DHEA and Fertility
Treatment for Diminished Ovarian Reserve (DOR)
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How DHEA improves fertility in women with low ovarian reserve.
Introduction to DHEA
DHEA (or dehydroepiandrosterone) is a naturally existing hormone that the female body converts into androgens (mainly testosterone). In an infertility setting, DHEA is used primarily to treat women with diminished ovarian reserve (DOR), which occurs either as a consequence of premature ovarian aging (POA) or female aging. Our studies have found, and others have confirmed, that DHEA revitalizes the ovarian environment in which eggs mature, resulting in:
- Increased IVF pregnancy rates
- Increased chance of spontaneous conceptions
- Shortened time to pregnancy
- Increased quality and quantity of eggs and embryos
- Decreased risk of miscarriage and chromosomal abnormalities in embryos
- Improved cumulative pregnancy rates in patients under fertility treatment
Introduced into fertility treatment by CHR in 2004, DHEA supplementation has demonstrated remarkable results worldwide. A 2010 survey found that about a third of all IVF centers in the world were already utilizing DHEA to improve pregnancy chances in women with DOR.
Four top infertility clinics told me I'd never have a baby without using a donor egg. However … five months after starting DHEA [we discovered] I was pregnant!
We published our first findings on DHEA in 2005 and since then many women with DOR who had been advised by other fertility centers that their only chance of conception was with egg donation have conceived with use of their own eggs using our DHEA and IVF protocols.
What is DHEA?
Our research into DHEA has found that women with DOR and/or advanced maternal age usually have abnormally low levels of androgens. It may be surprising, but our clinical experience, along with data from our collaborative research laboratory, suggest that low androgen levels are detrimental to a woman's fertility, and higher androgen levels are beneficial to the healthy development of eggs. We have found that prescribing a DHEA supplement to women with DOR raises androgen levels and increases pregnancy chances especially in women whose androgen levels rise successfully after DHEA supplementation.
DHEA is in the process of revolutionizing infertility care for older women and for younger women with premature aging ovaries
We have found that eggs that mature in an androgen-rich ovarian environment tend to develop into higher-quality eggs compared to those that mature in an androgen-deficient environment. Egg quality is important for improving pregnancy chances because high-quality eggs develop into high-quality embryos, which have better chances of implantation and lower chances of miscarriage.
How DHEA for Infertility Started
The story of DHEA began with a very important lesson, taught by one of our 42-year old patients. This patient had diminished ovarian reserve and failed to produce enough embryos during IVF cycles. On her own, she started supplementation with DHEA. When her oocyte (egg) yield greatly increased in subsequent IVF cycles, we started to question what was going on. She then informed us of her DHEA regimen. After approximately four months of DHEA supplementation, her 42-year-old ovaries were behaving like those of a much younger woman. Since then, we have been diligently investigating DHEA, and carefully analyzing outcomes, steadily publishing our DHEA study results and applying the new knowledge to clinical practice.
Dr. Gleicher and his patient featured on The Today Show discussing the discovery of DHEA for fertility.
Taking DHEA: What to Expect
Like any hormonal treatment, DHEA can have both positive and negative side effects. During the time CHR has been working with DHEA, we have carefully monitored the side effects of DHEA, and have been impressed by how rarely even the most common side effects seem to occur. We often hear from patients how much better DHEA supplementation makes them feel overall, which is likely explained by increased androgen levels in patients with DOR.
|Positive Side Effects of DHEA|
Negative side effects to DHEA are possible but rare, and it is important to note that side effects should disappear when DHEA treatment is stopped. These include:
|Negative Side Effects of DHEA|
Typical Dosage and Time to Get Pregnant
The general dose of DHEA is 75mg daily, which is split into three 25mg doses (to avoid the development of an upset stomach). The treatment is usually started at least 6 weeks prior to IVF treatment. Supplementation is stopped once a woman has conceived, as the body produces enough DHEA during pregnancy. The time to get pregnant after DHEA supplementation will be different for each woman.
It is important to note that DHEA alone is unlikely to be effective for women with diminished ovarian reserve who are trying to conceive. To maximize every woman's pregnancy chances, CHR uses DHEA within a well-designed fertility treatment framework, such as ovarian stimulation protocol tailored to each woman's needs, proper management of any contributing infertility factors and so on.
DHEA should always be taken under the supervision of a physician, as the hormone can interact with some prescription drugs and affect some medical conditions like diabetes, mood disorders, and estrogen-sensitive cancers.
Our DHEA Research and Patents
We are very proud that the U.S. Patent and Trademark Office (USPTO) has issued us two patents regarding the use of DHEA for infertility. After years of hard work and research, the approval of these patents was a milestone for our research team. You can read more details about our DHEA patents here.
CHR Publications on DHEA
Starting and resulting testosterone levels after androgen supplementation determine at all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR).Journal of Assisted Reproduction and Genetics, 2013 This study found that androgen conversion rates after DHEA supplementation vary depending on women's age and FMR1 genotypes.
- Human Reproduction, 2011 The article demonstrated that even with extremely low serum AMH levels (below 0.1 - 0.4 ng/ml), moderate but reasonable live birth chances can be expected with DHEA supplementation and proper ovarian stimulation. .
At CHR we're committed to fertility research and education, which we believe helps us deliver the best, most innovative, up-to-date care to our patients.
Research by CHR's world-renowned physicians — Dr. Norbert Gleicher, Dr. David H. Barad and Dr. Vitaly Kushnir — as well as our PhD-level laboratory staff and statistician appear frequently in the most prestigious medical journals in reproductive medicine, and all of our doctors are frequently invited to present their research at international fertility conferences.
CHR publishes research on a wide range of fertility topics, including DHEA's effects on female fertility. Our pioneering and groundbreaking research into DHEA first appeared in the April 2005 issue of Fertility and Sterility, and since then we've continued to research DHEA and its effects on women with DOR.
To chronicle our clinical research into DHEA, we put together a definitive list of all our DHEA-related publications here. For a complete list of CHR's scientific publications, please refer to our publications list.
Want to Learn More?
To learn more about DHEA and our POA program at CHR, simply complete the prematurely ovarian aging consultation form. We look forward to hearing from you.
Written by David Barad, MD
Last Updated: December 19, 2013