Trisomic pregnancy and elevated FSH: implications for the oocyte pool hypothesis
Trisomic pregnancy and elevated FSH: implications for the oocyte pool hypothesis
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DOI：
10.1093/humrep/der091
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发表时间：
2011-06-01
影响因子：
6.1
通讯作者：
Warburton, D.
中科院分区：
文献类型：
--
作者：
Kline, J. K.;Kinney, A. M.;Warburton, D.
背景：一些研究(但不是全部)支持这样的假设，即三体频率与卵母细胞池的大小有关，卵母细胞较少(卵巢年龄较大)的女性风险更高。我们通过比较患有三体妊娠丢失的女性与非三体丢失或染色体正常出生的女性的卵巢年龄的激素指标来检验这一假设。卵巢高龄的三个主要指标是低水平的抗苗勒氏激素(AMH)、高水平的卵泡刺激素(FSH)和低水平的抑制素B。数据被分开分析，来自两个地点的证据被结合起来。我们将159名三体妊娠丢失的女性与三个对照组进行了比较：60名其他染色体异常丢失的女性，79名染色体正常丢失的女性，以及344名与丢失的女性年龄匹配的活产(Lbs)女性。我们将荷尔蒙指标作为连续变量和分类变量进行分析。结果：AMH和抑制素B在三体丢失的女性和三个对照组中的任何一个之间没有差异。与正常对照相比，三体病例的平均卵泡刺激素(FSH)高0.137个单位(95%可信区间：0.055，0.219)；与其他染色体异常丢失或染色体正常丢失的女性相比，三体病例的FSH也更高，尽管不是很明显。与正常对照相比，三体病例与高FSH(>；=10mIU/ml)相关的校正优势比显著增加(校正优势比(OR)：3.8，95%CI：1.6，8.9)。结论：三体与高FSH的关联符合卵池假说，而与AMH无关。另一种解释也被考虑，包括FSH升高可能扰乱减数分裂过程或允许异常卵泡的募集。
BACKGROUND: Some studies, but not all, support the hypothesis that trisomy frequency is related to the size of the oocyte pool, with the risk increased for women with fewer oocytes (older ovarian age). We tested this hypothesis by comparing hormonal indicators of ovarian age among women who had trisomic pregnancy losses with indicators among women with non-trisomic losses or chromosomally normal births. The three primary indicators of advanced ovarian age were low level of anti-Mullerian hormone (AMH), high level of follicle-stimulating hormone (FSH) and low level of inhibin B.METHODS: The analysis drew on data from two hospital-based case-control studies. Data were analyzed separately and the evidence from the two sites was combined. We compared 159 women with trisomic pregnancy losses to three comparison groups: 60 women with other chromosomally abnormal losses, 79 women with chromosomally normal losses and 344 women with live births (LBs) age-matched to women with losses. We analyzed the hormone measures as continuous and as categorical variables. All analyses adjust for age in single years, day of blood draw, interval in storage and site.RESULTS: AMH and inhibin B did not differ between women with trisomic losses and any of the three comparison groups. Mean In(FSH) was 0.137 units (95% confidence interval (CI): 0.055, 0.219) higher for trisomy cases compared with LB controls; it was also higher, though not significantly so, for trisomy cases compared with women with other chromosomally abnormal losses or chromosomally normal losses. The adjusted odds ratio in relation to high FSH (>= 10 mIU/ml) was significantly increased for trisomy cases versus LB controls (adjusted odds ratio (OR): 3.8, 95% CI: 1.6, 8.9).CONCLUSIONS: The association of trisomy with elevated FSH is compatible with the oocyte pool hypothesis, whereas the absence of an association with AMH is not. Alternative interpretations are considered, including the possibility that elevated FSH may disrupt meiotic processes or allow recruitment of abnormal follicles.