DHEA Use in IVF: It Could be Harmful in Certain Cases!
DHEA, a “mild” male steroid hormone (androgen) produced by the adrenal glands and ovaries, is involved in the production of androstenedione and testosterone (“strong” androgens) as well as estrogen in the ovaries. DHEA levels tend to decline naturally with age.
Since DHEA is metabolized to testosterone in ovarian connective tissue (theca/stroma) and is then processed by the granulosa (follicle) cells to form estradiol, it should come as no surprise that the question would arise as to whether DHEA administration could serve to enhance fertility by fueling follicle growth and by improving egg development. It was precisely this question that prompted a study to be conducted in Israel (published in July 2010) where 75mg of oral DHEA was administered to a group of infertile women for 5 months. The conclusion reached was that the group of women who took DHEA did indeed experience enhanced fertility.
I do not doubt that DHEA therapy is likely safe for women with normal or low adrenal and ovarian DHEA or testosterone production, and in fact, could even be beneficial in some such cases. However, by causing a “testosterone overload,” such therapy could be highly detrimental to those women who are susceptible to this happening. Since sustained exposure to high Luteinizing Hormone (LH) bioactivity leads to overgrowth of ovarian connective tissue (hyperthecosis/stromal hyperplasia), and LH also stimulates conversion of DHEA to testosterone, it follows that DHEA supplementation can actually compromise follicle and egg development and egg quality, thereby reducing fertility potential. Women who are prone to ovarian hyperthecosis (e.g. older women, women with Diminished Ovarian Reserve [DOR] and those who have PCOS) are most likely to have negative consequences from DHEA supplementation.
To date, none of the studies to assess for a benefit of DHEA therapy have properly differentiated between young healthy normal women and those who are at risk of having ovarian hyperthecosis as mentioned above. Let me further expand on this explanation: Indeed “some” (a relatively small amount) of testosterone is needed for estrogen production, follicular growth and proper egg development. However, excessive ovarian testosterone will enter the follicular fluid, cause exhaustion of granulosa cells that produce estradiol, and compromise egg development. Thus women with an overgrowth of ovarian connective tissue (theca) should not receive DHEA supplementation in my opinion.
One possible but unrelated advantage of DHEA therapy was suggested by a study conducted a few years ago at Washington University School of Medicine in St. Louis, MO. The findings, reported in the November 2004 issue of the “Journal of the American Medical Association,” showed that judicious (selective) administration of 50mg DHEA daily for 6 months resulted in a significant reduction of abdominal fat and blood insulin in elderly women.
In some countries including Canada, DHEA treatment requires a medical prescription and medical supervision. Not so in the U.S.A where it can be bought over the counter. Since DHEA is involved in sex hormone production, including testosterone and estrogen, individuals with malignant conditions that may be hormone dependant (certain types of breast cancer or testicular cancer) should not receive DHEA supplementation. Also, if overdosed with DHEA, some “sensitive women” might so increase their blood concentrations of testosterone that they develop increased aggressive tendencies or male characteristics such as hirsutism (increased hair growth) and a deepening voice. Also, DHEA can interact other medications, such as barbiturates, corticosteroids, insulin and with other oral diabetic medications. The best advice for those women seeking to use DHEA is to consult their health care provider or fertility specialist before starting the process.