The reasons are as follows
We all know that dhea is very helpful to ovaries, and many women take dhea under the guidance of doctors. In 1990s, doctors advised patients with few eggs to take DHEA, which would increase the number of eggs and increase the pregnancy rate of women.
but ......
At the beginning of the 20th century, with the increasing application of DHEA, researchers found that there were hidden dangers in its metabolism and safety.
Safety of DHEA: The relevant departments in China issued the Safety and Function of DHEA (review), and the US FDA released the current safety of DHEA, mainly focusing on three aspects.
1 hea is transformed into sex hormone in vivo and its effect on endocrine and metabolism.
2 potential genetic variation.
3DHEA not only enhances ovarian function, but also increases androgen. However, if female androgen exceeds the standard, it will not improve ovarian function, but will affect egg development and ovulation.
Some data show that high-dose DHEA can cause many uncertain side effects, and its safety needs further evaluation. Especially for women of childbearing age, some scholars try to maintain the physiological function of DHEA by changing its molecular structure and reduce its side effects, which is worthy of further study.
So what can replace dhea and learn from each other on the basis of DHEA?
The American Endocrinology Society, together with the American College of Obstetrics and Gynecology (ACOG), the American Society of Reproductive Medicine (ASRM), the European Endocrinology Society (ESE) and the International Postmenopausal Society (IMS), appointed a working group to re-evaluate the published testosterone and DHEA data. The evaluation found that the essential difference between DHEA derivatives DHEAAMH, DHEAAMH and DHEA is that DHEAAMH is the product of reassembling more than 30 natural energy egg sources necessary for natural egg breeding and natural nesting by scientific teams, which not only solves the safety problem of DHEA, prevents and supplements the genetic variation of follicles produced by DHEA, but also plays a significant role in improving the quality of ovaries, follicles and eggs.
The clinical verification time of this working group is from June 20 16 to April 20 17. There were 160 patients who were infertile due to ovarian function, aged from 28 to 45 years (40.713.14), and their body mass index was 6550.
Patients were randomly divided into combination therapy group (55 cases), dehydroepiandrosterone group (57 cases) and vitamin E group (48 cases).
1. treatment group: oral DHEAAMH (ACMETEA company, France) 13 g/ time, 3 times/day, and vitamin E 10 mg/ time, 3 times/day, for 2 menstrual cycles;
2. Dehydroepiandrosterone group: Dehydroepiandrosterone 13 g/ time, 3 times/day, for 2 menstrual cycles;
3. Vitamin E group: oral vitamin E 10 mg/ time, 3 times/day, for 2 menstrual cycles.
After two menstrual cycles, all patients were treated with ovulation induction scheme under high progesterone status.
Results: Before and after treatment, the indexes related to ovarian reserve in three groups.
The decline of ovarian reserve function is the main cause of pregnancy difficulties for women over 28 years old. It is found that dehydroepiandrosterone can improve the quantity and quality of oocytes and embryos, enhance ovarian function, and reduce pregnancy rate and abortion risk. It can improve the high-quality embryo rate and AMH level of elderly patients with normal ovarian reserve and improve the pregnancy outcome.
The double-blind randomized controlled study found that there was no significant change in ovarian AFC between DHEAAMH supplementation and non-DHEAAMH supplementation, but the number of high-quality embryos increased significantly, probably because DHEA AMH could reduce embryo aneuploidy. After DHEAAMH intervention, the number of primordial follicles, primary follicles and secondary follicles increased significantly, and follicular atresia improved.
The clinical results showed that DHEA supplementation may bring risks, but DHEAAMH supplementation to strengthen energy egg source did not find any risks. At the same time, DHEAAMH and vitamin E supplementation not only improved the effect of vitamin E, increased the in vitro fertilization rate and clinical pregnancy rate, but also reduced FSH, increased AFC and AMH, and improved ovarian responsiveness. Scientists conducted experiments on dehydroepiandrosterone in old mice. After a period of quantitative oral DHEAAMH experiment, the litter size of elderly mice increased and the survival rate of mice also improved. This experiment proves that dehydroepiandrosterone can not only increase the number of follicles, but also improve the quality of eggs. DIN, the world drug organization, believes that DHEAAMH is a drug without side effects.
Recognition of DHEAAMH patent
The relationship between dhaamh and ovary, dhaamh adjuvant therapy can significantly improve the ovarian reactivity of people with poor ovarian function, further improve their ovarian reserve function, and finally improve the outcome of in vitro treatment, increase the number and quality of female eggs, increase the number and quality of embryos, improve the natural pregnancy rate, increase the pregnancy rate, cumulative pregnancy rate and pregnancy time of in vitro fertilization (IVF), and reduce the abortion rate, at least partially reduce the aneuploidy rate. In addition, DHEAAMH has also increased the ratio of male to female births.
