DHEA supplementation positively affects spontaneous pregnancies in women with diminished ovarian function

Abstract

The aim of this article is to describe unexpected spontaneous pregnancies in poor responder patients with long-term infertility, when treated with dehydroepiandrosterone (DHEA) supplementation prior to in vitro fertilization (IVF). Our evaluation was carried out in two groups of women. The first group included 39 young women with <40 years, all treated with DHEA because of a previous poor response. The second group included 38 women over 40 years who received DHEA supplementation. Controls for latter group were 24 comparable women who had not been treated with DHEA before the first IVF cycle to evaluate the spontaneous pregnancy rate during preparation to IVF. Three tablets daily of 25 mg micronized DHEA were administered for at least 12 weeks before starting a long stimulation protocol for IVF. Surprisingly, spontaneous pregnancy rate significantly increased after DHEA treatment, allowing to achieve 10 spontaneous pregnancies and 9 spontaneous ongoing pregnancies among young poor responders. Pregnancy rate and ongoing pregnancy rate obtained before starting the IVF cycle were also significantly higher in older women treated with DHEA than in the control group: 21.05% and 13.15% and 4.1% and 0, respectively. Our results show that DHEA supplementation improves the ovarian function in poor responders and in women over 40 years, suggesting that this molecule alone can raise fecundity and fertility treatment success in women with poor prognosis for pregnancy.

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

“…These studies indicated that DHEA increased peak E2 levels on the day of hCG administration (five trials, WMD 240.64, 95 % CI 23.7-457.58, p = 0.03; Fig. 7a) [12,14,15,23,25]. A random effect was used instead of a fixed effect because of the higher heterogeneity between trials (I 2 = 77 %).…”

“…Six of these were self-control comparisons [12,14,15,23,25,27]. We excluded one because the study population of Singh et al [27] was divided according to age, but also had positive results for DHEA treatment.…”

“…Four self-control studies showed no difference before and after DHEA supplementation (WMD 0.29, 95 % CI −0.16 to +1.03, p = 0.45, I 2 = 0 %) [14,23,25,26]. Four articles that compared DHEA pre-treatment groups with control groups also showed no differences in this factor, although they did display high levels of heterogeneity (WMD 0.73, 95 % CI −0.64 to +2.10, p = 0.30, I 2 = 95 %, Fig.…”

“…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].…”

Can serum estradiol levels on the fourth day of IVF/ICSI cycle predict outcome in poor responder women?

“…Following the early cancellation of the treatment cycle, administration of pretreatment adjuvants like dehydroepiandrosterone sulphate (DHEA), growth hormone, and/or testosterone, can reduce the number of cycles of the potentially poor responders without several failed IVF-ET treatment cycles [Eftekhar et al 2013;Fouany and Sharara 2013;Fusi et al 2013;Narkwichean et al 2013;Singh et al 2013;Yilmaz et al 2013]. In a randomized study Eftekhar et al [2013] evaluated the IVF-ET cycle outcome after the addition of growth hormone in an antagonist protocol among poor responders.…”