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DHEA Use in IVF: It Could be Harmful in Certain Cases!
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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.
73 Responses to “DHEA Use in IVF: It Could be Harmful in Certain Cases!”
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Ask Our DoctorsA Question
Hi Dr. Sher,
We recently had our first phone consultation. You mentioned DHEA possibly being bad for me. My FSH and LH are normal, but my AMH is very low at 0.4. My RE has me on 75 mg of DHEA. My first IVF cycle yielded 16 eggs, 9 fertilized, 2 implanted, 0 were able to be frozen and I had a blighted ovum. Would I be a poor responder to DHEA? Should I stop taking it? All the research I’ve seen online makes it sound beneficial, but your article has made me question it. Thanks for your advice!
I am definitely opposed to DHEA , especially in women such as you with reduced ovarian reserve. Go elsewhere on this blog and read the article I posted on “Nutritional Supplements” and you will find the reasoning behind my position, there.
Geoff Sher
hi
i am 42 and have 4 rounds of ivf. the 2nd time i fell pregnant but it turned out to be a chemical pregnancy. my fsh is 6.7, amh is 0.16.i have only 1 ovary, and was adised to dhea to help improve quality eggs. The last cycle i did i was on dhea for 3 months, had 2 transferred and 1 frozen. I was told to continue taking dhea for frozen cycle, it doesnt seem right ? what do you think. my embryos have always been graded well, but never seem to take. any advice would be appreciated.
Bonjour Dr Sher, je suis une femme de 36 ans (FSH 26; E87; AMH 0,16). La clinique de fertilité que je consulte me conseille de prendre du DHEA ? A noter que je n ai pas eu de règles depuis seulement la mi-juillet 2012, mais qu avant j avais des règles à chaque mois. De plus, je n ai jamais eu aucun autre traiement concernant l infertilité, car j en suis au début de mes démarches. Merci de vos éclaircissements.
Please have someone help you translate this to english and repost.
Thanks!
Geoff Sher
Hi, I was wondering if you can give me some advice? I just turned 41; I have 4 children; my last child was born 4 yrs ago. Recent day 3 blood work results were: estradiol 193 pmol/l; FSH was 5.8 U/L; LH was 2.4 U/L. I recently finished an IVF cycle. I stimulated 12 follicles; had 10 follicles retrieved; 9 follicles were mature; 7 follicles fertilized. My egg transfer was cancelled as the pgd results showed aneuploidy will all 7 embryos. As you can imagine, I was devastated. I was reading your info regarding dhea potentially being harmful to certain woman? I am wondering if I could be one of those woman? Could the dhea potentially have had a harmful effect on my eggs? I realize I am older & that could be the reason for the chromosomally abnormal eggs? Do you think the fertility medication could have had a negative result on my eggs? I just have a hard time accepting all my eggs are abnormal. I wonder if there was something that caused the abnormal eggs or if it is just me & I need to accept it? I really want to do another round of IVF, but I wonder if I should accept my defeat? I was on lupron to 10 mark until I started bravelle & menopur. Once I started on the bravelle & menopur, I reduced the lupron to the 5 mark. I was on 3 powders of bravelle & 1 powder of menopur. Your advise is greatly appreciated?! Almost all the info I have read indicates dhea is good for fertility but I wonder after reading your article, if it was harmful. I was on 50mg/ day of dhea. I had been taking it for at least 8 months prior to my IVF cycle. Thanks kindly for your input!!
I would say that the protocol for ovarian stimulation needs review, that you need also top be evaluated for immune issues but most importantly, you need to consider embryo bankng of CGH-normal blastocysts before you run out of time. Read up on each of these topics in this blog (elsewhere). Simply go to the home page of http://www.IVFauthority.com and type in the relevant subject matter into the search bar there.
Most important is to call 800-780-7437 and set up a free video call with me so we can discuss in detail.
Geoff Sher
Dr. Sher,
Thank you for your response!
