Abstract

ROLE OF DHEA IN DIMINISHED OVARIAN RESERVE, SYSTEMATIC REVIEW

Vinita Singh*, Pushpawati Thakur, Sarita Agrawal, Anjum, Byasdev.

Abstract

Introduction: DHEA is the major circulating steroid in human blood and it is a central intermediate in the metabolic pathway of sex steroid hormone formation. Dehydroepiandrosterone (DHEA) has been reported to improve pregnancy chances with DOR, and is now utilized by approximately one third of all IVF centres world-wide. Published data suggests that DHEA improves oocyte yields, oocyte quality and hence embryo quality (decreases aneuploidy) & quantity, increases IVF outcomes, pregnancy rates and spontaneous pregnancy chances. Aim: This systematic review aims to summarize the role of DHEA as an adjuvant to stimulation protocol in women with diminished ovarian reserve or poorresponders based on meta-analysis of the published controlled studies. Methods: All published articles on the role of DHEA in infertile women from JAN 2000 to OCT 2014 were reviewed. Result: Combined, these data suggest that DHEA supplementation may be effective in improving pregnancy chances in women with DOR. Treatment with DHEA both reduces ovarian oxidative stress and rates of atresia. Several studies have suggested an improvement in pregnancy rates with the use of DHEA. Potential mechanisms include improved follicular steroidogenesis, increased IGF-1, acting as a pre-hormone for follicular testosterone, reducing aneuploidy, and increasing AMH and antral follicle count. While the role of DHEA is intriguing, evidence-based recommendations are lacking. Conclusion:. Considering absence of significant side effects and availability of DHEA as a food supplement, here presented data support utilization of DHEA in association with DOR, though attempts should be made to further define best suited patient populations for such treatment, maximally effective treatment protocols and best delivery systems. Large randomized prospective trials are needed. Until such trials are conducted, DHEA may be of benefit in suitable, well informed, and consented women with diminished ovarian reserve.

Keywords: Dehydroepiandrosterone (DHEA), Diminished ovarian reserve (DOR), Poor ovarian response, In vitro fertilization (IVF).