Published Research > E.A.J. Ryan, E.A. Claessens, S. Blanco Mejia. Pregnancy rates in patients with diminished ovarian reserve (DOR) treated with dehydroepiandrosterone (DHEA) some with coenzyme Q10 (CoQ10). Meeting of the American Society of Reproductive Medicine, Boston, USA. October 2013.


14 Oct 2013

OBJECTIVE: To analyze the difference in pregnancy rates and live birth rates (LBR) in women with DOR or premature ovarian insufficiency (POI) treated with DHEA or DHEA+CoQ10, undergoing in vitro fertilization (IVF) cycles.

MATERIALS AND METHODS: We conducted a historical and prospective cohort study. We included women between 35-43 yrs age  who had DOR/POI as per the Bologna criteria 19.  IVF cycles were performed using day 3 agonist flare protocol, a dose of 300-450 IU FSH per day, split doses and 10,000 IU of HCG was given when lead follicle was 1.8-2.2 cm. Transvaginal ultrasounds for antral follicle count (AFC) day 3 FSH and LH levels. Follicle size and routine endocrine  hormone levels were measured during the stimulation period. Patients were taking 75 mg/day of DHEA for an average of 9.8 months prior to their IVF cycle. CoQ10 dose was 600 mg/d. Pregnancy rates and LBR per embryo transfer (PR/ET, LBR/ET) and  pregnancy loss rates (PLR) were calculated. Chi square test was calculated using Microsoft excel 2010 to test for the association of PR/ET, LBR/ET and PLR between groups,  t-test was used to detect significant differences at baseline for age, day 3 FSH, BMI and AFC between groups, p<0.05 was considered significant. Results are given in Mean ± SD or percentage (%).

RESULTS: We included 99 women (78 on DHEA and 21 on DHEA+CoQ10) who underwent a total of 168 IVF cycles. Baseline characteristics were similar, with significant difference for AFC only, 4.9 ± 4.6 for the DHEA group and 9.5 ± 7.7 for the DHEA+CoQ10 group (p <0.01) (Table 1). LBR/ET was statistically significant in the DHEA group alone compared to the DHEA+CoQ10 group (p<0.001). Nonetheless, there was no statistical difference observed for PR/cycle started, PR/ET or PLR (table 2 and graph).

CONCLUSION: Starting at age 35 there is a gradual reduction in fecundity down to age 46yrs. Even though we have all delivered women older than 46 yrs who got pregnant with their own oocytes, it is rare1. Decreasing pregnancy rates per cycle whether treated with Oral fertility Meds, COH/IUI or IVF all decrease significantly from age 35 to 462-9.

Casson10 in 2000 was the first to suggest that exogenous androgens could possibly improve fertility in older women or those with DOR/POI. It was not until Gleicher and Barad’s group in 200511 and subsequently Shulman12, Mamas and Mamas13, 14 and many others around the world , published similar papers,  did this concept gain acceptance, to the state  now that over 30% of world wide IVF centers use exogenous androgens in patients of any age with DOR/POI. “When too old15” to get pregnant with one’s own eggs have opened an avenue of treatment that  up to now recommended using donor eggs.
Bentov in his early publications on the use of mitochondrial nutrients in mice, opened another avenue for improving cell biology16-18. We have been very impressed with the concomitant use of DHEA with CoQ10 in our patients aged 35 to 40yrs age undergoing COH/IUI with a LBR/IUI cycle of 8.1( DHEA alone ) versus 14.3 (DHEA + CoQ10)  in  241 cycles in 114 patients presented at CFAS Victoria 2013. We had a twin pregnancy rate/IUI of 2.7 and 4.8%  confirming the DOR/POI status of these patients who satisfied the Bologna criteria19. Note the consistent 2/1 ratio of FSH to LH on day 3 of cycle, on average for all patients20. We expected to see the same dramatic improvement in our IVF subset with DOR/POI.  
The addition of CoQ10 to DHEA in women with DOR/POI undergoing IVF treatment did not seem to have a beneficial effect over DHEA alone.  However, administration of DHEA or DHEA + CoQ10 results in an acceptable LBR/ET in this poor prognosis group of patients in comparison with world-wide statistics. 
 
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ACKNOWLEDMENTS: We thank Ferring Canada for the unrestricted grant for this study.
Special thanks to Dr. Zohreh Nazemian for helping with statistical analyses.