荷尔蒙测试无法正确检测女性生育能力

More evidence that hormone testing for women's fertility does not work.

更多证据表明,检测女性生育能力的荷尔蒙测试并不奏效。

Women seeking to defer motherhood are often encouraged to check their fertility.

人们通常会鼓励希望推迟生育时间的女性检测自己的生育能力。

Though fecundity is tied to age, the effect of time's passage varies.

虽然生育能力与年龄有关,但其对不同人的影响不同。


Some 35-year-olds find they cannot get pregnant.

一些人35岁发现自己无法怀孕。

Others manage at the first attempt.

还有人第一次尝试就能成功。

The main causes of fertility's reduction with advancing years are declines in the number and quality of the eggs in a woman's ovaries.

生育能力随着年龄增长而下降的主要原因是,女性年龄越大,卵巢中卵子的数量越少,质量越低。

Unlike men, who manufacture sperm throughout their post-pubertal lives, albeit in ever-decreasing quantities, all of a woman's potential eggs develop while she is still a fetus.

而男性则不同。虽然男性制造精子的数量会不断减少,但他们在青春期后始终都在制造精子;而女性的所有卵子都是在胎儿时期开始发育的。

A newborn girl has over 1m of them.

一个刚出生的女孩有100多万个卵子。

By puberty, she is left with about 400,000.

到了青春期,就只剩下大约40万。

When the menopause arrives, that has been whittled down below 1,000, which are likely to be duds.

到了更年期,卵子数量会低于1000,并且很可能质量很低。

But fertility tests currently on offer neither count the number of eggs remaining nor assess their quality.

但目前为女性提供的生育测试既不计算其剩余的卵子数量,也不评估卵子的质量。

Rather, they rely on an indirect approach - sampling what are hoped to be relevant hormones.

这些测试依赖于一种间接的方法——对可能与女性生育能力相关的荷尔蒙进行采样。

Hormone tests do have some value in estimating the timing of menopause and the success of harvesting eggs for in vitro fertilisation.

荷尔蒙测试在预测更年期的时间和预测采集卵子进行体外受精的成功率方面确实有一定的价值。

But forecasting pregnancy?

但在预测怀孕方面呢?

The evidence suggests that they can't.

证据表明,荷尔蒙测试在这方面没有效果。

One test-sceptic is Anne Steiner of the Duke Fertility Centre, in North Carolina.

北卡罗来纳州杜克生育中心的安妮·斯坦纳就对测试持怀疑态度。

She suspects hormone tests do indicate how many eggs are left to a woman, but that this is not what matters - rather, it is the eggs' quality which is crucial.

她认为荷尔蒙测试确实能检测一个女人还剩下多少卵子,但这并不是问题的关键——卵子的质量才是关键。

Between 2008 and 2016 Dr. Steiner and her colleagues ran the Time to Conceive study.

2008至2016年,斯坦纳博士和她的同事们进行了“怀孕时间”研究。

Its purpose was to determine whether hormone levels could indeed assess a woman's fertility, independent of her age.

目的是在不考虑年龄的情况下,确定荷尔蒙水平是否能够评估女性的生育能力。

The team found then that those levels had no value in predicting pregnancy in the year subsequent to testing.

研究小组随后发现,荷尔蒙水平测试无法预测一年内是否能够怀孕。

Now, in a follow up to the original investigation, just published in Fertility and Sterility, Dr. Steiner has shown that they have no longer-term predictive power, either.

现在,在刚刚发表在《生育与不育》期刊上的后续研究中,斯坦纳博士表明,荷尔蒙水平也无法用于更长期的预测。


Time to Conceive looked at 750 women aged between 30 and 44 who were living with a male partner not known to be infertile, had no diagnosis of infertility of their own, and had recently started trying to become pregnant.

“怀孕时间”研究调查了750名年龄在30岁到44岁之间的女性,这些女性都分别与一名没有被诊断为不孕不育的男性伴侣生活在一起,并且最近开始尝试怀孕。

The team took blood and urine samples from these volunteers and measured levels of three hormones often examined by fertility tests.

研究小组从这些志愿者身上采集了血液和尿液样本,并检测了生育测试中经常检查的三种荷尔蒙的水平。

They then followed each volunteer for a year.

然后,他们对所有志愿者进行了一年的跟踪调查。

The upshot, published in 2017, was that hormone levels were uncorrelated with pregnancy within the 12-month window through which the researchers were looking.

2017年发表的研究结果是,在研究人员观察的12个月时间内,荷尔蒙水平与是否怀孕无关。

But perhaps, Dr. Steiner subsequently speculated, that window was too narrow.

但斯坦纳博士随后推测,也许这个时间太短了。

In 2020 she therefore got back in touch with the original participants for a follow-up.

因此,在2020年,她与最初的研究对象重新取得了联系,以便进行后续调查。

She asked them if they would fill out a questionnaire about how many children they had had, how long it had taken to get pregnant and whether they had been diagnosed with infertility.

她询问对方是否愿意填写一份调查问卷,内容包括他们有几个孩子,怀孕用了多长时间,以及他们是否被诊断为不孕不育。

Some 336 of them agreed to participate.

约336人同意填写问卷。

Among these there had been 239 pregnancies, resulting in 225 live births.

其中有239人怀孕,225例为活产。

More sadly, 73 participants were infertile.

悲伤的是,73名研究对象不育。

But the hormone levels in the tests carried out in the original study did not predict these outcomes.

但在最初的研究中,测试的荷尔蒙水平并没能预测这些结果。

There was no difference, the researchers found, between women with poor results and those with normal ones.

研究人员发现,不育的女性和最终生育的女性荷尔蒙水平没有区别。

In the case of one substance, for example - anti-Mullerian hormone, which is thought predictive because it is produced by cells in the egg-bearing follicles of the ovaries, and is thus believed to reflect the number of those follicles - 79% of those with low levels of it went on to give birth.

举一个例子,抗缪勒管激素被认为能够预测生育能力,因为它是由卵巢中有卵子的卵泡中的细胞产生的,因此人们认为它能够反映有卵子的卵泡的数量,而79%抗缪勒管激素低的人能够生育。

That was statistically indistinguishable from the 71% of mothers with normal levels.

荷尔蒙水平正常的女性71%能够生育,这两个数据在统计上相一致。

The decline in fertility, says Dr. Steiner, is thus clearly not related to the decline in the quantity of eggs, but presumably to their quality.

因此,斯坦纳博士说,生育能力的降低显然与卵子数量的减少无关,而可能与它们的质量有关。

And how to measure that remains unknown.

但如何检测卵子的质量仍是个未知数。

来源:经济学人

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