Здравствуйте, доктор!
Мне 43 года. Позади 3ИИ, 2ИКСИ и 1ЭКО. Неудачных. В последней клинике врач направил сделать тест на Инсулино-резистентность. Тест показал инсулин через 1час после нагрузки 75мл глюкозы 168uIU/mL при норме 40-75. Врач назначил мне метформин(глюкофаж) 500мг 3 раза в день и Аctos(pioglitazone HCL) 15мг 2 раза в день. С ноября я принимаю эти лекарства. На их фоне сделала в декабре последний ЭКО.
Вопрос:
Видите ли Вы взаимосвязь между Инсулино-резистентностью и бесплодием?
И если да, то назначаете ли лекарства как в моём случае?
В апреле я иду на очередную попытку ЭКО. Как Вы считаете нужно ли мне продолжать прием етих лекарств или одной диеты будет достаточно?
Также хотелось бы узнать Ваше отношение к ДГЭА. Я принимаю их 3 таб по 25мг 3 раза в день.
Спасибо!
Такая взаимосвязь может существовать (чаще у женщин с повышенной массой тела.)
И если да, то назначаете ли лекарства как в моём случае?
Нет не назначаю, т.к на сегодняшний день доказано, что такая терапия в программе эко НЕ УЛУЧШАЕТ результатов лечения.
Hum Reprod. 2006 Jun;21(6):1387-99. Epub 2006 Jan 31.
A systematic review and meta-analysis of randomized controlled trials on metformin co-administration during gonadotrophin ovulation induction or IVF in women with polycystic ovary syndrome.
Costello MF, Chapman M, Conway U.
Division of Obstetrics and Gynaecology, School of Women's and Children's Health, University of New South Wales, Sydney, Australia. mfcostello@unsw.edu.au
Erratum in:
* Hum Reprod. 2006 Oct;21(10):2728.
BACKGROUND: A systematic review of randomized controlled trials (RCTs) comparing whether metformin co-administration with gonadotrophins for ovulation induction (OI) with timed intercourse or IVF improves outcome in women with polycystic ovary syndrome (PCOS). METHODS: The quality of reporting of meta-analyses (QUOROM) guidelines were followed. A systematic computerized literature search of three bibliographic databases was performed. RESULTS: Eight RCTs were included in the overall review. Meta-analysis demonstrated that the co-administration of metformin to gonadotrophin OI does not significantly improve ovulation [odds ratio (OR) = 3.27; 95% confidence interval (95% CI) = 0.31-34.72] or pregnancy (OR = 3.46; 95% CI = 0.98-12.2) rates. Metformin co-administration to IVF treatment does not improve pregnancy (OR = 1.29; 95% CI = 0.84-1.98) or live birth (OR = 2.02, 95% CI = 0.98-4.14) rates but reduces the risk of ovarian hyperstimulation syndrome (OHSS) (OR = 0.21; 95% CI = 0.11-0.41, P < 0.00001). CONCLUSIONS: Current data on the use of metformin in the gonadotrophin OI or IVF treatment settings are inconclusive because of the review's failure to exclude an important clinical treatment effect. Further RCTs are necessary to definitively clarify whether metformin co-administration during gonadotrophin OI or IVF will improve the efficacy of these treatments in PCOS women.
Hotelos' bi takge uznat' naschet DHEA. Ya prinimayu po 1 tab 25mg 3 raza v den'. Mne ih propisal doctor v poslednei klinike. Prinimayu s serediny noyabrya. A na IVF v aprele. Kak Vi schitaete, ne mnogovata li doza? I voobsche Vi ih naznachaete svoim pacientam, ya tak ponimayu vozrastnim?
Spasibo!
P.S. moi ves 59kg pri roste 168cm - eto k voprosu o metformine. Actos ya otmenila sama sebe uge kak nedelyu. A s metforminom sdala test, gdu rezul'tata.
Именно при этих состояниях имеет смысл применение кортикостероидв (преднизолон, дексаметезон и т.д.)
При всех других состояних применение кортикостероидов не оправдано. И при проведении эко, в том числе. На сегодняшний день этот факт даже не обсуждается в литературе. Интерес пропал в уже в начале столетия.
Hum Reprod. 2003 Jan;18(1):218-9; author reply 219.
Low dose prednisolone administration in routine ICSI patients does not improve pregnancy and implantation rates.
Ubaldi F, Rienzi L, Ferrero S, Anniballo R, Iacobelli M, Cobellis L, Greco E.
Centre for Reproductive Medicine, European Hospital, Rome, Italy. ubaldi.fm@tin.it
BACKGROUND: Glucocorticoids have been used in conjunction with zona dissection to improve pregnancy and implantation rates in IVF patients. The aim of this prospective randomized study was to evaluate the effect of low-dose prednisolone in addition to the standard protocol, on pregnancy and implantation rates in routine ICSI patients before and after embryo replacement. METHODS: A total of 313 patients in 360 consecutive cycles (patients <39 years old and with three or less than three ICSI attempts) performed at our centre were randomly assigned by computer-generated list to receive either prednisolone (10 mg/day in two divided doses), starting on the first day of ovarian stimulation and continuing for 4 weeks (group A), or no treatment (group B). RESULTS: The mean age, number of previously failed IVF attempts, basal FSH levels and the mean rank of trials were comparable between groups A and B. The mean (+/- SD) number of metaphase II oocytes retrieved (11.9 +/- 5.5 versus 12.0 +/- 5.1), 2-pronuclei fertilization rate (67.2 versus 65.8%), the pregnancy and the implantation rates were not different between the study and control groups (49.0 and 23.6% versus 50.0 and 23.3% respectively). CONCLUSION: Low-dose prednisolone treatment in addition to the standard protocol before and after embryo replacement does not appear to have a significant effect on pregnancy or implantation rates.