Table of Content

15 September 2013, Volume 32 Issue 5
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述评
专家论坛
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述评

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Female Reproduction and Systemic Endocrine Diseases ZHANG Yi-wen 2013, 32 (5):  319-322.  Abstract ( 1736 )   PDF (483KB) ( 7501 )   The modern endocrine system has been conceptually expanded to almost all tissues or cells of human body. Activation of the pulsatile secretion of hypothalamic GnRH-Pituitary Gn is the key step of initiating ovarian function, which is related to other four hypothalamic endocrine systems. Both the neuroendocrine-immune network and neuroendocrine-nutrition regulating network also impact the GnRH-Gn pulsatile secretion or ovarian gametogenesis, as well as steroidogenesis. This paper discussed the influence of systemic endocrine diseases on female reproduction，and elucidated the effects of stress on the systemic endocrine organs and ovarian axis by a psychoneuroendocrine disorder, functional hypothalamic anovulaton. Related Articles | Metrics

专家论坛

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Application of Assisted Reproductive Technologies in Disorders of Reproductive Endocrine System LIU Hong;CHEN Zi-jiang 2013, 32 (5):  323-326.  Abstract ( 1695 )   PDF (538KB) ( 7360 )   The reproductive endocrine system regulates reproductive phenomena, including ovulation, implantation, maintenance of gestation, et al. Disorders of this system result in female infertility; over 30% of female infertility are caused by the reproductive endocrinopathies. The classify of those disorders is very complicated. The pathophysiological mechanism is related with the hypothalamic-pituitary-gonadal axis at different level. In this review, treatment and management of disorders of the reproductive endocrine system were concisely introduced, which was based on the mainstream guidelines published by international associations and Chinese Medical Association. Related Articles | Metrics

热点问题

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Endocrine Abnormalities and Recurrent Spontaneous Abortion LI Qian;LIANG Xiao-yan 2013, 32 (5):  327-329.  Abstract ( 1668 )   PDF (609KB) ( 7360 )   The recurrent miscarriage is traditionally defined as three or more consecutive pregnancy losses before 20 weeks. The causes of recurrent spontaneous abortion are not clear，including genetic factors, uterine abnormalities，immunologic and endocrine factors，infections，and unexplained abortion. The endocrine disorders is related to recurrent miscarriage, including disorders of both reproductive glands and other glands. This article discussed the relationships between recurrent spontaneous abortion and endocrine disorders such as luteal insufficiency，thyroid dysfunction，hyperprolactinemia，insulin resistance and hyperandrogenism. However, it needs more study to understand the mechanism of recurrent miscarriage caused by endocrine abnormalities. Related Articles | Metrics

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The Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescent CHEN Xiao-li;HONG Yu;YANG Dong-zi 2013, 32 (5):  330-334.  Abstract ( 1799 )   PDF (677KB) ( 7442 )   Polycystic ovary syndrome（PCOS） is the most common endocrinopathy in women. PCOS often occurs in perimenarcheal girls，and similarities between the physiological changes of puberty and the pathological features of PCOS have been noted. The diagnosis of adolescent PCOS should simultaneously meet the three indexes of Rotterdam Consensus，hyperandrogenism as hyperandrogenemia（elevated blood androgens found using sensitive assays），oligo-amenorrhea for at least 2 years after menarche, and polycystic ovaries also including increased ovarian volume（＞10 cm3）. Although metabolic syndrome is not included in the diagnosis of PCOS，metabolic condition in adolescent PCOS patients should be considered. Treatments of adolescent PCOS should include the modification of lifestyle and dietary，improvement of metabolic disorders，and restoration of cyclical menses. Related Articles | Metrics

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Genetics of the Polycystic Ovary Syndrome ZHANG Chun-mei;ZHAO Yue;QIAO Jie 2013, 32 (5):  335-338.  Abstract ( 1849 )   PDF (680KB) ( 7420 )   Polycystic ovary syndrome（PCOS） is a highly complex endocrine disorder，characterized by oligomenorrhea or amenorrhea，hyperandrogenemia，and polycystic ovaries. Genetic factors play important roles in PCOS etiology，and many candidate genes have been identified. Currently，the proposed susceptible genes include those involved in the regulation of steroid hormone biosynthesis and function，chronic inflammation，and insulin and TGF-β signaling pathway. The promising start of genome-wide association study（GWAS） provides new insights into the pathogenesis of PCOS. However，due to the genetic and phenotypic heterogeneity of PCOS，there is not a conclusion on the specific contributing genes of PCOS. In this review，we discussed the progress of the genetic analysis of PCOS. Related Articles | Metrics

