育龄女性卵泡早期INHb、FS、ACTa血清水平与年龄的相关性

目的:探讨育龄女性内分泌激素抑制素(INHb)、卵泡抑素(FS)、激活素(ACTa)随年龄而发生的变化趋势。方法:采用双抗体夹心酶联免疫吸附技术(Sandwich ELISA),检测97名无内分泌疾病的育龄妇女月经周期d 3血清中INHb、FS、ACTa水平,并分析其与年龄的相关性。结果:INHb随年龄增长而降低(r =-0.567,P<0.01),FS随年龄增长而升高(r =0.398,P<0.05),ACTa不随年龄而变化(r =0.179,P>0.05),但ACTa/FS随年龄增长而降低(r =-0.502,P<0.05)。结论:INH-FS-ACT系统随年龄增长而有一定的变化趋势,并可预示卵巢功能的减退。     

宫颈粘液过氧化物酶在月经周期中的变化规律

本文对29例月经周期正常妇女的宫颈粘液过氧化物酶进行了30个周期的研究。在月经周期不同时间测定宫颈粘液过氧化物酶(CMPx)活性及血清促黄体生成素(LH)、雌二醇(E_2)和孕酮(P)。结果表明:在排卵前三天酶活性明显下降,至排卵后一天开始上升。卵泡期,酶活性与E_2呈负相关(r=-0.67);黄体期,酶活性与P呈正相关(r=0.79)。本研究提示:1.CMPx在排卵周期具有特定的变化规律,其变化受体内激素水平影响,可作为预告排卵的指标。2.如简化测定方法,可为自然避孕提供新途径。     

自然周期IVF取卵时机的掌控

目的:寻找自然周期体外受精-胚胎移植(IVF-ET)技术取卵时机的敏感指标。方法:对206例不孕妇女实施自然周期IVF-ET治疗,分析不同获卵结局与血清激素及尿黄体生成素(LH)变化的关系。结果:206例患者,获卵率为75.2%、提前排卵率为15%、未获卵率为9.7%。雌二醇(E2)和LH水平在取卵前、后变化最明显,LH峰值日血清E2和LH水平在获卵组、提前排卵组和未获卵组组间无统计学差异(P0.05),而决定取卵时获卵组E2为119.4±21.7μg/L,LH为13.3±9.4 IU/L;孕酮(P)为1.19±0.57μg/L,与提前排卵组(E2:77.6±22.5μg/L,LH:3.0±1.6 IU/L;P:3.35±1.64μg/L)和未获卵组(E2:167.8±53.5μg/L,LH:30.8±11.3 IU/L;P:0.84±0.45μg/L)比较有统计学差异(P0.05)。应用半定量尿LH试纸变化确定取卵时机显示,自尿LH峰下降到10~25 IU/L和5~10 IU/L时获卵率最高,分别为80.6%和84.8%。结论:E2和LH水平在排卵前、后变化最明显,是预测自然周期取卵时机的敏感指标。当出现LH峰时,尿LH自峰值降至5~25 IU/L,血清E2水平降至100μg/L左右,血清LH水平在10~20 IU/L是最适宜的取卵时机。     

2135个供精人工授精自然周期卵泡排卵特点及影响因素分析

目的:探讨自然月经周期卵泡排卵的特点和影响因素.方法:回顾性分析2009年1月至2010年12月在广东省计划生育专科医院行供精人工授精助孕的1412例妇女共2135个自然周期卵泡监测的资料.结果:排卵时卵泡直径中位数为19.00 mm,第2.5 ～97.5百分位数为17.50～ 23.50 mm.随着女性年龄递增,卵泡直径呈逐渐变小的趋势(P =0.001),但不同月经周期、卵泡所在部位、发生未破裂卵泡黄素化综合征(LUFS)和妊娠等因素下卵泡直径差异无统计学意义(P＞0.05).排卵时间中位数为月经周期第15天,第2.5 ～97.5百分位数为月经周期第11 ～24天.月经周期＜25天者周期妊娠率低于周期≥25天者,但差异无统计学意义(P=0.144).LUFS发生率3.47％ (74/2135),注射HCG(4.82％)或重组人绒促性素α者(7.78％)LUFS发生率显著高于未用药扳机者(2.78％)(P=0.000).90.86％(1501/1652)卵泡在尿黄体生成素(LH)峰出现强阳性后才发生排卵.与尿LH峰弱阳性或阳性比较,尿LH峰强阳性时排卵时间后移、周期妊娠率增加(P＜0.05).结论:自然月经周期卵泡排卵多发生在月经周期第11 ～ 24天和尿LH峰强阳性后.绝大部分卵泡排卵时直径为17.50 ～23.50 mm,并随着女性年龄递增而卵泡直径逐渐变小.     