Prior to my initial writing to you, I did make an appointment for a telephone consult with yourself. I am anxiously awaiting that consultation! I look forward to your suggestions which hopefully can bring me success!
I have spent many hours reading through your site. Thank you for having so much information!
I have stopped taking the dhea. I hope that is what you would have recommended? I have also started acupuncture & will continue with that once a wk until I am able to try another round of IVF.
I realize every month matters, especially for someone my age. Could you advise how soon I can try another round of IVF?
Thank you kindly,
Tracie
Lets defer until you and I talk Tracie. I look forward to that.
Geoff Sher
Hi Dr. Sher,
Thank you again for having such great information on your blog!
I am suspicious that I could have PCOS. I have read your blogs about PCOS & wonder if this was part of the reason my previous cycle failed? Could the use of the DHEA, along with the protocol, be behind the cause of my genetically abnormal eggs? I could very well be grasping, but I feel there had to be another contributing factor to my eggs being low quality. I do not believe it was solely because of my age. I believe there had to be another reason not even one egg was genetically normal.
Thank you again for you kindness in answering me!
Tracie
As you are aware, I am not inn favor of using DHEA with IVF, under any circumstances but especially in those with DOR, and PCOS. However, I would like to invite you to call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
“Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
“Nutritional supplements in IVF”
“PCOS”
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
Geoff Sher
Hi
I have had 3 miscarriages, the last 2 years ago, all pregnancies were “natural.” I have not been able to get pregnant again and have since been seeing a fertility specialist. We have tried several things, but in the end, I’m 40, 12 FSH and other numbers that are not encouraging (my doc gives me a 5-9% chance of getting pregnant). My tubes are open and I’m very healthy otherwise. I had a failed IVF a month ago – 5 eggs, 1 fertilized but didn’t take after transfer. I was on very high doses of Follistim (600 mL) and all of my other drugs along the way to try to help. I’m going to begin round 2 and it was recommended that I add 25mg of DHEA 3 times a day and take estrovace (?) a week or so before my next cycle starts. Thoughts? I’m pretty desperate and it doesn’t look good. thanks.
First, it is important to know that most miscarriages are due to a chromosomal embryo defect. However, when miscarriages occur one after another ((Recurrent Miscarriage) there is often an underlying implantation dysfunction. This can be due to an Immunologic Implantation Dysfunction. Thus before you go any further, in my opinion that needs to be assessed (see below). Clearly also, you have diminished ovarian reserve and when this happens, especially at age 40 and above, then time becomes an issue because you are running out of eggs. Finally there is the inevitable negative effect of age on egg/embryo quality.
So, your first step is to exclude and address the possibility of an immune issue. Then you need to decide whether you want to try (for a reduced chance of success per cycle with your own eggs or go directly to egg donation. If the decision is try with your own eggs then in my opinion Embryo banking with CGH embryo selection is the best choice for you (see below.
Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
“Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
“Agonist/Antagonist Conversion Protocol”
“Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
“Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
“Staggered IVF”
“Embryo Banking”
“Egg Donation”
“Age and IVF Outcome”
Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Thank you. I will make a call and look into the articles. I appreciate your help and quick response!
Hi Dr. Sher.
This has been a recent topic for us and DHEA is used by many mostly due to CHR’s data on DHEA. I actually used it after my cancelled cycle at the age of 34- after 450iu of FSH, just 2-3 follicles. 8 months of DHEA later, 23 eggs, 10 fertilized and I had my son that way. I still credit DHEA for the improvement- I had my testing done before the second cycle and both my FSH and AMH(doubled) got better so something had to have helped, right? I just wonder why you do not mention the CHR study. Thank you. Value your opinion!
Congratulations on your IVF success!
I thank you for your comment and am happy that you attribute your result to the effect of DHEA but I do not buy the study you quote and for reasons hat relate to the known danger of overexposure of the developing eggs in older women and those with diminished ovarian reserve to excessive ovarian testosterone production, I strongly discourage the use of DHEA in my patients.