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Etiology of Premature Ovarian Failure CHEN Bei-li;CAO Yun-xia 2013, 32 (5):  339-343.  Abstract ( 1741 )   PDF (788KB) ( 7365 )   Premature ovarian failure（POF） is defined as the recession of ovarian function in women under the age of 40 years. The lost fertility and the lowered level of estrogen caused by POF are two factors affected reproductive health and life quality. And the morbidity is tending towards younger women in recent years. The etiological factors and pathogenesis of POF are extremely heterogeneous，involving genetic factors，immune factors，iatrogenic factors，metabolic factors，environmental factors and infection. This review discussed the etiology of POF. Related Articles | Metrics

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Progress in Medical Treatment of Abnormal Uterine Bleeding HU Yan-jun;ZHU Yi-min;HUANG He-feng 2013, 32 (5):  344-348.  Abstract ( 1796 )   PDF (791KB) ( 7449 )   FIGO Menstrual Disorders Group (FMDG) put forward that the abnormal uterine bleeding （ＡＵＢ） was a suitable overarching term for the symptom of disturbed menstrual bleeding，and that the terms ′menorrhagia′ and ′disfunctional uterine bleeding (DUB)′ should be discarded . The heavy menstrual bleeding (HMB) should be used to replace the term of menorrhagia for the symptom of excess menstrual bleeding. FMDG classified the AUB according to the causes using the PALM-COEIN system. Medical management should be the initial treatment for AUB of COEIN causes, including multi-dose regimens of combined oral contraceptives or oral progestins，NSAIDs，tranexamic acid and the levonorgestrel-releasing intrauterine system (LNG-IUS). LNG-IUS is the most effective medical treatment for idiopathic HMB. Desmopressin is effective in management of HMB in women with bleeding disorders. Metformin is applied to regulate the menstrual cycle in PCOS women. And Metformin has therapeutical effect on the endometrial hyperplasia combined with progestin-resistant. Moreover, there are more choices for HMB treatment, such as the new four-phasic estradiol valerate/dienogest contraceptive pills, the modified-release formulation of tranexamic acid, the combined contraceptive vaginal ring, and vaginal danazol. Related Articles | Metrics

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Progress in Diagnosis of Amenorrhea HU Lin-li;SUN Ying-pu 2013, 32 (5):  349-351.  Abstract ( 1689 )   PDF (678KB) ( 7404 )   The normal menstruation depends on the intercoordination between the hypothalamus- pituitary- ovary system and the endometrium induced by ovarian hormone. Dysfunction of any aspect will result in amenorrhea，and then affect fertility. There are many causes of amenorrhea. The key of successful treatment is the clarified diagnosis. The overall diagnosis of amenorrhea should combine history，physical examination，endocrine and auxiliary examination. The most common causes of amenorrhea are hypothalamic amenorrhea，polycystic ovary syndrome，hyperprolactinemia and premature ovarian failure. This review discussed the etiological diagnosis of amenorrhea. Related Articles | Metrics

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Hormone Replacement Therapy should be Personalized CHEN Mei;YU Qi 2013, 32 (5):  352-355.  Abstract ( 1656 )   PDF (817KB) ( 7448 )   Hormone replacement therapy （HRT） is of choice for menopause population, to alleviate effectively those symptoms of menopause and to prevent the postmenopausal osteoporosis. However, it is necessary that HRT be personalized. The principles of personalized HRT are based on many aspects, such as symptoms, age, baseline diseases, indications and contraindications. When HRT is prescribed, many other aspects should be considered, including preparation and dose of HRT drug, route of administration, and the best ′treatment window′. The HRT should start at minimum dose with the best effect of treatment. Related Articles | Metrics

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Individualized Medicine Selection of Postmenopausal Hormone Replacement Therapy OU Hua;YU Qi 2013, 32 (5):  356-360.  Abstract ( 1615 )   PDF (836KB) ( 7519 )   Hormone replacement therapy （HRT） can effectively alleviate those symptoms of female menopausal，and prevent the postmenopausal osteoporosis and some senile chronic diseases. There are a large number of menopausal women in China. It's necessary for most of gynecologists to have an exact recognition on HRT. And for the clinical operation，they should provide the right instruction on HRT for the individual patient. However，both patients and doctors are concerned about safety of HRT. Recent evidences from clinical research showed that the HRT safety was significantly related to the enable timing and individualized dosage regimen. HRT should be started in the window period，while the individualized dosage regimen should be based on the different age，specific symptoms，the family disease history and baseline diseases. The Standardized follow-up is necessary during treatment. Related Articles | Metrics

