Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value?
Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value?
Amh value reflects the function of ovary. If the value is less than 1, the possibility of premature ovarian failure cannot be ruled out. As long as the follicles develop normally, they can still be IVF. It is suggested that before IVF, we should go to the hospital to monitor follicles by color Doppler ultrasound to see the development and ovulation of follicles. If the follicular development is poor, it is necessary to inject drugs such as urine chorion first to promote follicular growth. Pay attention to rest, don't be overworked, and eat more fresh fruits and vegetables, which can also play a certain auxiliary role in the growth of follicles. Hu (hanyu pinyin)
A document published in JAMA (Journal of American Medical Association) in June 20 17 shows that the average AMH value of 750 people aged 35-45 is lower than 1. Through drug and artificial intervention, 60% of the dominant follicles were successfully cultivated, and the pregnancy was successful, and the embryo developed smoothly.
The research proposes to change the diet structure of women, such as protein food and multivitamins; Secondly, it is very important to exercise to ensure the immunity of the body. One is administration; On the contrary, DHEA prescribed by ordinary doctors has become DHEA AMH.
20 10 Margaret E. Wierman, vice president of American endocrinology society and professor of the university of Colorado, published an article in the journal of clinical endocrinology and metallurgy, which completely changed the history of DHEA. He said: "We have no data to support the use of testosterone or DHEA by women alone, and there is no evidence that it is necessary to treat female patients with androgen deficiency syndrome. Specifically, fertility is a complex system, and it is not a testosterone that can simply solve problems such as ovarian function, cognitive decline, cardiovascular disease, metabolic disease, and sexual dysfunction. "
Conclusion: What he means is to solve the fertility problem. Simply supplementing DHEA has certain limitations and the therapeutic effect is not ideal.
At the same time, there is the insecurity brought by DHEA, such as gene mutation, the quality of the supplemented eggs is worse, and the polycystic eggs are inedible, so DHEA has been completely eliminated from North America and Europe.
Since then, the American Endocrinology Society, the American College of Obstetrics and Gynecology, the American Society of Reproductive Medicine, the European Endocrinology Society and the International Postmenopausal Society have jointly appointed a working group to reevaluate the published factors affecting fertility, and issued the treatment guidelines for the compound pregnancy repair factor DHEA AMH. Significance analysis of DHEA AMH: DHEA balances the hormone level of the pre-pregnancy mother, and AMH increases the egg reserve function.
That's why everyone found that all DHEA in North America and Europe, North America and Europe had been removed. DHEA AMH completely replaced DHEA.
Compound Pregnancy Repair Factor DHEAAMH—— Guidelines for Multi-system Treatment
Natural pregnancy \ test tube-how to have a healthy environment for the implantation of eggs and embryos?
Significance analysis of DHEA AMH: DHEA balances the hormone level of the pre-pregnancy mother, and AMH increases the egg reserve function.
Female conception is a physiological process in which sperm and eggs meet and reach the uterus.
(1) First of all, the internal and external reproductive systems develop normally to ensure normal sexual life, and the fallopian tube has good functions of taking eggs, transporting eggs, fertilizing and transporting fertilized eggs to the uterine cavity.
(2) The hypothalamus-pituitary-ovary function of female endocrine axis is normal, mature follicles are discharged, corpus luteum is formed, and the function is sound.
(3) Periodic changes in the proliferative and secretory phases of endometrium are beneficial to the implantation of fertilized eggs, and any abnormality in these links will lead to pregnancy disorders.
In 2000, the European Union proposed for the first time that in addition to drugs, it should also help women with healthy natural pregnancy and test tubes in plant extraction. Subsequently, the United States also proposed to cooperate with the European Union to study how to assist in vitro fertilization and natural conception. The American Endocrinology Society, American College of Obstetrics and Gynecology and other organizations appointed working groups, from a multi-dimensional and multi-system perspective, comprehensively considered factors such as natural pregnancy of women, success of test-tube and embryo quality, and issued treatment guidelines for DHEA AMH, a compound pregnancy repair factor.
DHEA AMH is a natural compound nutritional factor, which can regulate women's physiological cycle, hormone balance, nesting and spawning, and can be taken orally. DHEAAMH acts on the ovary, which can delay the aging of the ovary and keep the female characteristics. For endometrial cells, it can promote the proliferation of endometrial cells, which is necessary for the implantation of fertilized eggs. If the endometrium is too thin, it is difficult to plant fertilized eggs.
What are the factors that affect the success rate of IVF?
1, embryonic factor
Eggs and sperm are fertilized to form embryos. Therefore, the quantity and quality of eggs and the quantity and quality of sperm are very important.
