DHEA is one of the more commonly used IVF supplements at fertility centers throughout the world, particularly in the United States. Although some doctors are not as enthusiastic about incorporating DHEA into their IVF protocols, scientific evidence has been accumulating for some time for its fertility benefits among women with diminished ovarian reserve (DOR). Read on to learn the science behind DHEA supplementation in IVF cycles, and see if it could help you realize your best chance of success on your fertility journey.
What is DHEA?
DHEA, short for dehydroepiandrosterone, is a weak androgen. Even though it’s one of the “male” hormones, DHEA exists in abundance in both male and female bodies and plays an important role in steroidogenesis in both sexes. DHEA is secreted by the adrenal glands and the brain, as well as the reproductive glands (ovaries for women, testes in men). It is not found in food, so it is important to supplement after levels begin to drop naturally around age 30 for reproduction.
Why is DHEA important for female fertility?
It may sound counter-intuitive to think that a male hormone is crucial for female fertility, but research in the last two decades suggests that this indeed is the case. Why is DHEA necessary for normal reproductive functions in women? The molecular and genetic mechanisms are still being investigated, but the basic answer is at least two-fold:
- In women, DHEA is an intermediate step in the endogenous production process of estrogens. Estrogens are a group of female hormones responsible for thickening of the uterine lining (endometrium), maturation of ovarian follicles and regulation of gonadotropin secretion, all with direct implications for fertility.
- In both men and women, DHEA is converted into testosterone in the body. Studies have found that an adequate level of ovarian testosterone is essential in healthy development of oocytes in women.
What fertility benefits of DHEA have been shown in studies?
Supplementing with DHEA for 8-12 weeks before the start of IVF cycles have been shown to improve outcomes, primarily through improved number and quality of oocytes available for fertilization. Reported IVF benefits of DHEA include:
- More, and higher-quality, oocytes retrieved: This results in a larger number of higher-quality embryos to transfer, which is arguably the most important factor for IVF success.
- Lower aneuploidy rates in embryos: In one study, the percentage of chromosomally abnormal embryos were about one-third lower in women who took DHEA before IVF than those who didn’t.
- Better IVF pregnancy rates: One case-control study of 190 women found a 2.4-fold increase in pregnancy rates among women who supplemented with DHEA compared to those who did not. A smaller Israeli study found an even more striking difference of a 5-fold increase.
- Lower miscarriage rates: Women over 42 who were on DHEA supplementation before IVF had miscarriage rates less than half of national average, a multi-center study found.
Who might need DHEA for IVF, and why?
Not everyone benefits from DHEA supplementation before IVF. Most women, up to age 35 or so, have enough endogenous androgens to keep their ovaries functioning properly, releasing a healthy egg every month for a chance to fertilize. However, DHEA levels begin to fall after age 30 – and some women have conditions that lower their androgen levels before then, leading to lower-quality oocytes. These women can benefit from DHEA for fertility purposes:
- Women over 40. Testosterone levels naturally decline with age, and many women benefit from a boost from DHEA.
- Women with diminished ovarian reserve (DOR), regardless of age.
- Women who had PCOS when younger, but have normal or even low androgens in their 30s and 40s.
Why use DHEA when oocytes actually need testosterone?
Taking DHEA is an indirect way to raise the testosterone level in the ovaries where the oocytes go through their final maturation process before ovulation. You might think, then, that it would be better to take testosterone directly. There are two main reasons reproductive endocrinologists have their patients take DHEA, rather than testosterone.
- Availability: DHEA is an over-the-counter supplement in the United States, which means it’s widely available without a prescription. In many other countries, DHEA is regulated like a medication, and you would need a prescription to purchase DHEA.
- Physiology: As a stronger male hormone, testosterone has more side effects than DHEA, and the side effects are usually more severe, which makes testosterone a less favored choice. Some physicians also think that letting the body convert DHEA to testosterone is closer to what happens naturally – as each organ converts DHEA to generate the “right” amount of testosterone for that specific organ, the thinking goes, we can avoid inundating the organs with more testosterone than they need.
What does this mean for women undergoing IVF?
- Know where you stand in terms of your ovarian reserve and testosterone levels. Your OBGYN doctor or a fertility specialist can tell you whether your ovaries are in good shape, through a few simple blood tests, including AMH, FSH and testosterone.
- Ask your fertility doctor if DHEA supplementation can improve your chances of pregnancy, if you are over 40 or your test results indicate DOR. There are some contraindications to DHEA supplementation, and your physician can help you decide if it’s for you. They can also design your IVF protocol that tries to maximize the benefits of DHEA.
- Ask your doctor about adding a smaller amount of DHEA to your prenatal vitamins regime, if you are between 35 and 39 and are trying to conceive.
- Some women have a harder time converting DHEA into testosterone, due to genetic variations, as well as endocrine and immune conditions. Fertility specialists with thorough understanding of DHEA mechanism are able to identify these women by periodically monitoring the serum levels of DHEA, DHEA-S, testosterone and sex hormone-binding globulin while they are on DHEA supplementation. If you are one of these women, your physician may increase your DHEA dosage or recommend direct testosterone supplementation to improve your IVF outcomes.
- Some physicians are not as familiar with DHEA use in the fertility context, and you may need to look for doctors who are more up to date on the research. (To their credit, scientific breakthroughs take an average of 17 years to be applied widely in clinical settings – and DHEA supplementation in IVF is just about hitting that time frame now.)
- Consider supplementing with a combination of DHEA and Coenzyme Q10 (CoQ10). A recent Canadian study found a synergistic effect between the two supplements, where women supplementing with both responded better to ovarian stimulation. More on CoQ10 and poor ovarian response here.
As always, we strongly recommend everyone considering DHEA supplementation for fertility purposes to discuss it with a qualified healthcare provider first. If you – or your healthcare team – have any questions, please let us know via LiveChat. We are with you.