Happy New Year!
Geoff Sher
Dear Dr Sher,
Thanks for your interesting thoughts on DHEA.
I am cycling in March this year IVF # 4. I am 38 and my husband is 42. I am not Insulin resistant and my AMH is 2.6. My last 2 cycles I have done PGD as we are doing IVF for secondary infertility and gender selection. The first cycle I had 8 tested but all were abnormal except 1 mortula that resulted in a negative. I commenced DHEA 75mg and my second cycle I had 2 normal hatching blasts however both were male and we are trying for a female. My DHEA levels were tested after my first PGD cycle and were below normal. Just before my last cycle they were mid range.
I am still on the DHEA and think that was the reason I got two beautiful blasts last cycle. I am scared to stop but would love your opinion.
Many thanks.
I respect that, but as a point of interest, I doubt you ever had DOR. I wish you well. Good luck in your next attempt.
G-d bless!
Geoff Sher
Hi Dr. Sher,
I am 33 and I have been trying to conceive since 2008. I Have an FSH of 17.8 and an amh of .16, Does this mean I have low ovarian reserve or bad egg quality or both? Will I ever be able to conceive naturally?
Thanks,
Ann
Hi Ann,
Yes indeed you likely have severely diminished ovarian reserve (DOR) ans although that does not rule out ca natural pregnancy, you do not have the time to waste trying. You need IVF.
Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
“Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
“Agonist/Antagonist Conversion Protocol”
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
“Staggered IVF”
“Embryo Banking”
“Egg Donation”
Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Dr. Sher,
Thanks so much for the quick response. I have another question. Is there a reason as to why at my age I have DOR? Is this something I was born with? Is there any way I can improve it or is IVF my only option? Also my Dr recommended we try Insemination , is that something you would recommend as well?
Once again THANK YOU!
Thanks,
Ann
I respectfully would not recommend IUI because the success rates are too low , and with DOR you do not have the time to waste.
Yes it is usually genetically determined.
Geoff Sher
hi,
i have a few questions, I am 22 and my doctor put me on DHEA due to adrenal fatigue. i was also diagnosed with hypothyroidism at the age of 19. I have been on DHEA for about 9 months now. I have 2 children and have no problem falling pregnant. In the last few days I found out I am 5 weeks pregnant. I have since stopped seeing the doctor who gave me the DHEA and started seeing a new doctor who dosent know much about DHEA. He is worried that taking the medication I may have harmed the forming embryo. I cant get in contact with my old doctor to ask him what effects the DHEA might cause and now I am very worried and scared.
I have been trying to find something on the Internet about taking DHEA while pregnant but have had no luck, but I have noticed woman use DHEA for fertility treatment.
I am very confused and scared and need some advice please!!!
thank you.
As you are probably aware I am not pro-DHEA in infertile women considering IVF , especially not those who have diminished ovarian reserve or are older (>39Y). However, I know of no evidence to support the thesis that if you use DHEA and conceive that the embryo wil;l propagate a compromised conceptus. I would sleep easy if I were you.
Good luck!
Geoff Sher
Hello Dr. Sher
I am a 35 year old. At 33 I underwent 4 IVF’s with no success. I decided to go to an endochronologist due to a history of thyroid problems. He diagnosed me with Hashimoto disease and treated me for that. During treatment we discovered I had an adult onset of Congenital Hyperplasia of the Adrenal. I am about to start another IVF course and my endochronologist would prefer I have DHEA but my fertility doctor disagrees as he supports your opinion on DHEA. I was wondering if my case may be an exception due to the Congenital Hyperlasia? Your opinion would be greatly appreciated.
Thank you.
Please see my response to Emily above (regarding autoimmune disease and NKa. The congenital adrenal hyperplasia will require prior control with dexamethasone or prednisone before a stimulation with fertility drugs should be contemplated.
Good luck!
