title: DHEA supplementation may improve IVF outcome in poor responders: a proposed mechanism.
abstract: OBJECTIVE
  Dehydroepiandrosterone (DHEA) supplementation for poor responders may improve ovarian response and IVF treatment outcome. This study aimed to determine the mechanism of action of DHEA, and specifically, the stage of folliculogenesis influenced by DHEA.
  
  
  METHODS
  This is a prospective, self-controlled study of poor responders to IVF treatment, comparing day 3 biochemical (anti-Mullerian hormone (AMH), inhibin B and FSH) and ultrasound (antral follicle count (AFC)) ovarian reserve markers and IVF treatment outcome before and after DHEA supplementation of at least 3 months duration.
  
  
  RESULTS
  Thirty-two women were included. Following DHEA, there was a significant increase in AFC (P=0.0003) without significant changes in the baseline biochemical parameters AMH, inhibin B, or FSH. The enhanced response comprised increased peak estradiol levels (P=0.0005), number of follicles >15 mm, oocytes, MII oocytes and embryos (P=0.004, P=0.00001, P=0.0004 and P=0.0006, respectively) and oocytes number/total FSH dose (P=0.0009). The proportion of cancelled cycles due to very poor response decreased significantly (P=0.02).
  
  
  CONCLUSIONS
  DHEA does not appear to exert influence via recruitment of pre-antral or very small antral follicles (no change in AMH and inhibin B) but rather by rescue from atresia of small antral follicles (increased AFC).
authors: IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem 91031, Israel. drjordanahyman@gmail.com
authors: Jordana H
authors: JH
authors: Hyman
authors: Ehud J
authors: EJ
authors: Margalioth
authors: Ron
authors: R
authors: Rabinowitz
authors: Avi
authors: A
authors: Tsafrir
authors: Michael
authors: M
authors: Gal
authors: Sarah
authors: S
authors: Alerhand
authors: Nurit
authors: N
authors: Algur
authors: Talia
authors: T
authors: Eldar-Geva
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D003687:Dehydroepiandrosterone / Q000627:therapeutic use*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: C422364:inhibin B; D003687:Dehydroepiandrosterone; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone