Randolph John F, Ginsburg Kenneth A, Leach Richard E, Blacker Charla M, Moghissi Kamran S, Diamond Michael P, Reame Nancy E
National Center for Infertility Research at Michigan and the University of Michigan, Ann Arbor, Michigan 48109-0276, USA.
Fertil Steril. 2003 Aug;80(2):320-7. doi: 10.1016/s0015-0282(03)00612-5.
To determine whether women with rigorously defined unexplained infertility demonstrated altered GnRH secretion, as reflected by serum LH secretion patterns.
Prospective observational study.
National Center for Infertility Research at Michigan.
PATIENT(S): Nine women with rigorously defined unexplained infertility and 11 healthy, parous age-matched control women.Gonadotropin-releasing hormone (25 ng/kg) as a bolus injection.
MAIN OUTCOME MEASURE(S): Daytime pulse patterns of LH secretion measured every 10 minutes; mean serum concentrations of LH, FSH, E(2), P, PRL, and cortisol; and response to a physiologic dose of GnRH in the early follicular, late follicular, mid-luteal, and late luteal phases of the same menstrual cycle.
RESULT(S): Serum LH pulse frequency and pulse amplitude and LH secretion in response to a physiologic bolus of GnRH were not significantly different in unexplained infertility patients at any phase of the cycle. Luteinizing hormone pulse frequency and amplitude, as well as response to GnRH, varied significantly across the cycle. Mean early follicular serum LH and FSH concentrations were significantly higher in unexplained infertility patients than in fertile control subjects (LH: 5.31 +/-.51 vs. 4.03 +/-.33 [mIU/mL +/- SEM]; FSH: 5.81 +/-.63 vs. 3.80 +/-.45) but were not different at any other phase of the cycle.
CONCLUSION(S): These data do not support the hypothesis that unexplained infertility is caused by an abnormality in pulsatile GnRH secretion or abnormal pituitary sensitivity to GnRH. However, the results are consistent with a difference in negative feedback from the ovary to the pituitary in unexplained infertility patients that is suggestive of diminished ovarian reserve.
通过血清促黄体生成素（LH）分泌模式反映，确定严格定义为不明原因不孕症的女性是否存在促性腺激素释放激素（GnRH）分泌改变。
前瞻性观察研究。
密歇根州国家不孕研究中心。
9名严格定义为不明原因不孕症的女性和11名健康、年龄匹配且已生育的对照女性。静脉推注促性腺激素释放激素（25 ng/kg）。
每10分钟测量一次LH分泌的日间脉冲模式；LH、促卵泡生成素（FSH）、雌二醇（E₂）、孕酮（P）、催乳素（PRL）和皮质醇的平均血清浓度；以及在同一月经周期的卵泡早期、卵泡晚期、黄体中期和黄体晚期对生理剂量GnRH的反应。
在月经周期的任何阶段，不明原因不孕症患者的血清LH脉冲频率、脉冲幅度以及对生理剂量GnRH刺激的LH分泌均无显著差异。LH脉冲频率和幅度以及对GnRH的反应在整个周期中变化显著。不明原因不孕症患者卵泡早期血清LH和FSH的平均浓度显著高于可育对照受试者（LH：5.31±0.51 vs. 4.03±0.33 [mIU/mL±标准误]；FSH：5.81±0.63 vs. 3.80±0.45），但在周期的其他任何阶段均无差异。
这些数据不支持不明原因不孕症是由脉冲式GnRH分泌异常或垂体对GnRH敏感性异常所致的假说。然而，结果与不明原因不孕症患者卵巢对垂体负反馈的差异一致，提示卵巢储备功能下降。