The primordial follicles of women of childbearing age decrease at the rate of 1000 follicles/month, and the rate of follicle decrease is even faster after the age of 35. By menopause, the number of remaining primordial follicles has been less than 1000. When the woman is too old, the ovarian function is low, and the ovarian reserve is insufficient, on the one hand, the number of eggs available will be less. For example, some patients can take more than a dozen eggs at a time, while others can only take 2-3 eggs. On the other hand, the poor quality of the obtained eggs will also lead to the poor quality of the matched embryos.
When the sperm motility is poor or the deformity rate is high, it will affect fertilization and the embryo quality will also decline.
When one spouse has chromosome abnormality, the formed embryo may carry abnormal chromosome, and the probability of embryo abortion or spontaneous abortion will also increase. (Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value? )
2. Endometrial factors
Besides embryo quality, endometrial factor is an important factor affecting the success of test tube. The thickness of endometrium is 8- 12mm, and the tri-linear shape indicates that it is a good endometrium. Clinically, repeated intrauterine operations often lead to endometrial inflammation, adhesion, or unexplained endometrial thinning, which reduces the cycle pregnancy rate of IVF-ET.
In addition, intrauterine abnormalities such as endometrial polyps, submucosal fibromas, intrauterine adhesions and congenital uterine malformations may adversely affect the pregnancy outcome, leading to decreased fertility, failed implantation or abortion.
3. Uterine environment
Hormonal abnormalities such as hyperandrogenism, hyperprolactinemia, vitamin deficiency and abnormal thyroid function may affect embryo implantation.
Tubal effusion may poison the embryo or wash the embryo with liquid and affect implantation.
4. Age factor
Age is the most primitive factor affecting the success rate of pregnancy.
According to statistics, the success rate of patients over 43 years old has dropped below 20%. The influence of age on fertility is mainly caused by the aging of eggs, which is irreversible and cannot be adjusted by drugs.
On the issue of fertility, women's age plays a vital role. Generally speaking, even if the man is 50 or 60 years old, the impact on fertility is not obvious, but it is not good for the woman. With the growth of the woman's age, the fertility will gradually decline, and the decline will be obviously accelerated after the age of 35, and it will be completely lost after menopause, and this process is irreversible. At present, no medicine can "restore" women's fertility.
5. Emotional factors
The woman's emotional factor is the key factor to ensure the baby's health. If she is too nervous and anxious, she may secrete harmful hormones and interfere with the body balance under stress, thus affecting the development of follicles and the good state of embryos in the mother after transplantation.
6. Immune factors
The failure of repeated transplantation is probably related to maternal immune factors. There may be problems in the immune system of the mother and embryo, and the factors that attack the embryo can easily lead to embryo apoptosis and implantation failure.
7, doctors, laboratory factors
The level of medical staff is a very important part of the whole test tube treatment. If we are not sure about the details due to human negligence, it will easily lead to the failure of the whole test tube, which is not only related to the technology and experience of medical staff, but also related to the whole medical system.
The success rate can often effectively reflect the technical level of medical staff. Therefore, choosing famous reproductive centers and reproductive experts can bring higher guarantee for the success rate of test tubes. (Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value? )
How to improve the success rate of IVF?
No one can accurately predict whether IVF will succeed once or several times. In addition to medical technology, laboratory culture conditions, patients' age, etiology, constitution, endometrial environment and other factors, there are some unforeseen or unexplained factors.
Young women may not succeed at one time, and older women may not have a bumpy road to seeking children. So how to improve the success rate of IVF?
1, cooperate with the doctor to choose the plan that suits him.
Many patients think that 1, 2 nd and 3 rd generation IVF has been upgraded. In fact, different test-tube babies have different indications.
Before receiving IVF treatment, it is recommended that the husband and wife go to the hospital together for relevant examinations. After a series of examinations according to the examination plan given by the doctor, you can let yourself and the doctor know your physical condition and choose the treatment plan that suits you.
Step 2 adjust your lifestyle
Before IVF treatment, women need to develop good eating and living habits, which can effectively improve the success rate of IVF.
Inhalation of nicotine will make sperm quality worse, and if alcoholism is added, the damage to sperm will undoubtedly be greater. Girls smoking or second-hand smoke can also lead to few eggs, premature ovarian failure is difficult to conceive.
Women staying up late for a long time will disrupt the body's biological clock, cause the body's rhythm disorder, lead to a series of endocrine dysfunction, and change the ovulation cycle. In addition, staying up late is easy to hurt the liver, and the detoxification ability of the liver is reduced, which will affect the quality of sperm and eggs and even affect the implantation of embryos.
Before entering the test tube cycle, the weight should be adjusted to the best pregnancy state. Overweight or underweight will affect the success rate of test tubes. You can cooperate with some aerobic exercise to keep your body in a better state.
