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Dehydroepiandrostendione sulphate and prediction of live birth after IVF in young women with low anti-Müllerian hormone concentration

Baseline dehydroepiandrostendione sulphate (DHEAS) has been demonstrated to discriminate between young, expected poor responders with favourable clinical pregnancy prospects after IVF treatment and their counterparts with significantly lower pregnancy chances. This study investigated DHEAS ability to predict live birth before starting the first gonadotrophin-releasing hormone (GnRH) antagonist ovarian stimulation for IVF/intracytoplasmic sperm injection in young women (≤37years) with low serum AMH (<6.5pmol/l). Medical records of 90patients were analysed. DHEAS was predictive for live birth (AUC-ROC 0.69, 95% CI 0.59-0.79). Its predictive accuracy for live birth was similar to that of the number of oocytes retrieved. The cut-off value for DHEAS of 5.4μmol/l offered the best discriminative performance between patients who achieved live birth and those who did not. The live birth rate per initiated cycle in women with DHEAS concentration >5.4μmol/l was 5-fold higher compared with women with DHEAS ≤5.4μmol/l (38.9% versus 7.4%, P<0.001) despite similar oocyte yield in both groups. In conclusion, the association between baseline DHEAS and probability of live birth after the GnRH antagonist IVF cycle in young women with low AMH was demonstrated. This association could not be explained by the effect of DHEAS on the oocyte yield. This study demonstrates an association of baseline dehydroepinadrostendione sulphate (DHEAS) concentration with implantation rate and live birth rate after the first gonadotrophin-releasing hormone antagonist IVF cycle in young women who are expected to respond poorly to ovarian stimulation. Compared with the number of oocytes retrieved, DHEAS showed a similar ability to distinguish women who will achieve a live birth from those who will not. However, as a parameter available to clinicians and patients before commencing an ovarian stimulation for IVF, DHEAS could be used in predicting probability of live birth at the initial consultation. Women whose DHEAS concentrations were above the derived cut-off value 5.4 μmol/l had 5-fold more favourable prognosis for live birth than their counterparts with DHEAS concentrations below the cut-off value. The findings could not be explained by the difference in the oocyte yield and/or the number of embryos transferred but rather by the possible association between the endogenous DHEAS concentration and the oocyte competence to produce a viable embryo.

DHEAS; GnRH antagonist protocol; IVF; anti-Müllerian hormone; live birth; poor response

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