Geoff Sher
Hi Dr. Sher,
Thank you for your response. I unfortunately cannot see a response to Emily. I am on drugs to control my condition.
Thank you again.
I responded in regard to the association between autoimmune thyroid disease (Hashimoto’s) and immunologic implantation dysfunction. Might I suggest that you call 800-780-7437 tomorrow and set up a Skype or telephone consultation with me to discuss your case.
Geoff Sher
Hi Dr. Sher
That would be great. Do you have an international number to call as I am in South Africa?
The # to call is 702-699-7437.Please all
ow for time differences.
Geoff Sher
Hello Dr. Sher,
I read with great interest your views on DHEA. I have been on it for about 6 months now and it was a prescription based keto form made by a compunding pharmacy and is just supposed to support adrenals without getting converted to estrogen or testosterone(that’s what the pharmacist says). I have since done one IVF cycle with transfer of 2 and it did not work. It was 7 cell and a 5 cell embryo, day 3 transfer. But the poor response could have been caused by the high dose menopur that I was on (that’s what I think)or just my age. Recently I switched to the over the counter form DHEA as I have read numerous success stories from poorly responding women. I was on 50mg and saw my always very normal cycles getting screwed (having periods twice in a span of 15 days!) I am giving dhea a benefit of doubt and continuing with it but reading views coming from an authority like yourself is giving me sleepless nights and I am about to stop doing dhea completely. Could you please answer this – What is your definition of DOR and a poor responder? On my first IVF (at 32 years old), I had 10 eggs retrieved (cycle didn’t work), was given depot lupron to help with my endometriosis (not sure if it helped or hurt) fast forward to 34, 35 and 36 years old, I had 4 eggs retrieved on each of my 3 cycles ( I have 4 total fertilized embryos frozen-not CGH tested though). I do not respond well to fertility medications. My AMH is 1.0 and FSH is 10.8 and I am 37 years old. Do you think I am DOR and a poor responder and should not be doing DHEA ? Do you think it could be helping/hurting me? Please advise and thank you so much for answering questions on a public forum. It is greatly appreciated.
With an AMH of 1.00 and an FSH over 9.o + your blunted response to COS, I do think you have DOR and I personally recommend DHEA. Also, the protocol used for stimulation in cases of DOR is critical….see below.Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
Geoff Sher
I have no comment except that there is presently no data/ evidence to suggest that this would be effective.
Geoff Sher
Thanks for your response Dr. Sher! I thought you don’t recommend DHEA for DOR from all that I have read so far, so I was a little surprised by your response. In fact, I thought it might be a typo
) Thanks!
It WAS definitely a typo…sorry!
Geoff Sher
Dr. Sher,
I just had a 3 day transfer yesterday of a 5 cell embryo that “looked great” according to the RE and embryologist, but just a “bit behind”. Out of 4 eggs retrieved, 3 mature, this is the only one that fertilized and we did ICSIthis time. This is our 2nd ivf and our first one was same antagonist protocol with slightly lower dose of meds and we got 6 eggs and 4 fertilized properly without icsi. That was in June and 3 made it to day 5 ans they transferred a morula and early blast and it was a bfn. In September we tried a MDL protocol and my body didn’t respond at all so my re had me take dhea for 4-5 months to see if it would be helpful to get more eggs. I am 35 now and have severe endometriosis with an endometrioma so large on 1 ovary that she can’t get any eggs from that side. I’m worried that, a 5 cell on day 3 transfer just won’t work and also I’m confused as to why fertilization seemed better without icsi and why we got less eggs after taking dhea. My amh went from 1.6 a year ago to .33 last month after taking dhea. My fsh stayed basically the same though. I really appreciate your insight! I’m concerned that the dhea possibly did more harm than good. Also are there other protocols that don’t use Lupron that you would recommend?
