To improve egg quality and enhance female fertility, continuous supplementation with FERTINATAL® DHEA is recommended for a minimum of 6 weeks*. Evidence from medical research shows that positive effects of DHEA supplementation on egg quality continue accumulating until approximately 16 to 20 weeks (4-5 months)*. This page explains why.
6 to 20 weeks of FERTINATAL® DHEA to improve egg quality*
The information below is based on research published by (among a few others) the Center for Human Reproduction (CHR), the fertility center that introduced DHEA supplementation into fertility care1. In developing FERTINATAL®, Fertility Nutraceuticals, closely followed the specifications of DHEA that CHR researchers used in their studies on the effects of DHEA on female fertility.
In those studies, CHR investigators demonstrated that the kind of DHEA used in FERTINATAL® enhances female fertility by improving egg quality*. Many other fertility centers around the world now utilize DHEA supplementation to increase egg quality, following the same supplementation schedule.
* THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION.THIS PRODUCT IS NOT INTENDED TO DIAGNOSE, TREAT OR CURE ANY DISEASE.
In initial studies, CHR reported that positive effects on egg quality were first noticed after about 6 weeks of DHEA supplementation. The positive effects of DHEA continued to accumulate up to about 16-20 weeks of supplementation (4-5 months). Given the result, CHR now starts active infertility treatments (like in vitro fertilization, or IVF) after at least 6 weeks of DHEA. If the first IVF cycle does not result in a pregnancy, CHR continues with DHEA supplementation, uninterrupted.
Because FERTINATAL® is designed to replicate this experience*, uninterrupted supplementation with FERTINATAL® DHEA is also recommended for at least 6 weeks and up to 16-20 weeks.
Egg quality and oocyte maturation process
Why such a long time? It has to do with how normal oocyte (egg) maturation process takes place in the ovary. With CHR's continuous work on DHEA's effects on egg quality and animal studies conducted by others, the possible mechanism of DHEA's role in improving egg quality has been emerging:
Women are born with all their eggs, waiting in the ovary in an immature, dormant state. After women reach puberty, these immature eggs start to get "recruited" into the maturation process. At any given moment during a woman's reproductive life span, hundreds to thousands of eggs are in various stages of maturation. Only one of these eggs usually reaches full maturity and is released from the ovary (ovulation) each month for possible fertilization and pregnancy.
The figure above describes this maturation process of eggs. The process in the ovary takes at least 120 days from start (pre-antral follicles) to finish (ovulation), sometimes taking even a little longer. In order for immature follicles to develop into good-quality eggs during this 120-day journey, the entire process should preferably take place in an ovarian hormonal environment that encourages healthy maturation of eggs.
This is essentially why supplementation with FERTINATAL® DHEA is recommended for at least 6 weeks, up to 16-20 weeks to improve egg quality*: to help immature eggs through the entire length of their maturation process, 6 weeks or more of DHEA supplementation seems to make sense. This uninterrupted DHEA supplementation appears especially important for older women, whose ovarian environment may have deteriorated due to the natural aging process, as well as women with "older" ovaries.
How might DHEA improve egg quality*?
Recent research by CHR in humans and by other investigators in mice offers a few hints on how DHEA might work in improving egg quality*. DHEA is a mild androgen (male hormone), naturally existing in abundance in both men and women. DHEA is converted into other androgens (mostly testosterone) and the estrogen (a female hormone) in the body.
Animal studies conducted in mice have shown that androgens play a crucial role in the maturation process of eggs8. For a long time, androgens were considered detrimental to egg quality, but mice with non-functioning androgen receptors turned out to have much lower fertility rates than normal mice with functioning androgen receptors, suggesting that androgens are indeed essential for development of healthy eggs and normal fertility.
Follicles (fluid-filled sacs in the ovary that contain eggs) have androgen receptors during earlier stages of egg development8. These androgen receptors start appearing at least 90 days before ovulation in the primary follicle stage, but are most abundant during the pre-antral and early antral follicle stages (approximately 20-65 days before ovulation), and disappear by the time the follicles reach the antral follicle stage, approximately two weeks before ovulation. These findings suggest that positive effects of androgens on egg quality may be more pronounced during these early stages*.
Supporting this concept, older women and women with "older" ovaries were found to have low testosterone levels in a recent CHR study. DHEA, once converted in the body to testosterone, may beneficially affect the ovarian environment during these early stages of follicle maturation, improving the quality and quantity of eggs available for pregnancy*. Given how long it takes for the early-stage eggs to reach ovulation, it does seem to make sense that such long-term DHEA supplementation is needed to improve egg quality*.