由于社会角色的转变,女性生育延迟现象明显。女性卵巢功能一般从35岁时开始下降,主要表现为卵泡数量减少和卵母细胞质量下降。目前临床上对于卵巢功能低下的诊断主要依据血清卵泡刺激素(follicle stimulating hormone, FSH)、血清抗苗勒氏管激素(anti-Müllerian hormone, AMH)、窦卵泡计数、年龄、月经和抑制素B等指标。目前研究发现,伴随年龄的增加,女性卵巢内细胞会出现线粒体功能失调、染色质短缩、DNA修复减少、表观遗传学改变和代谢失序。本文在简要介绍卵巢功能低下临床诊断的基础上,对衰老导致卵巢功能低下的相关因素进行了总结,并深入探讨了其发生的分子机制及潜在的干预靶点,以期为有效改善高龄女性的卵巢功能提供思路。

Societal changes regarding the role of women have significant impacts on women’s willingness and the timing of childbearing. Ovarian reserve in woman typically begins to decline at the age of 35, and it is primarily characterized by a reduction in the number of ovarian follicles and a decline in oocyte quality. The clinical diagnosis of ovarian insufficiency relies on multiple variables including changes of follicle stimulating hormone (FSH), serum anti-Müllerian hormone (AMH), inhibin B, antral follicle count, menstruation and age. It is proven that ovarian cells demonstrate dysfunction associated with aging including mitochondrial dysfunction, telomere shortening, impaired DNA repair, epigenetic changes and metabolic/energetic disorders. In this review, we introduce the clinical diagnosis and management of ovarian insufficiency. We mainly discuss the molecular mechanism and potential interventions. We are optimistic that this information and knowledge will inform the important decisions for women and society regarding childbearing.