女大生卵巢退化如60歲老婦 2014年06月02日 一名20歲女大生，疑因讀書壓力太大，導致16歲就停經，抽血檢查發現卵巢功能如60歲老婦，開業婦產科院長蔡鋒博醫師表示，該名少女已有熱潮紅、骨鬆等更年期症狀，目前僅能開藥減緩惡化，卵巢早衰年輕病例不常見，多數卵巢老化跟年紀有關，一般女性34歲後開始退化，37歲半後更快，卵巢老化會使受孕不易，現在針對高齡不孕或卵巢功能極差婦女，有新做法增加懷孕成功率，就是分次取卵，授精成胚胎並急速冷凍，累積較多數量後再解凍植入子宮。報導╱林明佳、王璐華攝影╱施偉平蔡鋒博醫師表示，針對高齡不孕或卵巢功能低下，但想懷孕婦女，以往凍卵技術還不成熟時，從病患身上取出數量稀少的卵子後，就需趕快授精成胚胎，再將新鮮胚胎植回子宮；但近年因冷凍技術成熟，現在新做法是分2~3次取卵，篩選出較健康的卵子授精成胚胎並急速冷凍，等累積較多數量再次解凍並植回母體，可大幅提高懷孕成功率，缺點是費用較貴，相較單次取卵授精成胚胎再植入，會貴1.5倍，治療也較耗時。 一般女性約34歲後卵巢開始退化，37歲半後更快，除年齡外，如因曾罹癌接受化療、動過婦科手術、有自體免疫疾病、壓力過大致月經不正常或停經，也可能使卵巢未老先衰。
經期變短要注意 若發現月經周期縮短，或經血量變少，很可能是卵巢老化，如出現這兩徵兆，應就醫檢查，並跟醫師諮詢治療方法，如是否提早生子、取卵冷凍，或在醫師指導下補充荷爾蒙等。 檢測卵巢功能目前最準確方法是抽血驗「抗穆勒氏管檢測」(AMH)，正常值應在2~6ng/mL，低於2ng/mL代表較差，低於1ng/mL表示老化嚴重，需自費，約800~1000元。
分次取卵再植入 針對高齡不孕或卵巢功能極差，又想懷孕婦女，往往面臨卵子品質不良或數目極少的問題，目前積極做法是分2~3次取卵，體外授精成胚胎後先冷凍起來，等累積較多數量，再次解凍植回子宮，可大幅提高懷孕成功率，但最多限植入4個胚胎，缺點是費時、費用也較貴、單次取卵植入約12~15萬元，取卵2次再植入約20萬元，約貴1.5倍。 疑有卵巢老化問題，建議立即就醫檢驗卵巢功能，了解自身卵巢狀況和卵子數量，在卵子還未消失殆盡前，做最有效的運用和治療，避免想生育卻無卵可用的憾事。
AMH has been synthesized. Its ability to inhibit growth of tissue derived from the Müllerian ducts has raised hopes of usefulness in the treatment of a variety of medical conditions including endometriosis, adenomyosis, and uterine cancer. Research is underway in several laboratories. Comparison of an individual's AMH level with respect to average levels is also useful in fertility assessment, as it provides a guide to ovarian reserve and identifies women that may need to consider either egg freezing or trying for a pregnancy sooner rather than later if their long-term future fertility is poor. As such, AMH may also be useful in assessing the need for fertility preservation strategies and detecting post-chemotherapy or surgical damage to the ovarian reserve. Measuring AMH alone may be misleading as high levels occur in conditions like polycystic ovarian syndrome and therefore AMH levels should be considered in conjunction with a transvaginal scan of the ovaries to assess antral follicle count and ovarian volume. It also has the potential to rationalise the programme of ovulation induction and decisions about the number of embryos to transfer in assisted reproduction techniques to maximise pregnancy success rates whilst minimising the risk of ovarian hyperstimulation syndrome (OHSS)AMH can predict an excessive response in ovarian hyperstimulation with a sensitivity and specificity of 82% and 76%, respectively. If there were more standardized AMH assays, it could potentially be used as a biomarker of polycystic ovary syndrome.
Anti-mullerian hormone is expressed by endometriosis tissues and induces cell cycle arrest and apoptosis in endometriosis cells
The anti-mullerian hormone (AMH) is a member of the transforming growth factor beta (TGF-beta) superfamily, which is responsible of the regression of the mullerian duct. AMH is expressed in the normal endometrium, where, acting in a paracrine fashion, negatively regulates cellular viability. Our objective was to evaluate the in vitro effects of the treatment with AMH of endometriosic cells.
Methods: AMH expression in human endometriosis glands was evaluated by immunohistochemistry. RT-PCR has been used to quantify the expression levels of AMH and AMH RII isoforms, as well as of cytochrome P450 in both endometriosis epithelial and stromal cells Effects of AMH and AMH-cleaved treatment in endometriosis cells were evaluated by flow-cytometry analysis.Finally, it has been evaluated the effect of plasmin-digested AMH on cytochrome P450 activity.
