Richardson S J, Nelson J F
Department of Medicine, McGill University, Montreal, Quebec.
Ann N Y Acad Sci. 1990;592:13-20; discussion 44-51. doi: 10.1111/j.1749-6632.1990.tb30312.x.
From mid-fetal life, the human ovary steadily loses follicles. While age-related alterations at the level of the hypothalamus-pituitary appear to determine the timing of menarche, the number of follicles remaining in the mature ovary is the major determinant of the timing of both the perimenopause and the menopause. As the residual follicle reserve nears exhaustion, some of the remaining follicles appear to be defective, as evidenced by the higher incidence of chromosomal abnormalities in the ova of older women. It is presently not possible, however, to distinguish the specific contribution of the ovum to the age-related decrease in fecundity and higher abortion rate because of such confounding variables as aging sperm or changes in the endometrium. When follicle counts from peri- and postmenopausal ovaries are placed with those from previous studies of younger women and children there appears to be an acceleration in the rate of follicle loss in the decade preceding menopause. We hypothesize that the elevated FSH levels observed in normal women in the decade preceding the menopause may be responsible for this apparent acceleration in the rate of follicle loss.
从胎儿中期开始，人类卵巢中的卵泡就不断减少。虽然下丘脑 - 垂体水平与年龄相关的变化似乎决定了初潮时间，但成熟卵巢中剩余卵泡的数量是围绝经期和绝经期时间的主要决定因素。随着残余卵泡储备接近耗尽，一些剩余卵泡似乎存在缺陷，老年女性卵子中染色体异常发生率较高就证明了这一点。然而，由于存在诸如老化精子或子宫内膜变化等混杂变量，目前尚无法区分卵子对与年龄相关的生育力下降和较高流产率的具体影响。当将绝经前后卵巢中的卵泡计数与之前对年轻女性和儿童的研究结果放在一起时，似乎在绝经前十年卵泡丢失率有所加快。我们推测，在绝经前十年正常女性中观察到的促卵泡生成素（FSH）水平升高可能是卵泡丢失率明显加快的原因。
