The Influence Factors Of Dehydroepiandrosterone On The Outcome Of The Patients With Diminished Ovarian Reserve Undergoing In Vitro Fertilization

BackgroundDiminished ovarian reserve(DOR) means a state of a decline of ovarian oocyte quality and quantity. Patients with DOR will have a series of clinical manifestations, the decrease of AFC,the level of AMH, and the increase of the level of FSH. In the process of the ART, the patients with DOR represent poor response to controlled ovarian hyperstimulation and the outcome is more disappointing.Dehydroepiandrosterone is the most abundant steroid hormone in homeostasis and the precursors of the synthesis of androgens, which is widely used in the patients with DOR. The curative effect of dehydroepiandrosterone is still controversial.Previous studies have shown that the curative effect of dehydroepiandrosterone is related to the age of the patients. There is lacking of a unified standard of the time for therapy of the dehydroepiandrosterone. Hence, our research make further efforts to study the influence of patient’s age and the time of therapy in the curative effect. ObjectiveTo explore the effect of patients’ age and time of therapy in the curative effects of the dehydroepiandrosterone in the patients with DOR. MethodsFrom May 2014 to Marh 2015, we have recruited 57 patients who full filled the diagnostic criteria of the diminished ovarian reserve and received 3 months treatment of the dehydroepiandrosterone in the dose of 25 mg three times a day. Blood samples of day 3 were collected pre- and post-treatment of DHEA for serum anti-Mullerian hormone(AMH), follicle stimulating hormone(FSH) and estradiol(E2) in each group. And make follow up patients’ outcome of the pre-treatment of dehydroepiandrosterone.From August 2014 to June 2015, we have recruited 125 patients who full filled the diagnostic criteria of the diminished ovarian reserve. They were distributed into five groups on the basis of length of pre-treatment. Blood samples of Day 3 were collected before and after pre-treatment of DHEA for detection of serum anti-Mullerian hormone(AMH), follicle stimulating hormone(FSH) and estradiol(E2) in each group. And we make follow up patitients’ s outcome of the treatment of the dehydroepiandrosterone.ResultsAfter 3 months pre-treatment of dehydroepiandrosterone, the ovrian makers is better than before. The ovrian makers in the the younger group is better than in the older group,and the numbers of retrieved oocytes of the younger group is more than the older group.Patients who received 3 months and 4 months pre-treatment of dehydroepiandrosterone have a significantly higher level of AMH than others in the other groups,and have a significantly lower level of FSH and E2 than the other groups.The numbers of retrieved oocytes is significantly higher in the patients who received 3 months and 4 months pre-treatment of dehydroepiandrosterone than the patients in other groups. ConclusionYounger patients with diminished ovarian reserve will benefit more from the pre-treatment of dehydroepiandrosterone. The curative effect is related with the time of pre-treatment, and taking longer pre-treatment may have a better outcome.