What is DHEA used for in IVF?

There are many different opinions in the community about DHEA. Studies have been done to determine how long-term dehydroepiandrosterone (DHEA) supplementation affects older women of reproductive age’s annual IVF pregnancy rates. These researches show that DHEA supplementation significantly improves IVF pregnancy rates in women over the age of 40. (1)

Is DHEA support helpful in IVF?

Since scientists brought DHEA supplementation for women with diminished ovarian reserve (or DOR) into fertility practice, IVF has undergone a revolutionary change. 

For women over 40, whose ovarian reserve falls as a natural component of aging, as well as for those suffering from premature ovarian aging (POA), it has significantly increased pregnancy outcomes. In fact, a recent study on DHEA and female fertility revealed a significant doubling of pregnancy rates. (2)

Which patients can benefit from DHEA?

Obstetricians usually prescribe DHEA supplements 6-8 weeks before the start of the cycle for the following groups of women:

  • All females over 40,
  • In younger women with DOR (diminished ovarian reserve) 

The objective is to increase androgen levels to the “young” normal range in the ovarian environment, which has been found to improve the number and quality of eggs that are obtainable. 

For this reason, when women take DHEA supplements, obstetricians regularly check androgen levels. If the required level of androgen is not achieved, patients will continue to take the supplements for longer than the typical 6–8 weeks until they are prepared to start their IVF treatment in Turkey cycle. (3)

How many weeks should the DHEA supplement be taken?

Enhancing egg number and quality is the purpose of DHEA supplementation in women whose infertility is driven by low androgen levels. Studies have revealed that for statistically significant increases in female fertility to be shown, DHEA supplementation should be taken for at least 6 to 8 weeks. 

Between 16 and 20 weeks on average, peak activity is reached. On the other hand, as was already mentioned, duration is not always the best predictor. The crucial factor is that the woman’s androgen (testosterone) levels increase to roughly one-third of the healthy range.

When time is of the importance, professionals initially advised starting fertility treatments after 6–8 weeks of DHEA supplementation and maintaining supplementing continuously until pregnancy was detected by rising hCG levels or until patients decided to stop trying to conceive with their own eggs. 

Recent recommendations, however, suggest that the initiation of an IVF cycle after DHEA supplementation should take into account both observed increases in androgen levels over baseline levels before treatment as well as a predetermined period of time with DHEA supplementation. (4)

When is the best time to start DHEA treatment?

DHEA works best for IVF when the eggs are in the earliest phases of ovarian maturation. 

This is due to the fact that healthy ovaries are constantly getting young follicles from the pool of resting follicles to start the 3 to 4-month maturation process. The stage of small developing follicles, from primary follicles to small antral follicles, is when healthy testosterone levels are crucial. 

Before reaching the gonadotropin-dependent stage, where they finally start to respond to fertility medications and can therefore be recovered in IVF cycles, growing tiny follicles need at least 6-8 weeks of additional maturation. For this reason, pre-supplementation with DHEA should commence at least six weeks before the start of an IVF cycle. (5)

Source: 

1- https://www.fertstert.org/article/S0015-0282(07)02649-0/fulltext

2,3,4,5- https://www.centerforhumanreprod.com/contents/additional-services/dhea-treatment/dhea-ivf

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