Dehydroepiandrosterone administration before IVF in poor responders: a prospective cohort study

Abstract

The use of dehydroepiandrosterone (DHEA) may improve ovarian stimulation outcomes in women of advanced reproductive age and could reduce embryo aneuploidy. In this prospective study, 48 women diagnosed with poor ovarian response received DHEA supplementation for at least 12 weeks. These women were compared with a group of poor responders (n = 113) who did not receive supplementation. During the study period, patients taking day 2 FSH and oestradiol were measured monthly before and after treatment. Stimulation characteristics, stimulation outcome and clinical outcome (clinical pregnancy and live birth rates) were reported. Evaluation of anti-Müllerian hormone (AMH) was carried out before initiation of treatment and immediately before the subsequent stimulation. Supplementation with DHEA for at least 12 weeks resulted in a modest, but statistically significant, increase in AMH levels and decrease in baseline FSH (P < 0.001 and P = 0.007, respectively). Administration of DHEA had no effect on any of the stimulation parameters nor was there any difference in clinical pregnancy rates and live birth rates between the two groups. Supplementation with DHEA significantly affects women with poor prognosis undergoing ovarian stimulation for IVF. Patients should be counselled about the uncertain effectiveness, potential side-effects and cost of this treatment.

The effect of dehydroepiandrosterone (DHEA) supplementation on women with diminished ovarian reserve (DOR) in IVF cycle: Evidence from a meta-analysis

“…1) showed that a total of nine studies were eligible for the metaanalysis, included four RCTs [5][6][7][8], four retrospective studies [10,11,19,20] and one prospective studies [21]. Of the total of 1208 patients, 540 cases were in the DHEA group and 668 cases were in the control group.…”

“…With respect to the cancellation rate of IVF cycles, five retrospective studies [10,11,21] and one RCT [8] were eligible. No differences in the cancelled cycles were demonstrated between the DHEA and control groups [OR = 0.74, 95% CI: 0.51-1.08].…”

“…Four RCTs [5][6][7][8], three retrospective studies [10,11,20] and one prospective study [21] were selected for our metaanalysis of the clinical pregnancy rate. Because Wiser's Case-control *** * ** Bei Xu 2014 [11] Case-control *** * ** Gleicher 2010 [19] Case-control *** * *** Francesco 2013 [20] Case-control *** * *** Vlahos N 2015 [21] Case-control *** * *** study reported the cumulative pregnancy outcome over two consecutive IVF cycles, to exclude potential differences, only the first cycle of data was selected for our study.…”

“…Because Wiser's Case-control *** * ** Bei Xu 2014 [11] Case-control *** * ** Gleicher 2010 [19] Case-control *** * *** Francesco 2013 [20] Case-control *** * *** Vlahos N 2015 [21] Case-control *** * *** study reported the cumulative pregnancy outcome over two consecutive IVF cycles, to exclude potential differences, only the first cycle of data was selected for our study. Pooling the data from eight studies, a difference outcome was observed; the clinical pregnancy rate was significantly higher in the DHEA groups than the control groups [OR = 1.47, 95% CI: 1.09-1.99].…”

Aromatase inhibitors in “poor” ovarian responders undergoing in vitro fertilization

“…Для синхронизации роста фолликулов в программах ВРТ в течение пяти дней до начала стимуляции овуляции назна-чались антагонисты ГнРГ [26]. Также с целью улучшения ответной реакции яичников на сти-муляцию вводимыми извне гонадотропинами в течение двух менструальных циклов на этапе, предшествующем лечению, и во время проведе-ния протокола ЭКО назначался дегидроэпиан-дростерон (ДГЭА) [27][28][29]. В качестве подготов-ки к лечению в программах ВРТ на протяжении различных по продолжительности периодов и в вариабельных дозировках применялся те-стостерон, соматолиберин и соматотропный гормон (СТГ), эстрогены, L-аргинин, силдена-фил и миоинозитол [29][30][31][32][33][34][35][36][37][38].…”