脱氢表雄酮对卵巢反应不良患者体外受精-胚胎移植的影响

Dehydroepiandrosterone supplementation improve in vitro fertilization outcome among women with poor response

目的探讨脱氢表雄酮(DHEA)对卵巢反应不良患者的卵巢储备功能和促排卵效果的影响。方法选择2009年9月～2011年5月间至少有1次体外受精-胚胎移植(IVF-ET)治疗失败的卵巢反应不良患者37例,口服DHEA 25～75 mg/d,1～3个月后,再次接受IVF-ET治疗。分析服用DHEA前后基础卵泡数、基础内分泌水平的变化和促排卵效果。结果患者服用DHEA(52.03±12.33)mg/d,(84.05±35.31)d后,基础窦卵泡数由3.62±1.34上升到5.76±2.47,P<0.01。卵泡刺激素(FSH)、黄体生成素(LH)的水平明显降低,雄激素的水平均显著升高,睾酮(T)、游离睾酮(FT)、DHEA分别由(1.01±0.50)nmol/L、(1.02±0.40)nmol/L、(175.38±48.12)nmol/L上升至(2.16±0.84)nmol/L、(1.68±0.78)nmol/L、(354.09±118.70)nmol/L,P<0.01。IVF-ET治疗过程中,获卵数、优质胚胎数均显著增加,获得了27.03%临床妊娠率。结论 DHEA能提高卵巢反应不良患者的雄激素水平,有效改善卵巢反应不良患者的卵巢储备功能和促排卵效果,进而提高IVF-ET的妊娠率。

Objective To evaluate the effect of treatment with dehydroepiandrosterone （ DHEA ） on in vitro fertilization and embryo transfer （IVF-ET） outcomes among women with poor response. Methods Thirty-seven poor response women with at least one IVF cycles received 50-75 mg of DHEA daily for one to three months. Antral follicle count （AFC）, basal follicle stimulating hormone （FSH）,luteinizing hormone （LH）, estradiol （E2 ）, testosterone （T）, free T （FT）, DHEA and IVF outcome parameters were compared before and after the DHEA treatment by paired t-test. Results Women received （ 52.03 ± 12.33 ） mg of DHEA daily for an average of （ 84.05 ±35.31 ） days. Paired analysis of endocrine parameters in 37 patients showed that AFC, T, FT and DHEA increased after DHEA supplementation （ P 〈 0.01 ）, while FSH and LH levels decreased. IVF cycle outcomes demonstrated significant increases on retrieved oocytes and high quality embryos after the DHEA treatment. Ten women conceived （ clinical pregnancy rate, 27.03 % ） and eleven healthy babies were born. Conclusion DHEA supplementation could significantly increase the androgen level in women with poor response, which could improve ovarian reserve, and increase the number of retrieved oocytes and pregnancy rate.