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Research Progress of Pathogenesis of Disorders of Sex Development WANG Chun-qing;TIAN Qin-jie 2013, 32 (5):  361-364.  Abstract ( 1699 )   PDF (833KB) ( 7456 )   Normal sex differentiation includes the formation of primordial gonads, sex determination and ovarian or testis development. The misregulation of gene expression in each process may lead to the disorders of sex development（DSD）. DSD is defined by congenital conditions of the atypical chromosome，gonadal or anatomical sex. With the development of molecular biotechnology，more and more genes and signaling pathways are discovered to be involved in sex differentiation and development. For example，some genes such as SRY、SF1、WT1 and Sox9 are closely related to testicular development, while others such as Wnt/Rspo1/B-catenin pathway and genes like Dax1、Foxl2 play an important role in ovarian differentiation. Some none-coding RNA and transforming growth factor also regulate the sexual differentiation. The developments of both testis and ovary are active, and transverse differentiation can appear according to some abnormal genes even after birth. Related Articles | Metrics

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Correlation Factors of Ovary Response and Selection of Individualized Ovarian Stimulation Protocols ZHANG Bo 2013, 32 (5):  365-368.  Abstract ( 1645 )   PDF (883KB) ( 7464 )   One of the critical factors related to the success rate of in vitro fertilization-embryo transfer (IVF-ET) was the oocytes and embryos, with moderate number and high quality, obtained by the controlled ovarian stimulation (COS) protocol of which effect mainly depended on the ovarian response to gonadotropin (Gn). The ovarian response was affected by a variety of factors，including patient′s age，antral follicles counnt（AFC），basal level of follicle stimulating hormone，serum levels of anti-Mullerian hormone（AMH）and inhibin B. It is benefit to develop individual strategy of COH treatment to predict accurately the ovarian response before COS. Related Articles | Metrics

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Study on the Status of Sexual Life among the Minorities Living in Guizhou Province for the Generations LU Wei-qun;ZHU Jiang 2013, 32 (5):  373-378.  Abstract ( 1962 )   PDF (1065KB) ( 7594 )   Objective：To investigate the status of sexual life among married minorities, and to analyze the effective factors. Methods：Total 1 550 volunteers from Miao，Buyi，Shui，Gelao and Dong Nation were chosed by the stratified cluster random sampling. They were married minorities form five minority autonomy counties of Guizhou Province. The closed questionnaires were used. The data were analyzed by SPSS 11.5. Results：The availability rate of collecting questionnaires was 93.6%. The average age was (40.47±12.83) years, 764 women and 687 men. The frequency of sexual life was two times per week in last one year. 67.1% of persons indicated that they had concordant sexual life. The factors affecting frequency of sexual life were ethnic，registered permanent residence. The factors affecting harmoniousness of sexual life were ethnic，age，occupation，yearly income of family，number of children，cure caused by contraceptive discomfort，health，reproductive health training and discussion sex with mates. Conclusions：The frequency of sexual life，the concordant degree of sexual life and the rate of discussion sex in mates were higher than those reported. It is important to combine the cultural characteristic of different ethnics with the reproductive health intervention in minority regions. Related Articles | Metrics

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Comparison in Curative Effects of Three Kinds of Intrauterine Device Removal Surgery in Post-menopausal Women LU Zhi-ru;ZHANG Li-na;LI Ying-hui 2013, 32 (5):  379-381.  Abstract ( 1784 )   PDF (1038KB) ( 7423 )   Objective：To evaluate the curative effect of three methods used in the intrauterine device（IUD） removal surgery in post-menopausal women. Methods：The selected 317 post-menopausal women requiring the IUD removal surgery were randomly divided into three groups. Women in group A orally took progynova（2 mg） for 5 days, and placed misoprostol 400 μg in the vaginal fornix 3 hours before the surgery. And tetracaine mucilage was used for surface anesthesia during operation. Women in group B used misoprostol combined tetracaine, with the same dosage and administration in group A. Women in group C only used tetracaine mucilage, with the same dosage and administration in group A. Clincal parameters were collected, including the vaginal bleeding time, the success rate of IUD removal surgery, and pain degrees during operation and after operation. Results：There was significant difference in the success rate of IUD removal surgery among A, B and C groups（χ2=15.585，P＜0.05）. There were also significant differences in the pain degree during IUD removal surgery and the vaginal bleeding time among three groups （the value of H was 144.366 and 31.567 respectively,P＜0.05）. Conclusions：The method combined progynova, misoprostol and tetracaine before IUD removal surgery among post-menopausal women was helpful to alleviate surgery pain, increase success rate, and shorten vaginal bleeding time after surgery. Related Articles | Metrics