雌激素受体β基因多态性和不明原因复发性流产的关系探讨

目的:研究雌激素受体β基因(ESR2)的多态性与不明原因复发性流产(URSA)之间的关系。方法:选择2010年8月至2015年5月我院收治的URSA女性85例作为研究组,另根据研究组受试者的年龄、体质量指数(BMI)、学历等基线资料匹配选择85例我院体检健康的有2次及以上的成功怀孕且活产的非妊娠妇女作为对照组。在月经周期的2~3天取各受试者的肘静脉血5 ml,比较两组妇女卵泡刺激素(FSH)、黄体生成激素(LH)和雌二醇(E_2)的血清水平,同时检测ESR2基因的rs1256049、rs4986938和rs1256030位点多态性,分析ESR2各基因位点多态性及其与激素水平间的关系。结果:两组妇女FSH和E2水平差异无统计学意义(P0.05)。研究组妇女LH水平明显高于对照组,差异有统计学意义(P0.05)。两组妇女的rs1256049、rs4986938、rs1256030位点的各基因型频率及不同位点与各基因型(野生型、杂合型、纯合型)血清FSH、E2和LH的水平间比较,差异均无统计学意义(P0.05)。对照组妇女中仅rs4986938位点与rs1256030位点多态性呈正相关(r=0.38,P=0.00),研究组妇女中仅rs1256049位点与rs4986938位点的多态性之间呈负相关(r=-0.17,P=0.02)。结论:ESR2的多态性与URSA之间无明显关系。三个位点间有一定的相关性,且在两组中是不同的,这种差异是否与URSA间存在一定的联系,还需要进一步研究。     

排卵期血中LH、FSH、E_2,尿中LH的波动

准确掌握排卵期对于不孕症的治疗至关重要。本文观察了七名月经周期正常的不孕妇女的排卵期。在排卵期中每3小时采血一次,及时检测激素波动的情况。同时立刻收集尿液,用半定量法测定尿中 LH,该法对于判断排卵时间的准确性,尚待观察。据作者报告,血中 LH 峰在排卵前12～15小时开始上升,而在排卵后 LH 峰则急速下降。FSH 较LH 峰提前12小时开始出现,并和 LH 同时形成波峰。E_2在测定时间内均显示高值,但并不是陡峰。     

每日和每8小时采血观察正常月经周期的内分泌动态

了解正常月经周期的内分泌动态,对于解释排卵机制问题和治疗排卵障碍都是不可缺少的,所以弄清楚内分泌的变动曲线是非常必要的。因此选有正常月经周期的未孕妇女32人,其中27人在一个月经周期内,每天采血1次,其余5人于月经第7～10天开始,至体温升高后4天止,每8小时采血,测定血中促黄体生成素(LH)、促卵泡激素(FSH)、雌二醇(E_2)和孕酮(P)。     

