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Meta-Analysis
. 2023 Jun 9:14:1156280.
doi: 10.3389/fendo.2023.1156280. eCollection 2023.

Efficacy of dehydroepiandrosterone priming in women with poor ovarian response undergoing IVF/ICSI: a meta-analysis

Jie Zhang  1 , Hongyan Jia  1   2 , Feiyang Diao  1 , Xiang Ma  1 , Jiayin Liu  1 , Yugui Cui  1
Affiliations
Meta-Analysis

Efficacy of dehydroepiandrosterone priming in women with poor ovarian response undergoing IVF/ICSI: a meta-analysis

Jie Zhang et al. Front Endocrinol (Lausanne). .

Abstract

Background: Dehydroepiandrosterone (DHEA) may improve the outcomes of patients with poor ovarian response (POR) or diminished ovarian reserve (DOR) undergoing IVF/ICSI. However, the evidence remains inconsistent. This study aimed to investigate the efficacy of DHEA supplementation in patients with POR/DOR undergoing IVF/ICSI.

Methods: PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) were searched up to October 2022.

Results: A total of 32 studies were retrieved, including 14 RCTs, 11 self-controlled studies and 7 case-controlled studies. In the subgroup analysis of only RCTs, DHEA treatment significantly increased the number of antral follicle count (AFC) (weighted mean difference : WMD 1.18, 95% confidence interval(CI): 0.17 to 2.19, P=0.022), while reduced the level of bFSH (WMD -1.99, 95% CI: -2.52 to -1.46, P<0.001), the need of gonadotropin (Gn) doses (WMD -382.29, 95% CI: -644.82 to -119.76, P=0.004), the days of stimulation (WMD -0.90, 95% CI: -1.34 to -0.47, P <0.001) and miscarriage rate (relative risk : RR 0.46, 95% CI: 0.29 to 0.73, P=0.001). The higher clinical pregnancy and live birth rates were found in the analysis of non-RCTs. However, there were no significant differences in the number of retrieved oocytes, the number of transferred embryos, and the clinical pregnancy and live birth rates in the subgroup analysis of only RCTs. Moreover, meta-regression analyses showed that women with lower basal FSH had more increase in serum FSH levels (b=-0.94, 95% CI: -1.62 to -0.25, P=0.014), and women with higher baseline AMH levels had more increase in serum AMH levels (b=-0.60, 95% CI: -1.15 to -0.06, P=0.035) after DHEA supplementation. In addition, the number of retrieved oocytes was higher in the studies on relatively younger women (b=-0.21, 95% CI: -0.39 to -0.03, P=0.023) and small sample sizes (b=-0.003, 95% CI: -0.006 to -0.0003, P=0.032).

Conclusions: DHEA treatment didn't significantly improve the live birth rate of women with DOR or POR undergoing IVF/ICSI in the subgroup analysis of only RCTs. The higher clinical pregnancy and live birth rates in those non-RCTs should be interpreted with caution because of potential bias. Further studies using more explicit criteria to subjects are needed.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42022384393.

Keywords: dehydroepiandrosterone; diminished ovarian reserve; fertilization in vitro; poor ovarian response; pregnancy outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of the study selection procedure.
Figure 2
Figure 2
Forest plots of clinical outcomes. (A) Clinical pregnancy rate; (B) Live birth rate; (C) Miscarriage rate.
Figure 3
Figure 3
Forest plots of ovarian reserve markers. (A) AFC; (B) AMH; (C) FSH.
Figure 4
Figure 4
Forest plots of variables during IVF procedure. (A) Total doses of gonadotropin; (B) Days of stimulation; (C) E2 level on the day of hCG administration; (D) Endometrial thickness.
Figure 5
Figure 5
Forest plots of oocytes and embryo yields. (A) Number of oocytes retrieved; (B) Number of embryos transferred.
Figure 6
Figure 6
Association between study’s individual effect sizes for the number of oocytes retrieved and (A) baseline age of women; (B) sample size of trials. Plotting characters are proportional to the study weight.
See this image and copyright information in PMC

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