Klein Nancy A, Harper Andrew J, Houmard Brenda S, Sluss Patrick M, Soules Michael R
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington 98105, USA.
J Clin Endocrinol Metab. 2002 Dec;87(12):5746-50. doi: 10.1210/jc.2002-020622.
This study sought to determine whether the shortened follicular phase in ovulatory older women is secondary to advanced (i.e. earlier) or accelerated (i.e. more rapid) folliculogenesis. Normal ovulatory women, aged 40-45 yr (n = 15) and 20-25 yr (n = 13), underwent daily venipuncture and transvaginal ultrasonography throughout the follicular phase of a spontaneous menstrual cycle (control cycle) and after pituitary down-regulation with a GnRH agonist (study cycle). As expected, the older subjects in the control cycles demonstrated an elevated d 3 FSH and a shortened follicular phase compared with the younger subjects. After release from hypothalamic-pituitary-ovarian axis suppression, the early follicular phase FSH peak occurred earlier (6.8 vs. 9.8 d; P < 0.01) and was of a greater magnitude (12.1 vs. 6.5 mIU/ml; P < 0.01) in the older subjects. The time from release of suppression until the subsequent LH surge was also shorter (17.5 vs. 20.8 d; P < 0.01) in the older group. However, the time from FSH peak to LH surge was similar in the older and younger groups (10.7 vs. 11.0 d; P = 0.74). Compared with younger women, older subjects had normal follicular phase levels of estradiol and inhibin A and lower levels of inhibin B in both control and study cycles. We conclude that the shortened follicular phase observed in older ovulatory women is due to earlier dominant follicle selection, independent of hormonal influences from the preceding luteal phase.
本研究旨在确定排卵功能正常的年长女性卵泡期缩短是继发于卵泡发育提前（即更早）还是卵泡发育加速（即更快）。年龄在40 - 45岁（n = 15）和20 - 25岁（n = 13）的正常排卵女性，在自发月经周期的卵泡期（对照周期）以及用促性腺激素释放激素（GnRH）激动剂下调垂体功能后（研究周期），每天接受静脉穿刺和经阴道超声检查。正如预期的那样，对照周期中的年长受试者与年轻受试者相比，第3天的促卵泡生成素（FSH）升高且卵泡期缩短。在下丘脑 - 垂体 - 卵巢轴抑制解除后，年长受试者卵泡早期FSH峰值出现得更早（6.8天对9.8天；P < 0.01）且幅度更大（12.1 mIU/ml对6.5 mIU/ml；P < 0.01）。年长组从抑制解除到随后促黄体生成素（LH）峰出现的时间也更短（17.5天对20.8天；P < 0.01）。然而，年长组和年轻组从FSH峰到LH峰的时间相似（10.7天对11.0天；P = 0.74）。与年轻女性相比，年长受试者在对照周期和研究周期中卵泡期雌二醇和抑制素A水平正常，抑制素B水平较低。我们得出结论，排卵功能正常的年长女性卵泡期缩短是由于优势卵泡选择提前，与前一黄体期的激素影响无关。