Hi Nat,
This sounds like a stimulation protocol issue. I think I can help but you would need to communicate with me .Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
In the meanwhile, please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
5.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
Geoff Sher
Hi,
After reading this blog, I was frightened that i had been taking dhea and was about to go into my second cycle of ivf. Ive been TTC for three years and have had 4 miscarriages. I had a failed ivf cycle because my eggs were all of poor quality. I assumed my doctor wanted us to do a donor egg, but instead she asked me to take 50 units of dhea daily for 4 months. Let me tell you my experience, we retrieved 25 eggs, 19 fertilized, and 14, yes 14, made it to grade A blastocysts!!!! What a difference from 15 eggs no blastocysts on out first ivf cycle!! The only thing I changed was adding the dhea. Please know everyone is different and you need to be looked at on a case by case basis. don’t let this doctor frighten you about dhea. It’s my miracle pill and I would recommend anyone to look into it to see if it’s right for you. Good luck to you all!
Eliza,
I am not trying to frighten anyone about DHEA.I have no reason to do so. I am pleased for you that you have developed better embryos while on DHEA,and I do not blame you for attributing your improved yield of eggs/embryos to the DHEA. However, I submit that this could well have been in spite of using it and due to other minor protocol changes and or timing of the trigger , rather than due to DHEA.
This having been said, I do not believe that DHEA is as potentially harmful in younger women with normal ovarian reserve. The ones at most risk are those who have elevated LH and already have high ovarian testosterone production (older women, women with diminished reserve, and women with PCOS). In such cases excessive local testosterone can in my opinion compromise egg/embryo development and since DHEA metabolizes to testosterone in the ovaries, it makes no sense to add fuel to the fire by using it. Indeed some can and do get away with it…but it is not worth the risk.
I wish you well and hope that your blastocysts are indeed competent and that you will be rewarded in that your ET will be results in a good outcome…After all, that is really all that matters in the end.
Geoff Sher
Hi Dr.Sher,
I am 32yo with a history of high FSH levels of 20-25 for past five years. Recently, I have started pursuing fertility and actively involved with treatment plans with local RE for past 3-4 months. Upon initial tests, I have had extremely poor prognosis with FSH 20, AMH <0.8, AFC 2-4 but with fairly regular cycles of 25-32 days. I believe My case of POA/DOR will be advanced to POI very soon.
I have been prescribed DHEA 75mg/daily to improve egg quality. My testoterone levels returned 6 after being on DHEA for 8 weeks now (there was no baseline test performed). So far I have had two failed IUI cycles with one clomid stim (100mg/daily CD3-CD7) and second stim with 225 IU FSH + 75IU LH stimulation for day 2-10.
It would be much appreciated to get your insight into my current regime of DHEA and if I should consider taking them or stop them.
Thank you for your advise.
Please read my article on DHEA use on this blog. I stand by the view that this is not something that anyone with diminished ovarian reserve should use. Much more important is that because of your relative youth, if a very aggressive individualized protocol is used, you might still be able to develop a few follicles with eggs that could propagate ab viable pregnancy. See below.
Please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “Staggered IVF”
10.“Embryo Banking”
11. “Egg Donation”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Good luck!
Geoff Sher
Dr. Sher,
So if I understand you correctly, you do not support DHEA in older women with DOR because with the condition of DOR and age, women are already producing more testosterone in the ovary? Over-production would in effect “shut down” the ovary and egg production, or reduce egg production. I realize that’s quite simplistic but did I understand that correctly?
I also understand that there is no test to determine the amount of testosterone in the ovary, correct? So there’s no way to know for sure.
Would blood testing of DHEA be helpful in determining the amount of DHEA in the body?
Finally, if I had achieved pregnancy with DHEA before, would you be more open to allowing it again? Of course, I believe it the be the reason but there are so many other variables it’s hard to be sure.
Thank you for your time and help.
I am glad you were successful while on DHEA, but I submit that it was likely in spite of using it. This having been said, there is no issue with what I would “allow”. I will only advise, but ultimately, the decision of what to do is for the patient to reach. It is never the role of the physician to dictate what to do in the IVF setting.
