不同年龄卵巢低反应患者DHEA补充前、后的IVF-ET临床结局比较

Comparison of clinical outcomes of IVF-ET before and after DHEA supplementation in patients of poor ovarian response with different ages

目的探讨脱氢表雄酮(DHEA)预处理对不同年龄卵巢低反应(POR)患者体外授精-胚胎移植(IVF-ET)卵巢反应性及临床结局的影响。方法选取83例行IVF-ET助孕≥1次的POR患者,根据年龄分为低龄组(<38岁)43例及高龄组(≥38岁)40例,连续服用DHEA75mg/d预处理3个月后再次进入IVF周期,DHEA用药前、后周期均采用微刺激或温和刺激方案。两组分别行自身前后对照研究比较用药前、后的卵巢储备功能指标(基础FSH、抗苗勒氏管激素(AMH)及窦卵泡数(AFC))、促性腺激素用药情况、IVF周期治疗参数(获卵数、胚胎发育相关指标及妊娠结局)。结果 DHEA用药后,低龄组及高龄组的AMH、AFC、HCG日E2值、获卵数、受精数均显著优于用药前(P均<0.05);但两组的受精率、卵裂率、可用胚胎率、优质胚胎率均与用药前无显著性差异(P均>0.05)。低龄组DHEA用药后的临床妊娠率显著高于用药前(P<0.05),而高龄组与用药前无显著差异(P>0.05)。低龄组及高龄组在DHEA用药后的种植率及流产率虽均有改善趋势,但均与用药前无显著性差异(P均>0.05)。结论 DHEA预处理可能通过促进早期卵泡发育而改善卵巢储备功能,提高低龄及高龄POR患者的卵巢反应性,并可进一步改善低龄POR患者的临床妊娠结局。

Objective:To evaluate the efficiency of dehydroepiandrosterone(DHEA)pretreatment on ovarian responsiveness and clinical outcome in patients of different ages with poor ovarian response(POR)treated with in vitro fertilization-embryo transfer(IVF-ET). Methods:Eighty-three POR patients undergoing IVF-ET assisted pregnancy for one or more than one time were divided into the younger group(<38 years old,43 cases and the older group(>38 years old,40 cases). The patients enrolled were treated with DHEA 75 mg/d for 3 months and then re-entered the IVF cycles. Microstimulation or mild stimulation were used before and after DHEA treatment. The ovarian reserve function indexes(basic FSH,AMH and antral follicle count(AFC),days and total dosage of gonadotropin,IVF cycle treatment parameters(numbers of oocytes retrieved,embryo development related indicators and pregnancy outcomes)were compared before and after DHEA treatment in the two groups respectively. Results:After DHEA treatment,AMH,AFC,E2 on HCG day,numbers of oocytes retrieved and fertilization number both in the younger and older groups were remarkably improved compared with those before DHEA treatment(P<0.05),but there were no significant differences in fertilization rate,cleavage rate,available embryo rate and high quality embryo rate before and after DHEA treatment in both groups(P>0.05). Although the implantation rate and abortion rate in both groups were improved after DHEA pretreatment,there was no significant difference before and after treatment in the two groups. Conclusion:DHEA pretreatment may improve ovarian reserve function and ovarian responsiveness by promoting early follicular development in young and elderly POR patients,and further improve the clinical pregnancy outcome of young POR patients.