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

Abstract

Purpose We reviewed the influence of dehydroepiandrosterone (DHEA) supplementation in patients with poor ovarian response (POR) undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI). Methods We searched Embase, MEDLINE, PubMed, and the Cochrane Library for relevant papers and used the Newcastle-Ottawa Scale scoring system to evaluate study quality. Dichotomous data were expressed as pooled relative risk (RR) estimates with fixed or random effect models. Continuous variables were expressed as the weighted mean difference (WMD). All data were analyzed using Revman Software v. 5 and are shown with 95 % confidence intervals (CI). Results Twenty-one studies met the inclusion criteria. DHEA pretreatment increased the clinical pregnancy rate (RR 1.53, 95 % CI 1.25-1.86), live birth rate (RR 1.87, 95 % CI 1.22-2.88), implantation rate (RR 1.56, 95 % CI 1.20-2.01), and antral follicle count (WMD 0.4, 95 % CI 0.14 to 0.66) while reducing miscarriages (RR 0.50, 95 % CI 0.27-0.90). After subgroup analysis, oocyte numbers and anti-Müllerian hormone levels were also enhanced after DHEA treatment. However, the endometrial thickness and estradiol levels on the day of injecting hCG to induce ovulation were similar between the DHEA supplementation groups and controls. Conclusions Based on the limited available evidence, DHEA supplementation seems to improve ovarian reserves and IVF/ ICSI outcome in patients with POR. Further research is required to clarify the effect of DHEA exposure in assisted reproduction technology.

Effects Of Hormonal Supplements In Women with Poor Ovarian Response Undergoing Assisted Reproductive Technology

“…DHEA has a promoting effect on follicular development and granulosa cell proliferation by increasing intraovarian androgen concentra-tions. It 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 (2).…”

“…There are several studies evaluating the impact of DHEA supplementation in women with POR undergoing ART. In all cases, DHEA was given as a supplement before ovarian stimulation during in-vitro fertilization (IVF) cycle and mostly, the main outcomes were the number of oocytes retrieved, clinical pregnancy and/or live birth rates (2,4,5).…”

“…In order to standardize the definition, European Society of Human Reproduction and Embryology Campus Workshop in Bologna proposed a subset of criterion including at least two of the following three features: (1) advanced maternal age (≥40 years) or any other risk factor for poor ovarian response (POR); (2) a previous POR (≤3 oocytes with a conventional ovarian stimulation protocol); and (3) an abnormal ovarian reserve test (antral follicle count, AFC<5 -7 or AMH <0.5 -1.1 ng-ml). In addition, two episodes of POR after maximal stimulation would be sufficient to define a patient as a poor responder in the absence of advanced maternal age or abnormal ORT (1,2).…”

Early ovarian ageing

“…A meta‐analysis has shown the benefit of dehydroepiandrosterone on IVF outcomes in women with low ovarian reserve, with increased clinical pregnancy rate, live birth rate (relative risk 1.87, 95% CI 1.22–2.88), and reduced miscarriage rate . There are data to suggest that this effect is age related, with younger women benefiting more than older women .…”

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].…”