Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy.
Gynecol Endocrinol. 2012 Sep;28(9):669-73. doi: 10.3109/09513590.2012.705386. Epub 2012 Jul 26.
To analyze the effect of dehydroepiandrosterone (DHEA) supplementation on follicular microenvironment and on in vitro fertilization (IVF) outcomes among poor responder patients.
We enrolled 24 patients diagnosed as poor responders based on ESHRE consensus criteria. One group received 25 mg/die three times daily of DHEA supplementation for 3 months previous to IVF cycle, while the other did not receive any treatment. COH was performed with rFSH and hMG, and a GnRH antagonist was administered according to a flexible protocol. We evaluated perifollicular vascularization of recruited follicles through power Doppler blood flow analysis and follicles were graded as described by Chui et al. Follicular fluids (FF) from F3-F4 follicles were collected, and FF levels of vascular endothelial growth factor (VEGF) and hypoxic inducible factor1 (HIF1) were measured.
FF levels of HIF1 were statistically significant lower in women treated with DHEA (14.76 ± 51.13 vs. 270.03 ± 262.18 pg/ml; p = 0.002). On the contrary, VEGF levels did not differ between the two groups. Concerning COH, in the DHEA-group the mean duration of treatment was significantly shorter (9.83 ± 1.85 vs. 12.09 ± 2.81; p = 0.023). Total numbers of oocytes retrieved, fertilized oocytes, good quality embryos, number of transferred embryos and clinical pregnancies tended to be higher in study group, but the results were not significant. On the other hand, considering the oocytes retrieved in selected F3-F4 follicles, there was a relation between HIF1 levels and oocytes quality. In fact, mature oocytes retrieved in selected follicles were significantly more numerous in DHEA-group (0.50 ± 0.52 vs. 0.08 ± 0.29; p = 0.018).
The improvement of reproductive parameters after DHEA supplementation in poor responders may be explained through the effect that this pro-hormone exerts on follicular microenvironment.
分析脱氢表雄酮（DHEA）补充对卵巢低反应患者卵泡微环境和体外受精（IVF）结局的影响。
我们招募了 24 名根据 ESHRE 共识标准诊断为卵巢低反应的患者。一组患者在 IVF 周期前接受 25mg/die，每日 3 次的 DHEA 补充治疗，持续 3 个月，而另一组患者则未接受任何治疗。采用 rFSH 和 hMG 进行 COH，并根据灵活的方案给予 GnRH 拮抗剂。我们通过功率多普勒血流分析评估募集卵泡的卵泡周围血管化，并按照 Chui 等人的描述对卵泡进行分级。收集 F3-F4 卵泡的卵泡液（FF），并测量 FF 中血管内皮生长因子（VEGF）和低氧诱导因子 1（HIF1）的水平。
接受 DHEA 治疗的女性 FF 中的 HIF1 水平显著降低（14.76 ± 51.13 vs. 270.03 ± 262.18 pg/ml；p = 0.002）。相反，两组之间的 VEGF 水平没有差异。关于 COH，DHEA 组的治疗持续时间明显缩短（9.83 ± 1.85 vs. 12.09 ± 2.81；p = 0.023）。研究组中获得的卵母细胞总数、受精卵母细胞数、优质胚胎数、移植胚胎数和临床妊娠数均有升高趋势，但结果无统计学意义。另一方面，考虑到在选定的 F3-F4 卵泡中获得的卵母细胞，HIF1 水平与卵母细胞质量之间存在一定关系。事实上，在 DHEA 组中，在选定的卵泡中获得的成熟卵母细胞数量明显更多（0.50 ± 0.52 vs. 0.08 ± 0.29；p = 0.018）。
卵巢低反应患者接受 DHEA 补充后生殖参数的改善可能是由于这种前体激素对卵泡微环境的作用。
