title: Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR).
abstract: BACKGROUND
  With infertility populations in the developed world rapidly aging, treatment of diminished ovarian reserve (DOR) assumes increasing clinical importance. Dehydroepiandrosterone (DHEA) has been reported to improve pregnancy chances with DOR, and is now utilized by approximately one third of all IVF centers world-wide. Increasing DHEA utilization and publication of a first prospectively randomized trial now warrants a systematic review.
  
  
  METHODS
  PubMed, Cochrane and Ovid Medline were searched between 1995 and 2010 under the following strategy: [<dehydroepiandrosterone or DHEA or androgens or testosterone > and <ovarian reserve or diminished ovarian reserve or ovarian function >]. Bibliographies of relevant publications were further explored for additional relevant citations. Since only one randomized study has been published, publications, independent of evidence levels and quality assessment, were reviewed.
  
  
  RESULTS
  Current best available evidence suggests that DHEA improves ovarian function, increases pregnancy chances and, by reducing aneuploidy, lowers miscarriage rates. DHEA over time also appears to objectively improve ovarian reserve. Recent animal data support androgens in promoting preantral follicle growth and reduction in follicle atresia.
  
  
  CONCLUSIONS
  Improvement of oocyte/embryo quality with DHEA supplementation potentially suggests a new concept of ovarian aging, where ovarian environments, but not oocytes themselves, age. DHEA may, thus, represent a first agent beneficially affecting aging ovarian environments. Others can be expected to follow.
authors.affiliation: Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, NY, USA. ykizawa@thechr.com
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000818:Animals; D002452:Cell Count; D003687:Dehydroepiandrosterone / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D010053:Ovary / Q000187:drug effects / Q000473:pathology; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data
chemical_list: D005300:Fertility Agents, Female; D003687:Dehydroepiandrosterone