e the keys lead to pregnancy in ivf-et-----庄广伦.ppt

What are the keys lead to pregnancy in IVF-ET Zhuang Guanglun Zhongshan University,Guangzhou,China Age ? ! Oocyte dysfunction is a major cause of infertility in women Age is the single most important predictor of fertility in women Age reduces developmental competence of oocytes oocyte donation abrogates the effects of age on women’s fertility The number of follicles decreases dramatically after 36 years old Seifer DB et al J Clin Endocri Metab 1996 With aging, the number of follicles declines Spindle abnormal increases Aneuploidy and mtDNA mutation raise Granulosa cells proliferate more slowly, apoptosis rate increases hormone production reduces Seifer DB et al J Clin Endocri Metab 1996 Cytoplasmic factors Predictor of ovarian reserve FSH≥20miu/ml, PR 6.5%-0% ≤ 20miu/ml, PR 16.5% Martin JS et al. Fertil Steril 1996 The number of antral follicles decreases while FSH increases with age. Normal FSH and high E2 level predict the ovarian reserve is between normality and ovarian failure Klein NA et al. J Clin Endocrinol Metab 1996 In follicular phase, inhibin B declines with FSH raising, reflecting poor ovarian reserve directly.Before basal FSH elevates, inhibin B begins to decrease . Seifer DB et al. Fertil Steril 1997 Age is an incurable disease COH A magic strategy The FSH Threshold The FSH Threshold Model:Follicle Selection FSH-stimulated induction of LH receptors on granulosa cells could enable the follicle to respond to LH and thereby continue to mature in the presence of continuously declining FSH concentrations in the mid-late follicular phas