A randomized, controlled, pilot trial on the effect of dehydroepiandrosterone on ovarian response markers, ovarian response, and in vitro fertilization outcomes in poor responders

Abstract

HKCTR-1149 (www.hkclinicaltrials.com) and NCT01915186 (www.ClinicalTrials.org).

Dehydroepiandrosterone treatment in women with poor ovarian response undergoing IVF or ICSI: a systematic review and meta-analysis

“…6a) [15,17,23]. Six trials including 163 patients that studied women older than 36 also indicated increased oocyte numbers after DHEA treatment (WMD 1.31, [13] Ca se-control None None N/A Intention to treat analysis *** * ** Barad [12] Prospective cohort study None None N/A Intention to treat analysis *** * ** Sonmezer [23] Prospective cohort study None None N/A Intention to treat analysis *** * ** Gleicher [32] Case-control None None N/A Intention to treat analysis *** * ** Wiser [14] RC T Artini [33] RC T Moawad [24] RCT Fusi [25] Prospective cohort study None None N/A Intention to treat analysis *** * ** Hyman [26] Prospective cohort study None None N/A Intention to treat analysis ** * ** Singh [27] Prospective cohort study None None N/A Intention to treat analysis ** * ** Yeung [32] RCT Yilmaz [36] Prospective cohort study None None N/A Intention to treat analysis *** * ** Jirge [15] Prospective cohort study None None N/A Intention to treat analysis *** * ** Kara [28] R C T Vlahos [2] Prospective cohort study None None N/A Intention to treat analysis **** * ** Xu [16] C a s e -control None None N/A Intention to treat analysis ** * ** Yeung [6] R C T Zangmo [17] Prospective cohort study None None N/A Intention to treat analysis ** * ** Zhang [29] RCT Tartagni [30] RCT Tsui [31] Prospective cohort study None None N/A Intention to treat analysis *** * ** Fig. 6b) [12,14,17,25,26,31].…”

“…However, the outcomes of these treatments have been less than satisfactory [1,5]. Dehydroepiandrosterone (DHEA) is an endogenous steroid produced in the zona reticularis of the adrenal cortex and by ovarian theca cells [6]. In the ovary, it promotes follicular development and granulosa cell proliferation by increasing intraovarian androgen concentrations [7].…”

“…DHEA can also enhance the level of follicular insulin-like growth factor-1 (IGF-1), which promotes folliculogenesis by enhancing the effect of gonadotropin and reducing follicular arrest [7][8][9]. Recently, treatment with DHEA has been shown to result in improved ovarian response in patients with POR [2, 6,[10][11][12][13][14][15][16][17]. An international survey showed that 26 % of IVF clinicians add DHEA as an adjuvant to IVF treatment protocols in such women [18].…”

Androgen actions in the ovary: balance is key

“…In the U.S., another problem is that, Congress legislatively prohibits funding of all IVF-related research, and there is lack of interest by the pharmaceutical industry to support such research. As a consequence, so far, therefore, only two small, greatly underpowered clinical trials of DHEA have been published in women with LFOR (Wiser et al 2010, Yeung et al 2014.…”

Efficacy of Dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): A proof of principle double blinded randomized placebo controlled trial

“…We have recently performed a meta-analysis examining this question and of 22 studies available at the time, only 3 controlled studies were eligible for analysis, which showed no benefit of DHEA supplementation on clinical pregnancy or miscarriage rates (30). More recently a few small randomised controlled studies, albeit having some methodological weaknesses, have similarly reported that DHEA does not improve clinical outcome in women with diminished ovarian reserve undergoing IVF treatment (31)(32)(33)(34) although it is significant that only one of these studies was placebo-controlled and even then the size of this RCT was very small with 16 participants per treatment arm (31).…”