Geoff Sher
Hi Dr. Sher, I have a DHEA question. We do IVF b/c my husband has CAVD. At 40 we did our first and we have a daughter from that cycle (flare protocol w/450 follistim; 6 eggs, 5 mature, 4 fertilized, one took). I am now 42 and we are looking for a second child. My second IVF (microdose flare, 450 follistim), my AMH was .67, my FSH 7 and my AFC 11. We got 5 eggs, 3 mature, 3 fertilized, none took. Third IVF (microdose flare, 600 follistim first 2 days, 450 after that) AMH 1.6 FSH 7.1 & AFC 13. I took DHEA for that cycle, 5 eggs, 4 mature, 3 fertilized and we got pregnant but lost it at 6 weeks. I’ve never been diagnosed with DOR since we arrived here due to my husband. I’m looking for any possible way to improve egg quality for our next (and probably last) IVF. Am I a good candidate for DHEA?
Respectfully I would not recommend DHEA. Your AMH and response could be in keeping with diminishing ovarian reserve and in such circumstances the last thing you would need in my opinion, is more androgens.
Geoff Sher
800-780-7437
Hi Dr. Sher. Given your stance on DHEA for older women I’m curious your take on why most clinics that recommend DHEA protocols do so for their older patients and those with low ovarian reserves.
We’ve had a successful IVF where I’ve used DHEA and one where I haven’t used DHEA. Now at 43 (almost 44) we’re trying for a 3rd. I used DHEA prior to retrievals in Jan and April, but both cycles produced low egg count (6 eggs, then 5 eggs) of which 3 were tested on Day 5 but all were abnormal. We’re going to do one last cycle later this summer and I’m torn on whether to do it with or without DHEA.
Thanks!
I cannot explain why others do what they do. I can only be accountable for what i recommend…sorry but that is the best I can offer.
My position is that the last thing a woman with DOR or an older woman’s eggs need is more ovarian testosterone.
Geoff Sher
hello I have an ovarian faillure since the age of 13 or 14 i cant remenber i am now 34 years old i have no period unless i take ellest duet but i have stop taking it for over a year i change adress and my New GP did not bother prescibing it to me again I really want a be pregnant and was wondering how i could take the dhea if you coild help me on it i would much appreciate best regard samantha
You are most likely going to need an egg donor.
Good luck!
Geoff she
In preparation for IVF, I am currently taking 25 mg of DHEA twice a day and am experience irregular periods, going from an approximately 21 day cycle to 29 days and then 14 days. I am 42 years old and my FSH was 25 and my AMH was .16 prior to starting DHEA. I am also taking 5 g of maca a day as well as CoQ10. After reading you opinion on DHEA, I want to stop taking it. Should I quit cold turkey, or taper off by taking 25 mg a day for a few days? Thanks!
Frankly I am against the use of DHEA in older women and those with diminished ovarian reserve as in my opinion it can compromise egg/embryo development. You can stop cold turkey.Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Nutritional Supplements in IVF”
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “Staggered IVF”
10.“Embryo Banking”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Hi doc
I am 34 years old,I had two IVF cycles which were failed last year as on my first cycle 16 egges were collected and only 9 became fertile,and the second time 9 were fertile again out of 11. This is the third time as my doctor suggested me to take DHEA before third attempt. I am on DHEA for about a month but it reduced my period or I should say starts one day later but only spotting. I was scared and stop taking DHEA immediately. My question is, I am aware that my ovary responded so slow each time i had my IVf. Would that DHEA give negative result on my third cycle?
I am (as you probably know), not a fan of DHEA. I would stop…but first e go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type in “Nutritional Supplements in IVF” (where you can read up on DHEA in IVF). Then consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Hello Dr. Sher,
I have been reading your blogs since January. In fact, I did ask your advise when I had my miscarriage after my IVF cycle. I am 31 years old. My first AMH level taken on 2011 was 0.36. Second AMH taken on 2012 was 0.86. I don’t know of any reason how my AMH level got improved in one year other than I lost some weight since 2011. Since I did become pregnant even with one embryo transfer, that gave me a little hope for a next try.
