卵母細胞質量 | Oocyte Quality

Store/卵母細胞質量 | Oocyte Quality

什麼是多囊卵巢綜合征？

估計有4%到6%的育齡婦女患有多囊卵巢綜合征（PCOS）。它是女性最常見的內分泌疾病。

如果女性有以下三種特徵中的兩種，她可能患有多囊卵巢綜合征：

  • 排卵或月經週期不規律的迹象。
  • 高雄激素血症的臨床或生化證據意味著有證據表明男性激素分泌新增。這是通過量測睾丸激素水准的血液測試來量測的。
  • 另一個迹象是多毛症或毛髮生長問題，這是不正常的毛髮生長激素依賴地區，包括上唇，下巴，臉，乳房和下腹。它可以是非常輕微到非常嚴重。

當你在經陰道盆腔超聲檢查中發現多囊卵巢時，影像看起來像是微小的囊腫樣結構。它們是包圍卵巢的卵子或卵泡，開始生長，然後在大約2-10毫米的小卵泡大小停止生長。這種表現很有特點，可以用來診斷。

值得注意的是，在診斷多囊卵巢綜合征時，必須排除像多囊卵巢綜合征這樣的其他疾病。診斷多囊卵巢綜合征前必須排除下列激素狀況：

  • 甲狀腺疾病、
  • 卵巢和/或腎上腺腫瘤、
  • 腎上腺酶缺乏和
  • 催乳素异常。

這種情況可能與多種不同的症狀有關，包括：

  • 高水准的雄性激素，也稱為雄激素。這會導致面部和體毛過多或多毛
  • 月經週期不規律或無月經週期
  • 在超聲波檢查中，卵巢可能有或可能沒有許多小囊腫
  • 不能懷孕
  • 痤瘡，油性皮膚
  • 體重增加或肥胖，通常腰部有多餘的重量
  • 减肥困難
  • 2型糖尿病
  • 高膽固醇、高甘油三酯水准
  • 高血壓
  • 頸部、手臂、乳房或大腿上增厚的深棕色或黑色皮膚斑塊（黑棘皮病）
  • 睡眠呼吸暫停-過度打鼾和睡眠時呼吸中斷

認識多囊卵巢綜合征的一個重要原因是，它會使人面臨胰島素抵抗綜合征類型的醫療問題。你可能患上2型糖尿病、高膽固醇、高甘油三酯和高血壓。女性也可能有患子宮內膜癌或子宮內膜异常生長的風險。這就是為什麼對多囊卵巢綜合征患者進行藥物治療並解决其不規則週期的原因。

多囊卵巢綜合征的病因是什麼？

多囊卵巢綜合征的確切病因尚不清楚。多囊卵巢綜合征有一個遺傳因素，這意味著多囊卵巢綜合征患者的母親或姐妹經常患有多囊卵巢綜合征。如果你的母親患有多囊卵巢綜合征，有百分之五十的可能性。許多患有多囊卵巢綜合征的女性都有體重問題，囙此研究人員正在研究多囊卵巢綜合征與人體分泌胰島素能力之間的關係。胰島素是一種調節糖、澱粉和其他食物轉化為能量供身體使用或儲存的激素。患有多囊卵巢綜合征的女性分泌過多的胰島素會導致卵巢反應，分泌過多的男性激素。胰島素還會破壞卵巢的成熟和卵子的釋放，造成不規則的週期。多囊卵巢綜合征患者卵巢正常功能的中斷會導致痤瘡、毛髮過度生長、體重增加和排卵問題。

診斷多囊卵巢綜合征有哪些方法？

將進行各種測試來診斷多囊卵巢綜合征。你的醫生會記錄病史，進行體檢，檢查你的荷爾蒙水准。這可能包括觀察甲狀腺、垂體和腎上腺激素水准。你可以通過口服兩小時葡萄糖耐量試驗和空腹胰島素來檢測你的糖代謝和糖尿病風險水准。

陰道超聲檢查卵巢是否有囊性表現，評估子宮內膜。

每個月，一組多個卵子在女性卵巢中開始成熟，但通常只有一個卵子成熟或佔優勢。患有多囊卵巢綜合征的女性，卵巢不能從垂體接收到正確的訊號，從而產生任何卵子完全成熟所需的激素。一些研究人員認為，這是因為高胰島素水准中斷了正常的訊號，使卵子生長。含有卵子的卵泡開始生長，但沒有收到正確的訊號。濾泡停止生長或停止生長，並變得閉鎖，在超聲上顯示為小的囊性區域。由於沒有卵子成熟或被釋放，排卵就不會發生，也就不會產生孕酮激素。如果沒有孕酮，女性的月經週期是不規則或缺席的。小的停滯或閉鎖的卵泡產生雄性激素，與多囊卵巢綜合征的症狀有關。

