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DHEA May Benefit Diminished Ovarian Reserve, Early Data Say


 

PRAGUE — Women with severely diminished ovarian reserve can experience dramatic improvements in ovarian function, pregnancy rates, and euploidy rates when treated with dehydroepiandrosterone, Dr. Norbert Gleicher reported at the annual meeting of the European Society of Human Reproduction and Embryology.

“We have very small numbers that we are presenting with great caution, but the benefits of DHEA are beginning to become apparent,” said Dr. Gleicher, who practices at a fertility center in New York.

“Over 90% of our DHEA patients have come to us from other programs with a recommendation for egg donation. They are not only women with diminished ovarian reserve, they are women with horribly diminished ovarian reserve—and still we have a third of them getting pregnant. It's remarkable.”

Several studies he presented at the meeting suggest that in women with diminished ovarian reserve, DHEA—a mild androgen supplement, given at a dosage of 25 mg three times a day—can improve spontaneous conception rates and in vitro fertilization (IVF) outcomes. “It seems to improve not just quantity but quality of oocytes,” said Dr. Gleicher in an interview.

In a case study published last year, Dr. Gleicher and his colleagues reported on their first experience with the use of DHEA in the context of IVF (Fertil. Steril. 2005;84:756.e1–3).

A 42-year-old woman with diminished ovarian reserve began taking the supplement without the physicians' knowledge during her IVF treatment. Before she started taking DHEA, the woman's estradiol level was 1,211 pmol/mL, but it rose to more than 18,000 pmol/mL after 7 months of DHEA treatment, said Dr. Gleicher. The patient underwent eight subsequent IVF cycles with DHEA treatment, resulting in a dramatic improvement in ovarian response and a total of 66 embryos. The woman did not get pregnant because she did not have any embryos transferred, choosing to cryopreserve them for future use, said Dr. Gleicher.

In another study, now in press, Dr. Gleicher compared 23 IVF patients before and after treatment with DHEA and noted a significant increase in fertilized oocytes after patients were treated (39% vs. 67%). “We did not look at pregnancy rates in this study because the numbers were too small, but this study confirms that DHEA improves egg and embryo numbers and egg and embryo quality,” he said.

Furthermore, a separate study comparing 88 DHEA-treated IVF patients with 99 controls (IVF patients who were not treated with DHEA) found higher clinical pregnancy rates (27% vs. 9%) and higher implantation rates (9% vs. 3%) in the treated group.

The study also found that preimplantation genetic diagnosis performed on the patients' embryos identified a significantly higher rate of aneuploidy in the non-DHEA-treated embryos (78%) compared with that of the treated embryos (57%), he added.

IVF treatment with DHEA in his fertility center involves 4 months of DHEA prior to IVF, during which time he has noted “an unexpectedly large number of spontaneous conceptions,” within the first 2 months of DHEA treatment, Dr. Gleicher said.

'We have very small numbers … but the benefits of DHEA are beginning to become apparent.' DR. GLEICHER

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