Is your IVF clinic recommending DHEA if you have diminished ovarian reserve, age-related infertility, low AMH levels or are over 35?

Have you been diagnosed with *low AMH, *POI (primary ovarian insufficiency), *DOR (diminished ovarian reserve) or are you a poor ovarian responder with stimulation medication in an IVF cycle? Do you struggle to harvest more than 3 eggs in an IVF cycle, or are over 35 years? Read on, and make sure your fertility clinic recommends DHEA supplementation where indicated.

 

DHEA (dehydroepiandrosterone) is a hormone produced naturally by the adrenal glands and ovaries. It plays a role in the production of other hormones, including estrogen and testosterone. It is critical for the early development of follicles. If fewer follicles are produced it may account for lower AMH levels or high FSH, so don’t be discouraged!

Levels of DHEA typically decline with age but could be lower in younger women due to autoimmune conditions, including those that attack the adrenals. Autoimmunity is now understood to be a common cause of premature ovarian failure.

 

Here's how DHEA may help increase the number and quality of eggs and embryos:

Egg quantity and quality:  DHEA supplementation has been proposed as a way to improve egg quality, particularly in women with diminished ovarian reserve or advanced maternal age. Studies suggest that DHEA may enhance the ovarian response to fertility treatments such as in vitro fertilization (IVF) by promoting the development of healthier eggs by supporting testosterone in early follicular development. DHEA seems to increase fertility prospects for those women trying to conceive naturally or through IUI too.

 

DHEA and miscarriage: DHEA reduces chromosomal abnormalities in eggs and therefore miscarriages. Women with DOR are more vulnerable to aneuploidy (chromosomally abnormal eggs). Research supports that DHEA may reduce the rate of aneuploidy, and resulting miscarriages.

 

Anti-inflammatory effects: DHEA has anti-inflammatory properties, which may be beneficial for fertility. Chronic inflammation in the reproductive system can negatively impact fertility by interfering with various processes, including implantation and embryo development. By reducing inflammation, DHEA may improve the chances of successful conception.

 

  • DHEA supplementation has been used in some fertility clinics since 2007, with encouraging results. Numerous randomised and placebo-controlled studies show that for those with DOR, age-related infertility, or an auto-immune condition the outcomes can be significantly improved. Testing will confirm levels.  If DHEA and testosterone are in the lower half of the normal range, supplement with DHEA.

 

 Supplementing and dosage notes

  • Test DHEAs as DHEA levels fluctuate all the time.  The sulfated version gives more reliable results.

  • Test testosterone too. Go for the higher end of normal for younger women. Levels of DHEAs and testosterone should be monitored throughout usage.  

  • DHEA is not recommended for those women with PCOS or those with hormone-sensitive cancer.

  • DHEA may interact with some medications. Check with your fertility specialist for suitability.

  • Take from 3-4 months before an IVF cycle, during the fertility-optimizing window.  

  • DHEA appears to boost pregnancy chances for those trying to conceive naturally.

Dosage

  • Start with 25mg daily building up to 25mg 3/d depending on levels.

  • Stop taking DHEA the day before egg retrieval or when you get a positive pregnancy test.

  • If conceiving naturally, stop DHEA once you are pregnant.

 Supporting DHEA levels through Diet and lifestyle

  • Elevated blood sugar and insulin levels can cause a decreased production of DHEA in the adrenals along with blood sugar imbalances creating vitamin and mineral imbalances that stress the adrenals and reduce DHEA production.

  • Stress can cause increased cortisol (stress hormone) levels.  If stress becomes chronic the ‘pregnenolone steal’ is activated. Pregnenolone is a byproduct of cholesterol metabolism that is necessary to produce both cortisol and DHEA. Sustained stress causes this process to shift towards cortisol production`’stealing’ the necessary pregnenolone from the DHEA production pathway, depleting levels.

  • Diet Including complex carbohydrates (fruits and vegetables) and good fat (lean chicken, fish, olive oil, etc.) in your diet is recommended to increase DHEA levels. A diet rich in omega-3 fatty acids can increase DHEA levels significantly. As a steroid hormone, good fats are essential for the production of cholesterol.

  • Sleep Sufficient rest or sleep is necessary for adequate functioning of the adrenal glands that produce DHEA.

 The ‘making Healthy Babies’ e-Course provides detailed information on the naturopathic support of DHEA PRODUCTION.

Fett, R., 2019,  It Starts With The Egg, Franklin Fox Publishing

JBRA Assist Reprod. 2018 Nov 1;22(4):369-374

 

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