When It Starts with the Egg was first published in 2014, the use of DHEA to improve egg quality and quantity in IVF was considered somewhat controversial, since there had only been a small number of clinical trials.
Even in 2015, however, a Cochrane Review concluded that “In women identified as poor responders undergoing ART, pre-treatment with DHEA or testosterone may be associated with improved live birth rates. The overall quality of the evidence is moderate.”
Since that time, there has been a steady stream of new studies adding even further evidence that in women with diminished ovarian reserve, supplementing with DHEA can significantly improve pregnancy rates. The main studies are explained briefly below, along with conclusions from two more recent meta-analyses.
|Design and Outcome|
|Barad (2006)||Comparing the outcomes of IVF cycles in 25 patients before and after taking DHEA. Demonstrated significant increases in fertilized oocytes and the number of normal day 3 embryos.|
|Barad (2007)||In a case-control study of 190 women taking DHEA for up to four months before IVF, compared to 100 not taking DHEA, the treatment group had a significantly higher pregnancy rate (28.4% vs. 11.9%).|
|Gleicher (2010)||In a matched case control study, 22 consecutive women with DOR, supplemented with DHEA, underwent preimplantation genetic screening (PGS) of embryos during in vitro fertilization (IVF) cycles.
DHEA supplementation to a significant degree reduced number (P = 0.029) and percentages (P < 0.001) of aneuploid embryos, adjusted for relevant covariates. Short term supplementation (4-12 weeks) resulted in greatest reduction in aneuploidy (21.6%
|Wiser (2010)||Randomized controlled trial of 33 women with diminished ovarian reserve. DHEA treatment produced improved embryo quality and a higher live birth rate (23% in the DHEA group, vs. 4% in the controls).|
|Xu (2014)||In 389 poor responders, half received DHEA before IVF. The DHEA group the DHEA group demonstrated a significantly higher implantation rate (18.7% vs. 10.1%; P<0.01) and ongoing Pregnancy Rs (26.7% vs. 15.8%; P<0.05) as compared with the control.|
|Vlahos (2015)||Women taking DHEA showed a slight increase in AMH, but there was no significant difference in pregnancy or live birth rate: 1/48 pregnancies in Control group 8/113 pregnancies|
|Kotb (2016)||In a randomized controlled trial of 140 women with diminished ovarian reserve, DHEA treatment increased the number of eggs retrieved, The DHEA group had a significantly higher clinical pregnancy rate (32.8% vs 15.7%, p=0.029) and ongoing pregnancy rate (28.5% vs 12.8%).|
|Chern (2018)||Retrospective study of 151 poor responders undergoing IVF. The women who took DHEA demonstrated a significantly greater number of retrieved oocytes, fertilized oocytes, day 3 embryos and top-quality embryos at day 3 and a higher clinical pregnancy rate, ongoing pregnancy rate and live birth rate than those in the control group.
The odds of pregnancy were 5 times higher in women taking DHEA.
|Nagels (2015) (Cochrane Review)||“We included 17 RCTs with a total of 1496 participants. Apart from two trials, the trial participants were women identified as ‘poor responders’ to standard IVF protocols. The included trials compared either testosterone or DHEA treatment with placebo or no treatment.When DHEA was compared with placebo or no treatment, pre-treatment with DHEA was associated with higher rates of live birth or ongoing pregnancy (OR 1.88, 95% CI 1.30 to 2.71; eight RCTs, N = 878, I² statistic = 27%, moderate quality evidence)”
“In women identified as poor responders undergoing ART, pre-treatment with DHEA or testosterone may be associated with improved live birth rates. The overall quality of the evidence is moderate.”
|“Twenty-one studies met the inclusion criteria. DHEA pretreatment increased the clinical pregnancy rate (RR 1.53, 95 % CI 1.25-1.86), live birth rate (RR 1.87, 95 % CI 1.22-2.88), implantation rate (RR 1.56, 95 % CI 1.20-2.01), and antral follicle count (WMD 0.4, 95 % CI 0.14 to 0.66) while reducing miscarriages (RR 0.50, 95 % CI 0.27-0.90).”|
|“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 (I2=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).”|
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