I consulted my infertility doctor and he was recommending to do a microdose protocol after I take DHEA supplement for 3 months. He mentioned that it is supposed to increase the quality. I see that from your blogs, you are against in taking DHEA. I just wanted to hear your opinion on my doctor’s plan of action for my next IVF. He did mention that if this doesn’t work, there is no point in doing IVF with my own eggs and suggest to go for a donor. But he seemed to be optimistic.
I appreciate your thoughts.
Thanks,
Sonya
No doubt there are differences of opinion and in my opinion, neither microdose flare protocols or DHEA is good for women with diminishing ovarian reserve.
Please go to the Home page of this blog, http://www.IVFauthority.com. When you get there, look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. ” Nutritional supplements in IVF”
Feel free to call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Dr Dr. Sher, I am 32yrs old with 2 children (not planning on having more). I recently had blood tests done and my Doctor diagnosed me with Adrenal burnout, also my estrogen / cortisol level are very low. She perscribed me 25mg DHEA daily for 6 months. I just want to know what the real risks are of DHEA?. and Is this something that I will become dependant on and have to take for the rest of my life? Many thanks
I do not think there are risks if you have normal or high ovarian reserve (as tesated on day 3 for AMH/FSH/LH/estradiol).
Geoff Sher
Hi! I am 41 yrs old and finished my 2nd failed IVF attempt. My 1st round, I used Follistim 225 in am, 75 in pm, and Menopur 150mg qpm x9 days,with Ganirelix on days 8 and 9, then Lupron 8 units day 10, then ET day 12. They retrieved 11 eggs, 10 fertilized normally, but only 3 were sent for biopsy on day 5. All 3 showed multiple aneuploid chromosomes. 2nd round, did same with Follistem and Menopur x10 days with Saizon 1cc daily on days 5-10, then Ganirelix days 8,9,10 with low dose hcg, and Lupron trigger day 11. They retrieved 14 eggs, 7 fertilized and only 2 for genetics testing on day 5. Again, failed ivf with monosomy 12 and trisomy 16. Is it worth another try?? My doc says no and to do donor eggs….my fsh is 5 and I had >20 follicles with each cycle. Is it time to face the truth and admit my eggs are just too old??
Sherry
It is not surprising to have embryo aneuploidy affect most embryos at 41. However not all of them. I personally do not agree with the protocols used for ovarian stimulation, especially not in older women (or in those with diminished ovarian reserve). I think I can help you but it is all about individualizing the protocols of stimulation. Please read up on this below and also on Staggered IVF with CGH embryo selection.
Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
5. “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
6. “IVF success: Factors that influence outcome”
7. “Staggered IVF”
8.“Embryo Banking”
9. Embryo Selection: The Critical Factor in IVF”
Please call 800-7800-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Hello Doctor.
My values entan in normal traits. I have one functioning ovary and suffer from endometriosis. In the first IVF got six ovules fertilized only three, I transfirienron all but did not pregnancy. In the second under my answer nor embreion one hit.
You recommend DHEA if endometrium.
I am in Venezuela.
No I do not recommend DHEA (see my article on this blog “Nutritional supplements in IVF”)
Geoff Sher
Dear Doctor —-
I have read your very interesting recommendations and responses to many women. One thing I cannot figure out is —- WHEN do you think it is OK to take DHEA? In one response you suggested that 36 yo woman producing few eggs and with DOR (diminished ovarian reserve) should take DHEA. THen later you were telling that women with DOR should never take DHEA>>??? Are you making opposite suggestions because of the age factor? Can you, please, be so kind and explain it clearly? Such and such category – maybe can take it, such and such category – should not take it bc of testosteron overproduction? Would be so very HELPFUL. THANK YOU, DOCTOR!
