outcome with normal follicle-stimulating hormone (FSH) concentration in the early follicular phase of the menstrual cycle.Methods Fifty-two patients undergoing IVF treatment were included in the study. Blood samples were collected for assessment of basal E₂, FSH, and inhibin-B levels. Transvaginal ultrasound of an unstimulated cycle was performed to determine the mean antral follicle count (AFC). Serum FSH concentration was measured again on day 10 for CCCT performance.Results The mean values of womens age, and basal and day 10 FSH levels were significantly higher in cancelled cycles than in the control group, whereas basal inhibin-B and AFC were significantly higher in the latter. The mean basal E₂ concentration was similar in both groups. The results from the logistic regression analysis show that CCCT (cut-off point FSH >12.5 mIU/ml; AUC_ROC=0.90) was a better single predictor of poor ovarian response than AFC (AUC_ROC=0.85) and inhibin-B (AUC_ROC=0.79) with a correct prediction for CCCT (86.5%), antral follicle count (84.6%), and for inhibin-B (82.7%).Conclusions In women with normal basal FSH level, the determination of E₂ has no prognostic value for the outcome of poor responders. However, CCCT, AFC, and inhibin-B tests, when applied separately, produce good prognostic values. CCCT is the best single predictor of poor ovarian response, followed by antral follicle count and basal inhibin-B values. In spite of that, CCCT does not add significantly to the simpler AFC ultrasound test in the prediction of poor ovarian response.     

The limited value of follicle-stimulating hormone as a test for ovarian reserve

Basal FSH measurements in general infertility patients should be considered as a screening and not as a diagnostic test. Excluding patients from assisted reproduction technology on the basis of an elevated FSH level should be restricted to those with a poor ovarian response to gonadotropin hyperstimulation.     

基础激素水平在判断卵巢储备功能中的作用

目的探讨不孕症患者基础激素水平在判断卵巢储备功能中的作用。方法采用放射免疫方法测定６０例１１２个促排卵周期周期第２天血卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）及雌二醇（Ｅ２）水平,Ｂ超观察卵泡发育情况,监测有无妊娠发生,分析基础激素水平与卵巢反应性、优势卵泡数目及周期妊娠率的关系。结果周期第２天血ＦＳＨ≥１５ＩＵ／Ｌ者,卵巢反应性差发生率高,优势卵泡数目少,周期妊娠率低。周期第２天血Ｅ２≥４５ｎｇ／Ｌ者,周期妊娠率低于血Ｅ２＜４５ｎｇ／Ｌ者。周期第２天血ＬＨ值与周期妊娠率无关。结论周期第２天血ＦＳＨ可作为判断卵巢储备功能的指标,而周期第２天血Ｅ２值对血ＦＳＨ值判断卵巢储备功能有辅助作用。     

The value of double-contrast enema in the assessment of ovarian carcinoma's diffusion

Because of the spread of ovarian carcinoma, peritoneoscopy plus diaphragmatic inspection, peritoneal cytology, and lymphangiography are the essential procedures for staging, reassessment, and restaging of the disease. Another procedure that can be important is double-contrast enema (DCE). Eighty-one patients with ovarian carcinoma were evaluated with all four procedures. In the 21 new cases, DCE was positive in 9 (42.8%), but the conversion rate was equal to 0. In 6 out of 27 reassessment patients DCE gave information about the disease's spread and in one patient changed the stage. In 17 restaging patients with clinical evidence of disease, five had positive DCE. In 16 restaging patients without clinical evidence of disease, no patient had positive DCE. Twenty six patients were submitted to laparotomy: the radiologic accuracy in patients with positive DCE was 86%; the total radiologic accuracy was equal to 77%. From the present data it appears that the radiological examination, although having a low-stage conversion index, may give a high percentage of information about the abdominal spread of the ovarian carcinoma.     

Histological assessment of impact of ovarian endometrioma and laparoscopic cystectomy on ovarian reserve

Aim: The rate of oocyte decline follows a biphasic pattern, characterized by acceleration between 32 and 38?years old. Ovarian reserve is also affected by external factors, including ovarian disease and iatrogenic damage. The aim of this study was to histologically evaluate the impact of ovarian endometriomas, laparoscopic cystectomy, and age on follicle reserve in healthy ovarian tissues and in surgically resected cyst walls. Material and Methods: Sixty-one patients were found to have ovarian endometriomas and 42 patients non-endometriotic cysts. A small amount of normal ovarian tissue was obtained during ovarian cystectomy. The follicles in normal ovarian tissue and resected cyst walls were histologically evaluated. Results: The density of follicles in ovarian tissues correlated with the age of the patients in both groups. In women aged <35?years, the relative density of follicles in healthy ovarian tissues was consistently lower in the endometriotic cyst group compared to the non-endometriotic cyst group, with the relative ratio at age 20, 30 and 35?years calculated to be 35.4%, 46.8% and 62.7%, respectively. There was no significant difference between the groups in patients over the age of 35. The resection rate of normal ovarian tissue in cystectomy specimen of the endometriosis group was significantly higher than in the non-endometriotic cyst group (P?相似文献