OBJECTIVE:To evaluate the role of dehydroepiandrosterone (DHEA) supplementation in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF).DESIGN:Prospective case-control study.SETTING:Private tertiary fertility clinic.MATERIALS AND METHODS:31 infertile women with POR diagnosed as per the Bologna criteria.INTERVENTIONS:DHEA supplementation for 2 months and a subsequent IVF cycle, after two previous IVF cycles with POR.MAIN OUTCOME MEASURE(S):Dose and duration of gonadotropin therapy, oocyte yield, embryo number and quality, pregnancy and live birth rate.RESULTS:No difference was seen in gonadotropin requirement before and after DHEA supplementation. There was a significant increase in total and metaphase II oocytes (5.9 ± 0.68 vs. 2.73 ± 0.24; 4.45 ± 0.47 vs. 2.09 ± 0.26), fertilization (3.65 ± 0.49 vs. 2.00 ± 0.27), Grade I embryos (1.52 ± 0.25 vs. 0.55 ± 0.18), pregnancy rate (30% vs. 9.1%) and live birth rate (25% vs 0%) in those who completed the cycle, following DHEA supplementation.CONCLUSIONS:Dehydroepiandrosterone supplementation results in an improvement in oocyte yield, embryo quality, and live birth rate in a group of women with POR having undergone at least two previous failures due to POR.

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Background: The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered. Aim: The study was conducted to assess the preparedness of ART clinics and staff to resume services; patients' reasons to initiate treatment; and key performance indicators (KPIs) of ART laboratories during the pandemic. Setting and Design: This was a semidescriptive, prospective study in two private in vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Materials and Methods: Time required for replenishing consumables and clinic preparedness to function under “new norms” of pandemic was documented. Infection mitigation measures and triaging strategy were evaluated. KPIs following resumption were analyzed. The Student's t -test was performed for comparing parameters. Results: Thirty percent of the patients consulted through telemedicine accepted or were eligible to initiate treatment on clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands was achieved within a week, but procuring consumables and injections was time-consuming. Fifty-two cycles of IVF were performed including fresh and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval were associated with reduced procedure time and no intervention for airway maintenance compared to general anesthesia. Self-reported pain scores by patients ranged from nil to mild on a graphic rating scale. Conclusions: This study provides practical insight for the resumption of IVF services during the COVID-19 pandemic.

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Purpose: The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered. The purpose of the study was to assess the preparedness of ART clinics and staff to resume services and patients reasons to initiate treatment and key performance indicators (KPIs) of ART labs during pandemic. Methods: Semi-descriptive report of two private in-vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Time required for replenishing laboratory supplies, and staff preparedness to function under new norms of pandemic was documented. Infection mitigation measures at workplace and triaging strategy were evaluated. KPIs of the clinics were evaluated. Results: One-third of the patients consulted through telemedicine accepted or were eligible to initiate treatment upon clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and only 9 percent delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands could be achieved within a week, but supply of consumables was a major constraint. 52 cycles of IVF were performed including fresh cycles and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval was associated with reduced procedure time and no intervention for airway maintenance, compared to general anaesthesia. Self reported pain scores by patients ranged from nil to mild on a graphic rating scale. Conclusion: This study provides a practical insight and will aid in forming guidelines for resumption of IVF services during pandemic.