不同黄体生成素与卵泡刺激素比值的多囊卵巢综合征患者抗苗勒管激素分泌特点及卵泡发育障碍机制

目的 比较不同血清黄体生成素(LH)与卵泡刺激素(FSH)比值(LH/FSH)的多囊卵巢综合征(PCOS)患者的抗苗勒管激素(AMH)分泌特点及卵泡发育障碍机制.方法 以LH/FSH为标准,将95例PCOS患者分为高比值组(49例,LH/FSH≥2),常比值组(46例,LH/FSH<2),以62例月经周期规则的输卵管性不孕患者为对照(对照组).3组患者均测定体质指数(BMI);采用酶联免疫吸附试验(ELISA)测定血清AMH水平;采用化学发光法测定血清生殖激素、空腹血糖、胰岛素及血脂水平;采用单因素方差分析法比较各组间生化代谢指标的差异;并运用简单相关分析法和多重线性回归法分析AMH水平与各生化代谢指标的关系.结果 (1)血清AMH水平:高比值组为(7.2±4.3)μg/L,常比值组为(5.2±3.8)μg/L,对照组为(3.7±2.2)μg/L,3组分别比较,差异均有统计学意义(P<0.01).(2)血清AMH水平与生化代谢指标的相关性:高比值组患者血清AMH水平与雌二醇水平呈负相关关系(r=-0.318);常比值组患者血清AMH水平与BMI、空腹血糖、稳态模型胰岛索抵抗指数(HOMA-IR)呈正相关关系(r=0.493、0.362、0.303).控制其他因素影响后,高比值组患者血清AMH水平与LH/FSH呈正相关关系(r=0.301),与雌二醇水平呈负相关关系(r=-0.429);常比值组患者血清AMH水平与BMI呈正相关关系(r=0.493).结论 高LH/FSH的PCOS患者卵泡发育障碍机制可能以下丘脑-垂体功能障碍为主,正常LH/FSH的PCOS患者则以代谢紊乱为主.     

定量尿LH试纸在卵巢储备功能评估中的临床价值

目的:探讨定量尿LH试纸在卵巢功能评估中的临床价值。方法:选取221例女性患者,根据卵巢储备功能分为卵巢储备功能低下(DOR)组、卵巢功能正常组和多囊卵巢综合征(PCOS)组。B超监测卵泡发育及排卵,定量尿LH试纸动态监测月经周期尿LH水平。结果:DOR和卵巢功能正常组患者的160个周期均出现尿LH峰,其中146个周期经B超证实有排卵,定量尿LH试纸诊断排卵符合率为91.25%(146/160);PCOS组均无尿LH峰出现,B超监测亦无排卵。PCOS组的基础尿LH值明显高于DOR组和卵巢功能正常组(P0.05),后两组的基础尿LH值比较无差异(P0.05)。排卵正常的患者中,DOR组尿LH峰值日早于卵巢功能正常组(P0.05)。结论:定量尿LH试纸作为一种新型尿LH检测试纸,不但可用于排卵监测,而且在卵巢储备功能评估方面具有良好的临床价值。     

育龄女性月经周期内及周期间血清抗苗勒管激素水平的变化研究

目的:探讨育龄女性血清抗苗勒管激素(AMH)水平在同一月经周期内和连续两个周期间的变化。方法:选择本院21~45岁,排卵规律的健康女性46例,于早卵泡期、排卵期和黄体中期分别抽取外周血,使用化学发光法对不同时间点血清AMH水平进行检测,评估月经周期内和周期间的血清AMH水平的稳定性,并且分析年龄、体质量指数(BMI)和性激素水平与血清AMH水平的相关性。结果:46例完成了1个月经周期3个时间点的检测,早卵泡期、月经中期和黄体期的血清AMH水平分别为2.90 ng/ml、2.74 ng/ml、2.72 ng/ml;3个时间点的AMH水平比较,差异无统计学意义(P0.05)。其中29例完成了连续2个周期6个时间点的检测,血清AMH水平分别为2.41 ng/ml、2.33 ng/ml、2.39 ng/ml、2.29 ng/ml、2.57 ng/ml和2.45 ng/ml;6个时间点的AMH水平比较,差异无统计学意义(P0.05)。30岁及以下女性早卵泡期AMH水平与睾酮(T)和雌二醇(E2)水平显著负相关(r=-0.436,P0.05;r=-0.499,P0.01);30岁以上女性早卵泡期AMH水平与年龄显著负相关(r=-0.570,P0.05)。结论:血清AMH水平在月经周期内和周期间维持稳定,可在月经周期任一天进行检测。综合年龄、AMH水平和基础性激素水平可帮助临床更好的评估育龄女性的卵巢储备功能。     

