Navot D, Rosenwaks Z, Margalioth E J
Lancet. 1987 Sep 19;2(8560):645-7. doi: 10.1016/s0140-6736(87)92439-1.
A clomiphene citrate (CC) challenge test was used to prospectively assess future fertility potential in 51 women aged 35 or more with unexplained infertility. Baseline (day 2-3 of the menstrual cycle) and response levels (day 9-11) of follicle stimulating hormone (FSH), luteinising hormone (LH), and 17-beta oestradiol were measured before and after administration of 100 mg clomiphene on days 5-9 of the menstrual cycle. Although all the women had a normal baseline FSH, 18 had an exaggerated FSH response of 26 mIU/ml or more (over 2 standard deviations above control values); this was regarded as a diminished ovarian reserve (DOR). In the DOR group mean response FSH was 38.9 mIU/ml (SD 13.8) and in 33 women with adequate ovarian reserve (AOR) it was 11.5 (4.9) mIU/ml (p less than 0.0001). In the DOR group 1 of 18 patients and in the AOR group 14 of 33 (42%) conceived (p less than 0.05). It is suggested that despite apparently normal ovulatory cycles, the DOR group has a compromised follicular apparatus. Disparity between normal oestradiol secretory capacity of the granulosa and diminished capacity to secrete inhibin could explain the inappropriately high FSH levels in response to the CC challenge.
使用枸橼酸氯米芬（CC）激发试验对51名35岁及以上不明原因不孕的女性进行前瞻性评估，以了解其未来的生育潜力。在月经周期第5 - 9天给予100mg氯米芬前后，测量卵泡刺激素（FSH）、黄体生成素（LH）和17-β雌二醇的基线水平（月经周期第2 - 3天）和反应水平（第9 - 11天）。尽管所有女性的基线FSH均正常，但有18名女性的FSH反应过高，达到26mIU/ml或更高（比对照值高出2个标准差以上）；这被视为卵巢储备功能减退（DOR）。在DOR组中，平均反应FSH为38.9mIU/ml（标准差13.8），而在33名卵巢储备功能正常（AOR）的女性中，该值为11.5（4.9）mIU/ml（p<0.0001）。在DOR组中，18名患者中有1名受孕，在AOR组中，33名患者中有14名（42%）受孕（p<0.05）。研究表明，尽管排卵周期看似正常，但DOR组的卵泡功能已受损。颗粒细胞正常的雌二醇分泌能力与抑制素分泌能力下降之间的差异，可能解释了对CC激发试验FSH水平过高的原因。
