Pregnancy Chances in Women over the Age of Forty
Keywords:
Ovarian Reserve, Dehydroepiandrosterone (DHEA) supplementation, ovarian stimulationAbstract
Objective:To determine whether Dehydroepiandrosterone (DHEA) improve ovarian response and pregnancy potential in women  whose age is ≥ 40 years, and whether such potential is age dependent.
Methods: Between January 2013 and October 2013, 39 infertile women ≥ 40 years were prospectively evaluated for ovarian response and pregnancy chances without and with DHEA treatment (A= 22 normal ovarian reserve & B= 17 poor ovarian reserve).
Results:  Group B women have  a significant lower baseline Anti Mullerian Hormone and Estradiol indicating a poor ovarian reserve. There were insignificant difference between the two  groups in term of follicle numbers after controlled ovarian stimulation, and the pregnancy rate is significantly better in group A.
Conclusion: our study failed to demonstrate any beneficial effect of DHEA to improve OR in women above or = 40 with baseline poor OR in term of  follicular recruitment and pregnancy rate after controlled ovarian stimulation. Efficacy of androgen supplementation with DHEA seems to vary depending on female age and baseline OR.
Â
References
Barad DH, Weghofer A and Gleicher N, “Age-specific level of basal follicle stimulating hormone assessment of ovarian functionâ€.Obstet. Gynecol.109, 1404–1410, 2007a.
Vav Roij IA, Broekmans FJ, Scheffer GJ Looman CW, Habbema JD et al. â€Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal studyâ€. Fertil. Steril. 83,979–987,2005.
Casson PR, Lindsay MS, Pisarska MD, Carson SA and Buster JE â€Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: a case seriesâ€. Hum.Reprod.15:2129–2132,2000.
Barad D and Gleicher N “ Increased oocyte production after treatment with dehydroepiandrosteroneâ€. Fertil. Steril. 84, 756,2005.
Barad D and Gleicher N “ Effect of dehydroepiandrosterone on oocytes and embryo yields, embryo grade and cell number in IVF “.Hum.Reprod. 21, 2845–2849,2006.
Barad D, Brill H, Gleicher N †Update on the use of dehydroepiandrosterone supplementation among women with diminished ovarian function “. J. Assist. Reprod. Genet. 24, 629–634,2007b
Gleicher N, Ryan E, Weghofer A , Blanco-Mejia S. and Barad DH, “ Dehydroepiandrosterone (DHEA) reduces miscarriage rates in women with diminished ovarian reserve: a multicenter study “.Reprod. Biol.Endocrinol. 7,108 ,2009.
Hugues N. Reply “ Effects of transdermal testosterone application on the ovarian response to FSH in poor responders undergoing assisted reproduction technique–a prospective randomized doubleâ€blind study. Hum Reprod ,21:3027 â€3028, 2006.
Tremellen KP, Kolo M, Gilmore A and Lekamge DN †Anti-mullerian hormone as marker of ovarian reserveâ€. Aust. J.Obstet.Gynaecol. 45, 20–24, 2005.
Gleicher N, Weghofer A, and Barad DH †Improvement in diminished ovarian reserve after dehydroepiandrosterone supplementation “. Reprod.Bio Medicine Online 21, 360–365, 2010.
Weghofer A, Dietrich W, Barad D H and Gleicher N†Live birth chances in women with extremely low-serum anti-Mullerian hormone levelsâ€. Hum . Reprod,26, 1905–1909,2011.
Ryan KJ, Petro Z, Kaiser J.†Steroid formation by isolated and recombined ovarian granulosa and tehcal cells “. J Clin Endocrinol. Metab; 28:355–358,1968.
Vendola KA, Zhou J, Adesanya OO, Weil SJ and Bondy CA “ Androgens stimulate early stages of follicular growth in the primate ovary “. J Clin Invest.101 (12):2622â€9, 1998.
Weil S, Vendola K, Zhou J and Bondy CA.†Androgen and follicle-stimulating hormone interactions in primate ovarian follicle development.†J Clin Endocrinol Metab, 84:2951–2956,1999.
Walters KA, Simanainen U and Handelsman DJ †Molecular insights into androgen actions in male and female reproductive function from androgen receptor knockout models “. Hum Reprod Update,11,543–558 , 2010.
Nielsen ME, Rasmussen IA, Kristensen SG, Christensen ST, Møllgard K, et al.(2011): In human granulosa cells from small antral follicles, androgen receptor mRNA and androgen levels in follicular fluid correlate with FSH receptor mRNA. Mol Hum.Reprod.17:63–70.
Arlt W, Justl HG, Callies F, Reincke M, Hubler D, Oettel M, Ernst M,Schulte HM, Allolio B, “Oral dehydroepiandrosterone for adrenal androgen replacement: pharmacokinetics and peripheral conversion to androgens and estrogens in young healthy female after dexamethasone suppression “. J Clin. Endocrinol Metab; 83,1928–1934, 1998.
Haning RV Jr, Hackett RJ, Flood CA, Loughlin JS, Zhao QY, Longcope C.,†Plasma dehydroepiandrosterone sulfate serves as a prehormone for 48% of follicular fluid testosterone during treatment with menotropins “. J Clin Endocrinol Metab, 76,1301– 1307,1993.
Gleicher N, Weghofer A and Barad DH, “Defining ovarian reserve to better understand ovarian agingâ€. Reprod Biol Endocrinol, 9,23,2011.
Walters KA, Allan CM and Handelsman DJ , †Androgen actions and the ovaryâ€, Biol Reprod,11,380–389,2008.
Menezo Y, Dale B and Cohen M †DNA damage and repair in human oocytes and embryos: a review†Zygote,11,357–365,2010.
Pitteloud N, Mootha VK, Dwyer AA, Hardin M, Lee H, et al .†Relationship between testosterone levels, insulin sensitivity, and mitochondrial function in men†Diabetes Care,11,1636–1642, 2005.
Zeleznik AJ, Littleâ€Ihrig L and Ramasawamy S “ Administration of dihydrotestosterone to rhesus monkeys inhibits gonadotropin stimulated ovarian steroidogenesisâ€.J Clin Endocrinol Metab,89 ,2,860â€6,2004.
Kilani Z, Shaban M, Haj Hassan L, Sherbiny W†Ovarian Stimulation Is Detrimental To IVF Outcome†KAJOG, 1,3,101-106,2010.
Narkwichean A, Maalouf W, [...], and Jayaprakasan K†Reproductive Biology and Endocrinology: Efficacy of dehydroepiandrosterone to improve ovarian response in women with diminished ovarian reserve: a meta-analysisâ€, 11,44,2013.
Downloads
Published
Issue
Section
License
- Papers must be submitted on the understanding that they have not been published elsewhere (except in the form of an abstract or as part of a published lecture, review, or thesis) and are not currently under consideration by another journal published by any other publisher.
- It is also the authors responsibility to ensure that the articles emanating from a particular source are submitted with the necessary approval.
- The authors warrant that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required.
- The authors ensure that all the references carefully and they are accurate in the text as well as in the list of references (and vice versa).
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Attribution-NonCommercial 4.0 International that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.