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Clinical Study of the Modified Laparoscopic Panhysterectomy LEI Lin;ZHAO Zhi-min 2013, 32 (5):  382-383.  Abstract ( 1731 )   PDF (938KB) ( 7384 )   Objective：To investigate the safety and efficacy of the modified laparoscopic panhysteroscopy（MLH）. Methods：From January 2011 to April 2012, 60 cases of panhysterectomy surgeries were randomly divided into two groups. Group 1 was underwent MLH. Group 2 was underwent the traditional laparoscopic panhysterectomy （TLH）. Clinical features related to operation were compared. Results：There were significant differences in the operative time，the bleeding volume within operation，the time of exsufflation after operation between two groups （P＜0.05）. There were not significant differences in the pelvic drainage，uterine size and the time of hospitalization between two groups （P＞0.05）. Conclusions：MLH can substitute TLH in clinical panhysterectomy with its shorter operation time, less bleeding volume，and better curative effect. Related Articles | Metrics

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Tight Junction：Structure and Function ZHAO Hai-jun;QIAN Yi;CUI Yu-gui;LIU Jia-yin 2013, 32 (5):  384-386.  Abstract ( 4272 )   PDF (953KB) ( 7633 )   Tight junction is a fundamental junctional complex of the adjacent epithelial cells，with multiple functions including the barrier effect regulating intercellular permeability and maintaining cellular polarity, which was consisted of several protein families including transmembrane proteins (such as occluding, claudin) and peripheral proteins (such as ZO protein). The structure and function of tight junction can be changed by many physio-/pathological factors such as anoxia, hormonal, inflammatory factors and estrogen. Tight junction has already been detected in human uterine endometrium and placenta. Factors of tight junction expressed in those tissues and organs. Abnormality of tight junction may be involved in the pregnancy complications. Related Articles | Metrics

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Application of Haploid Spermatid in the Treatment of Male Infertility LIU Shu-hua;ZHOU Ping 2013, 32 (5):  387-390.  Abstract ( 1811 )   PDF (1014KB) ( 7449 )   Some patients with non-obstructive azoospermia can get their offspring with paternal genetic material by the micro-injection with haploid spermatid or spermatid nucleus into oocytes（round spermatid injection，ROSI or round spermatid nucleus injection，ROSNI）. The haploid spermatid can be obtained from semen or by testicular biopsy. Although some ART babies fertilized successfully by ROSI were reported，there are still many unresolved problems, such as low rate of fertilization and low rate of baby birth, at present. One of the main causes of fertilization failure, or low fertility rate, is that the haploid spermatid can′t be accurately identified. The advantages and disadvantages of different methods to identify round spermatids, as well as mechanisms, were reviewed, so as to help ART laboratory to improve ROSI outcomes. Related Articles | Metrics

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Progress in Ovarian Hyperstimulation Syndrome JIANG Li-le;CAO Guo-chang;LIANG Lin-lin;ZHANG Cui-lian 2013, 32 (5):  391-394.  Abstract ( 1839 )   PDF (1065KB) ( 7443 )   Ovarian hyperstimulation syndrome（OHSS） is an exogenous or endogenous gonadotropin-induced syndrome. OHSS is associated mainly with exogenous gonadotropin，occasionally with Clomiphene，rarely with the natural cycles of pregnancy. In recent years，with the increasing incidence of anovulatory infertility，the controlled ovarian hyperstimulation becomes a necessary step in in vitro fertilization and embryo transfer. OHSS gradually became one of the most common complications with potentially high-dangerous in assisted reproductive technology. OHSS affects embryo implantation and embryo development, and it could be fatal in some severe cases. The research progress on the pathogenesis，clinical manifestations，prevention and treatment of OHSS were discussed in this review. Related Articles | Metrics

