Pregnancy Rates in Women with Diminished Ovarian Reserve (DOR) Undergoing IVF. A 10 Year Experience Using DHEA Supplementation

Introduction: DHEA has been suggested to have a beneficial effect on implantation, pregnancy rate and to reduce pregnancy loss rates, but its recommendation is still controversial. Our objective is to report pregnancy rate per embryo transfer (PR/ET), clinical pregnancy rate per ET (CPR/ET) and live birth rate (LBR) in women with DOR undergoing IVF treatment with DHEA supplementation.

Methods: In a retrospective study (February 2006-February 2016), we collected information on 166 DHEA-supplemented IVF cycles in women with DOR. We excluded cycles in women ≥44 years old, frozen cycles, and donor cycles. We divided the cycles by age groups: <35yo, 35-39yo, and 40-≤43yo. PR/ET included chemical pregnancies. CPR/ET was defined as an intra uterine pregnancy on ultrasound at 4 weeks post ET. Statistical analyses were performed using STATA version 11.1.

Results: A total of 166 DHEA-supplemented IVF cycles were included, 25 cycles in women <35yo, 71 cycles in women 35-39yo, and 70 cycles in women 40-≤43yo. For the three different age groups, the cancellation rate was 20%(n=5), 19.7%(n=14), and 25.7%(n=18). Even though the PR/ET was not statistically significant amongst the age groups, 30%(n=6), 50.9%(n=28), and 31.4%(n=16), p=0.08, we did see a beneficial trend for the 35-39yo group. The CPR/ET was 25%(n=5), 47.3%(n=26), and 31.4%(n=16), p=0.11. The LBR was 20%(n=4), 36.4%(n=20), 21.6%(n=11), p=0.17.

Conclusion: The use of DHEA supplementation in our 10-year practice experience in women with DOR undergoing IVF treatment had no statistical significance on PR/ET, CPR/ET and LBR. However, the CPR/ET was higher in our clinic than in the reported Canadian ART (CARTR) 2013 registry for women at risk for DOR (40-42 years old [23.4%]). Overall, the use of DHEA in women with DOR undergoing IVF treatment should not be dismissed and should be investigated in randomized well controlled trials.