Effectiveness Of Dehydroepiandrosterone Pretreatment Before IVF-ET For Women With Poor Ovarian Response:A Meta-analysis

Objective:To evaluate the effectiveness of dehydroepiandrosterone?DHEA?pretreatment with poor ovarian response?POR?before IVF-ET.Methods:Chinese and English databases such as PubMed,EMbase,Web of Science,The Cochrane Library,CBM,CNKI and WanFang Data,were reserched from inception to December 2017.Manually search the references included in the literature for supplementary search to collect randomized controlled trials?RCTs?about DHEA pretreatment with POR before IVF-ET.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Using RevMan 5.3 software to conduct meta-analysis.Results:11 RCTs with a total of 1064 POR women were included.When compared with placebo or no treatment,pre-treatment with DHEA was associated with higher rates of clinical pregnancy[RR=1.37,95%CI?1.09,1.72?,P=0.007]and the number of retrieved oocytes[WMD=0.98,95%CI?0.35,1.62?,P=0.003],while pre-treatment with DHEA was associated with lower rates of cycle cancellation[RR=0.50,95%CI?0.33,0.76?,P=0.001]and stimulating days of gonadotropin?Gn?[WMD=-0.74,95%CI?-1.11,-0.37?,P=0.000 1].Whereas no differences were found in live birth rate[RR=1.19,95%CI?0.60,2.33?,P=0.62],miscarriage rate[RR=0.84,95%CI?0.36,1.97?,P=0.69],total dose of Gn[WMD=-269.71,95%CI?-647.32,107.91?,P=0.16],MII oocytes[WMD=0.61,95%CI?-0.22,1.43?,P=0.15],E₂ level on the day of HCG administration[SMD=-0.09,95%CI?-0.40,0.21?,P=0.55],progesterone level on the day of HCG administration[SMD=0.06,95%CI?-0.13,0.25?,P=0.53],endometrial thickness on the day of HCG administration[WMD=0.63,95%CI?-0.67,1.94?,P=0.34],follicle-stimulating hormone?FSH?level[SMD=-0.02,95%CI?-0.34,0.29?,P=0.88],anti miillerian hormone level?AMH?[SMD=-0.16,95%CI?-0.75,0.42?,P=0.58]and antral follicle count[WMD=0.24,95%CI?-0.19,0.68?,P=0.27].Conclusion:Compared with taking placebo or no treatment,taking DHEA pretreatment before IVF-ET can improve clinical pregnancy rate,increase number of retrieved eggs,reduce cycle cancellation rate and shorten ovulation stimulation time in patients with POR.However,there was no significant effect on live birth rate,total Gn dose,number of eggs in MII,HCG day E₂ level,P value,endometrial thickness on HCG day,FSH level,AMH level and AFC.Oral DHEA is recommended in patients with POR prior to IVF-ET.