It probably does no harm in younger women who do NOT have diminished ovarian reserve but in my opinion, it is potentially harmful in those [women that are older and/or do have DOR.
Frankly, I personally do not believe it helps anyone.
Geoff Sher
Ok, I actually think this is exactly what you were trying to tell many women – older age – no DHEA because they most likely have DOR and are producing very few eggs. Correct? What can be the danger, though? If there will be an over-stimulation, what can happen, what is the risk you are trying to avoid? THANKS A LOT.
I did IUI at 38. Had natural pregnancy but it turned out to be molar pregnancy. Had 2 ivc(s) at 40: lupron, then menopur and gonalef: 5 eggs, 4 mature, 3 fertilized (8, 6, 5 cells), chemical pregnancy/misc at 6.5w. 2nd IVF: estrogen patch, then menopur., gonalef and gonorelix. 9 eggs, 5 fertilized (10, 8, 8, 7)-transferred. Misc at 5.5w. DOctor suggests banking embryos and sending them for genetic testing now. Is it true that in order to do genetic testing, embryos have to survive to day 5 in order to be frozen. So, it means that doctor’s recommended 2 cycles of ivf can turn into 3-4 cycles to collect and freeze 10 embryos? I appreciate your input.
I would agree with Banking of CGH-normal embryos and Staggered IVF for you. See below.
Please go to the Home page of this blog, http://www.IVFauthority.com. When you get there, look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Staggered IVF”
5.“Embryo Banking”
6. “Egg Donation”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
**My first IUI – I got pregnant but miscarried at week 9.
Copy!
Hi Dr.Sher,
Thank you for all the information you provide in this blog. Now i think DHEA is not for me.
I am almost 39 years old, Filipina and has been trying to conceive for 7 years. I have been diagnosed with PCOS 5 years ago, and had 2 failed IUI’s done by repro.endocrinologist. No other blood teats were done, like AMH, FSH,etc.
Now my doctor recommends we go for IVF this year. I am now looking for the best IVF clinic in Asia or in the Philippines where I reside, to help increase our chances of success. Presently there are 4 to 5 IVF clinics here in the Philippines. Going to USA will be very expensive for us.
What do you think are the most important things to consider when choosing an IVF clinic? We just want the best for us.
Any information you can share will be highly appreciated!
Thank you very much in advance
gning,
If you get the chance…access my new book (on http://www.Amazon.com) titled In Vitro Fertilization: The ART of making Babies”. There is an entire section there that addresses the issue of choosing an IVF Clinic.
Geoff Sher
Thank you for your reply Dr.Sher. I am looking forward to reading your book.
Dr., in your experience with many infertile patients, does PCOS patients have a good chance of success for standard IVF, given all other factors are normal?
Indeed yes!
Geoff Sher
Hi Dr,
I am 30 years old and have been diagnosed with POF (premature ovarian failure)a couple months ago. My FSH is through the roof but fluctuating (was at 80 at some point, but then got back down at 50, 40, then back up…). I haven’t had any menstruations for 18 months, when I stopped taking the oral contraceptive i had taken for 14 years. I don’t have ANY menopause symptoms other than the amenorrhea. A pelvic echography seemed to show that I had no follicule at all.
We don’t know what is causing it yet, but my doctor believes I could have a premutation of Fragile X (still waiting for the genetic testing results)or maybe it could have something to do with my Hashimoto disease (that was discovered a couple months ago -i now take Synthroid).
My doctor gave me a prescription for 3 months of DHEA but he also told me it would most likely not work for me. I havent started taking it yet because I want to research it and think it through. With what I read in your blog post, I would be at risk for a testosterone overdose if I were to take DHEA, is that right? What would you recommend?
Thank you very very very much!
Sorry but the DHEA won’t help in my opinion. Nothing will restore egg production. You now need an egg donor.
Geoff Sher