Thursday, 23 December, 2010

Dehydroepiandrosterone (DHEA) supplementation in infertility?

In 2005, the Center for Human Reproduction (CHR) first introduced dehydroepiandrosterone (DHEA) supplementation to the infertility field and reported that DHEA had increased egg numbers in women with “older” ovaries going through IVF treatment (Fertility and Sterility). CHR researchers have since reported that DHEA treatment has much broader benefits in the treatment of female infertility - a finding recently confirmed by a study from Israel.

A recent worldwide survey of in vitro fertilization (IVF) centers concluded that approximately one-third have introduced DHEA supplementation into their treatment regimens for women with so-called diminished ovarian reserve.

Investigators at CHR now report to have elucidated at least one of the mechanisms by which DHEA exerts beneficial effects on egg and embryo quality, thereby improving pregnancy chances and reducing miscarriages after IVF. The mechanism involves improvement of chromosomal integrity of embryos.

It is well known that as women age, the risk of chromosomal abnormalities in pregnancies and offspring increases. Most chromosomal abnormalities in embryos result in miscarriages. Collaborating in 2009 with colleagues from Toronto, Canada, investigators from CHR reported unexpectedly low spontaneous miscarriage rates in pregnancies conceived on DHEA supplementation. They suspected that such low miscarriage rates had to be the consequence of lower aneuploidy (chromosomal abnormalities), but proof was lacking.

In a recently published study, investigators from CHR now, for the first time, confirmed that DHEA reduces chromosomal abnormalities (aneuploidy) in embryos through preimplantation genetic screening (PGS). The greatest reduction in aneuploidy (22%) was observed with 4-12 weeks of DHEA supplementation prior to IVF.

Norbert Gleicher, CHR’s Medical Director, comments: “This is the first direct evidence that DHEA beneficially affects egg and embryo quality by reducing chromosomal abnormalities.” He continues: ”It appears likely, however, that this is not the only way by which DHEA exerts its positive effects on older ovaries. Indeed, DHEA may only be a forerunner for a whole new family of infertility drugs, which, ultimately, still may allow older women to conceive through well-designed infertility treatments.”

David H. Barad, Clinical Director of CHR’s IVF Program, adds: “Our finding may have implications far beyond infertility because it suggests that beneficial effects of DHEA supplementation on embryos' chromosomal health could also be extended to normally fertile older women.” DHEA supplementation, like taking folic acid to prevent neural tube defects, could become routine in prenatal care.