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目的探讨卵巢低反应患者补充脱氢表雄酮(DHEA)后卵巢储备指标及体外受精结局的变化。方法纳入50名前次IVF-ET治疗失败,证明是卵巢低反应,并再次要求IVF-ET治疗的患者。采用前瞻性单因素自身对照研究。入选患者接受DHEA 75mg/日,至少治疗3个月后,每个患者采用与前一周期相同的卵巢刺激方案和FSH起始剂量促排卵。比较DHEA治疗前后,月经周期第三天AFC数量、FSH、抑制素B、抗苗勒氏管激素水平等卵巢储备指标;比较前后周期血清雌二醇(E2)峰值、HCG日>15mm卵泡数量、回收卵母细胞和MII卵母细胞的数量、胚胎的数量和质量等治疗反应指标;比较治疗前后,临床妊娠率、流产率、活产率等体外受精周期结局差异。结果 50例患者DHEA治疗前后AFC数量显著增加(P<0.05),月经第3天FSH、抑制素B和抗苗勒氏管激素水平无明显改变(P>0.05);补充DHEA后,卵巢刺激反应得到了显著改善,E2峰值水平、>15mm的卵泡数量、获卵数、MII的卵子数量均有显著增加(P>0.05),治疗前后受精率相似(分别为67±42%和72±30%,P>0.05),可移植胚胎数量显著增加,由平均数量0.85个增至2.0个(P<0.05),可移植胚胎的优胚率由26%增至47%,但没有统计学意义(P>0.05)。由于反应不良取消周期的比例显著降低(P<0.05),使用DHEA后周期妊娠率为30%,活产率为20%。50例患者对DHEA耐受良好,无严重不良反应。结论补充DHEA后可以增加胚胎数量,改善胚胎质量,提高临床妊娠率,改善卵巢低反应体外受精结局。其改善结局的机制可能是通过减少2-10mm的窦卵泡闭锁,增加AFC途径实现的。
Objective To investigate the changes of ovarian reserve index and in vitro fertilization outcome after DHEA supplementation in patients with low ovarian response. Methods Fifty patients previously treated with IVF-ET who failed to respond to the previous IVF-ET treatment proved to be ovarian hyporesponsive. Prospective, single-factor, self-controlled study. Patients enrolled in DHEA 75 mg / day for at least 3 months of treatment, each patient ovulation induction with the same ovarian stimulation schedule and FSH starting dose as in the previous cycle. The ovarian reserve indexes such as AFC quantity, FSH, inhibin B and anti-Müllerian hormone levels on the third day of the menstrual cycle were compared before and after DHEA treatment. The serum estradiol (E2) The number of oocytes and MII oocytes retrieved, the number and quality of embryos, and other indicators of therapeutic response; comparison of clinical pregnancy rate, abortion rate, live birth rate and other in vitro fertilization cycle outcome differences. Results The amount of AFC in 50 patients before and after DHEA treatment significantly increased (P <0.05), and the level of FSH, inhibin B and anti-Müllerian hormone did not change significantly on the 3rd day after menstruation (P> 0.05). After DHEA supplementation, the ovarian stimulation response (P> 0.05). The fertilization rates were similar before and after treatment (67 ± 42% and 72 ± 30%, respectively) , P> 0.05), the number of transplanted embryos increased significantly from 0.85 to 2.0 (P <0.05), and the excellent embryo rate of transplanted embryos increased from 26% to 47%, but there was no statistical significance (P > 0.05). Due to the significant reduction in the proportion of cancerous cycles (P <0.05), the pregnancy rate after DHEA was 30% and the live birth rate was 20%. 50 patients were well tolerated DHEA, no serious adverse reactions. Conclusion Supplementation of DHEA can increase the number of embryos, improve the quality of embryos, improve the clinical pregnancy rate and improve the outcome of IVF in vitro fertilization. Its mechanism to improve the outcome may be through the reduction of antral follicles 2-10mm atresia, increase the AFC pathway to achieve.