Urinary follicle-stimulating hormone peak as a biomarker for estimating the day of ovulation

OBJECTIVE: To evaluate urinary follicle-stimulating hormone (FSH) as a biomarker for the day of ovulation. DESIGN: Prospective observational study. SETTING: Clinical research center. PATIENT(S): Thirteen women were monitored with measurements of serum and urinary hormones and ovarian ultrasonography during 20 menstrual cycles. Data on urinary hormones and ultrasound evaluations from a total of 65 menstrual cycles from 42 women were analyzed. INTERVENTION(S): Blood and/or urine samples were collected daily. Daily transvaginal ultrasonography was used to detect follicular collapse. MAIN OUTCOME MEASURE(S): LH, FSH, and E(2) were measured in serum. FSH, estrone conjugates (E1C), and pregnanediol-3-glucuronide (PdG) were analyzed in urine. The day of luteal transition (DLT) was calculated using two algorithms. RESULT(S): In 20 cycles, the urinary FSH peak was closer to the day of follicular collapse (-0.85 days) than was the peak day of serum E(2) and the day of luteal transition, as calculated by one algorithm. The FSH peak was not closer to the day of follicular collapse than the peak values of urinary LH, serum FSH, or the day of luteal transition as calculated by a second algorithm. The most consistent correspondence between a hormone peak and ovulation was for serum E(2), serum FSH, serum LH, and urinary FSH. In 65 cycles for which urinary hormone data and ultrasound evaluations were available, the urinary FSH peak occurred within 1 day of follicular collapse in 97% of cycles. CONCLUSION(S): Urinary FSH is a useful biomarker for estimating the day of ovulation in population-based studies.     

Immunoreactive luteinizing hormone in acetone precipitates and kaolin extracts of human urine

Urinary luteinizing hormone (LH) was precipitated with acetone and measured in a radioimmunoassay specific for LH. Recovery experiments were done adding the Second International Reference Preparation of Human Menopausal Gonadotropin (2nd IRP-HMG) to the urine of a hypophysectomized patient. Parallelism of the dilution curves of 2nd IRP-HMG and several dilutions of acetone precipitates of urine confirmed the validity of the assay. Direct acetone precipitation and acetone precipitation of kaolin extracts were compared for LH and follicle-stimulating hormone (FSH) recoveries. The methods gave comparable results for immunochemical FSH, but LH values for acetone precipitates were 3.7 to 4.3 times higher than those in the kaolin extracts and the discrepancies were comparable for all age groups. Measurement of serum LH and urinary LH by direct acetone precipitation during four normal menstrual cycles and in 2 patients with gonadal agenesis before and after estrogen administration confirmed that the urinary excretion reflected the serum LH concentration.     

Pituitary LH response to LHRH during puerperium.

Forty puerperal women and 15 normally menstruating women used as controls were given 100 microgram of synthetic luteinizing hormone releasing hormone (LHRH) in a single intravenous injection. Serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) were measured by a specific radioimmunoassay (RIA). The LH-beta RIA method, which is unaffected by hCG at sample levels as high as 500 IU/ml, was used to determine serum LH levels. Basal serum FSH and LH levels determined immediately after delivery were lower than those in the follicular and luteal phases during the normal menstrual cycle. These levels rose gradually after delivery, and finally returned to normal levels during the 16th to 25th days of the puerperal period. Small, but significant, LH response to LHRH was observed 6-10 days after delivery, and gradually returned to normal thereafter, though the response was poor during the first 35 days of the puerperal period when compared with that of the controls. On the other hand, no FSH response to LHRH was observed until 16-25 days after delivery, when the response was greater than that of the controls.     

