Is there a role for DHEA supplementation in women with diminished ovarian reserve?

PURPOSE: Poor ovarian reserve and poor ovarian response presents a challenge to IVF centers. Dehydroepiandrosterone (DHEA) supplementation is increasingly being used by many IVF centers around the world in poor responders despite the lack of convincing data. We therefore examined the rationale for the use of DHEA in poor responders, address the relevant studies, present new data, and address its potential mechanisms of action. METHODS: All published articles on the role of DHEA in infertile women from 1990 to April 2013 were reviewed. RESULTS: Several studies have suggested an improvement in pregnancy rates with the use of DHEA. Potential mechanisms include improved follicular steroidogenesis, increased IGF-1, acting as a pre-hormone for follicular testosterone, reducing aneuploidy, and increasing AMH and antral follicle count. While the role of DHEA is intriguing, evidence-based recommendations are lacking. CONCLUSIONS: While nearly 25 % of IVF programs use DHEA currently, large randomized prospective trials are sorely needed. Until (and if) such trials are conducted, DHEA may be of benefit in suitable, well informed, and consented women with diminished ovarian reserve

Racial differences in ART outcome between white and South Asian women

Objective: Racial differences in ART outcome have been previously reported in white compared to ethnic minorities, with larger studies showing better ART outcome in white compared with all the minority groups. Only one study assessed the outcome differences between whites and South Asians in the US, which showed a poorer outcome in South Asians despite similar embryo quality. Design: Retrospective. Patient(s): 238 Cycles in white women compared to 54 cycles in South Asians undergoing blastocyst transfers at a single private ART center. Intervention(s): None. Main outcome measure(s): Age, FSH, number of retrieved oocytes, IR, clinical PR and live birth rates. Results: South Asians were younger than white women, had lower basal FSH level, had a higher incidence of PCOS, but had equivalent gonadotropin use, # retrieved oocytes, #ET, IR, clinical PR, and live birth rates. Conclusions: Contrary to previous studies, we found no differences in ART outcome between white and South Asian women undergoing RT, despite the significantly younger age group and lower basal FSH in the South Asian population. Larger studies are needed to confirm our findings