title: Dehydroepiandrosterone plus climen supplementation shows better effects than dehydroepiandrosterone alone on infertility patients with diminished ovarian reserve of low-FSH level undergoing in-vitro fertilization cycles: a randomized controlled trial.
abstract: BACKGROUND
  This study aimed to assess the effect of dehydroepiandrosterone (DHEA) plus climen (estradiol valerate and cyproterone acetate drug combination) on infertility patients with diminished ovarian reserve (DOR) and to determine if the combination of DHEA plus climen is superior to DHEA alone in improving ovarian response.
  
  
  METHODS
  A total of 124 women were randomized into the DHEA group (n = 64) and the DHEA plus climen group (n = 60) for 12 weeks before being subjected to in-vitro fertilization (IVF) cycles. To investigate if there is a FSH-related difference on the effect of the addition of climen, the DHEA group and the DHEA plus climen group were further divided into four subgroups according to a basal FSH level cut-off of 10 mIU/ml. We performed a comparison of Day 3 blood samples before and after treatment and IVF outcome parameters, including AMH, FSH, E2, AFC, oocytes retrieved, MII oocyte numbers, embryo numbers and accumulated embryo scores.
  
  
  RESULTS
  After 12 weeks of pretreatment, the DHEA plus climen group demonstrated a significantly higher level of AMH (P = 0.001) and a significantly lower level of FSH (P = 0.001) compared with the DHEA group. When the two groups were divided into four subgroups based on the FSH cut-off of 10 mIU/mL, a significant increase of AMH (P = 0.034) was found in the high-FSH DHEA plus climen group, whereas there was no significant difference in the high-FSH DHEA group (P = 0.322). A significantly higher accumulated score of embryos was observed in the low-FSH DHEA plus climen group compared with the low-FSH DHEA group (P = 0.034).
  
  
  CONCLUSIONS
  These observations suggest that patients with DOR of a low-FSH level might benefit more from DHEA plus climen supplementation than from DHEA supplementation alone.
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. 413959928@qq.com.|Hangzhou Women's Health Hospital, Zhejiang, China. 413959928@qq.com.
authors.forename: Huanhuan
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. 747634147@qq.com.
authors.forename: Yaping
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. zhoup_325@aliyun.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. hxj0117@126.com.
authors.forename: Xiaojin
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. 13721020782@139.com.
authors.forename: Qianhua
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. zzg_100@163.com.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. caoyunxia6@126.com.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Reproductive Endocrinology, The Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China. weizhaolian_1@126.com.
authors.forename: Zhaolian
authors.initials: Z
authors.lastname: Wei
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D017373:Cyproterone Acetate / Q000008:administration & dosage / Q000627:therapeutic use*; D003687:Dehydroepiandrosterone / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C103294:estradiol valerate, cyproterone acetate drug combination; D003687:Dehydroepiandrosterone; D017373:Cyproterone Acetate; D004958:Estradiol; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone