| Objective:To investigate the effect of dehydroepiandrosterone (DHEA) supplementation on in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) data and outcomes among patients with diminished ovarian reserve (DOR), In order to provide theoretical proof for clinical application. To explore the mechanism of effect of dehydroepiandrosterone (DHEA) in the treatment of diminished ovarian reserve by investigating the levels of serum DHEA, Anti-Miillerian Hormone (AMH) and the expression of androgen receptor (AR) in ovaries of rats between different age groups, and the changes of serum DHEA, AMH levels and AR expression with DHEA treatment.Methods:Our study was devided into two parts:Part one:A retrospective analysis was conducted for277DOR patients treated by IVF/ICSI from Jan2009to Dec2012in reproductive medicine center of Tianjin medical university general hospital, Patients were divided into two groups according to the pretreatment with DHEA supplementation or not:patients receiving DHEA25mg three times a day for three to four months were taken as the experimental group, while those without DHEA supplementation were taken as the control group. We performed a comparison of the general condition of the patients, clinical characteristics of controlled ovarian hyperstimulation, embryos development and IVF outcome parameters between the experimental group and control group, including age, body mass index (BMI), duration of infertility, basic hormone levels, antral follicle count (AFC), The dosage and duration of gonadotropin (Gn), peak estradiol level, the number of follicles, retrieved oocytes, MⅡ oocytes, high quality embryos, oocyte retrieval rates, oocyte maturation rate, fertilization rate, cleavage rate, high-quality embryonic rate, implantation rate, clinical pregnancy rate, the cycle cancellation rate, abortion rate, etc. We also conduct a comparison of ovarian reserve parameters in experimental group, before and after DHEA treatment, including the changes of basic hormone levels and antral follicle count (AFC).Part two:1. SD female rats were divided into young, pubertal, adult and aging groups according to their age. Serum DHEA and AMH levels were measured by ELISA, and real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was performed to quantify the RNA expression of AR in ovary. We performed a comparison of serum DHEA, AMH levels and AR expression between different age groups.2. Fouty aging rats were randomly assigned into treated group and control group, the treated rats were orally given DHEA soybean oil solution daily, and the control group given soybean oil for30days. The therapeutic efficacy of DHEA treatment was evaluated by the changes in the serum level of DHEA and AMH, and the AR mRNA expression in ovary.Results:Part one:General condition of the patients and the dosage and duration of gonadotropin is similar between group with and without DHEA supplementation (P>0.05). peak estradiol level, the number of follicles, retrieved oocytes, oocyte retrieval rates were significantly higher in DHEA group than those in control group (P<0.05), but there were no significant differences in oocyte maturation rate, fertilization rate, cleavage rate, high-quality embryonic rate in the two groups (P>0.05). The clinical pregnancy rate were significantly higher in DHEA group than those in control group (P<0.05), and there was a trend toward a increased implantation rate and reduced cycle cancellation rate(P>0.05), but there were no significant differences in abortion rate(P>0.05).Part two:The serum level of DHEA and AMH, and the AR mRNA expression in ovary were significantly lower in aging group than those in other group (P<0.05). The serum level of DHEA in treated group is significant higher than that of control group (P<0.05), there was a trend toward a increased AMH level in treated group (P>0.05), and the AR expression was up-regulate significant (P>0.05) in treated group than that in control group.Conclusion:1. DHEA supplementation has a beneficial effect on ovarian reserve, enhance ovarian response and improve the clinical outcome of IVF in patients with DOR.2. DHEA has no significant effect on the quality of oocyte and embryo. Further research and evaluation are needed to follow up.3. The serum level of DHEA and AMH, and the AR mRNA expression in ovary decreased with aging.4. DHEA can up-regulate the expression of AR which are essential for the follicle growth, thus DHEA may improve ovarian reserve by interacting with AR. |
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