臨床婦人科産科64巻4号

2010年04月発行

今月の臨床 これを読めばすべてわかる―最新の産婦人科超音波診断

V　不妊診療における超音波検査

卵巣予備能評価

著者： 本田育子¹

所属機関： ¹山近記念総合病院産婦人科

ページ範囲：P.762 - P.769

文献概要

　妊娠する能力は加齢に伴って低下する．妊孕能をみるうえで年齢は最重要な因子であるが個体差が存在する．近年の初産年齢の上昇と，不妊治療，とりわけ生殖補助医療（assisted reproductive technology : ART）患者数の増加に伴い，卵巣予備能検査（ovarian reserve test : ORT）は汎用されるようになった．ORは卵巣の潜在能力を表す用語であり，また将来の生産力fecundityが消失するまでの猶予期間を予測することで治療の有無にかかわらずカウンセリングの指針となり，直接的には卵巣内の卵子の数と質を反映するものであろう．しかしながら，検査の大部分はARTでのgonadotropinに対する卵巣の反応性，採卵数やキャンセル周期の予測，卵巣刺激方法やgonadotropin投与量を決定するために用いられている^1）．現在，卵子の質を評価できるORTはなく，meta-analysisの結果からみてgonadotropinに対するpoor responseは予測できても妊娠の成否を予測するには至っていない^2）．またpoor responseの予測は，今後の不妊治療のカウンセリング資料となるが，ARTの妊娠継続率が依然として低い現状においてはORTの必要性が問われている^1）．ORTの有用性に限界はあるものの，若年者におけるORT異常は迅速な治療あるいは卵巣機能の温存をはかる必要があり，高年齢者においてはORTが良好であれば不妊治療からの除外を回避する指標になる．

　ORTは，basal FSHやAMH（Anti-Müllerian hormone）などの内分泌学的検査と超音波検査の2つに分けられる．超音波検査の代表的な指標として，胞状卵胞数（antral follicle count : AFC），卵巣体積，卵巣血流があり，近年meta-analysis ^3）もみられるが，各報告者によって卵巣poor responseの基準，検査方法，診断のcut-off値，妊娠の定義が異なる．poor responseの予測では，卵巣体積よりもAFCが有用であり，非妊娠の予測では2つのパラメーターとも有用性は示されていない^{3, 4）}．

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