卵泡刺激素和黄体生成素阈值与阈值窗及卵泡的发育  

The relationship between FSH/LH threshold,threshold window and follicular development

作　　者：朱桂金[1] 聂睿[1] 徐蓓[1] 

机构地区：[1]华中科技大学同济医院生殖中心,武汉430030

出　　处：《生殖医学杂志》2008年第6期401-404,共4页Journal of Reproductive Medicine

摘　　要：一年一度的达菲林IVF训练营于2008年5月9～10日在四川峨眉山下举办,本次训练营云集了我国辅助生育技术领域临床经验丰富的专家,也吸引了130多位来自全国各地的生殖医学同道。本期训练营的主题是"超排卵的FSH/LH阈值和卵巢反应性",超排卵中的Gn阈值。探讨给予多少Gn时为卵巢恰当反应、过度反应或低反应。低反应是常见的问题,与年龄因素、卵巢功能储备低下及超排卵方案不当有关。临床上的疑惑是卵泡募集启动初始Gn的阈值该如何掌握,大剂量Gn的应用是否可以纠正低反应?判断低反应的预后指标是什么?至于高反应,特别是对于多囊卵巢综合征(PCOS)病人,卵泡募集FSH阈值的掌握也是难题,因为其恰当反应范围更窄。超排卵中80%正常反应者又如何从FSH阈值探讨恰当的Gn启动剂量?Howles等提出通过年龄、FSH、BMI及AFC等预测因子推测出Gn启动剂量公式,提供一种恰当反应,即获取适当卵子又达到可接受的妊娠率,并减少多胎妊娠与卵巢过度刺激综合征(OHSS)副反应。我国的辅助生育技术已经走过了20多个春秋,过去,我们只是跟随外国技术发展的足迹,按图索骥。如今,我们不断求索,不断进步,已发展了自己的实践和经验,也有自己的发明与创造。IVF的临床妊娠率逐步提高,达到甚至超越国际水平。近年来由超排卵方案衍生的微刺激方案,减少Gn剂量的刺激,带来了接近自然周期的效果,克服了常规的降调超排方案的缺点。"轻刺激——从克罗米芬到来曲唑"是对传统超排卵方案的挑战。The concept of FSH threshold was firstly proposed by Brown in 1978, which means serum FSH concentrations need to surpass a distinct level to induce ovarian activity. FSH concentrations below the threshold level may cause the failure of follicular development and related Ez production, even though the time of administration is prolonged indefinitely. FSH threshold represents the follicular sensitivity to FSH, and it can serve as the marker of FSH sensitivity. The threshold window means the duration of elevated FSH levels above the threshold, and emphasizes the importance of a limited duration except for the achievement of FSH threshold. LH level of the minimal threshold is needed for appropriate development of follicles and the synthesis of steroid hormone but LH level surpass the upper limit（ceiling）, which may cause the arrest of follicular development. LH window means the LH level between the minimal threshold and ceiling. The normal follicular development needs LH level above the threshold but lower than ceiling. So LH concentrations should not be too high, also not be too low in the process of ovulation induction.

关 键 词：FSH阈值 FSH阈值窗 LH上限值 卵泡发育 

分 类 号：R711.5[医药卫生—妇产科学]