19 Nov 2009
INTRODUCTION: It is well known that the success rate of I.V.F./I.C.S.I. traditionally diminishes rapidly in all women from age 35 to 45 and this is also associated with a dramatic increase in the pregnancy loss rate due in major part to increased aneuploidy, due to malfunction of the chromosomal spindle.
We previously reported dramatic reduction in the pregnancy loss rates especially in women over 35 years compared to the U.S.A. 2004 national I.V.F. statistics in pregnancies conceived while on DHEA (ASRM 2008). We wished to analyze how effective DHEA co-treatment was in our subgroup of patients undergoing I.F.F. after failed C.O.H./I.U.I.
METHODS: A retrospective cohort study was performed in a private university affiliated fertility center. From the total of 227 patients placed on DHEA between February 2006 and January 1, 2009, we selected only those patients over 35 years of age who required I.V.F./I.C.S.I. as their form of treatment. All these patients were on 25 mg of micronized pharmaceutical grade DHEA T.I.D. until we got a positive B-h.c.g.
RESULTS: Of the 32 patients, 24 were between 35 and 39 years of age inclusive, and 8 were over 40 years of age. The average number of treatment cycles for this group was 1.1 cycles. Of the 32 patients, 28 (87%) became pregnant. Of the 28, one was chemical (3%), three (11%) were early losses (<12 weeks); twelve (43%) were single; eight (29%) were multiple (twins); and four (14%) are still ongoing.
The pregnancy rate in the 35 to 39 year of age group was 92%, and for the over 40 years of age group, the pregnancy rate was 71%. The average age of all 32 patients was 38.1 years of age. The pregnancy rate per cycle started was 37.84%.
CONCLUSIONS: In the subgroup of our 227 patients on DHEA supplementation who failed to get pregnant either solely on DHEA or oral aromatase inhibitors or C.O.H./I.U.I., the prognosis with I.V.F./I.C.S.I. is excellent. This give credence to previously published data from Dr's Gleicher and Barad C.H.R. New York (Yale) that an elevation of the intra-follicular testosterone in older (>35 yrs) women probably improves the function of the chromosomal spindle acting through the mitochondria, thereby reducing the aneuploidy rate. This increased intra-follicular testosterone somehow increases the male to female birth ratio in favor of males. From all our DHEA delivered babies to date, we have a 59% male preponderance, which is in keeping with the Gleicher group findings.
Supported by Toronto West Fertility Center.