2. Isfahan University of Medical Sciences Dissertation defense meeting Resident of Gynecology and Obstetrics

3. Evaluation of the effect of dehydroepiandrosterone on in vitro fertilization (IVF) outcome among women with advanced age of fertility and normal ovarian reserve

4. Provider
Dr . Elham Ghoreishy
Supervisors
Dr . Fateme Mostajeran
Dr . Hatav Tehrani

5. INFERTILITY & STILLBIRTH
AGE > 35 years

6. AGE
DHEA
STEROIDOGENESIS

7. Method:
Randomized controlled double blinded Clinical Trial study: women with age > 35 y undergoing IVF due to infertility at the Isfahan infertility center and Shahid Beheshti infertility center 2015 – 2017.

8. INCUSION CRITERIA AGE > 35 years Normal ovarian reserve
FSH , AMH , Inhibin normal range
18 ≤ BMI ≤ 25
Semen Analysis normal

9. - Pelvic / Ovarian surgery - Metabolic Disorder
EXCLUDED
CRITERIA
Text
- Pelvic / Ovarian surgery - Metabolic Disorder
Use of DHEA/ OCP pills
Chronic Disease

10. Through a computer-assisted block randomization , women were allocated at random to 2 groups.
Participants in the intervention group received 25 mg three times daily of DHEA , orally 8 weeks before starting the cycle of ovulation induction. Participants of placebo group received placebo tablets during the same period.

12. Pituitary suppression was achieved by administration of triptorelin acetate 0.1mg/daily subcutaneously in the mid luteal phase.
recombinant human FSH 300IU/daily subcutaneously was administered.
when the leading follicle was >17-18mm diameter, human chorionic gonadotropin(hCG) 10000IU subcutaneously was injected.

13. Oocytes aspiration was performed 36 hours later.
3 days after oocyte recovery, the 2 best quality embryos were transferred.
Progesterone ampoule 50 mg twice daily intramuscular was started on the day following oocyte aspiration and continued for an additional 10 weeks to support luteal phase in case of pregnancy.
Pregnancy was diagnosed by measuring increasing serum levels of β-hCG 14 days after embryos transfer.

14. Clinical pregnancy was established if a fetal heart beat was observed by transvaginal ultrasonography.
After clinical pregnancy patients followed until 20 weeks.

15. Statistical analysis
SPSS version 22 , was used to perform statistical analysis. Quantitative and qualitative variables were described by mean ± standard deviation (SD) and frequency (percent), respectively.
Chi-squared test was used to compare qualitative variables among the groups. Wherever normality of the quantitative variables was confirmed by Kolmogorov–Smirnov test, an independent t test was used.
A non-parametric test, Man-Whitney test, was used.
A P value less than 0.05 was considered statistically significant.

16. RESULTS

17. SAMPLE SIZE
Text
DHEA - 45 53
5 & 3
106 53 - 4 49
Placebo

18. Table 1. Comparison between the two groups (DHEA versus Placebo)
DHEA, n = 45
Placebo, n = 49
P value
Age
37.07 ± 1.19
37.24 ± 1.27
0.486
BMI
22.31 ± 1.31
22.67 ± 1.09
0.156
Clinical pregnancy
21(46.7%)
18(36.7%)
0.329
Miscarriage
2(4.4%)
5(10.2%)
0.438
Endometrial thickness
9.63 ± 0.70
8.05 ± 0.70
0.001
Duration of stimulation
8.98 ± 1.29
10.59 ± 1.43

19. Comparison between the two groups (DHEA versus Placebo)

20. DISCUSSION

21. Dehydroepiandrosterone decreases the age-related decline of the in vitro fertilization outcome in women younger than 40 years old
Tartagni et al
2015
Gleicher et al
2010
Improvement in diminished ovarian reserve after dehydroepiandrosterone supplementation
NHHHHHHH اتا
Effect of dehydroepiandrosterone adminstration in chinese women over 37 years undergoing assisted reproductive techniques.
Xuemei liu et al
2016

22. To be the first report from IRAN, blindness, fairly proper sample size, and randomization using computer assisted program, were strengths of the study. The finding of our study is limited to the population and should be interpreted with a cautions.

23. CONCLUSION

24. Our results suggest that IVF in the following of DHEA treatment has potential of improving fertility in women with advanced age and normal ovarian reserve. Although there is a great need for more studies (larger) enjoying with strong methodological considerations to our knowledge, this study was the first randomized, double blinded clinical trials in IRAN that suggest potential benefits of DHEA pretreatment for better infertility management in women with advanced reproductive age and normal ovarian reserve.

25. The End
If we had DHEA
Maybe …