Table 1 Study characteristics of controlled studies (both RCT and non-RCTs) of DHEA supplementation in poor-responders or diminished ovarian reserve

Barad D, et al. (2007)

Case–control

POA defined by age-specific baseline FSH levels > 95% CI of mean value for the age group; but < 12 mIU/ml DOR defined as baseline FSH > 12 mIU/ml and/or estradiol level ≥ 75 pg/ml

89 cases* and 101 controls *only 64 of 89 undergoing IVF

Cases : DHEA 25 mg three times daily for mean duration 73 days continuously until

-Allow cases to conceive naturally; the other entered IVF using microdose agonist

Day 3 embryo transfer

-Clinical pregnancy rate -No. of retrieved oocytes -Implantation rate -Miscarriage rate -Normal day 3 embryos -Time from initial visit to pregnancy (Cox regression analysis)

-Cases were slightly older (P < 0.05) -Fertility treatments were different (P < 0.001) -Women in control entered IVF cycle more rapidly

positive pregnancy test

flare followed by high dose FSH + HMG (300–450 + 150 IU)

Control : None

-Similar protocol for both cases/controls

Wiser A, et al. (2010)

RCT (open- labeled)

Age ≤ 41 yr, Poor response, previous IVF cycle with high dose Gn (FSH 300 IU) with oocyte <5 or cycle cancellation

17 Cases

Cases : DHEA 75 mg/day orally ≥ 6 weeks before stimulation

- Similar protocol for both cases/controls

Day 2–3 embryo transfer

-Peak estradiol levels

Counted 55 IVF from 33 patients (both arms went through

16 Controls

Control : None

- Standard long GnRH agonist protocol

Up to 3 embryos

-No. of retrieved oocytes

Including of repeat cycles without adjustment of randomisation

- Using rFSH 450 IU + rLH 150 IU

-Embryo quality and No. of reserve embryo

Gleicher N, et al. (2010)

Case–control

DOR defined by abnormally age specific hormone levels deviated from 95% CI; elevated FSH or low AMH

22 Cases

Cases : DHEA 25 mg three times daily At least 4 weeks before stimulation

Microdose agonist flare followed by high dose FSH + HMG (300–450 + 150 IU)

Not being stated

-Pregnancy and live birth rates (secondary outcome)

Clinical pregnancy rate, miscarriage and No. of oocyte retrieved (our outcomes) are not the main outcome of the study.

44 matched Controls (1st single IVF cycle analysis only)

-Similar protocol for both cases/controls

Pregnancy was not outcome of interest

-Aneuploidy rate

Control : None

-No. of oocytes retrieved

-Total gonadotropin dosage