脱氢表雄酮可以改善卵巢低反应患者的体外受精结局

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DHEA75mg／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。

DHEA can improve vitro fertilization outcome in poor ovarian responser

Objective： To study the the change of ovarian reserve and vitro fertilization outcome after DHEA supplementation in Poor Ovarian Responser. Methods： 50 patients who have been proved Poor Ovarian Responser in the previous IVF - ET treatment, then requested again IVF - ET, were included. This is a Prospective single factor and self - control study. Each patient received DHEA treatment （75 mg/day）, at least 3 months. After DHEA treatment, each patient used the same ovarian stimulus project and FSH starting dose as the previous cycle. Then, before and after DHEA supplementation of at least 3 months duration, comparing day 3 ovarian reserve markers, thatis biochemical anti -Mullerian hormone （AMH）, inhibin B and FSH and antral follicle count （AFC）） ; comparing serum levels of estradiol （E2） peak, the number of follicles 〉 15 mm on HCG day, the number of recycling oocytes and MII oocytes; comparing the clinical pregnancy rate, live births rate, miscarriage rate and so on. Results： Fifty women were included. Following DHEA, there was a significant increase in AFC （ P 〈 O. 05 ） without significant changes in the baseline biochemical parame- ters AMH, inhibin B, or FSH （P 〉 O. 05 ）. The enhanced response comprised increased peak estradiol levels, number of follicles 〉 16 mm, oocytes, MII oocytes and embryos （P 〈0. 05）. fertilization rates were similar （67 ±42% and 72 ± 30% , respectively, P 〉 O. 05）, Transplanted embryonic number increased significantly by the average number of O. 85 to 2. 0 （ P 〈 0.05 ）, High quality transplanted embryonic rate increased from 26% to 47%, but has no statistical significance （P 〉 0. 05） ; The proportion of cancelled cycles due to very poor response decreased significantly （ P 〈 0.05 ）. The pregnancy rate was 30% , the live birth rate was 20%. DHEA was well tolerated in fifty women, no serious adverse reaction was observed. Conclusion： Supplementary DHEA can increase the number of embryos, improve embryo quality, improve the clinical pregnancy rate and vitro fertilization outcomes, which may be by reducing 2 -10ram small sinus follicle atresia, increase the AFC numbers.