title: Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: a case series.
abstract: 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 microg/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.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine,6550 Fannin, Suite 801, Houston, Texas 77030, USA. pcasson@vtmednet.org
authors.forename: P R
authors.initials: PR
authors.lastname: Casson
authors.forename: M S
authors.initials: MS
authors.lastname: Lindsay
authors.forename: M D
authors.initials: MD
authors.lastname: Pisarska
authors.forename: S A
authors.initials: SA
authors.lastname: Carson
authors.forename: J E
authors.initials: JE
authors.lastname: Buster
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000494:pharmacology; D003687:Dehydroepiandrosterone / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000494:pharmacology; D006728:Hormones / Q000097:blood; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood
chemical_list: D006063:Chorionic Gonadotropin; D006728:Hormones; D013739:Testosterone; D003687:Dehydroepiandrosterone; D004958:Estradiol; D005640:Follicle Stimulating Hormone