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

Abstract

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.

Premature Menopause

“…43 Recently, short-term treatment with dehydroepiandrosterone, an adrenal steroid available as an oral supplement, has been suggested to offer some hope in improving the biology of any residual gametes in the ovaries of young women diagnosed with POI. [44][45][46] Despite the recognized reproductive compromise, women diagnosed with POI remain at risk for unplanned conception, given that spontaneous resumption of follicular activity is not uncommon. Contraceptive strategies are thus recommended for those wishing to avoid pregnancy.…”

Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF

“…The age of patients varied from 21 to 42 years. According to Fratharelli and Peterson's work [9], patients with testosterone levels less than 20 ng/dl on day 3 were five times less likely to achieve success in IVF treatment. Patients were divided into 2 groups.…”

“…Yingying Qin's group suggested that basal T level was a predictor for ovarian response and pregnancy outcome in women with diminished ovarian reserve; but could not in those with normal serum FSH [8]. However, Fratharelli and Peterson's study showed that patients with Day 3 testosterone level lesser than 20 ng/dl were five time less likely to achieve pregnancy [9]. This might be explained by limited sample size and heterogeneous population mixed by patients with polycystic ovary syndrome (PCOS) and/or endometriosis as PCOS and endometriosis are associated with higher or lower serum T levels.…”

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.…”