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From : 7260678
Added: Nov 6, 2009
DHEA真的可增加AMH！1 2 3 6.7.9 10 Supplementation with dehydroepiandrosterone (DHEA) improves ovarian reserve, as reflected by anti-müllerian hormone levels N. Gleicher, A. Goyal, A. Weghofer, D.H. Barad O-186 Tuesday, October 20, 2009 5:15 PM Article Outline • Copyright OBJECTIVE: Dehydroepiandrosterone (DHEA) supplementation of women with diminished ovarian reserve (DOR) significantly improves oocyte/embryo numbers, quality, time to pregnancy, IVF pregnancies, cumulative pregnancies, and reduces miscarriages. This study attempts to determine whether DHEA objectively improves ovarian reserve (OR). DESIGN: Cross-sectional and longitudinal cohort study. MATERIALS AND METHODS: Anti-Müllerian hormone (AMH) was evaluated in 120 women with DOR, supplemented with micronized DHEA for 30 - 120 days (mean 73 ± 27) at 25 mg TID. OR was evaluated using linear regression, assessing AMH over DHEA days. 55 women reached in vitro fertilization (IVF), were longitudinally evaluated and assessed for pregnancy, examining interaction between DHEA days and pregnancy in regard to AMH response. RESULTS: Cross-sectional, AMH significantly improved after DHEA (p=0.002). Age (p=0.007) and length of DHEA treatment (p=0.019) were independently associated with increasing AMH. Under age 38 all ages demonstrated higher AMH levels, and improved AMH proportionally more than females 38. Longitudinal, AMH improved by ca. 60% from 0.22 ± 0.22 ng/mL to 0.35 ± 0.03 ng/ml Those reaching IVF had pregnancies in 23.64%. Pregnant women showed more improvement in AMH than those who did not conceive (p=0.001). CONCLUSIONS: This study presents objective evidence for improvements in OR after DHEA at all ages. Concurrent with reported clinical outcomes, it is more pronounced in younger (premature aging) than older (physiologic aging) women. DHEA-associated improvements in OR statistically reflect subsequent improvements in cumulative clinical pregnancy rate. AMH, therefore, is reflective of improving OR and pregnancy chances in women who receive DHEA supplementation. Center for Human Reproduction - New York and Foundation for Reproductive Medicine, New York, NY; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT; Department of Obstetrics and Gynecology, Vienna University School of Medicine, Innere Stadt, Wien, Austria; Departments of Epidemiology and Social Medicine as well as Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY Supported by: The Foundation for Reproductive Medicine and intramural CHR grants. PII: S0015-0282(09)02390-5 doi:10.1016/j.fertnstert.2009.07.212 © 2009 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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