Published Research > Sonia Blanco Mejia and Edward A.J. Ryan. Pregnancy rates in poor-ovarian-response patients undergoing conventional IVF treatment supplemented with dehydroepiandrosterone and coenzyme Q10. 31st Annual Research Day & Henderson lecture, Department of Obstetrics and Gynecology, University of Toronto. May 11th, 2014.


9 May 2014

Objective:
To analyze differences in pregnancy rate (PR), pregnancy loss rate (PLR) and live birth rate (LBR) in women with poor ovarian response (POR) undergoing conventional IVF treatment with the addition of dehydroepiandrosterone (DHEA) or DHEA + Coenzyme Q10 (DHEA+CoQ10).
Methods:
We conducted a retrospective cohort study (Feb 2006-Feb 2014). We included women with POR as per the Bologna criteria.1 All of these patients had failed to get pregnant on several cycles of COS-IUI. IVF cycles were performed using day 3 agonist flare protocol, a dose of 300-450 IU FSH per day and 10,000 IU of HCG when lead follicle was between 1.8-2.2 cm. Transvaginal ultrasounds for antral follicle count (AFC) and follicle size were performed during the monitoring period, as well as  blood  for hormone levels. PR per embryo transferred (PR/ET), PLR, and LBR/ET were determined. Equality of means was tested using two-sample t-test, Fisher’s exact test was used to test for the association of categorical variables, statistical analyses were done using Stata version 11. Results are given in means ± SD for age, FSH, BMI and months on DHEA, and in percentages (%) for cancellation rate, PR/ET, PLR, and LBR/ET. Statistical significance was set at p < 0.05 level.
Results:
We included 118 women, 92 on DHEA and 26 on DHEA+CoQ10 who underwent a total of 198 IVF cycles. From those 198 IVF cycles, 150 were on DHEA and 48 were on DHEA+CoQ10. Baseline characteristics were not significantly different between the DHEA and DHEA+CoQ10 groups, age 39.5 ± 3.5 years vs. 40.1 ± 2.2 years, p = 0.257; FSH 10 ± 4.9 mIU/ml vs. 11.1 ± 7.2 mIU/ml, p = 0.115; and BMI 23.9 ± 3.6 kg/m2 vs. 24.5 ± 4.1 kg/m2, p = 0.161, respectively. The average duration of DHEA pre-treatment was 7.3 ± 5.1 months for the DHEA group, versus 10.8 ± 6.9 months for the DHEA + CoQ10 group (p < 0.001). There was no statistical difference between the DHEA and the DHEA+CoQ10 groups for cancellation rate (26% vs 39.6%, p = 0.100), PR/ET (35.1% vs 41.4%, p = 0.526), PLR (23.1% vs. 41.7%, p = 0.272), and LBR/ET (27% vs 24.1%, p = 0.818).
 
 
Conclusion:
The addition of CoQ10 to DHEA in women with POR undergoing conventional IVF treatment does not seem to have a beneficial effect over DHEA alone.  The administration of DHEA to conventional IVF treatment resulted in an acceptable LBR/ET in this poor prognosis group of patients perhaps due to a lower aneuploidy rate and better spindle quality at time of first meiotic division. A LBR of 27% or 24% per ET is very acceptable in this advance age group with POR,2-5  and compares well with the only RCT on POR patients undergoing IVF with DHEA.6
References:
1.-Ferraretti AP, La Marca A, Fauser BC, et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26:1616-24.
2.-Elizur SE, Lerner-Geva L, Levron J, Shulman A, Bider D, Dor J. Cumulative live birth rate following in vitro fertilization: study of 5,310 cycles. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2006;22:25-30.
3.-Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84:435-45.
4.-Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009;360:236-43.
5.-Olivius K, Friden B, Lundin K, Bergh C. Cumulative probability of live birth after three in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2002;77:505-10.
6.-Wiser A, Gonen O, Ghetler Y, Shavit T, Berkovitz A, Shulman A. Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod. 2010;25:2496-500.