Kula Krzysztof, Bednarska-Czerwińska Anna, Stefański Borys, Olszak-Wąsik Katarzyna, Marchlewska Katarzyna
Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
The Gyncentrum Katowice, Katowice, Poland.
Endokrynol Pol. 2023;74(1):106-112. doi: 10.5603/EP.a2023.0004.
Changes in sex hormone secretions during the menstrual cycle may affect fertility. It has been shown that a prematurely raised progesterone (P4) level after therapeutic injection of human chorionic gonadotropin caused changes in endometrial gene expression and lowered the pregnancy rate. The aim of the present study was to investigate the complete menstrual patterns of P4 together with its derivatives testosterone (T) and oestradiol (E2) in subfertile women during their natural cycles.
Daily serum levels of P4 (ng/mL), T (ng/mL), E2 (pg/mL), and sex hormone binding protein (SHBG, nmol/L) were measured throughout a single 23-28-day menstrual cycle in 15 subfertile women aged 28-40 years with patent oviducts and normospermic partners. Knowing SHBG levels, the free androgen (FAI) and free oestrogen (FEI) indexes were calculated for each cycle day in each patient.
Baseline (cycle day one) levels of luteinising hormone (LH), thyroid stimulating hormone (TSH), P4, and T were comparable with reference intervals for a normal cycle, whereas follicle stimulating hormone (FSH), E2, and SHBG exceeded those. During cycles, the levels of P4 correlated positively with E2 levels (r = 0.38, p < 0.05, n = 392) an negatively with T (r = -0.13, p < 0.05, n = 391). T correlated negatively with E2 (r = -0.19, p < 0.05, n = 391). Menstrual cycle phases were hidden. The curve of the mean/median daily levels of P4 rose prematurely, was parallel with the E2 rise, and culminated closely, but with more than 4 times greater amplitude of P4 (2571% of baseline levels in day 16) than of E2 (580% in day 14). In turn, the curve of T declined in a U-shaped manner with a nadir (-27%) on day 16. Averaged daily levels of FEI, but not FAI, varied significantly between 23 and 26 days long and the 27-28-day cycles.
月经周期中性激素分泌的变化可能会影响生育能力。研究表明，治疗性注射人绒毛膜促性腺激素后孕酮（P4）水平过早升高会导致子宫内膜基因表达发生变化，并降低妊娠率。本研究的目的是调查不育女性在自然周期中P4及其衍生物睾酮（T）和雌二醇（E2）的完整月经模式。
在15名年龄在28 - 40岁、输卵管通畅且配偶精子正常的不育女性的一个23 - 28天的月经周期内，每天测量血清中P4（ng/mL）、T（ng/mL）、E2（pg/mL）和性激素结合蛋白（SHBG，nmol/L）的水平。根据SHBG水平，计算每位患者每个周期日的游离雄激素（FAI）和游离雌激素（FEI）指数。
促黄体生成素（LH）、促甲状腺激素（TSH）、P4和T的基线（周期第1天）水平与正常周期的参考区间相当，而卵泡刺激素（FSH）、E2和SHBG则超过参考区间。在整个周期中，P4水平与E2水平呈正相关（r = 0.38，p < 0.05，n = 392），与T呈负相关（r = -0.13，p < 0.05，n = 391）。T与E2呈负相关（r = -0.19，p < 0.05，n = 391）。月经周期阶段不明显。P4的平均/中位数每日水平曲线过早上升，与E2的上升平行，并在接近峰值时达到顶点，但P4的上升幅度（第16天为基线水平的2571%）比E2（第14天为580%）大4倍多。相反，T的曲线呈U形下降，在第16天达到最低点（-27%）。FEI的平均每日水平在23至26天的周期和27 - 28天的周期之间有显著差异，而FAI则没有。
