Klein N A, Battaglia D E, Fujimoto V Y, Davis G S, Bremner W J, Soules M R
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle 98195, USA.
J Clin Endocrinol Metab. 1996 Mar;81(3):1038-45. doi: 10.1210/jcem.81.3.8772573.
Women experience a decline in fertility that precedes the menopause by several years. Previous studies have demonstrated a monotropic rise in FSH associated with reproductive aging: however, the mechanism of this rise and its role in the aging process are poorly understood. The purpose of this study was to characterize ovarian follicular development and ovarian hormone secretion in older reproductive age women. Sixteen women, aged 40-45 yr, with regular ovulatory cycles were studied. The control group consisted of 12 ovulatory women, aged 20-25 yr. Serum obtained by daily blood sampling was analyzed for FSH, LH, estradiol (E), progesterone, and inhibin (Monash polyclonal assay). Follicle growth and ovulation were documented by transvaginal ultrasound. Older women had significantly higher levels of FSH throughout the menstrual cycle. E, progesterone, LH, and inhibin levels did not differ between the two age groups when compared relative to the day of the LH surge. Ultrasound revealed normal growth, size, and collapse of a dominant follicle in all subjects. Older women had significantly shorter follicular phase length associated with an early acute rise in follicular phase E, reflecting accelerated development of a dominant follicle. We conclude that older reproductive age women have accelerated development of a dominant follicle in the presence of the monotropic FSH rise. This is manifested as a shortened follicular phase and elevated follicular phase E. The fact that ovarian steroid and inhibin secretion were similar to those in the younger women suggests that elevated FSH in women of advanced reproductive age may represent a primary neuroendocrine change associated with reproductive aging.
女性在绝经前数年生育能力就开始下降。以往研究表明，促卵泡生成素（FSH）随生殖衰老呈单向升高：然而，这种升高的机制及其在衰老过程中的作用尚不清楚。本研究的目的是描述老年育龄妇女的卵泡发育和卵巢激素分泌情况。研究了16名年龄在40 - 45岁、排卵周期规律的女性。对照组由12名年龄在20 - 25岁的排卵女性组成。通过每日采血获取的血清用于分析FSH、促黄体生成素（LH）、雌二醇（E）、孕酮和抑制素（莫纳什多克隆检测法）。经阴道超声记录卵泡生长和排卵情况。老年女性在整个月经周期中FSH水平显著更高。相对于LH峰日，两个年龄组的E、孕酮、LH和抑制素水平没有差异。超声显示所有受试者优势卵泡的生长、大小和塌陷均正常。老年女性的卵泡期显著缩短，同时卵泡期E早期急性升高，反映出优势卵泡发育加速。我们得出结论，在FSH单向升高的情况下，老年育龄女性优势卵泡发育加速。这表现为卵泡期缩短和卵泡期E升高。卵巢甾体激素和抑制素分泌与年轻女性相似这一事实表明，高龄育龄女性FSH升高可能代表与生殖衰老相关的原发性神经内分泌变化。
