Effect of dehydroepiandrosterone on oocyte and embryo yields, embryo grade and cell number in IVF

Barad, David H.; Gleicher, Norbert

doi:10.1093/humrep/del254

Cited by 200 publications

(161 citation statements)

References 42 publications

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“…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]. We also compared the results from case-control trials.…”

Section: Oocyte Numbersmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Niu

Wang

et al. 2016

J Assist Reprod Genet

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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.

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Section: Oocyte Numbersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zhang

Niu

Wang

et al. 2016

J Assist Reprod Genet

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“…They noted a significant increase in oocyte and embryo numbers, better embryo grades, and improved average embryo scores [20]. In a subsequent study by the same group, eighty nine patients with poor ovarian reserve were supplemented with DHEA for 4 months.…”

Section: Published Studiesmentioning

confidence: 92%

Is there a role for DHEA supplementation in women with diminished ovarian reserve?

Fouany

Sharara

2013

J Assist Reprod Genet

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Purpose Poor ovarian reserve and poor ovarian response presents a challenge to IVF centers. Dehydroepiandrosterone (DHEA) supplementation is increasingly being used by many IVF centers around the world in poor responders despite the lack of convincing data. We therefore examined the rationale for the use of DHEA in poor responders, address the relevant studies, present new data, and address its potential mechanisms of action. Methods All published articles on the role of DHEA in infertile women from 1990 to April 2013 were reviewed. Results Several studies have suggested an improvement in pregnancy rates with the use of DHEA. Potential mechanisms include improved follicular steroidogenesis, increased IGF-1, acting as a pre-hormone for follicular testosterone, reducing aneuploidy, and increasing AMH and antral follicle count. While the role of DHEA is intriguing, evidencebased recommendations are lacking. Conclusions While nearly 25 % of IVF programs use DHEA currently, large randomized prospective trials are sorely needed. Until (and if) such trials are conducted, DHEA may be of benefit in suitable, well informed, and consented women with diminished ovarian reserve.

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“…Successively, it has been proposed for a category of women such as those affected by premature ovarian failure (POF), premature ovarian aging (POA), diminished ovarian reserve (DOR) as defined by the Bologna criteria [5] and in women with increased stimulating hormone (FSH) [6]. Some authors reported increased number of oocytes retrieved and improved embryo quality [7,8], low aneuploidyrate [9], higher pregnancy rates [10] and increased spontaneous pregnancies in patients with POF (27 Mamas, 2009a) and high AMH levels [2,11], however no positive effect was found when women with normal ovarian reserve were treated with DHEA [12]. The beneficial effect of the use of DEA for women with DOR undergoing IVF has been mainly reported by retrospective studies, while results from recent meta-analyses and randomized control trials showed that DHEA pre-treatment did not improve clinical pregnancies.…”

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Fabozzi¹

2017

OGIJ

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In the last two decades a series of adjuvant therapies have been proposed to improve the success of IVF and most of them are currently prescribed even though the quality of scientific evidence supporting their efficacy in improving live birth rates after IVF is weak. The aim of this paper is to describe some of the therapies mostly used by women undergoing IVF such as dehydroepiandrosterone, testosterone, low-dose aspirin, low-molecular-weight heparin (LMWH), corticosteroids and endometrial scratching, and to assess the current evidence about their safety and efficacy. (Relative Risk (RR) 2.13; 95% CI 1.12-4.08). Similar results were obtained in subgroup analyses including randomized controlled trials and case-control studies (RR 2.57; 95% CI 1.43-4.63) and self-controlled studies (RR 3.95;). However, the effects of DHEA on oocyte retrieval, implantation, and abortion were not significant. The Cochrane review conducted in 2015 showed higher ongoing pregnancy rates or live birth rates following the pre-treatment with DHEA. Nevertheless, no benefit was observed when studies with high risk of bias were excluded [14,15]. Finally, a third meta-analysis analysing the effect of DHEA in women with DOR including a total of nine studies, four RCTs, four retrospective and one prospective concluded that clinical pregnancy rates were increased significantly in DOR patients who were pre-treated with DHEA (OR = 1.47, 95% CI: 1.09-1.99), whereas no differences were observed in the number of oocytes retrieved, the cancellation rate of IVF cycles and them is carriage rate between the cases and controls (WMD= −0.69, 95% CI: −2.18-0.81; OR = 0.74,95% CI: 0.51-1.08; OR = 0.34, 95% CI: 0.10-1.24). However, restricting the analysis to only RCTs, a non-significant difference in the clinical pregnancy rate was observed(OR = 1.08, 95% CI: 0.67-1.73) [15]. Keywords: Conclusive statementAlthough the effect of DHEA on improving ovarian response seems to be promising, there is insufficient evidence to recommend DHEA supplementation at this time. Furthermore, the long-term risk of DHEA administration remain unknown. More RCTs with large sample size are needed to obtain good quality evidence on its safety and efficacy. Testosterone (TT)Testosterone is a downstream molecule in the steroidal pathway from DHEA. It can be administered either trans-dermally or orally. Different RCTs report a beneficial effect of TT pre-treatment [16,17] and the meta-analysis from Bosdou et al. [18] analyzing both trials conducted by Massin et al. [16] and Kim et al. [17] reported that pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy (risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%) and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. A second meta-analysis conducted by also reported that testosterone-treated women achieved a significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy ra...

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Effect of dehydroepiandrosterone on oocyte and embryo yields, embryo grade and cell number in IVF

Abstract: This study confirms the previously reported beneficial effects of DHEA supplementation on ovarian function in women with diminished ovarian reserve.

Cited by 200 publications

References 42 publications

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

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

Is there a role for DHEA supplementation in women with diminished ovarian reserve?

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

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