19 Nov 2009
OBJECTIVE: To investigate the effect of dehydroepiandrosterone (DHEA) pre- and co-treatment on improving the outcome of IUI.
METHODS: This was a multicenter retrospective case control study conducted in an academically afilliated private infertility centers.
Patient(s): Forty infertile women with previous low ovarian response but with normal basal FSH (4.3-10.0 IU/ml) were treated with 75 mg oral DHEA per day for at least 60 days prior to and during controlled ovarian stimulation (COS) by FSH together with IUI. A control group of 99 infertile women matched for age and basal FSH were treated with the same COS protocol without DHEA pre or co-treatment.
Main outcome measures: pregnancy rate, basal antral follicle count, no. of mature follicles, serum levels of E2, P, LH, endometrial thickness, no. of FSH units used, pregnancy rate (PR) and overall costs per cycle.
RESULTS: Pregnancy rate was significantly higher in the DHEA group compared with controls (14/30 versus 9/99, respectively) RR 5.385 (CI 2.1-13.8). DHEA treatment resulted in significantly more basal antral follicles (mean) compared with controls (2.9 versus 1.5 follicles, respectively). The number of mature follicles was not significantly different between the two study groups but the mean progesterone, estradiol and E2 level /mature follicle were higher in the DHEA group compared with the controls. Endometrial thickness on the day of HCG injection was not significantly different between the two groups. The total number of FSH units and the overall cost /cycle was higher in the DHEA group compared with the controls.
CONCLUSION: The pregnancy rate was significantly higher in the DHEA group compared to the control group, particularly in older women 36-40 and > 40 years. DHEA treatment prior to and during COS improved ovulation indices and pregnancy rates of IUI cycles. However it may increase the total units of FSH needed and overall cost per cycle. A properly designed randomized controlled trial is needed to address this question.