de Ziegler Dominique, Brioschi Pierre-Alain, Fanchin Renato, Bulletti Carlo
J Assist Reprod Genet. 2003 Jan;20(1):29-32. doi: 10.1023/a:1021258721796.
Sporadic cases of late follicular phase progesterone elevation have been described in ART cycles despite routine blockage of endogenous gonadotropins with GnRH agonists, the mechanism of which has been eluding our scrutiny. In this issue of JARG, Levran et al. report the first cases of adult-onset mild form of congenital adrenal hyperplasia (CAH) linked to a deficit in 17-hydorixyloase (17-OH ase). Contrary to CAH due to deficit 21-OH ase, these not only affect the adrenals but also the FSH driven production of E2 and androgen by the ovary thereby leading to progesterone "accumulation" during the follicular phase. Levran's findings offer new hypotheses for explaining the cases late follicular progesterone elevation particularly, when encountered in COH cycles associated with poor E2 elevation. And more importantly, Levran's findings offer new possible options for minimizing their consequences on ART outcome.
尽管在辅助生殖技术（ART）周期中常规使用促性腺激素释放激素（GnRH）激动剂阻断内源性促性腺激素，但仍有散发性晚期卵泡期孕酮升高的病例被报道，其机制一直未得到我们的仔细研究。在本期《辅助生殖与遗传杂志》（JARG）中，莱夫兰等人报告了首例与17α-羟化酶（17-OH ase）缺乏相关的成人起病型轻度先天性肾上腺皮质增生症（CAH）病例。与因21-羟化酶缺乏导致的CAH不同，这些病例不仅影响肾上腺，还影响促卵泡生成素（FSH）驱动的卵巢雌激素（E2）和雄激素生成，从而导致卵泡期孕酮“蓄积”。莱夫兰的研究结果为解释晚期卵泡期孕酮升高的病例提供了新的假设，尤其是在与雌激素（E2）升高不佳相关的控制性卵巢刺激（COH）周期中遇到此类情况时。更重要的是，莱夫兰的研究结果为尽量减少其对辅助生殖技术结局的影响提供了新的可能选择。