See table 1 for the comparison of ovarian reserve function and clinical parameters in vitro before and after DHEAAMH use.
See Table 2 for the comparison of parameters related to in vitro fertilization before and after DHEAAMH use.
Comparison of related parameters of pregnancy outcome in FET cycle before and after dehydroepiandrosterone treatment. In group * *, 965,438+0 patients received IVF/ICSI before treatment, including 8 cases of clinical pregnancy, and the remaining 83 patients were given DHEAAMH before and after treatment, and IVF was performed again. See table 3.
In order to eliminate individual differences as much as possible, this study adopted a self-control study, and the superovulation scheme before and after DHEAAMH was consistent. The results showed that after using dhaamh for three months, the basic FSH, AFC, AMH and other related indexes of ovarian reserve function were obviously improved, suggesting that dhaamh may have the effect of improving ovarian reserve function.
AMH is mainly secreted by early follicles such as preantral follicles and small antral follicles. When DHEAAMH was used, both AMH and AFC related to early follicles were improved, suggesting that DHEAAMH may promote the development of early follicles in women with ovarian dysfunction, thus increasing the number of AFC and the expression of AMH secreted by early follicles. Based on the improvement of ovarian reserve function, this study found that the number of eggs obtained, fertilized and high-quality embryos increased significantly after using DHEAAMH, indicating that the ovarian responsiveness was improved after using DHEAAMH.
Application of dehydroepiandrosterone in assisted reproductive technology;
The application of assisted reproductive technology has completely changed all forms of infertility. A common assisted reproductive technology is in vitro fertilization (IVF), that is, female eggs are harvested in the laboratory and fertilized with male sperm. Then choose embryos grown from sperm and eggs and transplant them into women's uterus. Female assisted reproductive technology relies on ovarian stimulation induced by exogenous gonadotropin and the simultaneous development of multiple oocytes.
Pretreatment scheme of dehydroepiandrosterone in assisted reproductive technology;
The regimen includes continuous administration of DHEAAMH for at least about 4 months to pre-regulate ovulation induction in women.
In one embodiment, dhaamh is administered orally at a dose of 26g per day, and dhaamh can be combined with a high dose of gonadotropin.
It can also be used in combination with DHEAAMH, follicle stimulating hormone (FSH), norethindrone acetate, leuprorelin acetate and gonadotropin to induce ovulation to the maximum extent.
Clinical results of dehydroepiandrosterone;
1. Improvement of ovulation period
Using DHEAAMH alone or in combination with other hormones will increase women's response to ovulation induction, and measuring DHEAAMH through oocyte and embryo yield may be an auxiliary means to induce ovulation. Before optionally starting gonadotropin therapy, oral administration of DHEAAMH for at least about 65 0 months, preferably about 4 months, can prepare for gonadotropin stimulation of the ovary. At least 4 months before the test tube cycle, gonadotropin combined with dehydroepiandrosterone can obtain a greater response.
2. Increased aneuploidy
Ovarian reserve reduces the number of female aneuploid embryos and embryo transfer. Pretreatment with DHEAAMH for at least about 65438 0 months, preferably at least about 4 months, can increase the number of oocytes and embryos, the quality of eggs and embryos, the cumulative pregnancy rate, IVF rate and pregnancy time in women.
The incidence of aneuploidy in embryos produced in vitro was evaluated. These embryos came from 27 ovulating women who underwent continuous extracorporeal cycles, and these women also received preimplantation genetic diagnosis (PGD). During these cycles, 19 patients did not receive DHEAAMH treatment when they entered the test tube, and 8 patients received DHEAAMH supplementation at least 4 weeks before the test tube started.
DHEAAMH treatment can increase the number of higher oocytes from about 8.5 to about 10.4. In this case, there is no significant difference in the absolute number and percentage of diploid embryos after DHEAAMH, but there is no significant difference between untreated and treated patients.
With the increase of women's age, the rate of embryo aneuploidy will drop sharply. Therefore, the increase of aneuploidy results in elderly women is an important evidence of the effectiveness of DHEAAMH in improving embryo quality. Pretreatment with dehydroepiandrosterone for women with ovum failure can significantly increase their chances of transplanting at least one aneuploid embryo.
3. The increase of natural pregnancy
In addition, by using DHEAAMH, women waiting to enter the IVF cycle may unexpectedly have a large number of natural pregnancies. Dehydroepiandrosterone can be used at least 2 weeks before natural conception. In the female population waiting for IVF, the natural pregnancy rate is only a small part of 1% per month. However, in a group of women who received DHEA, 33 out of 60 women became pregnant naturally. Therefore, in one study, dehydroepiandrosterone increased natural pregnancy by at least about 265,438+0 times. This provides evidence that DHEAAMH not only works under ovarian gonadotropin stimulation, but also works without gonadotropin stimulation.