卵巢衰老的临床干预新进展

Advances in clinical treatment of ovary aging

女性生育力的降低显著早于全身机体的衰老,卵巢储备一般在35岁开始下降。目前卵巢衰老的诊断主要依据年龄、基础血FSH、抑制素B和血清抗苗勒氏管激素(AMH)水平及窦卵泡计数。卵巢衰老包括生理性卵巢衰老(NOA)、隐匿性卵巢功能不全(OPOI)和早发性卵巢功能不全(POI)。在IVF周期中补充生长激素、脱氢表雄酮以及辅酶Q10可以部分改善NOA患者的IVF结局。目前针对POI尚无有效的临床治疗手段。卵巢组织玻璃化冷冻联合体外激活的POI临床研究获得了较好的妊娠结局。干细胞移植干预POI患者的临床研究提示其良好的应用前景。逆转卵母细胞衰老的技术中,自体生殖系线粒体能量移植(AUGMENT)在小规模临床试验中能够显著改善卵母细胞的质量和临床妊娠率。本文就卵巢衰老的临床诊断、发病机制和干预方法进行综述。

Female fertility decreases earlier than the body physiological senescence,and ovarian reserve remarkable declines from the age of35.The current diagnosis of ovarian aging is based on age,basal blood level of FSH,inhibin B,anti-mullerian hormone(AMH)and antral follicle count(AFC).According to the severity,ovarian aging can be divided into physiological ovarian aging(NOA),occult premature ovarian insufficiency(OPOI),and premature ovarian insufficiency(POI).The addition of growth hormone(GH),DHEA or coenzyme Q10to the IVF cycle protocol can partially improve the clinical outcome in patients with physiological ovarian aging.There is no effective treatment for premature ovarian insufficiency at present.Ovarian vitrification combined with in vitro activation contributed to an improved pregnancy outcome in POI patients.Stem cell transplantation for POI patients showed promising application prospect in clinical study.Autologous germline mitochondrial energy transfer(AUGMENT),a kind of method to reverse oocyte aging,can obviously improve the oocyte quality and clinical pregnancy outcome in small-scale clinical trials.This article reviews the clinical diagnosis,pathogenesis and intervention of ovarian aging.