月經(jīng)周期與卵巢周期課件

單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,*,*,NEW CONCEPT,MENSTRUAL CYCLE AND OVARIAN CYCLE,ART,中月經(jīng)周期與卵巢周期,的理念,OUTLINE,題綱,?,?,?,?,?,人類月經(jīng)周期的發(fā)生,Generation Of Menstrual Cycle,Humans Menarche,Humans Menopause,為什么人類會有初潮？,為什么人類有更年期,?,卵巢周期的概念,Concept Of Ovarian Cycle,額外排卵,Luteal Out Of The Phase,?,?,?,?,?,?,傳統(tǒng)的卵泡發(fā)育與,art,超排、取卵,COS/OPU Are Base On,Aging Woman,高齡婦女卵泡發(fā)育的異常調(diào)節(jié)與可利用性卵泡,體內(nèi)黃體酮升高對內(nèi)膜的影響比對卵子發(fā)育的影響更大,Elevated P Level,冷凍是,ART,成功的重要技術(shù),Cryopreserve And ART,隨時(shí)取卵,OPU At Any Time Is Innovation Practice,隨時(shí)取卵是對人類生殖技術(shù)一種重新的認(rèn)識過程,New Technique Is Based,On New Concept,人類月經(jīng)周期的發(fā)生,?,Generation of humans menstrual,cycle,月經(jīng)來潮是人類性腺發(fā)育成熟，具,備生育功能的表現(xiàn)，臨床表現(xiàn)為周,期性子宮內(nèi)膜剝落,出血。,人類月經(jīng)周期的發(fā)生,Generation of humans menstrual cycle,GnRH pulsatile,LH,Luteo-follicular,transition,P,E2,FSH,Ovulation,Endometrium,Proliferation,Secretion,人類月經(jīng)周期的發(fā)生,Generation of humans menstrual cycle,Hypothalamus,?,Regulation Is Much Precise In HPOA,during child-bearing age,GnRH,LH,FSH,ovary,I,n,h,i,b,i,n,(,-,),Pituitary,I,月經(jīng)周期是指陰道,出血第一天到下周,期陰道出血的第一,天，其受到下丘腦,-,垂體,-,卵巢軸的內(nèi)分,泌調(diào)節(jié)，,這一生理,調(diào)節(jié)過程是非常精,確的。,為什么人類會有初潮？,?,人類女性月經(jīng)初潮在,12-,16,歲，是青春期向生育,Humans menarche,期的過渡，此時(shí)身體各,系統(tǒng)逐漸發(fā)育成熟，尤,其是中樞神經(jīng)系統(tǒng)，這,使得,下丘腦,對于女性內(nèi),分泌系統(tǒng)的調(diào)節(jié)開始變,得穩(wěn)定和完善,。,Developments of Reproductive Endocrine,are Involved in regulation of the,Hypothalamus,老母雞還下蛋嗎？,CAN AN OLD HEN ALSO LAY EGGS?,Is menopause as experienced,by humans unique in the animal world?,三文魚產(chǎn)卵后還活么？,THE SALMON WILL DIE AFTER LAYING EGGS?,生殖器官衰老比其他器官早，物種有異，,大多有更年期，不過長短不一而已,生命期,life span,生育期,reproductive,來源,resource,http:/ yrs,10-20yrs,2.5-3.5yrs,30yrs,3-5yrs,75,th,-300,th,（,d,）,3rd,、,5,th,(yrs),100,th,-300,th,（,d,）,41,th,-60,th,(week),3,rd,yrs,Organ senescence is earlier,in reproductive system,Specifics have differences,majority with the menopausal,為什么人類有更年期,?,?,Humans menopause,人類生殖衰老要比動物來的早，存在更年期的過程，這決定于出生時(shí),始基卵泡的數(shù)量及隨后缺乏增補(bǔ)過程，以及人類生殖過程中僅有單個(gè),優(yōu)勢卵泡成熟，以保持單胎妊娠，在該過程中大量卵泡凋亡閉鎖被耗,竭。,青春前期,Pupilarity,Number of primordial follicle is constant since birth,出生時(shí)始基卵泡數(shù)量恒定，缺乏增補(bǔ)機(jī)制,性成熟期,Sex,Maturity,絕經(jīng)期,Menopause,每次月經(jīng)周期中大量非優(yōu)勢卵泡的閉鎖凋亡,Majority of the non dominant follicle atresia,卵泡池耗竭，女性進(jìn)入絕經(jīng)期,Follicle pool exhaust,women going to menopause,更年期,Menopause=Prodigals?,就是,Is it proper?,我爸給我的錢，這個(gè)是固定資產(chǎn)，我是花花公子，從不賺錢，只懂揮霍。,如同人類卵巢始基卵泡出生后數(shù)量固定，不會進(jìn)行有絲分裂增殖，反而在,卵泡發(fā)育的同時(shí)，大量卵泡閉鎖凋亡。,這,個(gè),比,喻,合,適,嗎,？,敗家子,？！,卵巢周期的概念,Concept Of Ovarian Cycle,?,月經(jīng)周期是卵巢周期的臨床反映，兩者是不等同的。卵巢,周期是指,FSH,峰上升誘導(dǎo)的卵泡發(fā)育，直到排卵。,月經(jīng)周期,FSH,卵巢周期,卵巢周期的概念,Concept Of Ovarian Cycle,?,月經(jīng)周期與卵巢周期并非總是同步化,?,卵巢周期啟始于黃體,-,卵泡過渡期，兩個(gè)周期部分重疊,?,早卵泡期啟始卵泡募集的,rFSH,主要由雌激素控制。