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5B - DHEA Is an Effective Treatment for Poor Responders

Against

from Section II - IVF Add-ons

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

DHEA is a pro hormone produced by the adrenal gland and is a precursor to testosterone and consequently oestrogen production by the ovary. Its use in women with anticipated poor response to IVF has been suggested for some time. The concept behind its use is the potential improvement in follicle sensitivity to FSH through an increase in local androgen production within the ovary. There is also a suggestion that DHEA can improve abnormal mitochondrial dynamics within the cumulus cells in women with poor ovarian response [1]. As attractive as these concepts may be, the use of DHEA in women with potential poor response is supported by very little clinical evidence, and consequently its usage seems to stem from a desperation within the clinical community, given the very few options available in this group of women. The majority of studies in the literature are either retrospective or involve a small group of participants. They are also underpowered and associated with significant heterogeneity, with different definitions of poor ovarian reserve used amongst studies.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2021

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References

Li, CJ, Chen, SN, Lin, LT., et al. Dehydroepiandrosterone ameliorates abnormal mitochondrial dynamics and mitophagy of cumulus cells in poor ovarian responders. J Clin Med. 2018;7(10):293.CrossRefGoogle ScholarPubMed
Mostajeran, F, Tehrani, H, Ghoreishi, E. Effects of dehydroepiandrosterone on in vitro fertilization among women aging over 35 years and normal ovarian reserve. J Family Reprod Health. 2018;12:129–33.Google ScholarPubMed
Schwarze, JE, Canales, J, Crosby, J, Ortega-Hrepich, C, Villa, S, Pommer, R. DHEA use to improve likelihood of IVF/ICSI success in patients with diminished ovarian reserve: a systematic review and meta-analysis. JBRA Assist Reprod. 2018;22:369–74.Google ScholarPubMed
Gleicher, N, Weghofer, A, Barad, DH. Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS). Reprod Biol Endocrinol. 2010;8:140.CrossRefGoogle ScholarPubMed
von Wolff, M, Stute, P, Eisenhut, M, Marti, U, Bitterlich, N, Bersinger, NA. Serum and follicular fluid testosterone concentrations do not correlate, questioning the impact of androgen supplementation on the follicular endocrine milieu. Reprod Biomed Online. 2017;35:616–23.CrossRefGoogle Scholar

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