Catteau-Jonard Sophie, Pigny Pascal, Reyss Anne-Céline, Decanter Christine, Poncelet Edouard, Dewailly Didier
Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, Avenue Eugène Avinée, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France.
J Clin Endocrinol Metab. 2007 Nov;92(11):4138-43. doi: 10.1210/jc.2007-0868. Epub 2007 Aug 14.
We previously hypothesized that the excess of anti-müllerian hormone (AMH) at the level of selectable follicles could be involved in the follicular arrest of polycystic ovary syndrome (PCOS), mainly through inhibition of FSH effect on aromatase expression.
In this study, we investigated whether a decrease in the serum AMH level was concomitant to the appearance of a dominant follicle induced by administration of mild amounts of exogenous FSH in women with PCOS.
A total of 30 women with PCOS in whom anovulation was resistant to clomiphene citrate received recombinant FSH using the low-dose step-up protocol during only one cycle. Serum levels of estradiol, AMH, LH, FSH, inhibin B, and ultrasound parameters were assessed twice a week until 3 d after the appearance of one or more dominant follicle(s).
The day of dominance (d 0) was defined by the appearance of at least one follicle more than 10 mm growing 2 mm/d. From d -14 before dominance to d +3, the mean serum AMH level and the 2- to 5-mm follicle number at ultrasound declined steadily, although not significantly by ANOVA. Mean AMH relative values (100% being the value at d 0) declined significantly (P = 0.04), from 125 +/- 32% at d -14 to 105 +/- 15% at d -4. Within the same time lag, the mean FSH relative values increased from 91 +/- 17% to 107 +/- 19% (P = 0.013). In the 87 samples obtained from d -14 to -4, absolute values of AMH were positively and negatively associated with those of LH and FSH, respectively, in an independent manner (P = 0.009 and P = 0.03, respectively). In the 55 samples collected at d 0 and +3, they were negatively correlated to those of estradiol (r = -0.272; P < 0.05).
These data suggest that in anovulatory women with PCOS, gently increasing the serum FSH level reduces the AMH excess, thus relieving the inhibition from the latter on aromatase expression by selectable follicles and allowing the emergence of a dominant follicle.
我们之前曾假设，在可选择卵泡水平上抗苗勒管激素（AMH）过量可能参与多囊卵巢综合征（PCOS）的卵泡停滞，主要是通过抑制FSH对芳香化酶表达的作用。
在本研究中，我们调查了在PCOS女性中，给予少量外源性FSH诱导优势卵泡出现时，血清AMH水平的降低是否与之相伴。
总共30例对枸橼酸氯米芬无排卵反应的PCOS女性，在仅一个周期内采用低剂量递增方案接受重组FSH治疗。每周两次评估血清雌二醇、AMH、LH、FSH、抑制素B水平及超声参数，直至出现一个或多个优势卵泡后3天。
优势日（第0天）定义为至少有一个直径超过10 mm且每天生长2 mm的卵泡出现。从优势前第14天到第+3天，平均血清AMH水平及超声检查时直径2至5 mm的卵泡数量稳步下降，尽管经方差分析无显著差异。AMH平均相对值（以第0天的值为100%）显著下降（P = 0.04），从第-14天的125±32%降至第-4天的105±15%。在同一时间间隔内，FSH平均相对值从91±17%增至107±19%（P = 0.013）。在第-14天至-4天获得的87份样本中，AMH绝对值分别与LH和FSH绝对值呈正相关和负相关（分别为P = 0.009和P = 0.03）。在第0天和第+3天采集的55份样本中，它们与雌二醇呈负相关（r = -0.272；P < 0.05）。
这些数据表明，在无排卵的PCOS女性中，轻度增加血清FSH水平可降低AMH过量，从而解除其对可选择卵泡芳香化酶表达的抑制，使优势卵泡得以出现。
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