The effect of dehydroepiandrosterone (DHEA) supplementation on women with diminished ovarian reserve (DOR) in IVF cycle: Evidence from a meta-analysis

Qin, Junqi; Li, Fan; Qin, Aiping

doi:10.1016/j.jgyn.2016.01.002

Cited by 55 publications

(36 citation statements)

References 18 publications

(54 reference statements)

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“…A 2017 systematic review (AMSTAR score = 9, N = 1208) showed DHEA might lead to a slightly higher pregnancy rate in patients with DOR (OR = 1.47; 95% CI, 1.09‐1.99), but have no significant influence on the number of retrieved oocytes, cycle cancellation rate and the miscarriage rate . A systematic review published by Ji et al.…”

Section: Resultsmentioning

confidence: 99%

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

Jiang

Chen

Wang

et al. 2019

J Evidence Based Medicine

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More women postpone childbearing nowadays while female fertility begins to decline with advancing age. Furthermore, with the rolling out of the two-child policy, there is a huge demand for a second child for Chinese aged women. There are various assisted reproductive technology (ART) strategies applied for age-related infertility without solid evidence. On behalf of the Society of Reproductive Medicine, Chinese Medical Association, we would like to develop a Chinese guideline of ART strategies for age-related infertility. This guideline was produced following the recommendations for standard guidelines described in the 2012 WHO Handbook for guideline development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. A protocol was formulated and a Guideline Development Group was formed with specialists of reproductive medicine, methodologists from Chinese GRADE working group, and patient representative. Questions regarding the ART strategies for aged infertility were formulated and 8 most important ones were chosen to be structured in PICO format (Population, Intervention, Comparison, Outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria and be categorized as high, moderate, low, or very low. Twenty-five recommendations were formulated among members of the Guidelines Development Group (Delphi method) basing on the overall quality of the evidence, in addition to the balance between benefits and harms, values and preferences, and resource implications. The final recommendations were agreed on by consensus during face-to-face meetings. This is the first Chinese practice guideline in reproductive medicine developed following the standard and scientific method. K E Y W O R D Sadvanced maternal age, assisted reproductive technology, evidence-based clinical practice guideline, infertility

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Section: Resultsmentioning

confidence: 99%

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

Jiang

Chen

Wang

et al. 2019

J Evidence Based Medicine

View full text Add to dashboard Cite

show abstract

“…A recent meta-analysis indicated the clinical pregnancy rate was statistically increased in DOR patients who were pre-treated with DHEA, there was no significant improvement on the number of oocytes retrieved and the cancellation rate, and there was a non-significant difference in the clinical pregnancy rate when data were restricted to RCTs [32]. DHEA is diverted from DHEAs in GCs after removing the sulfate by steroid sulfatase [33].…”

Section: Discussionmentioning

confidence: 99%

The effect of dehydroepiandrosterone supplementation on ovarian response is associated with androgen receptor in diminished ovarian reserve women

Hong

Nie

et al. 2017

J Ovarian Res

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BackgroundDiminished ovarian reserve(DOR) is associated with female infertility and poor response to ovarian stimulation. Our objective was to assess the effect of dehydroepiandrosterone(DHEA) on DOR women and to explore whether the improvement of ovarian response after DHEA supplementation was dependent on the expression levels of androgen receptor(AR).MethodsA prospective cohort study was performed in the Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital during August 2014 to August 2016. 103 DOR women who completed the study were divided into the DHEA group (n = 53), which received DHEA supplementation (25 mg three times a day) for 8 weeks, and the control group (n = 50), which did not receive DHEA, before the IVF cycles. Serum hormone levels(FSH, LH, E2, T, DHEAs, AMH, INHB), antral follicle count(AFC) and the expression of AR and FSH receptor(FSHR) in granulosa cells(GCs) were measured, meanwhile ovarian response parameters and IVF outcomes were compared. The GCs from another 36 DOR women were cultured with different concentrations of DHEA in vitro. Then, we compared the expression of AR and FSHR in GCs according to the different numbers of oocytes retrieved both in DHEA and control group.ResultsIn the present study, DHEA supplementation resulted in significantly higher levels of serum T(P = 0.047), DHEAs(P = 0.019) and AR mRNA expression in GCs(P = 0.049). In vitro experiment, the protein and mRNA expression of AR and FSHR in the preovulatory GCs were significantly increased in response to DHEA supplementation(P <0.05). No significant differences were found in ovarian reserve, ovarian response, or IVF outcomes between the two groups. Subgroup analyses showed the levels of AR and FSHR mRNA in GCs were significantly increased in DHEA group with ≥5 oocytes retrieved(P <0.05).ConclusionDHEA supplementation can increase the expression of AR in preovulatory GCs both in vivo and in vitro. The selective beneficial effects of DHEA supplementation on ovarian response in DOR women may depend on the increasing expression of AR and FSHR in GCs.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR-IPR-15006126). Retrospectively Registered 19 March 2015.

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“…In addition, DHEA has been suggested to increase fertilization rates and embryo quality ( 27 , 32 , 35 , 36 ). Equally, other investigations including meta-analyses ( 15 , 37 – 39 ) have demonstrated no clear benefit in terms of oocytes collected, embryo quality, or clinical pregnancy and live birth rates ( 30 , 40 – 43 ). Thus, the use of these adjuvant therapies in IVF remains highly controversial and inconclusive ( 2 ).…”

Section: Introductionmentioning

confidence: 97%

DHEA Supplementation Confers No Additional Benefit to that of Growth Hormone on Pregnancy and Live Birth Rates in IVF Patients Categorized as Poor Prognosis

et al. 2018

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BackgroundIn vitro fertilization (IVF) patients receive various adjuvant therapies to enhance success rates, but the true benefit is actively debated. Growth hormone (GH) and dehydroepiandrosterone (DHEA) supplementation were assessed in women undergoing fresh IVF transfer cycles and categorized as poor prognosis from five criteria.MethodsData were retrospectively analyzed from 626 women undergoing 626 IVF cycles, where they received no adjuvant, GH alone, or GH–DHEA in combination. A small group received DHEA alone. The utilization of adjuvants was decided between the attending clinician and the patient depending on various factors including cost.ResultsDespite patients being significantly older with lower ovarian reserve, live birth rates were significantly greater with GH alone (18.6%) and with GH-DHEA (13.0%) in comparison to those with no adjuvant (p < 0.003). No significant difference was observed between the GH groups (p = 0.181). Overall, patient age, quality of the transferred embryo, and GH treatment were the only significant independent predictors of live birth chance. Following adjustment for patient age, antral follicle count, and quality of transferred embryo, GH alone and GH–DHEA led to a 7.1-fold and 5.6-fold increase in live birth chance, respectively (p < 0.000).ConclusionThese data indicated that GH adjuvant may support more live births, particularly in younger women, and importantly, the positive effects of GH treatment were still observed even if DHEA was also used in combination. However, supplementation with DHEA did not indicate any potentiating benefit or modify the effects of GH treatment. Due to the retrospective design, and the risk of a selection bias, caution is advised in the interpretation of the data.

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The effect of dehydroepiandrosterone (DHEA) supplementation on women with diminished ovarian reserve (DOR) in IVF cycle: Evidence from a meta-analysis

Cited by 55 publications

References 18 publications

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

The effect of dehydroepiandrosterone supplementation on ovarian response is associated with androgen receptor in diminished ovarian reserve women

DHEA Supplementation Confers No Additional Benefit to that of Growth Hormone on Pregnancy and Live Birth Rates in IVF Patients Categorized as Poor Prognosis

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