如何治療多囊卵巢綜合征？

多囊卵巢綜合征沒有治療方法，囙此需要加以管理以防止出現問題。治療是基於每個個案。以下是多囊卵巢綜合征的治療方法。多囊卵巢綜合征的治療是基於患者的目標。

生活方式：這是長期健康最重要的因素。鍛煉是關鍵。患有多囊卵巢綜合征的婦女需要比一般的常規或常規的有氧運動更多的運動。醫學研究所建議每天進行一小時的有氧運動。不必一次完成。每天可以分成兩個30分鐘的例行公事，但鍛煉是關鍵。此外，飲食對生活方式的改變也很重要。

健康的體重：保持健康體重的女性有助於控制多囊卵巢綜合征。由於肥胖很常見，健康的飲食和體育活動有助於保持健康的體重。

Ref: https://fertility.wustl.edu/getting-started-infert...

肌醇及褪黑素對多囊卵巢綜合征的影響:

提高卵母細胞質量(1,2,3,6)

改善卵巢功能(3,4)

受精率和胚胎質量(5,6,7)


What is PCOS?

An estimated four to six percent of women of childbearing age have polycystic ovarian syndrome (PCOS). It is the most common endocrinopathy of women.

If a woman has two of the three following characteristics, she may have polycystic ovary syndrome:
Evidence of an ovulation or irregular menstrual cycle.
Evidence of hyperandrogenemia either clinically or biochemically means there is evidence of elevated male hormone production. This is measured by a blood test that measures testosterone level. Another indication is hirsutism or hair growth issues, which is abnormal hair growth in hormonal dependent areas, including the upper lip, the chin, the face, the breast and the lower abdomen. It can be very mild to very severe.
When you have a polycystic ovary appearance on a transvaginal pelvic ultrasound, the image looks like tiny cyst-like formations. They are eggs or follicles rimming the ovaries, starting to grow and then stopping at a small follicle size of approximately 2-10 mm. This appearance is very characteristic and can be used for making a diagnosis.
Of note, when making the diagnosis of PCOS other medical conditions that present like PCOS must be eliminated. The following hormone conditions must be ruled out prior to making the diagnosis of PCOS: thyroid disease, ovarian and/or adrenal tumors, adrenal enzyme deficiency and prolactin abnormalities.

This condition can be associated with a variety of different symptoms, including:

  • High levels of male hormones, also called androgens. This can cause excessive facial and body hair or hirsutism
  • An irregular or absent menstrual cycle
  • May or may not have many small cysts in their ovaries as seen on an ultrasound
  • Inability to get pregnant
  • Acne, oily skin
  • Weight gain or obesity, usually carrying extra weight around the waist
  • Difficulty losing weight
  • Type 2 diabetes
  • High cholesterol, high triglyceride levels
  • High blood pressure
  • Patches of thickened and dark brown or black skin on the neck, arms, breasts or thighs (acanthosis nigricans)
  • Sleep apnea — excessive snoring and interrupted breathing while sleeping

An important reason to recognize PCOS, is that it can put a person at risk for insulin resistance syndrome type medical issues. You can develop a high risk for Type 2 Diabetes, high cholesterol, high triglyceride levels and high blood pressure. A woman can also be at risk for endometrial cancer or abnormal growth of the lining of the uterus. This is why it is important for people with PCOS to be treated medically and have their irregular cycles addressed.

What causes polycystic ovarian syndrome?

The exact cause of PCOS is not known. There is an inheritable component to PCOS which means women with the condition frequently have a mother or sister with PCOS. There is a fifty percent chance of getting PCOS if your mother has the condition. Many women with PCOS have a weight problem, so researchers are looking at the relationship between PCOS and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body’s use or for storage. Women with PCOS make too much insulin causes the ovaries to react and make too many male hormones. Insulin also disrupts how your ovaries mature and release eggs, creating irregular cycles. The disruption in normal functioning of the ovary in PCOS can lead to acne, excessive hair growth, weight gain and ovulation problems.
What tests are used to diagnose PCOS?

Various tests will be done to diagnose PCOS. Your doctor will take a medical history, perform a physical exam and check your hormone levels. This may include looking at the thyroid, pituitary and adrenal hormone levels. You may have your glucose metabolism and diabetes risks levels tested which is done with an oral two hour glucose tolerance test and a fasting insulin.

A vaginal ultrasound may be performed to examine the ovaries for cystic appearance and to evaluate the lining of the uterus (or endometrium).
Why do women with PCOS have trouble with their menstrual cycle?

