Fuentes Ariel, Sequeira Karina, Tapia-Pizarro Alejandro, Muñoz Alex, Salinas Abril, Céspedes Pablo, Escalona Javier, Godoy Ana
Faculty of Medicine, Hospital San Borja-Arriarán, Institute of Maternal and Child Research (IDIMI), Universidad de Chile, Santiago, Chile.
Front Endocrinol (Lausanne). 2019 Jul 16;10:458. doi: 10.3389/fendo.2019.00458. eCollection 2019.
Patients with poor ovarian response (POR) to exogenous gonadotropins stimulation for assisted reproductive technology (ART) have decreased circulating androgens during spontaneous cycles. The Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) is a 4-tier stratification of women with POR to controlled ovarian stimulation (COH) based on age and biomarkers of ovarian reserve has been proposed to maximize the clinical management of this group for ART. The aim of the present study was to characterize the levels of androgens during COH in follicular fluid (FF) and serum in POSEIDON subgroups and compared them with women of normal ovarian response. Sixty nine consecutive patients undergoing ART were included and testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S), estradiol, sex hormone-binding globulin (SHBG), and insulin-like growth factor 1 (IGF-1) were measured in serum and FF collected at the time of oocyte pick-up. The number of retrieved oocytes was registered for each patient for their allocation to the respective POSEIDON subgroup. The control group comprised 19 women and the POSEIDON group 1 (age < 35, normal ovarian reserve biomarkers) = 14, group 2 (age ≥ 35, normal ovarian reserve biomarkers) = 8, group 3 (age < 35, poor ovarian reserve biomarkers) = 6 and group 4 (age ≥ 35, poor ovarian reserve biomarkers) = 22. Serum levels of total testosterone, androstenedione and DHEA-S were not different in group 1 vs. control but significantly decreased in group 3 vs. control. DHEA-S in FF was also significantly decreased in group 3 vs. control. In addition, serum testosterone was decreased in groups 2 and 4 vs. control; and serum androstenedione and estradiol were reduced in group 4 vs. control. No differences were observed for estradiol, SHBG and IGF-1 in FF. Finally, a high correlation between serum and FF DHEA-S was observed when data from samples of all groups were pooled. Group 1 did not show hypoandrogenemia however group 3 had low levels of all measured androgens in serum and DHEA-S in FF. Such differences might help to better characterize and/or improve the clinical management of women with POR according to their respective POSEIDON stratification.
对于辅助生殖技术（ART）中接受外源性促性腺激素刺激时卵巢反应不良（POR）的患者，在自然周期中其循环雄激素水平会降低。基于年龄和卵巢储备生物标志物，面向患者的个体化卵子数量策略（POSEIDON）对接受控制性卵巢刺激（COH）的POR女性进行了四级分层，旨在优化该组患者ART的临床管理。本研究的目的是描述POSEIDON亚组在COH期间卵泡液（FF）和血清中的雄激素水平，并与卵巢反应正常的女性进行比较。纳入了69例连续接受ART的患者，在取卵时采集血清和FF，检测睾酮、雄烯二酮、硫酸脱氢表雄酮（DHEA-S）、雌二醇、性激素结合球蛋白（SHBG）和胰岛素样生长因子1（IGF-1）。记录每位患者获取的卵子数量，以便将其分配到相应的POSEIDON亚组。对照组包括19名女性，POSEIDON组1（年龄<35岁，卵巢储备生物标志物正常）=14例，组2（年龄≥35岁，卵巢储备生物标志物正常）=8例，组3（年龄<35岁，卵巢储备生物标志物不良）=6例，组4（年龄≥35岁，卵巢储备生物标志物不良）=22例。组1与对照组相比，血清总睾酮、雄烯二酮和DHEA-S水平无差异，但组3与对照组相比显著降低。组3与对照组相比，FF中的DHEA-S也显著降低。此外，组2和组4与对照组相比血清睾酮降低；组4与对照组相比血清雄烯二酮和雌二醇降低。FF中的雌二醇、SHBG和IGF-1未观察到差异。最后，将所有组样本的数据汇总后，观察到血清和FF中DHEA-S之间存在高度相关性。组1未显示雄激素缺乏血症，然而组3血清中所有检测的雄激素水平以及FF中的DHEA-S水平较低。这些差异可能有助于根据各自的POSEIDON分层更好地表征和/或改善POR女性的临床管理。
