卵巢早衰－訂做優生寶寶

卵巢早衰

蔡醫師你好：我33歲已經停經，以為已經沒有辦法生小孩，但最近在你的網頁上看到一個生長激素可以起死回生，是真的嗎？阿美妳好:妳看到的報告是最近美國生殖醫學會的一個研究論文，但這個生長激素使用長達8個月，使AMH原來不到增加到1.91，濾泡從1顆增加到11顆，如果要到本院，妳可以任何時間過來，除了禮拜天以外。卵巢早衰 ,DHEA??

希臘的一個不孕症治療中心 (Dr. Mamas) 發表他們的經驗。他們提出了 5 個早發性卵巢衰竭的案例，FSH 30 ~ 112 mIU/mL，LH 30 ~ 84 mIU/mL，E₂ 18 ~ 35 pg/mL，停經期間 6個月到 1 年。使用 DHEA (每天50 mg) 2個月到半年不等後，月經再來，有的自然受孕，有的配合人工受精懷孕。
在美國生殖醫學會期刊 (Fertility and Sterility, 2008) 的報告，這是希臘的一個不孕症治療中心 (Dr. Mamas) 發表他們的經驗。他們提出了 5 個早發性卵巢衰竭的案例，FSH 30 ~ 112 mIU/mL，LH 30 ~ 84 mIU/mL，E₂ 18 ~ 35 pg/mL，停經期間 6個月到 1 年。使用 DHEA (每天50 mg) 2個月到半年不等後，月經再來，有的自然受孕，有的配合人工受精懷孕。
有一篇有關DHEA的研究報告 (Human Reproduction Vol.21, No.11 PP.2845-2849, 2006) 。該研究主要係調查以 DHEA 對卵巢功能下降患者助孕的效果。在紐約市一家人類生殖中心針對病人研究成果，25 位卵巢功能低下的患者在做試管助孕前後以 DHEA 來治療，每天服用 75 mg DHEA (25 mg t.i.d) ，平均使用 17.6 +/- 2.13 星期 (平均 4-5 個月)，比較使用前後的相關數據，包括 E₂ 值，卵和胚胎數目及品質，植入胚胎的統計，發現均有明顯增加。該臨床報告的結論是：DHEA 的補充對卵巢功能下降患者確實有助益。DHEA 的作用機轉DHEA 的英文全名是 dehydroepiandrosterone，中文名稱為脫氫表雄酮，是一種經由腎上腺皮質、中樞神經系統以及卵巢膜細胞所製造分泌的天然類固醇，並且可以在其他周邊組織被轉換成具有活性的雄性素 (androgen) 或動情激素 (estrogen)；在生理劑量下，DHEA 可以增加血清中類胰島素生長因子 (insulin-like growth factor)的含量，以及作為動情激素的前驅物，婦女如果長期接觸雄性素也會造成 PCOS-like 類似多囊性卵巢的症狀。根據老鼠的動物實驗中，服用 DHEA 會讓老鼠形成類似多囊性卵巢的症狀，並且有比較多可使用的卵子，少有萎縮跡象的卵子。

一般而言，年齡較老的卵巢，有比較少的室性卵泡 (antral follicles)、卵子有很高的萎縮率，並且卵泡中的卵子也不容易排出；Cassion 等人曾在 2000年發表的研究報告提出，使用 DHEA確實可以少量增加卵泡數目與 E₂的值； Cassion 的報告與上述2006年的報告的主要差異，在於 Cassion 的研究中，使用DHEA 的時間只有兩個月而已，而在 2006年的研究是使用了四個月的效

果，所以要達到效益或許要使用達四個月。

Growth Hormone

Normalization of Anti-Mullerian Hormone (AMH) Level After Growth Hormone Replacement in a Woman With Congenital Growth Hormone Deficiency P. Hughes , R. Gada , M. Amols , D. Rhodes , C. Coddington P-9 Full Text PDF Article Outline Copyright BACKGROUND: Growth hormone (GH) and insulin-like-growth factor-1 (IGF-1) have clinical effects on the reproductive system in women. Children with congenital GH deficiency have been described to have delayed pubertal development and are more prone to infertility. Anti-mullerian hormone (AMH) is used as a marker for ovarian reserve and is thought to remain stable throughout the menstrual cycle and gradually decline over women's lifetimes. OBJECTIVE(S): To describe a case of a woman with congenital growth hormone deficiency who had return of ovarian function after growth hormone replacement following undetectable levels of AMH. MATERIALS AND METHOD(S): A 32 year-old woman with congenital growth hormone deficiency (CGHD) was evaluated at our center for multiple issues. She was diagnosed with CGHD at the age of 6 and was on replacement until 2007. After a gastrointestinal illness she developed IgA nephropathy, requiring high dose corticosteroids. During treatment she discontinued GH and became amenorrheic with hypoestrogenic symptoms. In November of 2009 her evaluation for possible ovarian insufficiency revealed an antral follicle count (AFC) of one. However, laboratory evaluation was deferred as she was taking oral contraceptives (OCP). Her IGF-1 was found to be extremely low at <25 ng/mL and she re-instituted GH therapy, taking 0.4mg of Humatrope daily. In March of 2010 she did not have return of menses despite discontinuation of OCP's in November. Repeat evaluation revealed an AFC of one, FSH 12.4 IU/L, estradiol 40 pg/mL and AMH was undetectable. Despite six months of GH therapy her IGF-1 was low at 108ng/mL. Her GH dose was increased to 0.5 mg daily. RESULT(S): In August 2010, after 10 months of GH replacement, her menses had returned to regular 28 day cycles and her hypoestrogenic symptoms had resolved. Her GH was adequately replaced with an IGF-1 level of 151ng/mL. Her AFC had risen to 16 and her laboratory tests had returned to normal levels; FSH 7.7IU/L, estradiol 33 pg/mL and AMH 1.9 ng/mL. CONCLUSION(S): This case report is the first to document a patient with CGHD and AMH levels. In this case GH correction played a significant role in this patient's ovarian function. Assessing GH status in patients with CGHD is a key component in their fertility evaluation. AMH has been shown to be a stable marker of ovarian reserve. In this case there was a demonstrated dynamic shift in AMH level that was related to the patient's GH status.

卵巢功能極低的救星－生長激素 http://www.youtube.com/watch?v=X4bexorAx50