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Dehydroepiandrosterone treatment in women with poor ovarian response undergoing IVF or ICSI: a systematic review and meta-analysis

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Abstract

Purpose

We reviewed the influence of dehydroepiandrosterone (DHEA) supplementation in patients with poor ovarian response (POR) undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).

Methods

We searched Embase, MEDLINE, PubMed, and the Cochrane Library (1980–2015) for relevant papers and used the Newcastle–Ottawa Scale scoring system to evaluate study quality. Dichotomous data were expressed as pooled relative risk (RR) estimates with fixed or random effect models. Continuous variables were expressed as the weighted mean difference (WMD). All data were analyzed using Revman Software v. 5 and are shown with 95 % confidence intervals (CI).

Results

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). After subgroup analysis, oocyte numbers and anti-Müllerian hormone levels were also enhanced after DHEA treatment. However, the endometrial thickness and estradiol levels on the day of injecting hCG to induce ovulation were similar between the DHEA supplementation groups and controls.

Conclusions

Based on the limited available evidence, DHEA supplementation seems to improve ovarian reserves and IVF/ICSI outcome in patients with POR. Further research is required to clarify the effect of DHEA exposure in assisted reproduction technology.

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Authors and Affiliations

  1. Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Meixiang Zhang, Wenbin Niu, Jiawei Xu, Xiao Bao, Linlin Wang, Linqing Du & Yingpu Sun

  2. Center for Reproductive Medicine, The First Affiliated Hospital of Inner Mongolia University, Hohhot, People’s Republic of China

    Yu Wang

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  1. Meixiang Zhang
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Correspondence to Yingpu Sun.

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The authors declare that they have no conflict of interests.

Funding

This work was supported by the National Natural Science Foundation of China (No. 31271605 to Yingpu Sun) and by the Youth Innovation Fund of the First Affiliated Hospital of Zhengzhou University (to Wenbin Niu).

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Capsule Summary

A meta-analysis of more than 1,000 patients suggests that dehydroepiandrosterone as an adjuvant to IVF/ICSI treatment protocols improved the outcomes for women with a poor ovarian response.

Meixiang Zhang and Wenbin Niu contributed equally to this work.

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Zhang, M., Niu, W., Wang, Y. et al. Dehydroepiandrosterone treatment in women with poor ovarian response undergoing IVF or ICSI: a systematic review and meta-analysis. J Assist Reprod Genet 33, 981–991 (2016). https://doi.org/10.1007/s10815-016-0713-5

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  • DOI: https://doi.org/10.1007/s10815-016-0713-5

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