| DHEA is a relatively recent development in the treatment of aging ovaries. Yet in a very short time, DHEA has demonstrated remarkable results in the treatment of Prematurely Aging Ovaries using the protocols we have developed at CHR.
Contact us for more on DHEA and premature ovarian aging.
DHEA's beneficial effects
The investigators at CHR have been using the mild male hormone dehydroepiandrosterone DHEA now for a number of years very successfully in women with diminished ovarian reserve (DOR), whether their ovarian impairment is due to advanced age or premature ovarian aging (POA). In doing so, we have been able to demonstrate that in such women DHEA supplementation has quite remarkable beneficial effects that can only be summarized as rejuvenating ovarian function.
Inspired by a patient
The story of DHEA began not too long ago with a very important lesson taught to us by one of our patients. In a nutshell, the patient started taking DHEA, an over-the-counter mild male hormone, without our knowledge. When she greatly increased her oocyte (egg) yield in an IVF treatment, we investigated to find the cause of the miraculous results. That was when we learned about her DHEA regimen, and indeed, after approximately four months of DHEA usage, her 43-year-old ovaries were behaving like those of a woman in her 20s. Since that time, we have been diligently investigating DHEA and carefully analyzing the results.
View CBS video feature reporting patient's DHEA story
Highlights of DHEA effects
Table 1 includes a summary of our observations of the effects of DHEA taken by women with diminished ovarian reserve (DOR):
Table 1: EFFECTS OF DHEA IN WOMEN WITH DOR
| Increases egg (oocyte) and embryo counts |
| Improves egg and embryo quality |
| Increases number of embryos available for embryo transfer |
| Increases euploid (chromosomally normal) embryos available |
| Speeds up time to pregnancy in fertility treatment |
| Increases spontaneously conceived pregnancies |
| Improves IVF pregnancy rates |
| Improves cumulative pregnancy rates in patients under treatment |
| Decreases spontaneous miscarriage rates |
| likely reduces aneuploidy (chromosomal abnormalities ) in embryos |
During all the time we have been working wtih DHEA at CHR, we have carefully monitored side effects of the medication and have been impressed by how rarely even the most common side effects, such as oily skin, acne and hair loss, seem to occur.
See our report, New findings: DHEA also reduces miscarriage rates - especially in older women, (CHR Voice, Summer 2008).
DHEA also promises non-fertility benefits, as well
We, however, have been even more surprised that quite often what we really heard were anything but side effects; indeed, many more patients than complained about side effects, commented to us how much better overall DHEA supplementation makes them feel. Table 2 summarizes some of the specifics.
Table 2: POSITIVE SIDE EFFECTS OF DHEA
| Improved overall feeling |
| Physically stronger |
| Improved sex drive |
| Mentally sharper |
| Better memory |
In addition, there has also come a study, reported in the prestigious Journal of Clinical Endocrinology and Metabolism (Davis et al. 2008; 93:801-8), in which investigators from Australia report that DHEA appears to improve cognitive functions in women. Specifically, they noted that higher endogenous DHEA levels are independently and favorably associated with executive function, concentration and working memory. It seems our patients knew all along what they were talking about!
Contact us for more on DHEA and premature ovarian aging.
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DHEA qualifications
Owing to the extremely dramatic improvement of the patient mentioned above in ovarian response
after DHEA use, we felt ethically obliged to publicize
this finding as quickly as possible since, in older women, time is,
of course, of essence. A more formal scientific report of this more of this case
appeared in Fertility and Sterility, the
official organ of the American Society for Reproductive Medicine (ASRM).As we have emphasized from the beginning, one case in medicine may
give hope but is certainly not enough to reach far reaching conclusions
of any kind. We have emphasized this fact from day one, not only to
our patients but have also stressed it in our writings. At the same
time, however, we have mounted a strong effort to investigate the use
of DHEA as a potential extender of female fertility and have done so
in two distinctive formats.
Contact us for more on DHEA and premature ovarian aging.
The ultimate study format for any clinical trial is the double blinded,
prospectively randomized study. Such a study has been approved by our
Institutional Review Board (IRB) and is under way. This study, however,
mandates the use of a placebo, a sugar pill, in half of all patients.
In practical terms this means that one half of all patients in this
study will receive no treatment for up to four months. To give no treatment
to an older woman who, maybe, has only a few months of reproductive
life left, would not be considered ethical. We, therefore, had to restrict
this study to a relatively young patient population, between the ages
of 35 and 40 years. Women above age 40 will not be enrolled in this
study. They, however, are given the option of using DHEA, anyhow, by serving
as their own controls. In this study, we compare patients’ IVF
outcomes, before they started using DHEA, to IVF cycle outcomes after
the use of the medication. This form of a study is, of course, not
as well controlled as a double blinded, prospectively randomized study,
but, as this case so well demonstrates, such studies are not always
possible in medicine and, sometimes, we have to accept a second best
study format.
