脱氢表雄酮在卵巢储备功能低下高龄患者体外受精/卵胞质内单精子注射-胚胎移植中的应用研究

Application of DHEA to advanced aged patients with diminished ovarian reserve in in vitro fertilization or intracytoplasmic sperm injection and embryo transfer

目的探讨口服脱氢表雄酮(DHEA)辅助治疗在卵巢储备功能低下(DOR)高龄患者体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中的临床疗效。方法选取行IVF/ICSI助孕治疗的DOR患者152例,所有患者均行2次及以上助孕周期,前一周期为未加用药周期(治疗前组),本次为用药周期(治疗后组),进行自身用药前后对照分析。比较口服DHEA后卵巢储备功能的变化情况,同时比较是否加用DEHA患者IVF/ICSI-ET的临床治疗参数、实验室参数及临床结局。结果 (1)口服DHEA后患者血清抗苗勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-s)、睾酮(T)及窦卵泡计数(AFC)较用药前升高,卵泡刺激素(FSH)较前下降,差异有统计学意义(P<0.05);(2)治疗后组h CG注射日E2及孕酮(P)水平、获卵数、受精率、可移植胚胎数、胚胎种植率及临床妊娠率高于治疗前组,Gn总用量、Gn使用时间、周期取消率低于治疗前组,差异有统计学意义(P<0.05)。结论 DOR的高龄患者在进入IVF/ICSI周期前口服DHEA可改善其卵巢储备功能及助孕结局。

Objective To investigate the effects of dehydroepiandrosterone （DHEA） supplementation on in vitro fertilization or intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET） outcomes and changes in ovarian reserve among patients with diminished ovarian reserve （DOR）. Methods The study enrolled 152 treatment cycles in 152 couples who accepted IVFflCSI. All patients had repeated IVF/ICSI-ET cycles. The last cycle without DHEA supplementation were taken as before treatment group and this time received DHEA supplementation were taken as after treatment group, as self-control study. The ovarian reserve in after treatment group were compared between before and after oral DHEA subgroup. Also the IVF treatment parameters and outcomes were compared. Results 1） In after treatment group, serum anti-Mtlllerian hormone （AMH）, testosterone （T）, dehydroepiandrosterone sulfate （DHEA-s）, and the number of antral follicle count （AFC） were increased and basic follicle-stimulating hormone （FSH） value was reduced after DHEA treatment which had a statistical significant （P〈0.05）. 2） Serum estradiol （E2） and progesterone （P） levels on the day of human chorionic gonadotropin 0aCG） injection, the number of retrieved oocytesand available embryos, fertilization rate, embryo implantation rate, clinical pregnancy rate were significantly higher in after treatment group than in before treatment group. The dosage and duration of gonadotropin （Gn） used, cycle cancellation rate were significantly lower in after treatment group than in before treatment group. Conclusion DHEA supplementation can improve ovarian reserve and outcome of IVF/ICSI in aged patients with DOR.