title: Dehydroepiandrosterone as an adjunct to gonadotropins in infertile Indian women with premature ovarian aging: A pilot study.
abstract: BACKGROUND
  Dehydroepiandrosterone (DHEA) supplementation is a relatively recent development that augments ovarian responsiveness in patients with poor ovarian reserve and premature ovarian aging (POA).
  
  
  OBJECTIVE
  To evaluate the efficacy of DHEA supplementation prior to gonadotropins for ovulation induction in women with POA.
  
  
  METHODS
  Prospective randomized controlled study.
  
  
  METHODS
  Fifty infertile women with POA were randomized into two groups of 25 each. Group 1 received tablet DHEA 25 mg while group 2 received placebo thrice daily for 6 months. After 3 months, gonadotropin induction with intrauterine insemination was done.
  
  
  METHODS
  Groups were compared using t-test and Mann-Whitney U-test as appropriate. Pre- and post-parameters were compared using t-test -paired and Wilcoxon signed-rank tests as appropriate.
  
  
  RESULTS
  Of 50 patients, 62% (31/50) presented with primary and 38% (19/50) with secondary infertility. The mean age was 32.1 ± 4.7 years. Serum antimullerian hormone levels (1.5 ± 0.6-1.9 ± 0.4 ng/ml vs. 1.4 ± 0.5-1.5 ± 0.6 ng/ml) and antral follicle count (3.2 ± 1.0-9.3 ± 3.1 vs. 3.3 ± 1.1-3.4 ± 1.4) improved significantly in DHEA group after 3 months. Serum follicular stimulating hormone and estradiol levels though showed significant intra-group improvement (16.9 ± 5.5 mIU/ml to 14.7 ± 6.2 mIU/ml and 86.6 ± 57.5 pg/ml to 105.6 ± 54.3 pg/ml, respectively) with DHEA, the inter group difference was not significant. Ovulation increased from 48% to 86.3% in DHEA group versus 44-66% in placebo group. Six women (24%) conceived after DHEA in comparison to none in the placebo group.
  
  
  CONCLUSIONS
  DHEA supplementation may have a beneficial role as an adjunct to gonadotropins in the treatment of infertility with POA, but further evidence is required.
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nisha
authors.initials: N
authors.lastname: Malik
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Kriplani
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nutan
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhatla
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Garima
authors.initials: G
authors.lastname: Kachhawa
authors.affiliation: Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Yadav
keywords: Antimullerian hormone; dehydroepiandrosterone; premature ovarian aging