Human Reproduction, Vol. 15, No. 10, 2129-2132,
October 2000
© 2000 European Society of Human Reproduction and Embryology
Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: a case series
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine,6550 Fannin, Suite 801, Houston, Texas 77030, USA
In patients with poor response to ovarian stimulation with gonadotrophins, growth hormone (GH) is sometimes used to increase paracrine insulin-like growth factor-1 (IGF-1) effect. We postulated that dehydroepiandrosterone (DHEA) administration to poor responders would augment gonado-trophin effect via a similar mechanism. Baseline ovarian stimulation response to a cycle with DHEA in five healthy non-smoking women <41 years old was compared with day 3 FSH <20 mIU/ml. All had documented poor response to vigorous gonadotrophin administration. After day 2 ultrasounds, DHEA-sulphate (DHEA-S), FSH, human chorionic gonadotrophin (HCG), and testosterone were measured, and the women were given 80 mg/day of oral micronized DHEA for 2 months. While still on DHEA, they underwent ovarian stimulation with FSH given i.m. twice a day, and HCG (10 000 IU) at follicular maturity, followed by intrauterine insemination. Cycle parameters assessed were peak oestradiol, and peak oestradiol/ampoule. The DHEA/ovarian stimulation cycles occurred between 4 and 24 months after the control cycles. After 2 months DHEA treatment, DHEA-S increased to 544 ± 55 µg/dl, and testosterone increased to 67.3 ± 6.1 ng/dl. All five subjects (six cycles; one subject had two DHEA cycles) had increased responsiveness; peak oestradiol concentrations increased from 266.3 ± 69.4 pg/ml to 939.8 ± 418.9 pg/ml. The oestradiol/ampoule ratio increased in all six cycles, by a mean of 2.94 ± 0.50 fold (P = 0.012). One of the cycles resulted in a delivered twin pregnancy. In this small series, DHEA improved response to ovarian stimulation even after controlling for gonadotrophin dose. Supplemental DHEA treatment during ovarian stimulation may represent a novel way to maximize ovarian response.
Key words: androgens/dehydroepiandrosterone/gonadotrophins/ovarian stimulation/poor responders
1 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, University of Vermont, Burlington,VT 05405, USA. E-mail: pcasson{at}vtmednet.org
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