21 Oct 2015
Objective: Treatment of patients with diminished ovarian reserve (DOR) is one of the biggest challenges in assisted reproductive therapeutics. Dehydroepiandrosterone (DHEA) and Coenzyme Q10 (CoQ10) are supplements that have been purported to have a beneficial effect in these patients. Our objective was to compare the effect of combining DHEA and CoQ10 supplementation with DHEA alone in COH and IVF cycles in patients with DOR.
Design: Clinical retrospective study.
Materials and Methods: We extracted data from patients charts treated by DHEA (25mg tid) with/without CoQ10 (600mg daily) in a private infertility clinic between Feb. 2006 to June 2014. Pre-stimulation parameters analyzed included age, BMI, day 3 FSH and antral follicular count (AFC). Ovarian response parameters analyzed included total dose of gonadotropins, peak serum estradiol (E2), follicles number > 16 mm on day of triggering and fertilization rate for IVF cycles. Clinical outcomes analyzed included clinical and ongoing pregnancy rates per cycle initiated.
Results: 797 COH cycles and 253 IVF cycles were included. Of these, 330 COH cycles involved both DHEA and CoQ10 (D+C) and 467 cycles of DHEA (D) alone; 78 IVF cycles involved D+C and 175 D. In both COH and IVF groups, AFC was significantly higher with D+C compared to D alone (7.4±5.7 vs. 5.9±4.7 and 8.2±6.3 vs. 5.2±5, respectively, p 16 mm on the trigger day during COH cycles (3.3±2.3 vs. 2.9±2.2, respectively, p=0.01), but no difference was observed in IVF cycles (5.5±3.5 vs.5.9±4.6, p=0.4). There was lower gonadotropin consumption during D+C IVF cycles compared with D cycles (3,414±1141 IUs vs. 3,877±1143 IUs respectively, p=0.032) without difference in the COH comparison. For COH cycles there was no difference in clinical or ongoing pregnancy rates in the D+C vs. D groups (8.1 vs. 10.9, p=0.2 and 6.2 vs. 8.2, p=0.3, respectively). Similarly, there was no difference regarding clinical or ongoing pregnancy rates in the D+C vs. D groups in the IVF cycles (25.1 vs. 29.5, p=0.5 and 21.1 vs. 23.1, p=0.7, respectively).
Conclusions: Combined DHEA and CoQ10 supplementation significantly increases the AFC compared to DHEA alone, which lead to a higher ovarian responsiveness during both COH and IVF, but without a difference in pregnancy rate.