Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 81362, Taiwan.
Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei, 112, Taiwan.
Reprod Biol Endocrinol. 2018 Sep 17;16(1):90. doi: 10.1186/s12958-018-0409-z.
Dehydroepiandrosterone (DHEA) is now widely used as an adjuvant for in vitro fertilization (IVF) cycles in poor ovarian responders (PORs). Several studies showed that DHEA supplementation could improve IVF outcomes of PORs. However, most of the PORs do not respond to DHEA clinically. Therefore, the aim of this study is to confirm the beneficial effects of DHEA on IVF outcomes of PORs and to investigate which subgroups of PORs can best benefit from DHEA supplementation.
This retrospective cohort study was performed between January 2015 and December 2017. A total of 151 PORs who fulfilled the Bologna criteria and underwent IVF cycles with the gonadotropin-releasing hormone antagonist protocol were identified. The study group (n = 67) received 90 mg of DHEA daily for an average of 3 months before the IVF cycles. The control group (n = 84) underwent the IVF cycles without DHEA pretreatment. The basic and cycle characteristics and IVF outcomes between the two groups were compared using independent t-tests, Chi-Square tests and binary logistic regression.
The study and control groups did not show significant differences in terms of basic characteristics. The study group demonstrated a significantly greater number of retrieved oocytes, metaphase II 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 measures in the control group. The multivariate analysis revealed that DHEA supplementation was positively associated with clinical pregnancy rate (OR = 4.93, 95% CI 1.68-14.43, p = 0.004). Additionally, in the study group, the multivariate analysis showed that serum dehydroepiandrosterone-sulfate (DHEA-S) levels < 180 μg/dl were significantly associated with a rate of retrieved oocytes > 3 (OR = 5.92, 95% CI 1.48-23.26, p = 0.012).
DHEA supplementation improves IVF outcomes of PORs. In PORs with DHEA pretreatment, women with lower DHEA-S level may have greater possibility of attaining more than 3 oocytes.
脱氢表雄酮（DHEA）目前被广泛用作卵巢反应不良（POR）患者体外受精（IVF）周期的辅助药物。几项研究表明，DHEA 补充剂可以改善 POR 的 IVF 结局。然而，大多数 POR 患者在临床上对 DHEA 没有反应。因此，本研究的目的是确认 DHEA 对 POR 患者 IVF 结局的有益作用，并探讨哪些 POR 亚组最能受益于 DHEA 补充。
本回顾性队列研究于 2015 年 1 月至 2017 年 12 月进行。共纳入符合博洛尼亚标准并接受促性腺激素释放激素拮抗剂方案 IVF 周期的 151 例 POR。研究组（n=67）在 IVF 周期前平均接受 90mg DHEA 治疗 3 个月。对照组（n=84）未接受 DHEA 预处理即进行 IVF 周期。采用独立 t 检验、卡方检验和二项逻辑回归比较两组的基本和周期特征及 IVF 结局。
两组在基本特征方面无显著差异。研究组获卵数、MII 卵数、受精卵数、第 3 天胚胎数和第 3 天优质胚胎数均显著多于对照组，临床妊娠率、持续妊娠率和活产率亦高于对照组。多变量分析显示，DHEA 补充与临床妊娠率呈正相关（OR=4.93，95%CI 1.68-14.43，p=0.004）。此外，在研究组中，多变量分析显示血清脱氢表雄酮硫酸酯（DHEA-S）水平<180μg/dl 与获卵数>3 显著相关（OR=5.92，95%CI 1.48-23.26，p=0.012）。
DHEA 补充可改善 POR 的 IVF 结局。在接受 DHEA 预处理的 POR 中，DHEA-S 水平较低的女性获得超过 3 个卵子的可能性更大。
