Dehydroepiandrosterone improves follicular fluid bone morphogenetic protein-15 and accumulated embryo score of infertility patients with diminished ovarian reserve undergoing in vitro fertilization: a randomized controlled trial

Abstract

ObjectiveTo evaluate the effect of dehydroepiandrosterone (DHEA) on infertility patients with diminished ovarian reserve undergoing in vitro fertilization.MethodsThis is a prospective study. Ninety-five patients with diminished ovarian reserve were included in this study. Of them, 42 patients were randomly allocated to the DHEA group, who received DHEA 75 mg daily for three consecutive menstrual cycles prior to IVF cycles, and 53 patients were allocated to the control group, who entered IVF cycles directly. All patients were treated with the same ovarian stimulation protocol. Follicular fluid samples from both groups were collected for bone morphogenetic protein-15 (BMP-15) and growth differentiation factor-9 (GDF-9). Fluid from the first aspirated follicle without any visible blood contamination was carefully collected. In addition, day 3 Blood samples were collected pre- and post-treatment of DHEA for serum anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol (E2) in the DHEA group.ResultsThe level of BMP-15 in follicular fluid samples from the DHEA group was significantly higher than that of the control samples (P=.000). Patients after DHEA treatment demonstrated a significantly higher level of AMH and a significantly lower level of FSH, E2 compared to themselves prior to DHEA therapy (P=.015; P=.036; P=.002; respectively). Moreover, the accumulated score of embryos was significantly higher in the DHEA group (P=.033).ConclusionsThese observations confirm the beneficial effect of DHEA for infertility patients with diminished ovarian reserve.Trial registrationChiCTR-TRC-14005002

Dehydroepiandrosterone improves the ovarian reserve of women with diminished ovarian reserve and is a potential regulator of the immune response in the ovaries

“…Several randomized prospective controlled studies investigated the effects of DHEA supplementation but their results were inconsistent. Some researchers obtained the same results as described earlier (34,(38)(39)(40), but the number of oocytes retrieved and the fertilization rate remained inconsistent (38,40,41), whereas others failed to show that DHEA was effective at improving IVF outcomes (40,41). These studies, …”

“…A previous casecontrol study showed that DHEA improved ovarian reserve and that it significantly increased antral follicle counts (AFCs), anti-Müllerian hormone (AMH) levels (32)(33)(34), numbers of fertilized oocytes, normal day 3 embryos, embryos transferred, and the average embryo score per oocyte (35) while significantly decreasing day 3 follicle-stimulating hormone (FSH) (33), fertilized aneuploid embryos (36), and miscarriage rates (37) (all p-values < 0.05). Estradiol (E2) levels tripled according to two studies (12,38) but decreased according to a third (34). Several randomized prospective controlled studies investigated the effects of DHEA supplementation but their results were inconsistent.…”

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

“…9a) [17,27]. The other five articles [2, 15,29,31,36] also showed similar results (WMD 0.38, 95 % CI 0.26-0.5, P < 0.0001, I 2 = 0 %; Fig. 9b).…”

“…Six selfcontrol studies also indicated that DHEA treatment increased the AFC, with no significant heterogeneity observed (WMD 0.4, 95 % CI 0.14-0.66, p = 0.002, I 2 = 24 %, Fig. 10) [15,26,27,29,31,36].…”

“…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].…”