Evaluation of Dehydroepiandrosterone Supplementation on Diminished Ovarian Reserve: A Randomized, Double-Blinded, Placebo-Controlled Study

Abstract

Introduction: We conducted a randomized, double-blinded, placebo-controlled study, to evaluate the effect of dehydroepiandrosterone (DHEA), on diminished ovarian reserve (DOR).

Materials and methods: Twenty patients with DOR received DHEA (oral 25 mg three times a day). Post-supplementation 12 weeks, D2/3 age-specific follicle-stimulating hormone (FSH), anti-mullerian hormone (AMH) levels, and antral follicle count (AFC), were repeated to evaluate response. Spontaneous pregnancy rates and regularization of menstrual cycles were also studied as secondary outcome.

Results: Predominant risk factors were age >35 years (28 %) and poor responders to ovarian stimulation (23 %). There was significant improvement of AMH levels (1.15 ± 1.49 vs. 1.53 ± 1.62) found before and after supplementation in the DHEA group. When the AMH values between DHEA and placebo group were compared, pre- and post-supplementation, no significant difference was found. There was decrease in FSH levels and increase in AFC value post-supplementation in both DHEA and placebo groups which was not statically significant. DHEA supplementation benefited clinically, as evidenced by the improvement in the menstrual abnormality spontaneous conception in two cases each.

Conclusions: A significant improvement in AMH levels pre- and post-supplementation of DHEA was noted. The same was not seen for FSH and AFC values.

Keywords: Anti-mullerian hormone; Antral follicle count; Dehydroepiandrosterone; Diminished ovarian reserve; FSH.

Fig. 1

Consort statement and methodology. *High-risk factors in infertile patients, who were subjected to tests of ovarian reserve, were age >35 years, previous ovarian surgery, family history of premature ovarian failure, poor responders to standard ovulation induction protocol, with clomiphene or gonadotrophins, suspected unexplained infertility. ^#DOR: Any one criteria for diagnosis of diminished ovarian reserve (DOR) in cases of infertility were [, –12]. (1) Age-specific FSH levels using the ELFA technique (enzyme-linked fluorescent assay) (>7 mIU/ml for age <33 years; >7.9 mIU/ml for age 33–37 years; >8.4 mIU/ml for age >38 years). (2) AMH levels done using the AMH Gen II enzyme-linked immunosorbent assay <1.05 ng/ml. (3) Sonographic antral follicle count AFC ≤ 4. The diameter of the follicle in the range of 2–10 mm was counted in both ovaries and added to give total antral follicle count