European Journal of Molecular & Clinical Medicine

Introduction: Diminished ovarian reserve (DOR), defined by age specific follicle stimulating hormone (FSH) levels and/or Anti mullerian hormone (AMH) levels < 1.5 ng/ml is seen in 10% cases of infertility which occur due to ovarian failure. Dehydroepiandrosterone (DHEA) supplementation for treatment of infertility in such cases is a recent development. This study aimed to determine whether DHEA supplementation objectively improves ovarian reserve as assessed by AMH levels since AMH has been recently validated as a specific marker for ovarian reserve and also whether these values are predictive of the outcome of treatment in terms of number of patients who conceive.
Material and methods: The study was done on 50 patients who presented to the OPD of Obstetrics and Gynaecology at Santokba Durlabhji Memorial hospital in the age group of 20-40 years with primary or secondary infertility due to DOR as determined by AMH levels <1.5 ng/ml. They were given DHEA 25 mg three times daily for at least 1 month till they conceived or till 6 months (whichever was earlier).Patients above the age of 40 years, those with infertility due to causes other than ovarian, with polycystic ovarian disease, endometriosis, ovarian cancers ; with chronic diseases and who conceived within 1 month of starting the treatment were excluded.
Results: The mean age of the study population was 31.14±6.00 years, mean duration of infertility was 4.26±3.25 years and the mean baseline AMH level was 0.73±0.48 ng/ml. The conception rate in this study was 26%. Following treatment with DHEA, the AMH levels increased significantly with the mean AMH level after 1 month of treatment being 1.08±0.82 ng/ml (p=0.007 for patients who did not conceive and p<0.001 for patients who conceived) while that at the end of 6 months were 1.64±0.98 ng/ml (p<0.001 for patients who conceived and who did not conceive). Only pre treatment AMH was found to be an independent predictor of conception [odds ratio = 7.5533 (95 % CI 1.5499 to 36.8106)].
Conclusion: DHEA supplementation positively affects the ovarian reserve in patients with DOR and also leads to better pregnancy outcome. Hence DHEA can be a low cost option for treatment of infertility in patients with DOR.