inhibin越低代表卵巢反應較差

inhibin越低代表卵巢對於COH誘導排卵之反應可能較差

優勢卵泡之篩選發生於月經來前之黃體期末期

http://jcem.endojournals.org/content/87/12/5746.full

Is the Short Follicular Phase in Older Women Secondary to Advanced or Accelerated Dominant Follicle Development?

1. Nancy A. Klein, 
2. Andrew J. Harper, 
3. Brenda S. Houmard, 
4. Patrick M. Sluss and
5. Michael R. Soules

-Author Affiliations

1. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington 98105; and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital (P.M.S.), Boston, Massachusetts 02114

1. Address all correspondence and requests for reprints to: Nancy A. Klein, M.D., Division of Reproductive Endocrinology, 4225 Roosevelt Way NE, Suite 305, Seattle, Washington 98105. E-mail: nklein@u.washington.edu.

 

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Abstract

This study sought to determine whether the shortened follicular phase in ovulatory older women is secondary to advanced (i.e. earlier) or accelerated (i.e. more rapid) folliculogenesis. Normal ovulatory women, aged 40–45 yr (n = 15) and 20–25 yr (n = 13), underwent daily venipuncture and transvaginal ultrasonography throughout the follicular phase of a spontaneous menstrual cycle (control cycle) and after pituitary down-regulation with a GnRH agonist (study cycle). As expected, the older subjects in the control cycles demonstrated an elevated d 3 FSH and a shortened follicular phase compared with the younger subjects. After release from hypothalamic-pituitary-ovarian axis suppression, the early follicular phase FSH peak occurred earlier (6.8 vs. 9.8 d; P < 0.01) and was of a greater magnitude (12.1 vs. 6.5 mIU/ml; P < 0.01) in the older subjects. The time from release of suppression until the subsequent LH surge was also shorter (17.5 vs.20.8 d; P < 0.01) in the older group. However, the time from FSH peak to LH surge was similar in the older and younger groups (10.7 vs. 11.0 d; P = 0.74). Compared with younger women, older subjects had normal follicular phase levels of estradiol and inhibin A and lower levels of inhibin B in both control and study cycles. We conclude that the shortened follicular phase observed in older ovulatory women is due to earlier dominant follicle selection, independent of hormonal influences from the preceding luteal phase.