Nihon University Itabashi Hospital, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
Animal Resource Science Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 3145 Ago, Kasama, Ibaraki, 319-0206, Japan.
BMC Pregnancy Childbirth. 2017 Sep 20;17(1):312. doi: 10.1186/s12884-017-1510-6.
The increase in serum estradiol (E) concentrations during the follicular phase becomes the index of oocyte maturation in vivo. When ovarian stimulation is performed to hypogonadotropic hypogonadism (HH) patients with only follicle stimulating hormone (FSH), proper increase in serum E concentrations is not observed. Even if oocytes are obtained, which usually have low fertilization rate. In this report, we would like to present an unique case, in which under low E concentrations and without luteinizing hormone (LH) administration, numerous mature oocytes could be obtained and a healthy baby delivered.
During controlled ovarian stimulation (COS) with only recombinant follicular stimulating hormone (rFSH) administrations, a 26-year-old Japanese woman with hypothalamic amenorrhea (i.e., hypogonadotropic hypogonadism) developed numerous follicles despite low serum E, 701 pg/ml, and high progesterone (P) concentrations, 2.11 ng/ml, on the day of induced ovulation. However, 33 cumulus-oocyte complexes (COCs) were successfully obtained; following the embryo culture, four early embryos and six blastocysts were cryopreserved. This patient received hormone replacement therapy (HRT), during which one of six cryopreserved blastocysts was thawed and transferred into the uterine lumen. The patient became pregnant from the first transfer, went through her pregnancy without any complications, and delivered a healthy male baby in the 39th week. Low E concentrations in follicular fluids (FFs) are suggestive that aromatase and/or 17β-hydroxysteroid dehydrogenase (17β-HSD) could be low.
Serum E concentrations may not be the most important index for oocyte maturation during COS, and suggested that oocyte maturation was in progress even under low serum E and high P conditions. Even if serum E concentrations did not properly increase, numerous mature oocytes could be obtained, resulting in the birth of a healthy baby.
在卵泡期，血清雌二醇（E）浓度的增加成为体内卵子成熟的指标。当对只有卵泡刺激素（FSH）的低促性腺激素性性腺功能减退（HH）患者进行卵巢刺激时，不会观察到血清 E 浓度的适当增加。即使获得了卵子，通常受精率也很低。在本报告中，我们将介绍一个独特的病例，在该病例中，在低 E 浓度且没有黄体生成素（LH）给药的情况下，可以获得大量成熟的卵子，并成功分娩健康的婴儿。
在仅用重组卵泡刺激素（rFSH）给药的控制性卵巢刺激（COS）期间，一名 26 岁的日本下丘脑闭经（即低促性腺激素性性腺功能减退）患者尽管血清 E 浓度低（701pg/ml）且孕激素（P）浓度高（2.11ng/ml），但在诱导排卵日仍发育出大量卵泡。然而，成功获得了 33 个卵丘-卵母细胞复合物（COC）；胚胎培养后，冷冻保存了 4 个早期胚胎和 6 个囊胚。该患者接受了激素替代疗法（HRT），在 HRT 期间，解冻了 6 个冷冻胚胎中的一个并移植到子宫腔中。患者第一次移植就怀孕了，怀孕期间没有任何并发症，并在第 39 周分娩了一个健康的男婴。卵泡液（FF）中的低 E 浓度表明，芳香酶和/或 17β-羟甾体脱氢酶（17β-HSD）可能较低。
血清 E 浓度可能不是 COS 期间卵子成熟的最重要指标，并表明即使在低血清 E 和高 P 条件下，卵子成熟也在进行。即使血清 E 浓度没有适当增加，也可以获得大量成熟的卵子，从而成功分娩健康的婴儿。
