Impact of dehydroepiandrosterone on clinical outcome in poor responders: A pilot study in women undergoing in vitro fertilization, using bologna criteria

Abstract

OBJECTIVE:To evaluate the role of dehydroepiandrosterone (DHEA) supplementation in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF).DESIGN:Prospective case-control study.SETTING:Private tertiary fertility clinic.MATERIALS AND METHODS:31 infertile women with POR diagnosed as per the Bologna criteria.INTERVENTIONS:DHEA supplementation for 2 months and a subsequent IVF cycle, after two previous IVF cycles with POR.MAIN OUTCOME MEASURE(S):Dose and duration of gonadotropin therapy, oocyte yield, embryo number and quality, pregnancy and live birth rate.RESULTS:No difference was seen in gonadotropin requirement before and after DHEA supplementation. There was a significant increase in total and metaphase II oocytes (5.9 ± 0.68 vs. 2.73 ± 0.24; 4.45 ± 0.47 vs. 2.09 ± 0.26), fertilization (3.65 ± 0.49 vs. 2.00 ± 0.27), Grade I embryos (1.52 ± 0.25 vs. 0.55 ± 0.18), pregnancy rate (30% vs. 9.1%) and live birth rate (25% vs 0%) in those who completed the cycle, following DHEA supplementation.CONCLUSIONS:Dehydroepiandrosterone supplementation results in an improvement in oocyte yield, embryo quality, and live birth rate in a group of women with POR having undergone at least two previous failures due to POR.

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

“…Three case-control trials, two RCTs, and a prospective cohort study covering 1398 patients were utilized to determine implantation rates [13,15,16,24,30]. The implantation rate in patients treated with DHEA was significantly increased compared with untreated control patients (five trials, RR 1.56, 95 % CI 1.20-2.01, p = 0.0007) with no indication of statistical heterogeneity (I 2 = 0 %, Fig.…”

“…Six trials including 528 patients were used to calculate live birth rates: four were RCT trials and two were prospective cohort trials [2, 14,15,24,30,32]. There were significantly higher live birth rates in the DHEA treatment groups compared with controls (RR 1.87, 95 % CI 1.22-2.88, p = 0.004) with no indication of statistical heterogeneity (I 2 = 26 %, Fig.…”

“…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.…”

“…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].…”

“…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].…”