甲地孕酮硅橡胶避孕环对人垂体、性腺激素和子宫内膜的影响

利用气相层析和放射免疫法测定了10例使用甲地孕酮硅橡胶阴道环(下称硅甲环)妇女尿中的E_1、E_2、E_3、P_2和LH 的含量,并用光学显微镜观察了子宫内膜的变化。实验证明10例使用硅甲环妇女中:有7例排卵,尿中LH、E_1、E_2、E_3和P_2的分泌曲线与正常组相似,但分泌总量减少,尿中三种雌激素的比例为E_3>E_1>E_2,该组的子宫内膜虽属分泌期,但腺体发育较差;2例不排卵,LH、E_1、E_2、E_3和P_2不出现典型的分泌曲线;另1例不排卵兼有突破性出血,尿中LH、E_1、E_2、E_3及P_2的分泌量在整个周期中波动甚大,三种雌激素的比例异常,这类不排卵型的子宫内膜仍处于增生期。本工作表明硅甲环对妇女下丘脑—垂体—性腺轴的影响较小,其避孕环节主要是影响卵泡的发育和黄体的正常功能。     

A pharmacokinetic and endocrine comparison of recombinant follicle-stimulating hormone and human menopausal gonadotrophin in polycystic ovary syndrome

Elevated LH concentrations are frequently encountered in patients with polycystic ovary syndrome (PCOS) and increased LH (either endogenous or superimposed through the use of HMG) may have detrimental effects on reproductive function. In spite of this, FSH-only products and HMG have been used indiscriminately for ovulation induction - on the basis that the administration of HMG to patients with PCOS, who are not receiving GnRH agonists, does not result in significant increases in serum LH concentrations as judged by daily single blood samples. However, both endogenous and exogenous LH have a relatively short terminal half-life and studies have reported normal serum LH, but abnormal urinary LH and emphasized that early morning urinary measurements are more informative than those in serum because they reflect nocturnal LH secretion. Therefore, the present study was undertaken to perform a pharmacokinetic and endocrine comparison of recombinant human FSH and HMG in PCOS patients including LH measurements in the urine. Five PCOS patients receiving s.c. recombinant human FSH (rhFSH) and five PCOS patients receiving i.m. HMG for ovulation induction according to a chronic low-dose step-up regimen underwent blood and urine sampling at the following study points: Point 0 was the day of HCG injection; Points 1 to 5 corresponded to days HCG -1 to -2; -3 to -4; -5 to -6; -7 to -8; and -9 to -10; respectively. Serum hormone measurements included oestradiol, FSH, LH, progesterone, inhibin A, androstenedione, testosterone, and free testosterone index. FSH and LH were also measured daily in 8-h urine samples reflecting overnight renal urine secretion. Hormone concentrations calculated as the area under the curve showed that both FSH and LH concentrations in urine were significantly higher in HMG group than in group rhFSH. It is concluded that both LH and FSH concentrations significantly accumulate in the urine of PCOS patients receiving HMG for ovulation induction in a chronic low-dose protocol as compared with rhFSH treatment.     

Comparative study of serum luteinizing hormone levels in human subjects as measured by radioimmunoassay and radioreceptorassay

A rapid, precise, sensitive, and specific radioreceptorassay (RRA) for serum luteinizing hormone (LH), using a 15,000 X g pellet from bovine corpora lutea, was developed. A comparative study of the serum LH levels in human subjects as measured by this RRA and by radioimmunoassay (RIA) using the same standard preparation was then conducted. The serum LH profile throughout the entire menstrual cycle and the pituitary responsiveness to LH-releasing hormone (LH-RH) stimulation during the two phases of the cycle were studied in two normal women. In addition, LH levels in two normal postpubertal men were measured in blood samples obtained before and after LH-RH administration. Similar, although not identical, LH profiles were found in all cases by both hormone assay methods. Higher RRA-assayable LH values were obtained throughout the menstrual cycle as compared with those obtained by RIA. A significant LH-RH pituitary response in terms of LH in both RRA and RIA during the luteal phase was observed as compared with that observed during the early follicular phase. In the two normal men, the LH values obtained with RRA were higher than those obtained with RIA. It is concluded that the LH RRA is a practical and efficient tool for clinical research.     

