Dehydroepiandrosterone supplementation within a gonadotropin-releasing hormone antagonist protocol in patients with poor ovarian response

Abdelmeged, Ayman Nady

doi:10.21608/egyfs.2011.254862

Dehydroepiandrosterone supplementation within a gonadotropin-releasing hormone antagonist protocol in patients with poor ovarian response

Document Type : Original Article

Author

Ayman Nady Abdelmeged

Department of Obstetrics and Gynecology and Minia Infertility Research Unit, Minia University, Egypt.

10.21608/egyfs.2011.254862

Abstract

Objective: The aim of this study was to compare IVF treatment outcomes between pre- and
post-treatment cycles among a cohort of women with known decreased ovarian reserve,
using dehydroepiandrosterone (DHEA) supplementation.
Materials Methods: A prospective cohort study in a private assisted reproduction centre.
Twenty-five women with significantly diminished ovarian reserve had IVF cycle before and
after 50 mg/day DHEA for 2 months, with otherwise identical hormonal stimulation.
Results: After treatment with DHEA, patients demonstrated a significant improvement in
day 3 FSH (7.1 ± 0.5 vs. 9.9 ± 1.5 mIU/ml) (p < 0.05), day 3 E2 (325.46 ± 9.7 vs. 227.37
± 16.95 pmol/L) (p < 0.05), day 3 testosterone (79.84 ±10.93 vs. 54. 64 ±10.31 μg/dl) (p <
0.05) , day 3 DHEA-S (99.94 ± 15.4 vs. 62 .54 ± 16.3 μg/dl) (p < 0.05), number of follicles
demonstrated by ULS on the day of hCG administration[Total (9 ±1.5 vs.6 ± 1.5) (p=0.01),
≥ 14 mm (4.5±1.5 vs.3.5 ± 1.5) (p = 0.01) and ≥ 17 mm( 4.5 ±1.5 vs. 2.5 ±1.5 ) (p = 0.01)],
serum E2 level on the day of hCG administration (4760±1524 vs. 3800±1684 pmol/L)(p < br />= 0.001), number of oocytes retrieved (7.5 ± 0.5 vs. 5.5 ± 0.5 ) (p = 0.01) and number of
mature oocytes (Metaphase II) (5.5± 0.5 vs. 3.5± 0.5 )( p = 0.01). Although there were significant differences in fertilization rate (72.6 % vs. 45.8 %) (p < 0.005), percentage of grade
I/II embryos (73.6 % vs. 50.4%) (p= 0.005), cumulative embryo score per oocyte retrieved
(18.5±1.2 vs. 10.5±1.2) (p = 0.001) and cancellation rate (15% vs. 40%) (p = 0.001).These
were not reflected on biochemical pregnancy, clinical pregnancy rate/cycle or clinical
pregnancy rate/embryo transfer.
Conclusions: DHEA supplementation for poor responder patients could have beneficial
effects on ovarian follicular function, improvement in hormonal profile and embryological
data. However, large prospective randomized placebo controlled trials are waited to demonstrate the improvement in clinical pregnancy rate after DHEA supplementation.

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