Hormonal optimization of ovarian function in women of advanced reproductive age with diminished ovarian reserve

BACKGROUND: In reproductive medicine, diminished ovarian reserve remains a pressing challenge, particularly in the search for effective strategies to address it. Surgical methods for ovarian activation are actively being investigated, along with ongoing research into hormonal therapies. In this context, researchers worldwide have focused on the potential application of dehydroepiandrosterone (DHEA) to improve ovarian reserve in women of advanced reproductive age who are planning pregnancy.

AIM: To evaluate the effects of DHEA administration on hormonal profile changes and ovarian reserve parameters in women of advanced reproductive age with diminished ovarian reserve, as well as to assess pregnancy and live birth rates in this population.

METHODS: The study included 118 women of advanced reproductive age diagnosed with diminished ovarian reserve. All participants underwent hormonal evaluation on days 2–3 of the menstrual cycle, including measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, anti-Müllerian hormone (AMH), and inhibin B, as well as folliculometry. The participants were then prescribed DHEA at 75 mg/day, with follow-up hormonal evaluation at 3, 6, and 8 months, along with repeated folliculometry. After treatment completion, data were analyzed, and pregnancy rates were evaluated.

RESULTS: DHEA administration at 75 mg/day for 8 months was associated with a significant reduction in gonadotropin levels (FSH: 9.91 [8.60; 10.90], LH: 7.63 [6.40; 8.60]) and an elevation in estradiol levels (90.22 [78.90; 107.60]; p < 0.001). A significant improvement in ovarian reserve parameters was observed, as evidenced by changes in laboratory markers (AMH: 1.08 [0.76; 1.40], inhibin B: 98.38 [88.60; 111.40]; p < 0.001) and ultrasound folliculometry findings, which demonstrated an increase in antral follicle count to 6–7. A significant reduction in the frequency of menstrual cycle irregularities was observed, with the incidence decreasing to 29.2% (26/118). Pregnancy occurred in 31.3% of women (37/118), with spontaneous conception in 62.1% (23/37) and conception achieved via in vitro fertilization in 37.8% (14/37). A live birth rate of 70.2% (26/37) was recorded, whereas 29.7% (11/37) of pregnancies ended in spontaneous miscarriage.

CONCLUSION: DHEA administration at 75 mg/day for 8 months in women of advanced reproductive age with diminished ovarian reserve is associated with improvements in ovarian reserve parameters and an increased likelihood of achieving a desired pregnancy.