DHEA – Improving Egg and Embryo Quality
Considering all of the potential causes for infertility, successful management of diminished ovarian reserve is particularly challenging. Typically, patients with this problem may be in their late 30’s or early 40’s and may or may not have laboratory indicators of diminished egg quality and number such as an elevated serum FSH, or decreased antimullerian hormone level. It is usually very difficult to achieve satisfactory ovarian response to stimulation hormones, and for this reason there is considerable interest in identifying novel approaches to this problem. There has been some skepticism about claims that various nutritional supplements or hormones can improve the number or quality of eggs (oocytes). The conventional wisdom has been that since women have their total allotment of oocytes at birth, efforts to improve the availability of eggs when ovarian function is waning, are prone to failure. However, recent research is calling this theory into question with one fairly recent paper suggesting that stem cells exist in the human ovary, capable of becoming competent eggs. While more research is needed to substantiate these findings, the use of hormones and/or nutritional supplements to improve ovarian response to stimulation seems possible based on recent findings.
A research paper currently in press looked at 50 patients undergoing IVF who had been previously identified as low responders. These patients were pre-treated for four months with DHEA at a dosage of 75 mg/day. Following treatment with DHEA a significant increase in the number of mature follicles was noted in the next IVF treatment cycle. The investigators found increases in the number of eggs retrieved, fertilization rates, and ultimately in the number of embryos available. In addition, a greater number of embryos qualified for freezing in the patients who were 35 years of age or younger.
This paper adds to a growing body of literature suggesting that there may be ways to improve the yield of eggs and embryos in patients classified as poor responders. Several other agents including growth hormone, testosterone, and Coenzyme Q10 have been shown to increase the number of eggs retrieved and embryos available although there is no consensus on dosing, nor is there very much data on fetal outcomes following pre-treatment with these nutritional supplements and hormones. Since DHEA in this study as well as in other publications is being administered well in advance of the actual IVF treatment cycle, it is reasonable to conclude that is having its effect on the follicles that are in the non-growing stage of development, somehow affecting these follicles in such a way as to allow a greater number to enter the growing group of follicles (antral follicles), resulting in a greater number of eggs available for retrieval, fertilization, and embryo development. Since other studies have shown decreased miscarriage rates have been demonstrated following DHEA treatment, one theory is that DHEA is altering the intra-ovarian environment and preventing damage to oocytes before they have been recruited and begun growing as antral follicles.
Clearly, we have much to learn concerning age related infertility. It is however encouraging to see some preliminary evidence that we can influence the intra-ovarian environment in a positive way.