Long-term androgen priming by use of dehydroepiandrosterone (DHEA) improves IVF outcome in poor-responder patients. A randomized controlled study

Introduction: Success with COH depends on the ability to recruit adequate numbers of follicles. Unfortunately, some patients produce too few follicles with COH and are classified as poor responders. Over the years, numerous techniques and therapies have been developed in an effort to help the poor responder, but few have met with success. Recently attempts of ovarian androgen priming have been developed on the basis that temporary exposure of follicles to increased levels of androgens may augment their responsiveness to FSH. Long-term DHEA exposure can induce histological and sonographic changes in normal ovaries similar to PCOS. This effect is cumulative as more of the antral follicles become exposed to treatment. Objective: The aim of this study was to compare the effect of DHEA supplementation on IVF treatment outcomes among a cohort of women with known decreased ovarian reserve using a short protocol. Design: It is a randomized controlled study. Materials and methods: Between July 2008 and April 2012, 133 patients with a prior poor response to ovarian stimulation in IVF were selected to undergo an IVF cycle. The cases were divided without prejudice into 2 groups; (1) study group (DHEA group); in which the patient began taking 25 mg of DHEA orally, three times a day, for at least 12 weeks before starting COH, ( 2) control group; in which the patient started COH without DHEA priming. Results: The study group had statistically significant higher numbers of retrieved oocytes (5.9 +/- 3.6) compared to the control group (3.5 +/- 2.9) - P < 0.001. Also, the study group had a statistically significant lower cancellation rate (13.4%) and a higher number of embryos transferred (2.8 +/- 0.9) compared to the control group (28.8% and 1.7 +/- 1.1, respectively) - P < 0.01 & < 0.001, respectively. Although the pregnancy rate (per embryo transfer) was higher in the study group (24.1%) compared to the control group (21.3%), no statistically significant difference was observed. However, if we calculate pregnancy rate per cycle, it was significantly higher in the study group (20.9%) compared to (15.2%) in the control group - P < 0.05. Conclusion: According to our findings, long-term androgen priming by use of DHEA improves IVF outcome in poor responder patients. Additional, larger studies, using different protocols are needed to reinforce our findings. (C) 2012 Middle East Fertility Society. Production and hosting by Elsevier B.V. All rights reserved.