The Effect of Dehydroepiandrosterone (DHEA) Supplementation on IVF or ICSI: A Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction A systematic review and meta-analysis were conducted to evaluate the efficacy of dehydroepiandrosterone (DHEA) supplementation in patients with diminished ovarian reserve (DOR) and/or poor ovarian response (POR) who were undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).

Patients and Methods We searched the PubMed, EMBASE, Web of Science, and Cochrane Library electronic databases for literature published until July 2018. The analysis included randomized controlled trials (RCTs) of the effects of DHEA versus placebo on IVF or ICSI. Two independent reviewers extracted information from the reports and evaluated the quality of the studies. Overall, we identified nine prospective RCTs involving 833 patients.

Results Compared to the controls, patients treated with DHEA exhibited increases in the number of retrieved oocytes (mean difference, 0.91; 95% confidence interval [CI], 0.23 – 1.59; p = 0.009), clinical pregnancy rate (relative risk [RR] = 1.27; 95% CI, 1.01 – 1.61; p = 0.04), and live birth rate (RR, 1.76; 95% CI, 1.17 – 2.63; p = 0.006). However, there was no intergroup difference in the miscarriage rate (RR, 0.37; 95% CI, 0.12 – 1.13; p = 0.08).

Conclusion DHEA supplementation improved the outcomes of IVF/ICSI in women with DOR or POR.

Zusammenfassung

Einleitung Es wurde eine systematische Überprüfung und eine Metaanalyse durchgeführt, um die Wirksamkeit der Dehydroepiandrosterone-(DHEA-)Supplementierung zu bewerten bei Patientinnen mit eingeschränkter ovarieller Reserve (DOR) und/oder unzureichender ovarieller Reaktion (POR), die sich einer In-vitro-Fertilisation bzw. einer intrazytoplasmatischen Spermieninjektion (IVF/ICSI) unterzogen.

Patientinnen und Methoden In einer Literaturrecherche wurde in den elektronischen Datenbanken von PubMed, EMBASE, Web of Science und der Cochrane Library nach Literatur gesucht, die vor Juli 2018 zu diesem Thema veröffentlicht worden war. In die Analyse aufgenommen wurden randomisierte kontrollierte Studien (RCTs), welche die Auswirkungen von DHEA auf IVF und ICSI mit Placebo verglichen. Die Studiendaten wurden von 2 unabhängigen Beurteilern gesammelt, die auch die Qualität der jeweiligen Studien evaluierten. Insgesamt konnten wir 9 prospektive RCTs mit insgesamt 833 Patientinnen ausfindig machen.

Ergebnisse Verglichen mit den jeweiligen Kontrollgruppen, nahm bei den mit DHEA behandelten Patientinnen die Anzahl gewonnener Eizellen zu (Mittelwertdifferenz, 0,91; 95%-Konfidenzintervall [KI], 0,23 – 1,59; p = 0,009); die klinische Schwangerschaftsrate (relatives Risiko [RR] = 1,27; 95%-KI, 1,01 – 1,61; p = 0,04) und die Lebendgeburtenrate (RR, 1,76; 95%-KI, 1,17 – 2,63; p = 0,006) nahmen ebenfalls zu. Es gab aber keine Differenz zwischen den Gruppen in Bezug auf die Fehlgeburtenrate (RR, 0,37; 95%-KI, 0,12 – 1,13; p = 0,08).

Schlussfolgerung Die DHEA-Supplementierung trug zu einer Verbesserung des Outcomes nach IVF/ICSI bei Frauen mit DOR oder POR bei.

Key words

dehydroepiandrosterone (DHEA) - diminished ovarian reserve (DOR) - poor ovarian response (POR) - in vitro fertilization (IVF) - intracytoplasmic sperm injection (ICSI)

Schlüsselwörter

Dehydroepiandrosteron (DHEA) - eingeschränkte ovarielle Reserve (DOR) - schlechte ovarielle Reaktion (POR) - In-vitro-Fertilisation (IVF) - intrazytoplasmatische Spermieninjektion (ICSI)

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