血清抑制素含量在月经周期中的变化及其与卵泡刺激素的相关性

目的了解育龄妇女在月经周期中血清抑制素(INH)含量的变化规律及其与卵泡刺激素(FSH)、黄 体生成素(LH)、雌二醇(E2)及孕酮(P)的相关性。方法建立一种改良的INH放射免疫测定法(RIA),对育龄妇 女正常月经周期中及绝经后妇女血清INH含量的变化进行监测;同时测定血清FSH、LH、E     

Ability of luteinizing hormone (LH) to acutely increase serum progesterone levels during the secretory phase of the rhesus menstrual cycle

The acute response (increase in serum progesterone) of rhesus monkeys to a single intravenous injection of luteinizing hormone (LH), follicle-stimulating hormone (FSH), or prolactin was examined. Blood samples were obtained at 0, 20, 40, 60, and 120 minutes posttreatment with gonadotropins on the morning of Day 6 or 21 of the cycle. Neither FSH nor LH induced an increase in progesterone when administered on Day 6. LH increased serum progesterone at all dose levels (50, 250, and 500 mcg) during the luteal phase of the cycle. Values for LH-treated animals were significantly greater than saline controls (P .05), were positively correlated with dose (.632), and the regression was significant (p .01). The mean effect of 1000 mcg of FSH suggests the ability of exogenous FSH to evoke a slight increase in progesterone secretion. Removal of the LH contaminant in FSH by incubation with LH antiserum did not influence the ability of FSH to increase progesterone levels, however, administration of LH antiserum just prior to giving FSH blocked the previously noted progesterone response to FSH. 60 IU of prolactin was without influence in both phases of the cycle. It is concluded that FSH induces changes in progesterone levels by either affecting the receptor site for LH or causing endogenous release of LH.     

Differences in hormonal characteristics of conceptive versus nonconceptive menstrual cycles

OBJECTIVE: To determine the hormonal characteristics of a fecund menstrual cycle. DESIGN: Prospective observational study. SETTING: Clinical research center. PATIENT(S): Fourteen patients having artificial insemination with donor semen provided daily blood and urine samples in a nonconceptive cycle and the consecutive conceptive cycle. INTERVENTION(S): Concentrations of E2, luteinizing hormone, follicle-stimulating hormone (FSH), and P4 were measured in serum. Urine samples were analyzed for metabolites of E2, P4, and FSH. MAIN OUTCOME MEASURE(S): The serum and urinary hormone profiles of the periovulatory period were compared in conceptive and nonconceptive cycles. RESULT(S): The mean peak value of periovulatory urinary FSH was significantly higher in conceptive cycles than in nonconceptive cycles. The mean serum E2 concentration was significantly higher on day 0 (day of peak urinary FSH concentration) in conceptive cycles than in nonconceptive cycles, but mean peak values of serum E2 did not differ significantly. No other significant differences were observed in serum and urinary hormone profiles between conceptive and nonconceptive cycles. CONCLUSION(S): A lower, broader peak of FSH in urine was observed in nonconceptive cycles compared with conceptive cycles. Urinary FSH measurements may be useful in predicting less fecund ovulatory cycles and may identify some types of reduced female fertility.     

正常卵巢与多囊卵巢的颗粒细胞E_2和P的产生及其卵泡液中E_2和雄烯二酮(A)含量的比较

为了解正常卵巢与多囊卵巢(PCO)颗粒细胞功能的异同.本研究对12例正常人卵泡期的25个卵泡和7例PCO的约60个卵泡的颗粒细胞进行了培养,用放免法测定卵泡液中雌二醇(E_2)和雄烯二酮(A)及培养液中E_2和孕酮(P)的含量.结果表明PCO的颗粒细胞对FSH和LH刺激更敏感,产生更多的E_2和P.FSH(10ng/ml)作用下PCO组产生的E_2和P分别比正常组高8.8倍(P<0.001)和2.6倍(P<0.05).LH(10ng/ml)作用下PCO组产生的E_2和P也分别高4.8倍(P<0.01)和2.0倍(P>0.05);PCO卵泡液中A的含量明显高于正常对照(P<0.05).PCO的颗粒细胞甾体激素合成酶的活性增高,可能是PCOS病人的高LH和高INS血症起关键作用.