女性基础睾酮水平对体外受精-胚胎移植妊娠结局的影响

宋家美; 陈慧; 徐佩琦; 孟昱时

女性基础睾酮水平对体外受精-胚胎移植妊娠结局的影响

昆明医科大学第二附属医院生殖医学科

基金项目:

基金：昆明医科大学重点学科 (B类) 建设项目 (2016-2020);

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出版历程
- 收稿日期: 2017-04-12

Effect of Female Basal Testosterone Level on the Pregnancy Outcome of in Vitro Fertilization Embryo Transfer

Funds:

基金：昆明医科大学重点学科 (B类) 建设项目 (2016-2020);

摘要

摘要: 目的通过对基础性激素正常的不孕女性, 研究其血清基础睾酮 (basal testosterone, bT) 水平对体外受精-胚胎移植 (in vitro fertilization embryo transfer, IVF-ET) 妊娠结局的影响, 评估bT水平对妊娠结局的预测价值及其临床运用的意义.方法选择基础性激素水平正常的不孕女性229例.根据是否妊娠分为妊娠组 (A组, 114例) 与非妊娠组 (B组, 115例) , 比较A、B两组患者的bT水平, 探讨bT水平能否对IVF-ET妊娠结局产生影响.再根据229例患者的b T水平情况差异进行受试者工作特征 (receiver operating characteristic, ROC) 曲线分析, 寻找其bT阈值.按照bT水平分为C组 (bT≤bT阈值组, 129例) 、D组 (b T>bT阈值组, 100例) , 进一步探讨bT水平与IVF-ET妊娠结局的关系.结果 (1) A组的bT水平、MⅡ卵率及优质胚胎率明显高于B组[ (0.94±0.34) , (0.63±0.32) ], [ (1 208/1 419) 85.13%, (906/1 168) 77.57%], [ (432/828) 52.17%, (319/701) 45.51%) ], 差异有统计学意义 (P<0.05) ; (2) bT对妊娠结局有中度预测价值 (灵敏性:51.8%、特异性:35.7%) , 最佳b T阈值为0.72 nmol/L; (3) D组的MⅡ卵率及临床妊娠率高于C组[ (1 078/1 173) 91.9%, (1 036/1 414) 73.27%], [ (59/100) 59%, (55/129) 42.64%], 差异有统计学意义 (P<0.05) .结论基础性激素水平正常的不孕女性b T水平可对IVF-ET结局进行初步评估及预测, 对于bT低于阈值的患者, 可以通过外源性补充雄激素的方式, 将bT提高至阈值水平, 最终改善不孕女性IVF-ET妊娠结局.
- 基础睾酮 /
- 体外受精-胚胎移植 /
- 妊娠结局
Abstract: Objectives To analyze the influence of female basal testosterone (bT) level of infertile women with normal serum sex hormones on the pregnancy outcome of in vitro fertilization embryo transfer (IVF-ET) and to evaluate the predictive value of bT on pregnancy outcome and its clinical significance. Methods A total of 229 cases of infertile women with normal serum sex hormones were selected and divided into pregnancy group (group A, n=114) and non-pregnancy group (group B, n=115) . The bT levels of the two groups were compared.The influence of bT value on IVF-ET pregnancy outcome was explored. Receiver operating characteristic (ROC) was analyzed according to the differences of bT levels of all the patients to find the bT threshold. Based on the bT levels, the patients were divided into group C (bT≤bT threshold, n=129) and group D (bT>bT threshold, n=100) . The relationship between bT value and IVF-ET pregnancy outcome was further explored. Results (1) The bT levels, MⅡ egg rate and high quality embryo rate in group A were significantly higher than those in group with B [ (0.94 ±0.34) , (0.63 ±0.32) ], [ (1208/1419) 85.13%, (906/1168) 77.57% ], [ (432/828) 52.17%, (319/701) 45.51%) ] (P<0.05) . (2) There was a moderate predictive value of bT on pregnancy outcome (sensitivity: 51.8%, specificity: 35.7%) . The best bT threshold was 0.72 nmol/L. (3) MⅡ egg rate and pregnancy rate in group D were significantly higher than those in group C [ (1078/1173) 91.9%, (1036/1414) 73.27%], [ (59/100) 59 % (55/129) 42.64%] (P<0.05) . Conclusions The bT levels of infertile women with normal sex hormone levels may preliminary predict and assess the outcome of IVF-ET. For the patients with bT level under the threshold, exogenous androgen supplements may be considered to increase to raise the bT level to a fine level therefore improve IVF pregnancy outcome.
- Serum testosterone basis /
- in vitro fertilization-embryo transfer /
- Pregnancy outcome

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参考文献(29)

