脱氢表雄酮预治疗对高龄卵巢储备正常患者体外受精-胚胎移植结局的影响

Effect of DHEA supplementation on pregnancy outcome of patients younger than 42 years old with normal ovarian function undergoing IVF program

目的：探讨脱氢表雄酮（DHEA）预治疗对高龄卵巢储备正常患者体外受精-胚胎移植（IVF-ET）周期结局的影响。方法：对156例36-42岁卵巢储备正常并行IVF的患者按照随机数字表随机分为两组。DHEA组81例,进入IVF周期前给予DHEA预治疗8周,对照组75例,不给予任何预处理。观察指标：获卵数、受精率、优质胚胎率、冷冻胚胎数、临床妊娠率、早期自然流产率、活产率、抗苗勒氏管激素（AMH）水平。结果：DHEA组患者优质胚胎率明显高于对照组（P〈0.05）;受精率、冷冻胚胎数、临床妊娠率、活产率均高于对照组,早期自然流产率低于对照组,但差异无统计学意义（P〉0.05）;DHEA组患者预治疗后AMH升高明显（P〈0.05）,对照组无明显变化;获卵数、周期取消率、h CG注射日子宫内膜厚度及E2水平、Gn使用量和使用天数差异均无统计学意义（P〉0.05）。结论：DHEA预治疗可以提高卵巢储备功能正常的高龄患者的优质胚胎率,其机制可能与AMH有关。

Objective To investigate the effect of DHEA supplementation on pregnancy outcome of patients aged between 36-42 years old with normal ovarian function undergoing IVF program. Methods 156 patients aged 36-42,with normal ovarian function ,who received in vitro fertilization-embryo transfer （IVF-ET） were divided into DHEA group （81 cases） and control group （75 cases） according to random number table. DHEA group received DHEA pretreatment for eight weeks before IVF-ET,and control group without any pretreatment. Mail outcome measures： number of oocytes, fertilization rate, good quality embryos rates, number of frozen embryos,clinical pregnancy rate,early spontaneous abortion rate,live birth rate,and level of anti- mullerianhormone. Results The high-quality embryo rate was significantly higher in the DHEA group than the control group （P 〈 0.05）. The fertilization rate ,the number of frozen embryos ,The clinical pregnancy rate, the early spontaneous abortion rate, and the live birth rate were have not significant differences. AMH increased significantly after DHEA pretreatment in DHEA Group （P 〈 0.05 ）, nosignificant change in the control group. The number of oocytes,the cycle cancellation rate,E2 levels on hCG-day, endometrial thickness, the dosage and duration of Gn had not significant differences between the two groups. Conclusion DHEA pretreatment can improve the high-quality embryo rate of patients between 36 and 42 with normal ovarian reserve, which may be associated with AMH.