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5A - DHEA Is an Effective Treatment for Poor Responders

For

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

Dehydroepiandrosterone (DHEA) is produced primarily from the adrenal gland (85%) under the influence of adrenocorticotropic hormone (ACTH) and to a lesser extent by the ovaries. DHEA is an intermediate in the sex steroid pathway and is converted to testosterone and estradiol within the ovaries. The anti-ageing properties of DHEA were first described in 1996, together with the decline in DHEA with advancing age. In reproductive medicine, DHEA has been hypothesised to play a role in improving folliculogenesis through multiple mechanisms. The first report of a possible benefit from DHEA in an IVF setting was in a case report published in 2005. A 42-year-old woman with an initial diagnosis of reduced ovarian reserve and who had one oocyte retrieved in her first IVF cycle self-medicated concomitantly with over-the-counter DHEA supplements and acupuncture. Her oocyte yield was noted to be steadily increasing with each ovarian stimulation, with 17 oocytes being retrieved after her ninth stimulation attempt.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2021

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References

Nagels, HE, Rishworth, JR, Siristatidis, CS, Kroon, B. Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction. Cochrane Database Syst Rev. 2015 Nov 26.CrossRefGoogle Scholar
Zhang, Y, Zhang, C, Shu, J, et al. Adjuvant treatment strategies in ovarian stimulation for poor responders undergoing IVF: a systematic review and network meta-analysis. Hum Reprod Update. 2020 Feb 28;26(2):247–63.CrossRefGoogle ScholarPubMed
Gleicher, N, Weghofer, A, Barad, DH. Antimullerian hormone (AMH) defines, independent of age, low versus good live birth chances in women with severely reduced ovarian reserve. Fertil Steril. 2010;94:2824–7.CrossRefGoogle Scholar
Homburg, R, Opoku, A. Battle-worn: setting up a multi-centre randomised controlled trial in the UK. BioNews 2018;967.Google Scholar

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