[1]杨军光, 王卓然, 吕冠军, 等.基础睾酮水平对IVF-ET结局的影响[J].中国优生与遗传杂志, 2014, 22 (1) :105-115.
[2]	[2]KIM C H, HOWLES C M, LEE H A.The effect of transdermal testosterone gel pretreatment on controlled ovarian stimulation and IVF outcome in low responders[J].Fertil Steril, 2011, 95 (2) :679-683.
[3]郑波, 戴芳芳, 许晓立, 等.体外受精-胚胎移植术后第14日血清总睾酮水平与助孕结局的关系[J].生殖医学杂志, 2012, 21 (6) :600-601.
[4]田东梅, 庄静, 任洁, 等.血清和卵泡液中睾酮水平与体外受精-胚胎移植结局的关系[J].国际生殖健康/计划生育杂志, 2015, 34 (3) :203-205.
[5]	[5]NARKWICHEAN A, MAALOUF W, CAMPBELL B K, et al.Efficacy of dehydroepiandrosterone to improve ovarian response in women with diminished ovarian reserve:a meta-analysis[J].Reprod Biol Endocrinol, 2013, 11 (1) :44.
[6]	[6]Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology.The Istanbul consensus worksh-op on embryo assessment:proceedings of an expert meeting[J].Hum Reprod, 2011, 26 (6) :1270-1283.
[7]中华医学会生殖医学分会.第一届实验室学组人类体外受精-胚胎移植实验室操作专家共识 (2016) [J].生殖医学杂志, 2017, 26 (1) :1-8.
[8]	[8]VODO S, BECHI N, PETRONI A, et al.Testosterone-induced effects on lipids and inflammation[J].Mediators Inflamm, 2013, 2013 (1, article 26) :183041.
[9]赵红翠, 朱亮.硫酸脱氢表雄酮在辅助生殖技术中的研究进展[J].生殖与避孕, 2012, 32 (2) :118-122.
[10]邓梅先.胰岛素抵抗与多囊巢合征卵综[J].长江大学报 (自然科学版) , 2011, 11 (8) :181-183.
[11]	[11]BOSDOU J K, VENETIS C A, KOLIBI ANAKIS E M, et al.The use of androgens or androgen-modulating agents in poor respondersundergoing in vitro fertilization:a systematic review and meta-analysis[J].Hum Reprod Update, 2012, 18 (2) :127-145.
[12]	[12]MIYAO M.Role of androgen in the elderly.Gender sensitive medicine and androgen-role of androgen in women[J].Clin Caleium, 2013, 23 (8) :1109-1115.
[13]	[13]VENDOLA K, ZHOU J, WANG J, et al.Androgens promote insulin-likegrowth factor-I and insulin-like growth factor-I receptor gene expression in the primate ovary[J].Hum Reprod, 1999, 14 (9) :2328-2332.
[14]	[14]MASSIN N, CEDRIN-DURNERIN I, COUSSIEU C, et al.Effects of transdermal testosterone application on the ovarian response to FSH in poor responders undergoing assisted reproduction technique a prospective, randomized double-blind study[J].Hum Reprod, 2006, 21 (5) :1204-1211.
[15]	[15] KIM C H, HOWLES C M, LEE H A.The effect of transdermal testosterone gel pretreatment on controlled ovarian stimulation and IVF outcome in low responders[J].Fertil Steril, 2011, 95 (2) :679-683.
[16]	[16]VENDOLA K A, ZHOU J, ADESANYA O O, et al.Androgens stimulate earlystages of follicular growth in the primate ovary[J].J Clin Invest, 1998, 101 (12) :2622-2629.
[17]	[17]WANG H, ANDOH K, HAGIWARA H, et al.Eeffect of adrenal and ovarian androgens on type 4 follicles unresponsive to FSH in immature mice[J].Endocrinoogy, 2001, 142 (11) :4930-4936.
[18]崔毓桂, 邵丽, 千日成, 等.雄激素与女性生殖[J].国际生殖健康/计划生育杂志, 2014, 33 (5) :329-333.
[19]	[19]KOPERA I, DURLEJ M, HEJMEJ A, et al.Effects of pre-and postnatal exposure to fluamide on connexin 43 expression in testes and ovaries of prepubertal pigs[J].Eur J Histochem, 2010, 54 (2) :e15.
[20]	[20]FRATTARELLI J L, PETERSON E H.Effect of androgen levels on in vitro fertilization cycles[J].Fertil Steril, 2004, 81 (6) :1713-1714.
[21]吴春香, 刘嘉茵.胚泡早期血清孕刚和睾丽水平对体外受精脏胎移植结局的影响[J].生殖医学杂志, 2008, 17 (6) :4.
[22]李晓晴, 王莹.年龄、基础FSH、窦卵泡数预测卵巢储备功能的临床研究[J].中国优生与遗传杂志, 2013, 21 (12) :129-131.
[23]	[23]QIN Y, ZHAO Z, SUN M, et al.Association of basal serum testosterone levels with ovarian response and in vitro fertilization outcome[J].Reprod Biol Endocrinol, 2011, 9 (1) :9.
[24]	[24]SEN A, DE CASTRO I, DEFRANCO D B, et al.Paxillin mediates extranuclear and intranuclear signaling in prostate cancer proliferation[J].J Clin Invest, 2012, 122 (7) :2469-2481.
[25]	[25]STECKLER T, WANG J, BARTOL F F, et al.Fetal programming:Prenataltestosterone treatment causes intrauterine growth retardation, reduces ovarian reserve and increases ovarian follicular recruitment[J].Endocrinology, 2005, 146 (7) :3185-3193.
[26]	[26]SEN A, PRIZANT H, LIGHT A, et al.Androgens regulate ovarian follicular development by increasing follicle stimulating hormone receptor and micro RNA-125b expression[J].Proc Natl Acad Sci U S A, 2014, 111 (8) :3008-3013.
[27]	[27]CATTEAU-JONARD S, DEWAILLY D.Pathophysiology of polycystic ovary syndrome:the role of hyperandrogenism[J].Front Horm Res, 2013, 40 (1) :22-27.
[28]	[28]LAKSHMI C.Hormone therapy in acne[J].Indian J Dermatol Venereol Leprol, 2013, 79 (3) :322-337.
[29]	[29]MNIF M F, KAMOUN M, KACEM F H, et al.Reproductive outcomes of female patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency[J].Indian J Endocrinol Metab, 2013, 17 (5) :790-793.

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