Dehydroepiandrosterone (DHEA) Pre-Treatment And Ovulation Induction For In Vitro Fertilization Among Women With A History Of Decreased Ovarian Reserve. D. H. Barad, N. Gleicher. The Center For Human Reproduction, New York, NY.
OBJECTIVE: Ovarian reserve declines with age, older women produce fewer oocytes/embryos with in vitro fertilization (IVF). We previously reported, based on a small number of cases, that pre-treatment with dehydroepiandrosterone (DHEA) appears to increase oocyte/embryo yield. This observation was further expanded in this study.
DESIGN: A retrospective cohort study of women with history of decreased ovarian reserve that were treated with dehydroepiandrosterone before undergoing ovulation induction for IVF.
MATERIALS AND METHODS: DHEA, at 25 mg TID, was administered to 45 women previously diagnosed with decreased ovarian reserve. All patients signed an informed consent prior to beginning DHEA treatment. Patients used DHEA for an average of 28 15 wks (range 4 to 48 weeks) before starting ovulation induction for IVF. All patients underwent the same ovulation induction with maximal ovarian stimulation (450 IU of recombinant FSH and 150 IU of hMG in a microdose GnRH-agonist protocol) before and after DHEA treatment. Cycle outcomes after DHEA treatment were evaluated for baseline follicle stimulating hormone (FSH) and estradiol levels, peak estradiol levels after stimulation, oocyte number retrieved, embryos obtained, embryo quality and number of embryos available for transfer. Embryo score was estimated by the product of day 3 cell counts and grade. All results are presented as means standard error of the mean. Comparisons were either by one-way analysis of variance with post-hoc Student-Neuman-Keuls testing, or Chi square. Statistical calculations were performed using SPSS version 10.1. This study was approved by our institutional review board.
RESULTS: The study evaluated a total of 76 completed IVF cycles in 45 patients, with 43 cycles being conducted before and 33 cycles after start of DHEA administration. Baseline FSH levels were high and did not change with DHEA treatment (9.5 0.7 mIU/ml versus 9.3 1.2 mIU/ml). Neither did baseline estradiol levels (67.5 5.0 pg/ml versus 64.0 6.4 pg/ml). Oocyte production increased, however, significantly from 4.4 3 to 8.6 5 oocytes per retrieval (p 0.001). Of 333 eggs retrieved, 35% (79/228) of eggs from post DHEA treatment cycles produced high grade (score 24) day 3 embryos compared to only 16% (17/105) pre-treatment; p 0.001.
CONCLUSION: This study confirms that DHEA increases oocyte yield and percentage of high quality embryos in women with diminished ovarian reserve and, therefore, may extend reproductive function in such women. Further studies are needed to determine optimal treatment protocols with DHEA. Increased oocyte production after treatment with dehydroepiandrosterone David H. Barad, M.D., M.S.,a and Norbert Gleicher, M.D.b a Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, New York, New York; and b Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
Objective: To describe a case of dramatically improved ovarian reserve in a 42.7-year-old woman who was using the dietary supplement dehydroepiandrosterone (DHEA) as well as acupuncture.
Design: Case report. Setting: Private IVF center.
Patient(s): A 42.7-year-old patient with initial severely decreased ovarian reserve.
Intervention(s): Serial ovulation induction with concomitant use of DHEA dietary supplementation as well as acupuncture.
Main Outcome Measure(s): Peak E2 concentration, oocytes retrieved, and cyropreservable embryos.
Result(s): In her first treatment cycle peak E2 was 1,211 pmol/mL. After seven months of DHEA supplementation her peak E2 in cycle 8 was 18,000 pmol/mL. Because of fear of hyperstimulation we reduced her gonadotropin stimulation by 25%. In the ninth cycle peak E2 was 9,178 pmol/mL, resulting in retrieval of 17 oocytes (16 embryos). In the last 11 months the patient has undergone nine treatment cycles while continuously and dramatically improving her ovarian response and banking of 66 embryos overall.
Conclusion(s): This case illustrates the possibility that ovarian function may be salvaged, even in women of advanced reproductive age. (Fertil Steril 2005;84:756.e1–3. ©2005 by American Society for Reproductive Medicine.)
