Efficacy of dehydroepiandrosterone (DHEA) supplementation for in vitro fertilization and embryo transfer cycles: a systematic review and meta-analysis

Abstract

Dehydroepiandrosterone (DHEA) supplementation might hold some promise in vitro fertilization and embryo transfer cycles. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy of DHEA in patients for in vitro fertilization. PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of DHEA versus placebo on in vitro fertilization were included. Two investigators independently searched articles, extracted data and assessed the quality of included studies. The primary outcomes were clinical pregnancy and live birth rate. Meta-analysis was performed using random-effect model. Six RCTs involving 745 patients were included in the meta-analysis. Overall, compared with placebo, DHEA supplementation was associated with the significant increase in clinical pregnancy (OR = 1.45; 95% CI = 1.04–2.03; p = .03), live birth rate (OR = 2.70; 95% CI = 1.24–5.85; p = .01) and endometrial thickness (Std. mean difference = 0.67; 95% CI = 0.02–1.32; p = .04) but showed no influence on E₂ on hCG day (Std. mean difference = 0.69; 95% CI =  −0.46 to 1.85; p = .24), embryos transferred (Std. mean difference = 0.42; 95% CI =  −0.04 to 0.88; p = .07) and miscarriage rate (OR = 0.43; 95% CI = 0.03–6.66; p = .55). DHEA supplementation could significantly improve clinical pregnancy, live birth rate, endometrial thickness and retrieved oocytes but failed to alter E₂ on hCG day, embryos transferred and miscarriage rate.

Chinese abstract

脱氢表雄酮（DHEA）的补充可能给体外受精与胚胎移植周期带来希望。然而, 结果仍存在争议。我们进行了系统回顾和Meta分析来评价DHEA在体外受精患者中的疗效。对PubMed、Embase、Web of Science、EBSCO、Cochrane library数据库进行了系统检索。纳入评价DHEA和安慰剂对体外受精影响的随机对照试验（RCT）。两名研究人员独立检索文章, 提取数据, 并对纳入研究的质量进行评估。主要结果为临床妊娠率和活产率。Meta分析采用随机效应模型。纳入Meta分析的六个随机对照试验包括745名患者。总体而言, 与安慰剂组相比, 补充DHEA与临床妊娠率的显著增加相关（OR =1.45; 95% CI =1.04–2.03; p=.03）, 与活产率（OR =2.70；95% CI =1.24-5.85；P =. 01）和子宫内膜厚度（标准均数差= 0.67；95% CI =0.02–1.32；P =. 04）的显著增加相关, 但对HCG日E2（标准均数差= 0.69；95% CI = -0.46-1.85；P = .24）, 胚胎移植（标准均数差= 0.42；95% CI=-0.04至0.88；P =. 07）和流产率（OR= 0.43；95% CI =0.03-6.66；P = .55）没有影响。补充DHEA可显著改善临床妊娠率、活产率、子宫内膜厚度和获卵情况, 但未能改变HCG日E2、胚胎移植和流产率。

Keywords:

• Dehydroepiandrosterone (DHEA)
• in vitro fertilization
• embryo transfer cycles
• efficacy
• meta-analysis

Disclosure statement

The authors declare no conflict of interest.