DHEA: a patient-driven innovation
The Center for Human Reproduction’s Dr. Norbert Gleicher discusses how CHR pioneered the use of DHEA in IVF after a patient in her 40s suddenly started producing high quality eggs and embryos.
The history of DHEA supplementation in women with low functional ovarian reserve at CHR is a patient-driven history, because the person who initiated our now 12-year long research in this area was a patient. It was at time of her presentation, a woman in her forties, she was I think 42 and a half years old, or so, who presented to us and she was found to have very low functional ovarian reserve. Indeed so low, that I recommended to her she go into egg donation. She insisted on trying and in her first cycle she produced only one egg. She also wanted to freeze her embryos because she wasn’t ready socially to be pregnant yet at that time. So we froze that embryo and she and I had another conversation and I told her, “This really doesn’t make any sense,” and she begged and begged and said, “Give me one more chance.” And so I said, “Okay, one more, but if it’s again only one, that will be it.” In the next cycle, she produced three beautiful eggs and three beautiful embryos, and so we could no longer refuse her. And this woman who was well-off, was very well-educated, she was a lawyer and a banker, she then went month after month, and every month she produced more eggs and more embryos. And we were kind of scratching our heads what was going on after six cycles, she was already 43 at that point, and this was roughly 12 years ago, 43 in those years was quite ancient. She, one day, came smiling into my office and said, “Dr. Gleicher, I have to tell you a little secret.” The secret she told me was that after the first cycle when I had told her that she would have at-best one more cycle, she had gone through the medical literature, and she had found a number of papers of which had recommended different treatments to improve egg numbers. And she chose DHEA because it was the only one which was available over the counter in the U.S. and she therefore didn’t have to tell us. And so suddenly, we understood, here at CHR, that what we had been observing – this constant increase month after month in her egg numbers and embryo numbers – may have something to do with her taking this DHEA. And she continued, even beyond six cycles, and she continued getting better to such a degree, actually, that I don’t remember if it was the 10th or 11th cycle, we had to take her medication dosage down because she developed typical ovaries that looked like polycystic ovaries, like polycystic ovary syndrome, which you usually only see in young women. So that observation with that one patient which we then published led us into starting to investigate DHEA.