Rao Rupali, More Akash, Shrivastava Jarul
Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Cureus. 2024 Jun 30;16(6):e63491. doi: 10.7759/cureus.63491. eCollection 2024 Jun.
This study represents a case of a 42-year-old female patient who had a history of infertility, undergoing treatment at the in vitro fertilization (IVF) centre in Sawangi, India. The patient presented with a medical history marked by recurrent medical termination of pregnancies, a small uterus diagnosed through metroplasty, and a significant impediment to fertility treatment attributed to poor ovarian reserve. Clinical assessment revealed the male partner's history of alcohol consumption and cigarette smoking, along with benazepril usage for hypertension (5 mg/day). Despite normal semen parameters, intrauterine insemination (IUI) proved unsuccessful, prompting a recommendation for IVF utilizing the intracytoplasmic sperm injection (ICSI) procedure. The patient displayed low anti-Mullerian hormone (AMH) levels, indicative of insufficient ovarian reserve. Dehydroepiandrosterone (DHEA) supplementation was advised orally for a period of one month to enhance ovarian function. Subsequent evaluation demonstrated a notable increase in AMH levels, facilitating the retrieval of six oocytes, comprising average-quality metaphase II (MII) oocytes and one dysmorphic metaphase I (MI) oocyte. Following ICSI, successful fresh embryo transfer ensued, resulting in a positive beta-human chorionic gonadotropin (β-hCG) test with serum β-hCG levels measuring 1676 mIU/mL, confirming the successful implantation of one of the two transplanted embryos. This case underscores the significance of DHEA supplementation in augmenting ovarian reserve and achieving favorable IVF-ICSI outcomes in patients with primary infertility. The holistic approach, encompassing lifestyle modifications and tailored medication, contributed to a positive pregnancy outcome. Further research is warranted to explore the broader implications of DHEA therapy in the management of infertility.
本研究报告了一例42岁女性患者的病例，该患者有不孕史，正在印度萨万吉的体外受精（IVF）中心接受治疗。患者的病史包括多次人工终止妊娠、经子宫成形术诊断为子宫较小以及因卵巢储备功能差而对生育治疗造成重大阻碍。临床评估显示男性伴侣有饮酒和吸烟史，同时服用苯那普利治疗高血压（5毫克/天）。尽管精液参数正常，但宫腔内人工授精（IUI）未成功，因此建议采用卵胞浆内单精子注射（ICSI）程序进行IVF。患者的抗苗勒管激素（AMH）水平较低，表明卵巢储备不足。建议口服脱氢表雄酮（DHEA）一个月以增强卵巢功能。随后的评估显示AMH水平显著升高，促使获取了6个卵母细胞，其中包括质量中等的中期II（MII）卵母细胞和1个形态异常的中期I（MI）卵母细胞。ICSI后，成功进行了新鲜胚胎移植，β-人绒毛膜促性腺激素（β-hCG）检测呈阳性，血清β-hCG水平为1676 mIU/mL，证实移植的两个胚胎中有一个成功着床。该病例强调了补充DHEA在增强卵巢储备以及使原发性不孕患者获得良好的IVF-ICSI治疗结果方面的重要性。包括生活方式调整和针对性药物治疗在内的整体方法促成了积极的妊娠结局。有必要进行进一步研究以探索DHEA疗法在不孕症管理中的更广泛意义。