In addition, under the guidance of a doctor, related vitamins and trace elements (including vitamin D and vitamin C, etc.) can be supplemented. ), antioxidant therapy, Chinese medicine conditioning and other methods to improve the overall physical quality. (Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value? )
3. Create conditions suitable for embryo implantation.
Embryo is a seed, and the endometrial environment is soil. Good soil can make embryos develop smoothly.
Endometrial injury, adenomyosis, endometritis, endometrial polyps or other endometrial lesions may all lead to the failure of embryo implantation and affect the success rate. Hysteroscopy before IVF will also help to eliminate these unfavorable factors.
Inflammation is the normal response of the body to stimulation, but in a more serious state, it will induce the uncontrolled release of inflammatory mediators IL- 1β, IL-6, TNF-α and NO, forming excessive inflammatory syndrome. We can see that IL- 1β, IL-6, TNF- when inflammatory repair factors in DHEA AMH induce inflammatory reaction in cells. However, after DHEA AMH was given different doses of inflammatory repair factors, we found that the levels of IL- 1β, IL-6, TNF-α and NOS decreased significantly in a dose-effect relationship. The results showed that the inflammatory repair factors in DHEA AMH had antioxidant and anti-inflammatory effects, and inhibited the inflammatory reaction induced by lipopolysaccharide to some extent.
It is found that the inflammatory repair factor in DHEA AMH can negatively regulate inflammatory regulatory factors and enzymes, inhibit the vicious circle of oxidative stress and over-expression of proinflammatory factors, which is the body's resistance to inflammation and reduces tissue damage. It is because some substances containing sulfhydryl groups in inflammatory repair factors promote the release of anti-inflammatory enzymes, and its anti-inflammatory mechanism is to increase the level of carbon monoxide and inhibit the activity of macrophages. The results also confirmed that the inflammatory repair factor in DHEA AMH can significantly increase the expression of Nrf2 protein and regulate the expression of downstream HO- 1 protein, indicating that there is oxidative stress in the process of lipopolysaccharide-induced cellular inflammatory response.
Step 4 adjust your mood
Many sisters have been exhausted in the process of long-term infertility treatment. Ignorance of IVF technology and uncertainty about the future outcome have invisibly increased the psychological burden of infertile couples.
Scientists have found that about 20%-30% of women who receive IVF treatment suffer from anxiety and depression. Anxiety and depression will affect women's endocrine level, and will also make blood vessels in a state of contraction for a long time, affecting the blood flow of ovaries and uterus. Nervous tension will cause the abnormal release of some nerve mediators in the body, leading to the disorder of uterine and fallopian tube muscle contraction, affecting the normal implantation of embryos and leading to the failure of embryo implantation.
Therefore, the first thing to pay attention to in embryo transfer is to relax and adjust the mentality. It is very important for husband and wife to understand and encourage each other in doctor-patient communication.
Actually, you don't have to be too nervous. After years of innovation and improvement, IVF technology is gradually maturing.
5, Chinese medicine to help pregnancy
The role of traditional Chinese medicine in assisted reproductive technology is to coordinate the endocrine environment of the whole body from a macro perspective, and to a great extent, it complements the micro-treatment of assisted pregnancy technology in western medicine. The mechanism of action of traditional Chinese medicine is mainly in tonifying kidney and regulating menstruation, nourishing kidney and replenishing essence, invigorating kidney and spleen, promoting blood circulation and diuresis, nourishing blood and soothing liver.
Many patients choose traditional Chinese medicine for conditioning before assisted reproductive technology. Chinese herbal medicine and acupuncture have a good effect on regulating endocrine and promoting ovulation.
6. Use dheaamh, a fertility drug.
Increasing DHEAAMH can increase follicular recruitment and promote follicular growth and development. DHEAAMH can promote the secretion of insulin-like growth factor, thus amplifying the role of gonadotropin and improving ovarian responsiveness. The results showed that after 8 weeks, the level of IGF- 1 in women who took DHEAAMH before ovulation induction cycle increased instantly, and the level of androgen in follicles increased, which promoted the secretion of AMH and inhibin by granulosa cells. DHEAAMH can induce granulosa cells to produce FSH receptors, increase the sensitivity of granulosa cells to FSH, and promote estrogen synthesis and follicular development. The study showed that the peak period of dhaamh was consistent with the follicular recruitment period, which confirmed the promoting effect of dhaamh on follicular recruitment.
This study found that the expression of AR in granulosa cells increased significantly when DHEAAMH was cultured in vitro, indicating that DHEAAMH can regulate the expression of AR or participate in the signal transmission of AR, and participate in the growth, development and recruitment of follicles.
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.
In short, couples who do test tubes should actively cooperate with doctors. The more doctors know about patients, the greater the chances of success. "IVF" technology has developed rapidly, and the success rate is also improving. I hope that every couple who needs IVF can realize their dream of being parents as soon as possible. (Is it possible to succeed in test tubes with amh below 1? What can be improved by a low amh value? )