老化的卵巢和子宮
出處:第一名的不孕症期刊 Hum Reprod Update. 2013年1月搶鮮版
老化的卵巢和子宮：新生物的見解。
SM尼爾森，安德森，特爾弗EE RA。
SourceSchool醫學，格拉斯哥大學西部醫院，格拉斯哥，英國。
摘要
背景:
高齡產婦與生育能力下降和不良妊娠結局。該評論詳細介紹最近的事態發展，在我們的理解中的生物學和機制，婦女和生殖衰老，生育和懷孕的影響。有關人口學，流行病學，臨床和生物學的研究方法社會學的網上圖書館（IBSS，SocINDEX），醫學和谷歌學術搜索，關鍵詞和層次醫學主題詞。在此，我們確定，側重於重點課題，它被認為有臨床相關的進展，卵巢和子宮老化的理解與改進的診斷和新的干預影響。最近被執行的結果映射的卵巢儲備功能(AMH)，卵泡動態和相關的生物標誌物，在整個生殖壽命。現在可評估環境，生活方式和產前暴露於濾泡動態，並確定其影響生殖細胞的漏洞期間的影響，也可促進早期識別個人與生殖壽命較短。如果婦女選擇到時候他們的家庭根據自己的卵巢儲備，這將重新定義計劃生育的意義。儘管最近報告的可能存在的幹細胞可被用於恢復原始卵泡，從而卵母細胞池，目前女性生殖老化的治療干預仍然有限。產婦高齡化蛻膜和胎盤發育的不利影響，這可能與反复暴露於性激素，並強調的高齡化與不良生產結局相關。結論高齡化具有無可爭議的卵巢和子宮的不利影響。卵巢老化，將有利於我們更好地了解早期識別個人最大的風險，和新的治療干預措施。在卵巢和子宮的變化除了與年齡有關的疾病，這有協同作用，減少的概率成功懷孕的結果。
陳醫師的意見: 晚婚及高齡求孕人口激增,卵巢及子宮的老化影響妊娠後的產科的負面結局，應審慎面對生育的規化，儘管人工生殖，借卵及代孕是不得已的手段，未婚凍卵(social egg freezing)也方興未艾，防患晚婚及高齡求孕時卵巢及子宮的老化，造成產科的悲劇。
原文
Hum Reprod Update. 2013 Jan-Feb;19(1):67-83. doi: 10.1093/humupd/dms043. Epub 2012 Oct 26.
The ageing ovary and uterus: new biological insights.
Nelson SM, Telfer EE, Anderson RA.
Source
School of Medicine , University of Glasgow , McGregor Building , Floor 2, Western Infirmary, Glasgow , UK .
Abstract
BACKGROUND Advanced maternal age is associated with reduced fertility and adverse pregnancy outcomes. This review details recent developments in our understanding of the biology and mechanisms underlying reproductive ageing in women and the implications for fertility and pregnancy. METHODS Sociological online libraries (IBSS, SocINDEX), PubMed and Google Scholar were searched for relevant demographic, epidemiological, clinical and biological studies, using key words and hierarchical MeSH terms. From this, we identified and focused on key topics where it was judged that there had been clinically relevant advances in the understanding of ovarian and uterine ageing with implications for improved diagnostics and novel interventions. RESULTS Mapping of the ovarian reserve, follicular dynamics and associated biomarkers, across the reproductive lifespan has recently been performed. This now allows an assessment of the effects of environmental, lifestyle and prenatal exposures on follicular dynamics and the identification of their impact during periods of germ cell vulnerability and may also facilitate early identification of individuals with shorter reproductive lifespans. If women choose to time their family based on their ovarian reserve this would redefine the meaning of family planning. Despite recent reports of the potential existence of stem cells which may be used to restore the primordial follicle and thereby the oocyte pool, therapeutic interventions in female reproductive ageing at present remain limited. Maternal ageing has detrimental effects on decidual and placental development, which may be related to repeated exposure to sex steroids and underlie the association of ageing with adverse perinatal outcomes. CONCLUSIONS Ageing has incontrovertible detrimental effects on the ovary and the uterus. Our enhanced understanding of ovarian ageing will facilitate early identification of individuals at greatest risk, and novel therapeutic interventions. Changes in both ovary and uterus are in addition to age-related co-morbidities, which together have synergistic effects on reducing the probability of a successful pregnancy outcome.
