Supplements for fertility: DHEA, Series #1

If you have followed my journey, you would know I was diagnosed with premature ovarian aging for unidentified reasons. Reproduction with my own eggs was extremely rare given my severely depleting egg reserves. It was ton of science, strong determination, and perseverance made our dreams possible. For women who are diagnosed with diminished reserve or premature aging, I want you to know there are always ways and hope; when correct measures are applied, women who are otherwise classified as poor responders in IVF cycles can conceive with their own eggs and deliver healthy babies.

I am going to write a series of posts to share about supplements and science behind using them. This one is focused on DHEA, frequently used for young woman with DOR to improve outcomes of IVF cycles. DHEA in fertility has been around for over a decade now and it’s use is considered still controversial among different fertility clinics. Understanding science behind this miracle drug will help you make an informed choice. Always consult with your doctor first before taking any supplements.

 

What is DHEA?

DHEA is an androgen, natural male hormone produced from cholesterol by the adrenal gland in the body and acts as mother of all hormones by acting as a building block of male and female sex hormones, including testosterone and estrogen. Synthetic forms of DHEA are created from wild yam root or soy, converted to bio-identical DHEA in a lab to be used as a health supplement. This hormone is also marketed as a “fountain of youth” product. For fertility, it is said to improve egg quality in women with diminished egg reserve generally over 40 or in women with premature aging.

 

 How does DHEA work?

DHEA gets metabolized into testosterone in ovarian connective tissue (theca/stroma) and is then processed by the granulosa (follicle) cells to form estradiol that promotes follicle growth and improves egg development; and thereby believed to enhance fertility 1. It thereby supports early stages of folliculogenesis by improving follicular environment, promoting preantral follicular growth, and preventing follicular atresia 2, 3

DHEA levels are highest from age seven to twenties, peaking in our mid-twenties, and tend to decline naturally with age. This is the reason why DHEA supplements are believed to help women with DOR.

DHEA is shown to improve fertility by increasing the number and quality of eggs and embryos, reducing chromosomal abnormalities in embryos and increasing pregnancy rates and live births in DOR women undergoing fertility treatments. There have also been claims that DHEA reduces the risk of miscarriages.

 

Clinical Studies Supporting DHEA Supplementation for Fertility

In 2010, the first controlled study by researchers from Tel Aviv University in Israel looked at the connection between the DHEA supplement and fertility rates4. The study consisted of 20 subjects in each control and treatment group received 75mg of DHEA supplementation daily for 40 days before starting fertility treatment. The results showed that women in the treatment group consisting of 20 subjects were three times more likely to conceive compared to women in control group. The treatment group also experienced higher rate of healthy pregnancies and deliveries, with a 23% live birth rate, as opposed to a 4% rate in the control group. The lead researcher of the study, Professor Adrian Shulman, recommended that women try this DHEA treatment for four to five months in conjunction with fertility treatments, especially if the treatments have not been successful.

Center for human reproduction (CHR) has extensively studied and published on this subject. I welcome you to explore more from Dr. Norbert Gleicher 6.

In 2016, a fertility center from France reported DHEA appeared to improve clinical pregnancy rate by decreasing the cancellation rate in poor responders in IVF. This conclusion was based on a large cohort of 224 patients comprising of 327 IVF cycles7.

 

DHEA safety and precautions

First things first: You should always talk to your doctor before taking any supplement.  Even the so called least harmful supplements can carry some risks of mild to severe side effects or possible interactions with medications and other supplements.

DHEA is believed to be relatively safe when taken in moderate doses for short periods of time of four to six months. Some side effects include acne, hair loss, upset stomach, high blood pressure, changes in menstruation, facial hair growth and deepening of voice.  It is essential to take DHEA supplements under your doctor’s supervision and monitor testosterone levels at the beginning of supplementation and thereafter keep an eye for symptoms and monitor hormones periodically. For women who show increased free testosterone levels after DHEA supplementation should stop its use as increased testosterone levels are detrimental to egg quality.

Long term use of DHEA is not well studied and is thought to cause hormonal imbalances in longer run.  After all, it is unnatural to have high levels of DHEA all the time, especially in older age. Its worth remembering DHEA supplements is not going to reverse the natural process of aging. Each woman is unique in her fertility needs and should weigh the risks and true individual benefits of DHEA supplementation. However, if your health history makes you a good candidate for the supplement, it may be a good idea to try it while under a doctor’s supervision.

Finally, if you conceive while taking DHEA supplements, it’s no brainier to stop taking the supplement when you find out you’re pregnant.

 

Resources

  1. http://www.sciencedirect.com/science/article/pii/S0301211512005817
  2. http://informahealthcare.com/doi/abs/10.3109/09513590.2012.705386
  3. http://www.ncbi.nlm.nih.gov/pubmed/20501640
  4. http://www.sciencedaily.com/releases/2010/07/100701145535.htm
  5. https://file.scirp.org/pdf/OJOG_2016060815440388.pdf
  6. http://www.centerforhumanreprod.com/dhea.html
  7. http://jfrh.tums.ac.ir/index.php/jfrh/article/view/951
  8. https://www.tandfonline.com/doi/abs/10.3109/09513590.2015.1137095
  9. http://natural-fertility-info.com/dhea-and-your-natural-fertility-2.html

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