DHEA Use to Improve Likelihood of IVF/ICSI Success in Patients With Diminished Ovarian Reserve: A Systematic Review and Meta-analysis

Abstract

The aim of this review is to determine if the use of DHEA increases the likelihood of success in patients with POR. We searched MEDLINE and EMBASE using the terms "DHEA and diminished ovarian reserve", "DHEA and poor response", "DHEA and premature ovarian aging". A fixed effects model was used and Peto's method to get the odds ratio (OR) with 95% confidence intervals (CI 95%). For quantitative variables, Cohen's method was used to present the standardized mean differences (SMD) with their corresponding confidence intervals. Only five studied fulfilled the selection criteria. DHEA was administered in 25 mg doses, three times a day. In all studies, the authors corrected for the presence of confounding variables such as partner's age, infertility diagnosis and number of transferred embryos. The meta-analysis of the five selected studies assessed a total of 910 patients, who underwent IVF/ICSI, of which 413 had received DHEA. DHEA use was associated with a significant increase in pregnancy likelihood (OR 1.8, CI 95% 1.29 to 2.51, p=0.001). When analyzing the association between DHEA use and the likelihood of abortion, we found low heterogeneity between studies (I 2 =0.0%) and the use of DHEA to be associated to a significant reduction in the likelihood of abortion (OR 0.25, CI 0.07 to 0.95; p=0.045). Analysis of the association of DHEA with average oocyte retrieval showed high variability between studies (I 2 =98.6%), as well as no association between DHEA use and the number of oocytes retrieved (SMD -0.01, CI 95% -0.16 to 0.13; p>0.05).

The Use of Androgen Priming in Women with Reduced Ovarian Reserve Undergoing Assisted Reproductive Technology

“…In addition to the differences described earlier, the study by Saharkhiz et al utilized testosterone gel only during stimulation and not at all prior to the onset of treatment. 78 Although the summary estimates for five of the six studies favor the use of testosterone in women with predicted or prior POR, [73][74][75][76]78 only one reported a significantly increased 32 Li et al 68 Zhang et al 86 Schwarze et al 69 Liu et al 70 Xu et al 71 Zhang et al 72 Wiser et al 54 Artini et al 55 Moawad clinical pregnancy rate. 75 We undertook a meta-analysis incorporating these six studies that compared testosterone with placebo or no treatment in 443 women with predicted or proven POR (►Figs.…”

“…14 There have also been numerous systematic reviews and meta-analyses published since the Cochrane review. 59, [68][69][70][71][72] These have been summarized in ►Tables 2 and 3. Although only one individual study suggests that DHEA significantly improves clinical pregnancy rates following IVF in women with a predicted or prior POR, 60 all the meta-analyses appear to support this finding (►Table 3).…”

“…85 In it, they make reference to the favorable results of the subgroup analysis (incorporating the predicted and prior poor responders) from the Cochrane review and the two RCTs undertaken in women with predicted or prior POR since then 60,61 but none of the other more recent metaanalyses. [68][69][70][71][72]86 With regard to testosterone, they reference the Cochrane review 32 and the subsequent study by Bosdou et al 77 ESHRE advises that the use of either DHEA or testosterone before ovarian stimulation is "probably not recommended" for poor responders due to the inconsistent evidence. They advocate larger RCTs.…”

Effect of acupuncture for diminished ovarian reserve: study protocol for a randomized controlled trial

“…An international survey [9] indicated DOR patients respond poorly to controlled ovarian stimulation (COS) resulting in retrieval of fewer oocytes, producing poorer quality embryos, and reduced implantation rates and pregnancy rates. Some studies suggested the addition of growth hormone (GH) [10] during ovarian stimulation could enhance the response of granulosa cells to gonadotropins, and dehydroepiandrosterone DHEA) [11] could improve ovarian function. However, there is insu cient evidence to support their effect.…”