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DHEA and Fertility

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DHEA and Fertility

DHEA and Fertility: When and How to Use It

DHEA supplementation has gained attention for its potential to improve fertility, particularly in women undergoing IVF. This guide provides an overview of when and how to consider DHEA, supported by clinical insights and evidence.

Should I Take DHEA to Improve Egg Quality?

Determining whether DHEA is appropriate for you depends on your individual health and fertility profile. DHEA has shown promise in improving egg quality and quantity in some women preparing for IVF. However, it is a hormone precursor, and its use should be undertaken with caution.

Before starting DHEA, testing your DHEA-S and testosterone levels is crucial to evaluate whether supplementation may benefit you. Regular monitoring ensures correct dosing and effectiveness.

How Does DHEA Help With Fertility?

DHEA is commonly recommended for individuals with diminished ovarian reserve (DOR) due to age or premature ovarian insufficiency (POI). Its primary role is to restore levels to those typically seen in younger, fertile women.

Dr. Norbert Gleicher of The Center for Human Reproduction in New York states: “DHEA supplementation for women with diminished ovarian reserve has revolutionized the practice of in vitro fertilization, vastly improving pregnancy outcomes for women with premature ovarian aging or age-related decline in ovarian reserve.”

Studies have shown that women with DOR often have low DHEA and testosterone levels. Supplementing with DHEA can normalize these levels, significantly increasing the number and quality of eggs retrieved during IVF. Research also indicates that DHEA supplementation improves pregnancy and live birth rates in IVF (e.g., Gleicher et al., 2016).

For young women with POI, DHEA may address the underlying issue of insufficient adrenal production of DHEA. Autoimmune conditions, including thyroid autoimmunity and endometriosis, are common causes of poor adrenal function. Testing DHEA and testosterone levels can help determine whether supplementation is appropriate.

Normal Levels of Female DHEA and Testosterone

Monitoring DHEA-S and testosterone levels ensures the proper use of DHEA for fertility enhancement. Key reference ranges include:

  • DHEA-S (sulfated DHEA): Optimal for fertility: ~180 mcg/dL; normal range: 95–270 mcg/dL.

  • Testosterone (total): Optimal: 25–45 ng/dL; normal range: 8–60 ng/dL.

Testing total testosterone is particularly useful when determining whether DHEA supplementation may be beneficial.

Do I Need DHEA If My Levels Are Normal?

Supplementation is most beneficial if DHEA-S levels are below 95 mcg/dL. If DHEA-S is between 95–180 mcg/dL, consider supplementation if total testosterone is below 25 ng/dL. Always consult with your healthcare provider for tailored guidance.

Potential Risks and Side Effects

DHEA is not suitable for everyone and carries potential risks, including:

  • Exacerbating PCOS: Women with PCOS often have elevated testosterone levels, and DHEA may worsen symptoms.

  • Hormone-sensitive cancers: Like other hormonal supplements, DHEA could theoretically promote the growth of hormone-sensitive cancers.

  • Interference with egg development: According to one mouse study, prolonged high doses may negatively impact late-stage egg development so caution is recommended.

Common side effects include oily skin, acne, and unwanted hair growth. Beneficial effects may include improved energy, mood, and cognitive function. Rarely, voice changes can occur.

Recommended Dosage and Monitoring

The standard clinical trial dose is 25 mg three times daily (75 mg total). However, this dose may be too high for most women. Starting with 25 mg once daily is often advisable. Regular testing of DHEA-S and testosterone levels every 1–2 months ensures appropriate dosing. Discontinue DHEA upon starting IVF medications or achieving pregnancy.

Managing Elevated DHEA-S Levels

If DHEA-S becomes elevated due to supplementation, reduce or pause the dose. High DHEA-S combined with high testosterone can impair late-stage egg development, potentially warranting an IVF cycle postponement. Elevated DHEA-S unrelated to supplements may indicate underlying PCOS or insulin resistance, which could benefit from interventions like inositol.

Conclusion

DHEA supplementation may offer significant benefits for individuals with diminished ovarian reserve or premature ovarian insufficiency, but its use requires careful evaluation and monitoring.