THE IMPACT OF DEHYDROEPIANDROSTERONE (DHEA) SUPPLEMENTATION ON IVF PREGNANCY RATES IN WOMEN AGES 40–47 YEARS. N. Gleicher, D. Barad. Center for Human Reproduction, New York, NY.
OBJECTIVE: To investigate the impact of long-term dehydroepiandrosterone (DHEA) supplementation on annual IVF program pregnancy rates among older reproductive age women.
DESIGN: Retrospective cohort analysis.
MATERIALS AND METHODS: We longitudinally examined IVF pregnancy rates of women above age 40 at our center from 2003–2006.We began infrequently giving DHEA to patients in mid-2004. In 2006 we prescribed DHEA supplementation to 45% of qualified women above age 40. We considered a patient qualified for DHEA supplementation, if she had failed a prior IVF cycle with %4 oocytes retrieved and/or demonstrated elevated FSH levels (R10 mIU/ml) and/or had been refused continuous IVF treatment with autologous oocytes at another IVF center. Patients received prescription for micronized, pharmaceutical gradeDHEA25 mg, p.o., TID for a minimum of 2 months prior to oocyte retrieval. All patients received microdose GnRHagonist
flare cycles with gonadotropin stimulation of 450 – 750 IU, all, but 150 IU of HMG, given as FSH. Laboratory and clinical protocols and personnel were unchanged. Continuous variables were tested for normality. Multivariate ANOVA adjusted for SPSS for Windows, standard version 15.0. Continuous variables are presented as means 1 SD.
RESULTS: From 2003 through 2006, there were 281 embryo transfers for women older than 40 years. The table summarizes IVF outcomes in % (per embryo transfer) for all ages above 40. Clinical pregnancy rates in 2006 (23.3%; 95% CI 14–33%) increased significantly from years 2003–2005 (11.3%; 95% CI 7–16%; P<0.02). During the same time blocks average baseline FSH levels remained the same (11.5 7.2 mIU/ml, 2003–2005, and 11.4 6.4 mIU/ml, 2006), while ages increased insignificantly in 2006 from 42.9 2.3 to 43.3 1.9 years. IVF pregnancy rates at younger ages (ages 30–39), in contrast, remained the same (33.8%, 34.1%, 32.7% and 32.7%).
CONCLUSIONS: These data suggest that DHEA supplementation in women above age 40 significantly improves IVF pregnancy rates. In view of these finding, we have expanded DHEA supplementation to all women above age 40, since women at those ages can universally be considered to suffer from diminished ovarian reserve.