Results: AMH andAMH RII isoforms, as well as cytochrome P450, were expressed in both endometriosis epithelial and stromal cells. Treatment of endometriosis stromal and epithelial cell growth with AMH was able to induce a decrease in the percentage of cells in S phase and increase percentage of cells in G1 and G2 phase; coherently, decreased cell viability and increased percentage of cells death fraction was observed. The plasmin-digested AMH was able to suppress most of the cytochrome P450 activity, causing an increase of pre-G1 phase and of apoptosis induction treating with plasmin-digested AMH in both cell lines, most marked in the epithelial cells. Conclusions: The data produced suggest a possible use of AMH as therapeutic agents in endometriosis.
Author: Pietro G SignorileFrancesca PetragliaAlfonso Baldi
Credits/Source: Journal of Experimental &Clinical Cancer Research 2014, 33:46
子宮內膜異位症之成因及治療 ( Endometrosis)子宮內膜異位症是一種常見且詭異的婦科疾病，一般患此病的患者年齡為生育年齡婦女以20～30歲最多，臨床症狀以經痛、性交疼痛、月經來之前點狀出血或經血量過多、不孕症、週期性下腹疼痛，就常見發生於婦女身上的症狀一般為：
骨盆腔疼痛（Pelvic pain）I、經痛，可能是原發性加劇或續發性，其經痛的特點為，起使於月經來臨之前數天持續至月經開始或結束時。疼痛的性質為悶痛，疼痛的位置為下腹中央或兩側、背部，有時會牽連至兩腿。II、性交疼痛或非週期性的下腹痛和背痛。性交疼痛常發生於深插時，且在月經來臨前較厲害，這種性交疼痛和身體的姿勢有相關連，改變性交姿勢，有時可減輕疼痛。
不孕症（Infertility）嚴重的子宮內膜異位症會引起輸卵管及卵巢周圍組織發炎及纖維化，導致粘黏、阻礙卵子的釋放及輸卵管捕捉卵子的過程，造成不孕。另外根據研究指出，患有此病之婦女，其腹膜液含有某些因子會妨礙精子的存活，卵子的捕捉，受精及胚胎發育的進行。
對於子宮內膜異位症所造成的原因，目前不十分確定，一般來說致病機轉（Pathogenesis）分為以下五點：子宮內膜組織之轉移，包括血行、淋巴循環、醫療過程造成轉移，以及經血逆流。體腔上皮的演變（Coelomic metaplasia）。原有之胚胎細胞（Embryonic cell rests）。免疫功能異常所促成的。其他（包括基因遺傳，或上述各種因素的組合，促成子宮內膜異位症的形成）。
就治療子宮內膜異位症一般有藥物治療、手術治療。藥物治療不能視為子宮內膜異位症的完全根治，而只是一種輔助治療。腹腔鏡手術為診斷的必要方法，一些婦女懼怕腹腔鏡而希望有不同於手術的另類療法，藥物療法可視為一種短期壓抑性的權宜措施，使用藥物將異位性的內膜萎縮或減少，使其造成不孕或引發經痛的影響降低，從而讓體內免疫系統吸收病灶；或趁病狀減輕的空檔趕緊懷孕或接著手術，以去除殘餘組織，可降低再發機率，都是使用藥物的主要目的。
就醫界治療子宮內膜異位症的藥物，主要有兩種：療得高（Danazol）：屬於一種男性賀爾蒙衍生物，主要作用乃是抑制體內女性賀爾蒙生成，副作用如體重增加、長青春痘、皮膚油膩、毛髮微粗及肌肉抽筋等。腦下垂體性腺賀爾蒙類似劑（GnRHa）：目前有短效的噴鼻劑型及長效的針劑型。主要是抑制腦下垂體性腺賀爾蒙的分泌，副作用如臉頰發熱、不眠、腰酸背痛心情煩燥現象，但不常發生；另有一獨特副作用，必須說明，即使用GnRHa如超過六個月，便可能出現骨質疏鬆的可能性，雖然停藥之後即可恢復，但醫界仍可建議不要使用超過六個月，已防止其發生。以上藥物主要作用均是降低體內女性賀爾蒙濃度，使賴以維生的子宮內膜異位病灶停止生長，甚至萎縮，以達到減輕病症的目的。但兩種藥物的作用機制及方式，卻是南轅北轍。所造成的副作用，亦各自不同。這也是女性最關心的問題。內膜異位雖然不是致命性疾病，但其造成女性生活的困擾卻很大，如果能夠在輕度時期及早發現並治療使其再發率降低，但如太晚發現，則縱使經過完全的處置也很難達到滿意的結果，對付此病最重視預防而不是治療，如有症狀應至醫院檢查為最好的對策。
Source: http://www.ncku.edu.tw/obgyn/testcubebaby/26.htm
子宮肌瘤 (uterine leiomyoma, myoma, fibromyoma, fibroleiomyoma.) 肌肉細胞形成的良性腫瘤，40-50歲是發生率最高的年齡，而它絕少發生在初經之前和停經之後。雖然肌瘤可發生於身體中任何含平滑肌的地方，但在骨盆腔卻最常發生於子宮，子宮肌瘤也是骨盆腔最常見的腫瘤。
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