Each month, a collection of multiple eggs start to mature in a woman’s ovaries but usually only one becomes mature or dominant. In women with PCOS, the ovary doesn’t receive the correct signals from the pituitary to produce the hormones it needs for any of the eggs to fully mature. Some researchers think this is because of high insulin levels which interrupts the normal signals to grow eggs. Follicles containing eggs start to grow but do not receive the correct signals. The follicles stop growing or arrest and become atretic remaining as small cystic areas seen on ultrasound. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. The small arrested or atretic follicles produce male hormones with contribute to the symptoms of PCOS.
How is PCOS treated?
There is no cure for PCOS, so it needs to be managed to prevent problems. Treatments are based on each individual case. Following are descriptions of treatments used for PCOS. The treatment of PCOS is based on the patient’s goals.
Lifestyle: This is the most important factor for long term health. Exercise is key. Women with PCOS need to exercise more than the average routine or regular areobic exercise. The Institute of Medicine recommends one hour of areobic exercise each day. It does not have to be done at one time. It can be broken into two thirty-minute routines each day, but exercise is key. In addition, diet is important to lifestyle changes.
A Healthy Weight: Women who maintain a healthy weight can help manage PCOS. Since obesity is common, a healthy diet and physical activity help maintain a healthy weight.

Ref: https://fertility.wustl.edu/getting-started-infert...

Effects of inositol and melatonin on polycystic ovary syndrome:

  • Improving oocyte quality (1,2,3,6)
  • Improving ovarian function (3,4)
  • Fertilization rate and embryo quality (5,6,7)

Refs:

  1. Salvatore Giovanni Vitale ,1 Paola Rossetti,2 Francesco Corrado,1 Agnese Maria Chiara Rapisarda,3 Sandro La Vignera ,4 Rosita Angela Condorelli,4 Gaetano Valenti,3 Fabrizio Sapia,3 Antonio Simone Laganà ,1 and Massimo Buscema2. How to Achieve High-Quality Oocytes? The Key Role of Myo-Inositol and Melatonin. International Journal of Endocrinology / 2016 / Article. Review Article | Open Access Volume 2016 |Article ID 4987436 | https://doi.org/10.1155/2016/4987436
  2. L Ciotta 1 , M Stracquadanio, I Pagano, A Carbonaro, M Palumbo, F Gulino. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. Randomized Controlled Trial. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-14.PMID: 21744744
  3. S Gerli 1 , E Papaleo, A Ferrari, G C Di Renzo. Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. Randomized Controlled Trial Eur Rev Med Pharmacol Sci. Sep-Oct 2007;11(5):347-54. PMID: 18074942
  4. Simona Dinicola 1 , Tony T Y Chiu, Vittorio Unfer, Gianfranco Carlomagno, Mariano Bizzarri. The rationale of the myo-inositol and D-chiro-inositol combined treatment for polycystic ovary syndrome. Review J Clin Pharmacol. 2014 Oct;54(10):1079-92. doi: 10.1002/jcph.362. Epub 2014 Jul 18. PMID: 25042908
  5. Pedro-Antonio Regidor 1 , Adolf Eduard Schindler 2 , Bernd Lesoine 3 , Rene Druckman 4. Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Review
    Horm Mol Biol Clin Investig. 2018 Mar 2;34(2):/j/hmbci.2018.34.issue-2/hmbci-2017-0067/hmbci-2017-0067.xml. doi: 10.1515/hmbci-2017-0067. PMID: 29498933
  6. Sina Mojaverrostami, D.V.M., 1 Narjes Asghari, M.Sc., 2 Mahsa Khamisabadi, D.V.M., 3 and Heidar Heidari Khoei, D.V.M. 4 , 5. The role of melatonin in polycystic ovary syndrome: A review. Journal ListInt J Reprod iomedv.17(12); 2019 DecPMC6943797. Int J Reprod Biomed. 2019 Dec; 17(12): 865–882. Published online 2019 Dec 30. doi: 10.18502/ijrm.v17i12.5789. PMCID: PMC6943797 PMID: 31970309
  7. Giuseppe Morgante, M.D.aRaoul Orvieto, M.D., M.M.Sc.b,cAlessandra Di Sabatino, M.D.aMaria C. Musacchio, M.D.aVincenzo De Leo, M.D.a. The role of inositol supplementation inpatients with polycystic ovary syndrome,with insulin resistance, undergoing thelow-dose gonadotropin ovulationinduction regimen. Fertility and SterilityâVol. 95, No. 8, June 30, 011. doi:10.1016/j.fertnstert.2011.01.03
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