Two other IVF centers, one in New York and the other in Chicago, have
joined us in the prospectively randomized study and we hope to be able
to report results within a reasonably short time period. Finding infertility
patients who agree to be randomized to possible placebo for four months
is, of course, not always easy. We have, however, so far been able
to place over 30 patients into the second study and are, therefore,
already in a position to report further preliminary results. These
results are currently being summarized for another formal scientific
publication. However, because of the obvious time pressures involved
in older women, we feel an ethical obligation to pass these preliminary
results on as soon as we become aware of them.
-View Dr. Gleicher's appearance on The Today Show where he discusses the results of CHR's work with DHEA.
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Overview of CHR's research
We have known for quite some time that many centers around the world have routinely started using DHEA. One of these centers has been Toronto West Fertility Associates, in Toronto, Canada. We have intermittently heard from them that anecdotally they had similar results to ours, but last December they were kind enough to send us their whole, meticulously kept data bank on DHEA usage at their center.
Their pregnancy experience results were, indeed, very similar to ours. What we, however, were most interested in this time was not pregnancy, but miscarriage rates. As we have repeatedly noted in our UPDATEs, we have come to believe that DHEA supplementation may reduce the number of chromosomally abnormal embryos (aneuploidy).
We reached this conclusion after making two observations: (1) In a small number of women who underwent PGD after they had been treated with DHEA, we found lower aneuploidy rates than in women without DHEA supplementation. Unfortunately, women in need of DHEA usually have small embryo numbers and, therefore, only very rarely qualify for PGD. This kind of data accumulation is, therefore, very slow and we so far have not reached statistically robust enough numbers.
(2) Our second, related observation was that we noted a surprisingly low miscarriage rate in DHEA pregnancies. Since miscarriages, especially in older women, are mostly due to chromosomal abnormalities, this observation, too, suggested the possibility that DHEA may reduce aneuploidy rates. To reach statistically robust conclusions, once again relatively large (pregnancy) numbers were required and we therefore, up to this point, have been cautious to not over interpret our own data.This is why the timing of the arrival of the Toronto data was so exciting; these data not only confirmed the high pregnancy rate in very unfavorable patients with diminished ovarian reserve, but demonstrated an identical reduction in miscarriage rate to the one observed by us (when compared to national IVF data). Since the combined data sets between CHR and the Toronto center involve an adequate size patient sample, we are now confident to state that DHEA supplementation significantly decreases the miscarriage rate in women with diminished ovarian reserve.
DHEA treatment is validated
Indeed, we even can go beyond this statement: While a reduction in miscarriage rates is seen in women of all ages, the reduction is smaller in women below age 35 than in women above age 35 years, where the reduction often exceeds 50 percent. This, of course, should not surprise since miscarriages are known to increase with advancing female age. Most of these miscarriages are, however, due to aneuploidy and this observation brings us back to where we started from: Our new data, on the decrease in miscarriage rates after DHEA supplementation especially in older women above age 35, strongly support that DHEA, indeed, reduces chromosomal abnormalities (aneuploidy rates) in embryos.
The importance of this observation cannot be overemphasized. Since older women represent in the USA the most rapidly growing age group of women having babies, our findings may have significance far beyond those older women who require fertility treatment. Indeed, if confirmed by further studies, DHEA may become a supplement to be given, like prenatal vitamins, to all (older) women contemplating pregnancy.
We, of course, have submitted an abstract on this exciting data to ESHRE and a full length manuscript is in preparation.
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Summary of DHEA data
The following is a summary of conclusions about CHR’s DHEA data,
as we presented them at these events, and as we understand them to
be reflected by the clinical experience we have witnessed so far in
our patients:
>>DHEA increases in older women oocyte numbers to a
statistically very significant degree.
>> DHEA also increases egg and embryo quality in older
women to a statistically very significant way.
>> DHEA appears to increase pregnancy rates with IVF
in older women; however, while we are observing
a very strong trend towards significance for this
finding, the data have not yet reached statistical significance.
>> We have observed preliminary evidence, which has
not reached statistical significance, and needs
to be viewed with extreme caution, that DHEA may reduce
the degree of chromosomal abnormalities in eggs and embryos of older women.
We are, therefore, to day in a position where we can state with considerable
conviction that treatment with DHEA benefits older women,
as reflected by their IVF- cycle outcomes. We have also considerable evidence, though not as much as in older
women, that DHEA treatment has a similarly beneficial effect
on younger women with prematurely aging ovaries.
>> We also confirmed the initial observation in our index patient that the effectiveness
of DHEA usage peaks after approximately 4 months of use.
>> Moreover, we strongly suspect (though do not yet
have absolute proof) that co-treatment with gonadotropins
further amplifies the positive DHEA effect on the
aging ovary.
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Want to know more?
To learn more about DHEA and our POA program at CHR, simply complete the Prematurely
Aging Ovaries Qualification Form. |
