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目的观察中药联合脱氢表雄酮(DHEA)预治疗对高龄卵巢储备正常患者体外受精-胚胎移植(IVF-ET)周期结局的影响。方法将233例36~42岁卵巢储备正常行IVF的患者按照随机数字表法分为3组。中药联合DHEA组(简称联合组)76例,进入IVF周期前给予中药联合DHEA预治疗8周;DHEA组82例,进入IVF周期前给予DHEA预治疗8周;对照组75例,不给予任何预处理。观察3组获卵数、受精率、优质胚胎率、冷冻胚胎数、临床妊娠率、早期自然流产率、活产率、抗苗勒氏管激素(AMH)、周期取消率、绒毛膜促性腺激素(h CG)注射日子宫内膜厚度及E2水平、Gn使用量和使用天数。结果联合组及DHEA组患者优质胚胎率明显高于对照组(P<0.05),两治疗组受精率、冷冻胚胎数、临床妊娠率、活产率高于对照组,早期自然流产率低于对照组,但差异无统计学意义(P>0.05)。两治疗组患者预治疗后AMH较治疗前均明显升高(P<0.05),对照组无明显变化。获卵数、周期取消率、h CG注射日子宫内膜厚度及E2水平、Gn使用量和用药时间3组比较,差异均无统计学意义(P>0.05)。结论中药联合DHEA预治疗可以提高卵巢储备功能正常的高龄患者的优质胚胎率,其机制可能与AMH有关。
Objective To observe the effect of traditional Chinese medicine combined with dehydroepiandrosterone (DHEA) on the cycle outcome of in vitro fertilization-embryo transfer (IVF-ET) in elderly patients with normal ovarian reserve. Methods A total of 233 patients with IVF whose 36-year-old ovarian reserve was normal were divided into 3 groups according to random number table. In the DHEA group, 76 cases were treated with traditional Chinese medicine combined with DHEA before entering the IVF cycle, 82 cases in the DHEA group were pretreated with DHEA for 8 weeks before entering the IVF cycle, and 75 cases in the control group without any pretreatment deal with. Observe the oocyte number, fertilization rate, high quality embryo rate, frozen embryo number, clinical pregnancy rate, early spontaneous abortion rate, live birth rate, anti-Müllerian hormone (AMH), cycle cancellation rate, chorionic gonadotropin (h CG) endometrial thickness and E2 level on the day of injection, Gn usage and days of use. Results The rate of high quality embryo in the combination group and DHEA group was significantly higher than that in the control group (P <0.05). The fertilization rate, frozen embryo number, clinical pregnancy rate and live birth rate in the two treatment groups were higher than those in the control group. Group, but the difference was not statistically significant (P> 0.05). After treatment, AMH in both treatment groups were significantly higher than those before treatment (P <0.05), but there was no significant difference in control group. The number of oocytes retrieved, cycle cancellation rate, endometrial thickness and E2 level at h CG injection, Gn dosage and time of administration were not significantly different (P> 0.05). Conclusion Traditional Chinese medicine combined with DHEA pretreatment can improve the quality embryo rate of elderly patients with normal ovarian reserve function, the mechanism may be related to AMH.