,?,黃體,-,卵泡過渡期期雌激素撤退日,FSH,上升，,3,天后達(dá)峰值,?,黃體期雌激素水平低，,rFSH,提前，月經(jīng)周期縮短（如年長）,?,雌激素水平長期不降，無,rFSH,，則無卵巢周期募集啟始,（如,PCOS,）,高齡婦女月經(jīng)期縮短,卵泡期并沒有縮短,Menstrual Cycle Shorten,while Ovarian Cycle Not in Aging Women,黃體期過渡階段撤退孕激素，導(dǎo)致,GnRH,分泌頻率的增加，促,使,FSH,升高，提前卵泡募集。,McCartney et al.2002,GnRH,E2,FSH,FSH,P4,卵泡募集與選擇,高齡的婦女前一個(gè)黃體期和早卵泡期,FSH,的升高。超聲和激素檢查發(fā)現(xiàn)，高齡婦女的卵泡在前一個(gè)黃體期提前,生長和被選擇成為優(yōu)勢卵泡。,van Zonneveld P et al,Hum Reprod.2003,隨著年齡的增長，,HPO,軸生理調(diào)節(jié)功能的精確度下降,REGULATION IS LESS PRECISE IN HPOA WITH THE AGING,Luteal out of phase,（,LOOP,）,E2,pmol/L,額外排卵,排卵,正常主導(dǎo),卵泡激素,峰,額外主導(dǎo),卵泡激素,峰,1000,50,0,0,FSH,募集波,Recruiment waves,1,2,3,1,Regulation Is Less Precise In HPOA With The Agin,隨著年齡的增長，,HPO,軸生理調(diào)節(jié)功能的精確度下降,Luteal out of phase,（,LOOP,）,?,LOOP,是指排卵周期的中、晚黃體期出現(xiàn)卵,泡期樣雌激素上升。,?,LOOP refers to E2 rising like follicle phase in mid-late luteal,phase,?,此種雌激素上升，是卵泡發(fā)育或排卵導(dǎo)致,的，是生育晚期或早期更年期過渡期的一,種表現(xiàn)。,?,LOOP is resulted from the developing follicle and,ovulation,which is a transition of later reproductive to,earlier menopause.,劉某,，,46,歲,D2,D8,D10,D11,D12,D20,D27,D31,D36,FSH 11.2 5.8 6.5 7.3 4.6 22.4 5.2 2.17,LH 5.2 7.3 9.2 9.3 28 5.9 3.8 21.4 0.38,E2 33 274 501 694 330 415 608 988 114,P 0.2 1.4 25 1.3 3.98 18,HCG 0.1,卵泡,12*14 19*14 21*16 20*14 24*24 30*27,消失,9*7 12*9 11*10,CC 50mg/d,達(dá),菲,賀美奇,林,75U,0.1,額外排卵,31,36,1,5,8,10,12,13,17,20,27,凍,(2,2/5),opu,（,1,）,ICSI,隨著年齡的增長，,HPO,軸生理調(diào)節(jié)功能的精確度下降,Luteal out of phase,（,LOOP,）,REGULATION IS LESS PRECISE IN HPOA WITH THE AGING,在卵泡早期、月經(jīng)期及黃體中期都可能存在,FSH,水,平上升導(dǎo)致的卵泡募集波,FSH waves may occur in earlier follicle phase/menstrual phase/,?,mid luteal phase in aging women,雌激素、黃體酮、抑制素,B,（,inhibin B,）及抗苗,勒氏激素（,AMH,）的不規(guī)律變化，導(dǎo)致了,FSH,上升,的時(shí)段及水平與月經(jīng)周期的分離,Irregular changes of,E2/P/inhibin B/AMH,result in the FSH rise,?,and out of the nature cycle in aging women.,隨著年齡的增長，,HPO,軸生理調(diào)節(jié)功能的精確度下降,Luteal out of phase,（,LOOP,）,REGULATION IS LESS PRECISE IN HPOA WITH THE AGING,?,在卵巢儲備功能正常的婦女的月經(jīng)周期中，由于,小卵泡分泌足夠的,inhibin B,及,AMH,，以及足夠的,E2,及,P,水平，月經(jīng)中期及黃體中期的,FSH,募集波受,到抑制，故只存在卵泡早期的,FSH,募集波，缺乏相,應(yīng)階段的卵泡發(fā)育，故不會存在排卵周期的中、,晚黃體期出現(xiàn)卵泡期樣雌激素上升,In normal menstrual cycle women,follicle with enough inhibin B/AMH/E2/P,would suppression the FSH waves in menstrual and mid luteal phase except for,follicle phase.THUS,no LOOP.,傳統(tǒng),ART,超排及取卵,?!,Conventional COS and OPU based,on physiological menstrual cycle,?,傳統(tǒng),ART,取卵方案是建立在經(jīng)典規(guī)律月經(jīng)周期的認(rèn),識上，通過對月經(jīng)周期相應(yīng)關(guān)鍵調(diào)節(jié)點(diǎn)激素水平,的增減，以達(dá)到一定數(shù)量卵泡的發(fā)育及成熟，以,獲得可利用的卵細(xì)胞。,?,其本質(zhì)是在規(guī)律月經(jīng)調(diào)節(jié)模式下數(shù)量的調(diào)整，不,改變月經(jīng)周期的模式。,高齡婦女卵細(xì)胞珍貴！,Oocyte is so valuable for aging women,?,卵巢周期的認(rèn)識幫助我們個(gè)體化對待高齡婦女月經(jīng)周,期各階段的發(fā)育卵泡，發(fā)現(xiàn)高齡婦女的有發(fā)育潛能卵,泡，進(jìn)行卵泡發(fā)育的監(jiān)測及取卵。,?,To monitor the potential follicles in aging women,?,在內(nèi)源性高,FS