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脱氢表雄酮对卵巢反应标志物、卵巢反应和体外受精结局的影响的随机、对照、初步试验:在卵巢低反应患者中的应用。

A randomized, controlled, pilot trial on the effect of dehydroepiandrosterone on ovarian response markers, ovarian response, and in vitro fertilization outcomes in poor responders.

机构信息

Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong, People's Republic of China.

Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong, People's Republic of China.

出版信息

Fertil Steril. 2014 Jul;102(1):108-115.e1. doi: 10.1016/j.fertnstert.2014.03.044. Epub 2014 May 3.

Abstract

OBJECTIVE

To evaluate whether pretreatment dehydroepiandrosterone (DHEA) supplementation improves ovarian response markers, ovarian response to standard low-dose gonadotropin stimulation, and in vitro fertilization (IVF) outcomes in poor responders.

DESIGN

Randomized, double-blind, placebo-controlled pilot study.

SETTING

Tertiary reproductive medicine unit.

PATIENT(S): Thirty-two women with anticipated poor ovarian response.

INTERVENTION(S): Randomization into DHEA group (n=16) receiving GNC (25 mg three times a day) or placebo (n=16) starting from at least 12 weeks before the scheduled IVF treatment according to a computer-generated randomization list.

MAIN OUTCOME MEASURE(S): Measurement of monthly ovarian response markers, including antral follicle count (AFC), serum antimüllerian hormone (AMH), and follicle-stimulating hormone (FSH) levels; comparison of ovarian response to a standard dose of gonadotropin stimulation at week 8 and IVF outcomes; and AFC after 12 weeks (primary outcome).

RESULT(S): The DHEA supplementation resulted in statistically significantly higher serum DHEA-S, free androgen index, and follicular DHEA-S levels. No statistically significant differences in the ovarian response markers (AFC, AMH, or FSH), the ovarian response to standard-dose gonadotropin stimulation, or IVF outcomes were found between the two groups.

CONCLUSION(S): No statistically significant improvement in ovarian response markers, ovarian response to standard dose gonadotropin stimulation, or IVF outcomes was found in poor responders receiving pretreatment DHEA.

CLINICAL TRIAL REGISTRATION NUMBER

HKCTR-1149 (www.hkclinicaltrials.com) and NCT01915186 (www.ClinicalTrials.org).

摘要

目的

评估预处理脱氢表雄酮(DHEA)补充是否能改善卵巢反应标志物、对标准低剂量促性腺激素刺激的卵巢反应以及体外受精(IVF)结局在卵巢反应不良者中的作用。

设计

随机、双盲、安慰剂对照的初步研究。

地点

三级生殖医学单位。

患者

32 名预计卵巢反应不良的患者。

干预

根据计算机生成的随机分组表,将患者随机分为 DHEA 组(n=16)和安慰剂组(n=16),DHEA 组每天服用 GNC(25 mg,每日 3 次),安慰剂组从计划 IVF 治疗前至少 12 周开始服用。

主要观察指标

每月卵巢反应标志物的测量,包括窦卵泡计数(AFC)、血清抗苗勒管激素(AMH)和卵泡刺激素(FSH)水平;比较第 8 周标准剂量促性腺激素刺激的卵巢反应和 IVF 结局;以及 12 周后的 AFC(主要结局)。

结果

DHEA 补充后,血清 DHEA-S、游离雄激素指数和卵泡 DHEA-S 水平显著升高。两组间卵巢反应标志物(AFC、AMH 或 FSH)、对标准剂量促性腺激素刺激的卵巢反应或 IVF 结局均无统计学差异。

结论

在接受预处理 DHEA 的卵巢反应不良者中,卵巢反应标志物、对标准剂量促性腺激素刺激的卵巢反应或 IVF 结局均无统计学显著改善。

临床试验注册号

HKCTR-1149(www.hkclinicaltrials.com)和 NCT01915186(www.ClinicalTrials.org)。

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