Abstract
Background: As regard to adjuvant supplementations, nowadays dehydroepiandrosterone (DHEA) is widely used all over the world and is considered to be a potential agent to ameliorate the assisted reproduction technologies outcomes of infertile women with poor ovarian reserve. Objective: To find out the role of DHEA supplementation in improving intracytoplasmic sperm injection (ICSI) outcome for infertile women with expected poor ovarian response in controlled ovarian stimulation. Setting: Assisted reproduction unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt. Duration: From April 2016 to May 2018. Study Design: A randomized double-blinded controlled trial. Methods: One hundred and forty infertile women with expected poor ovarian response prepared for ICSI procedure were included in this study. Patients were divided into two groups; group I (DHEA group) included 70 patients received 25 mg DHEA 12 weeks prior to ICSI cycle and group II (placebo group) included 70 patients received a placebo. Results: There was a highly statistically significant difference in basal AFC at start of ICSI cycle in group I (who received DHEA supplementation for 12 weeks prior to ICSI procedure) than in group II (13.8 ± 5.3 versus 10.7 ± 4.6 respectively) with P 0.05). Conclusions & Recommendations: DHEA supplementations improved basal AFC, increased the number & quality of oocytes and increased quality of embryos in infertile patients with expected poor ovarian response in ICSI procedure. So DHEA supplementations could be an important adjuvant for infertile women with expected poor ovarian response in ICSI procedure.
Highlights
Assisted reproductive technology (ART) represented mainly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is considered the corner stone in solving infertility problem especially with global increase in obesity which has a negative impact on fertility and ovarian reserve [1]
Infertile women had been defined as poor responders when they had at least two of the following three criteria; 1) women with advanced age (≥40) or the presence of any other risk factor for POR, 2) the presence of previous Poor Ovarian Response, 3) presence of any abnormalities in Ovarian Reserve Tests (ORT) (as antral follicular count (AFC) < 5 - 7 or antimüllerian hormone (AMH) < 0.5 - 1.1 ng/mL)
Many studies has reported the benefits of DHEA in poor responders, but In 2000, Casson et al [3] was the first who reported that DHEA could be used as adjuvant supplementation in poor responders may lead to an enhancement in ovarian response so in this study we tried to emphasize that effect on infertile women underwent ICSI procedure and expected to have poor ovarian response
Summary
Assisted reproductive technology (ART) represented mainly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is considered the corner stone in solving infertility problem especially with global increase in obesity which has a negative impact on fertility and ovarian reserve [1]. Day-3 follicle-stimulating hormone (FSH) was the first test that was introduced in 1988, clomiphene citrate challenge test (CCCT) in 1989, gonadotrophin releasing-hormone (GnRH) agonist in 1989, inhibin B in 1997, antral follicular count (AFC) in 1997, and antimüllerian hormone (AMH) in 2002 Most of these tests have poor predictive values, often for their indirect way for ovarian reserve assessment (e.g. FSH, CCCT and GnRH agonist) they have sometimes intracycle or intercycle variability (e.g. FSH) [14] [15]. As regard to adjuvant supplementations, nowadays dehydroepiandrosterone (DHEA) is widely used all over the world and is considered to be a potential agent to ameliorate the assisted reproduction technologies outcomes of infertile women with poor ovarian reserve. Conclusions & Recommendations: DHEA supplementations improved basal AFC, increased the number & quality of oocytes and increased quality of embryos in infertile patients
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