The chance to conceive is directly related to the number of follicles and eggs left in ovaries. Women in the relatively early stages in the process toward early menopause (i.e., women with POA ) have fewer follicles and eggs than they should at their age, but they usually still have enough for a good chance of pregnancy. In contrast, POF patients (i.e., women who are already in early menopause) are often down to such a small enough pool of follicles and eggs that they no longer have a realistic chance at pregnancy with use of their own eggs.
DHEA Supplementation and IVF
With ovaries prematurely aging but not yet in early menopause, we can still help most women get pregnant, typically with in vitro fertilization (IVF).
With POA, women usually still have a reasonable likelihood of achieving pregnancy with their own eggs, as opposed to donor eggs. Supplementation with dehydroepiandrosterone (DHEA) , a mild male hormone treatment introduced into fertility care by CHR physicians, has played a crucial role in vastly improving treatment outcomes of younger patients with POA (early pre-menopause) and older DOR patients. DHEA helps to rejuvenate ovarian function, helping women produce more better-quality eggs in preparation for IVF.
As reported in 2007, DHEA supplementation prior to IVF cycles more than doubled pregnancy rates [Barad et al. J Assist Reprod Genet 2007;24(12):629-34]. Our published data since then have shown that DHEA supplementation improves pregnancy rates, improves egg and embryo quality and reduces chromosomal abnormalities. At CHR, careful DHEA supplementation, coupled with aggressive ovarian stimulation protocols, has been an integral part of our treatment approach for women with on the unfortunate path toward early or premature menopause.
DHEA supplementation with POF, or outright early menopause, is still under investigation but appears much less successful. In contrast to women with POA, women in early menopause in most cases still needs egg donation to conceive.
IVF with Egg Donation
In vitro fertilization (IVF) with egg donation is a very effective treatment option for women with early menopause who want to conceive. In egg donation cycles, eggs are retrieved from a young donor with normal ovarian reserve (who are typically anonymous in our program), and fertilized using the patient’s partner's (or donor's) sperm. After a few days, embryos are transferred into the patient’s uterus.
Egg donation from young egg donors circumvents the problems of poor egg quality and small number of eggs, typical problems women in early menopause face. Because of the much higher egg quality and simply a larger number of eggs being available, pregnancy chances are much higher with egg donation. Indeed, recipients have the pregnancy chances and miscarriage risks of women at the egg donors' age and ovarian reserve status. Cumulative pregnancy rates from a single donor IVF cycle at CHR, therefore, have been consistently in the high 80s to low 90s.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.