19 Nov 2009
INTRODUCTION: The first reported benefit of the fertility of older women with elevated day 3 F.S.H. levels with the use of exogenously administered DHEA was by Casson et al, in 2000. From 2005 onward, Dr's. Gleicher and Barad from Yale University, N.Y. published several articles on this same theme.
We previously reported dramatic reduction in 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 (SSRM 2008). We wished to analyze how effective DHEA co-treatment was in our subgroup of patients undergoing 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 require C.O.H. / I.U.I. as their form of treatment. All these patients ere on 25 mg of micronized pharmaceutical grade DHEA T.I.D. until we got a positive pregnancy test.
RESULTS: Of the 38 patients who underwent C.O.H. / I.U.I., we had 21 pregnancies for an overall rate of 55%. Of these 21 pregnancies, 2 were chemical, 6 early pregnancy losses, 3 multiple and 10 singleton pregnancies, for a pregnancy rate per cycle started of 27.6%. Average number of cycles per patient was 2.1 and the average age of all patients was 40.2 years.
CONCLUSIONS: With these difficult patients, namely, poor ovarian responders aged 35 years, those who do not get pregnant on DHEA alone, or DHEA with an aromatase inhibitor, one should consider doing C.O.H./I.U.I. before proceeding to I.V.F. or using donor ova. The cumulative pregnancy rate compares very favorably and treatment is less invasive and more cost effective than proceeding directly to I.V.F.
Supported by Toronto West Fertility Center.