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Effect of Surgical Treatment for Endometrioma on the Clinical Outcomes of In Vitro Fertilization-Embryo Transfer JI Meng-xia;ZHA0 Xiao-ming 2013, 32 (5):  395-399.  Abstract ( 1717 )   PDF (1124KB) ( 7442 )   Patients with endometrioma always have poor IVF outcomes. Before IVF-ET, it is a problem whether to remove surgically endometrioma. Recently，a growing number of studies found that the surgery to remove ovrian endometrioma did not improve IVF outcomes because of the damaged ovarian reserve and lowered responsiveness to gonadotrophins. Meanwhile, the damage degree of surgery is related with operative procedure, surgeons′ experience, and surgical approach. In a word, surgery is not benefit to patients with endometrioma before IVF treatment. The ovarian endometrioma is considered to be treated surgically only under a few special conditions. Related Articles | Metrics

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Effects of Obesity on Reproduction SHEN Lei;DING Zhi-de 2013, 32 (5):  400-404.  Abstract ( 1732 )   PDF (1096KB) ( 7464 )   The occurrence of obesity increased almost two folds in the last decade，meanwhile the expense exhausted directly or indirectly by obesity and its complications reached about 10% of the overall state′s health expenditures. Besides its cardiovascular complications, obesity has significant negative effects on the reproductive system of both men and women，which was confirmed by animal experiments in male and female rodents. Obesity is a risk factor of prostatic cancer，sexual dysfunction, and the declined sperm quality, in males. Obesity is a risk factor of PCOS in females, the declined oocytes quality, and lowered fertile ability. Moreover，obesity has some severe detriments on the growth and development of children and teenagers. In this review，we elucidated the effects of obesity on reproductive endocrinology and metabolism，morphology of reproductive organs，sexual ability，and development of reproductive cells. Related Articles | Metrics

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Phthalic Acid Esters and Spontaneous Abortion GAO Fu-mei;SHEN Huan 2013, 32 (5):  405-408.  Abstract ( 1729 )   PDF (1111KB) ( 7436 )   Phthalic acid esters（PAEs）, as plasticizers, were widely used in production and articles for daily use. Because of their high-production, broad-spectrum and occulted-toxicity, PAEs are one of the most common environmental pollutants with the severe threat to human health. PAEs, can be absorbed and accumulated through a variety of ways. As endocrine disruptors, PAEs can exert an important influence on female reproductive health. It was found that PAEs affect the formation of placenta and the erosiveness of trophocyte by the PPARγ pathways, which may be one reason of sponstaneous abortion. Related Articles | Metrics

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Progress of Study on Endometrial Receptivity at Molecular Level of the Polycystic Ovary Syndrome LI Ai-jie;YANG Xue-feng 2013, 32 (5):  409-411.  Abstract ( 1644 )   PDF (912KB) ( 7383 )   Polycystic ovarian syndrome(PCOS) is a common endocrine disease in women of childbearing age. Most of patients with PCOS visit doctors because of their infertility. Patients with PCOS still have the high rate of abortion and low rate of pregnancy, although their ovulation and endocrine have been adjusted by drug treatment, which is mostly due to the lowered endometrial receptivity induced by long term of hormonal imbalance. It was shown that HA, MUC1, E-cadherin and GPER cyclically expressed in endometrium, and that expressions of these proteins were abnormal in endometrium of patients with infertility. It suggested that HA, MUC1, E-cadherin and GPER were bound up with endometrial receptivity. In this paper, roles of these factors were reviewed in the lowered endometrial receptivity of PCOS. Related Articles | Metrics

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Effect of Diabetes on Ovarian Function：a Mini Review LI Meng-xi;WU Qiong-fang 2013, 32 (5):  412-414.  Abstract ( 1683 )   PDF (1054KB) ( 7421 )   The number of patients with diabetes increased year by year. The infertility in those diabetic women is of important problem. It was found that the environment of long-term uncontrolled hyperglycemia could affect ovarian function and pregnancy by its effect on oocyte maturation and ovulation. The mechanism could be complicated, including the disturbed mitochondrial function of follicle cells, those ovarian stimulating factors such as Ang II, and the changed concentration of many hormones in blood (such as E2, T, P, insulin). It is benefit to improve ovarian function for those women with diabetes to control their blood glucose levels and to improve insulin resistance. Related Articles | Metrics