DHEA for Fertility
DHEA (dehydroepiandrosterone) is a hormone that is naturally produced and secreted by the adrenal glands (and, to a minor extent, the ovaries and testes) in both men and women. It is a precursor for many other hormones of reproductive significance, including testosterone (which surprisingly plays a very important role in female fertility).
Unfortunately, the body’s ability to synthesize DHEA declines with age. Levels peak from age 20-30 and then decline at an average rate of 2% per year thereafter. Through the course of adulthood, DHEA levels may decrease as much as 80%, with significant declines already realized in many by age 40, if not earlier.
Because DHEA supplementation has been shown to improve egg quality (reduce aneuploidy in embryos), increase the number of eggs retrieved in IVF cycles, increase pregnancy rates and IVF outcomes, and reduce the odds of miscarriage, DHEA supplementation for fertility has become a topic of supreme interest for those trying to get pregnant.
In this article, we will review what DHEA is, how it works to improve fertility, who should take it, potential side effects, common dosages, and more.
Table of Contents
Fast Facts on DHEA for Fertility
- DHEA is a precursor hormone for many male and female reproductive hormones.
- DHEA levels naturally decline as we age.
- Supplementing with DHEA increases egg quality and pregnancy rates for those trying to conceive naturally and those undergoing fertility treatments like IVF.
- DHEA supplementation has been shown to reduce the odds of pregnancy loss in those who supplemented with DHEA before pregnancy.
- DHEA is often recommended to women with Diminished Ovarian Reserve (DOR). DOR is commonly experienced due to age (being over 40) but can be experienced in much younger populations with Primary Ovarian Insufficiency/Premature Ovarian Failure.
- The effects of supplementing with DHEA compound over time. While it begins to take effect after 1-2 months, it reaches its peak effectiveness after 4-5 months of continuous use.
- The standard dosage of DHEA for fertility is 25 mg 3 times a day for a total of 75 mg per day.
Side effects at 75 mg per day are minimal and rare.
- Quality matters as DHEA is purchased as an over-the-counter supplement. CNY recommends using a pharmaceutical-grade micronized DHEA like Fountain DHEA.
How DHEA Improves Fertility
While the exact mechanism by which DHEA is not yet fully understood, the leading theory is that supplementing with DHEA enhances fertility by improving the hormonal environment within the ovary. That way when eggs are recruited for development, they grow in a more optimal environment for producing higher quality eggs. To understand fully why this works, let’s take a step back.
It is important to remember that a female is born with all eggs they will ever have (albeit in an immature stage). Each month approximately 1000 eggs are recruited from this waiting pool of immature eggs and start to develop with the “hopes” of being the one egg that is “chosen” for ovulation and subsequently fertilized.
It has long been assumed that all eggs, even those in the waiting pool, degrade as a woman ages. By the time a woman is 40, these eggs have degraded quite a bit so when they are recruited to begin their final stages of maturation they are already of very poor quality. However, reproductive endocrinologists now believe that the immature eggs stuck in the waiting pool remain in excellent condition. They end up being poor quality by the time ovulation occurs because they enter a poor ovarian environment for development.
What exactly constitutes a poor ovarian environment? Well, there are many potential answers to that questions, but those with Diminished Ovarian Reserve (those who generally see the most benefit from taking DHEA) happen to have lower DHEA and Testosterone levels compared to a fertile population. While it is generally assumed that testosterone, a “male” hormone plays no role in the female body, testosterone is not only present in females but is crucially important in the ovary during the early stages of egg maturation.
As you might expect, when you take DHEA as a supplement, its levels (along with levels of testosterone and estrogen) increase. So, when DHEA is supplemented in someone with DOR, newly recruited eggs enter an ovarian environment with suitable levels of DHEA and testosterone for proper egg development.
Proper egg development then leads to:
- improved ovarian response (aka more eggs)
- higher pregnancy rates
- lower miscarriage rates
Below we will explore these in detail.
DHEA and Ovarian Reserve/Response
For those with diminished ovarian reserve, simply recruiting enough eggs for an IVF or egg freezing retrieval can be a challenge. Even with the use of significant stimulatory medications like FSH, most with DOR retrieve less than 3 eggs. This can present quite the challenge when trying to attain pregnancy with assisted reproductive technologies as some eggs and embryos do not survive the lab.
One early study that shined a light on the true potential of DHEA for fertility was a case study that followed one individual through a series of 9 egg retrievals . At the time of her very first egg retrieval, she was 42 years old and only retrieved one egg. After this first retrieval, she began to supplement with 75 mg of DHEA. Her second retrieval yielded 3 eggs, and her next even more. Through the course of 11 months, this individual went through 9 egg retrievals and froze 66 embryos. On her 9th egg retrieval alone, she retrieved 17 eggs and froze 16 fully developed as embryos.
DHEA Supplementation and Pregnancy Rates
Studies show that DHEA has the ability to improve egg and embryo quality in those with Diminished Ovarian Reserve. It, therefore, comes as no surprise that many studies have further shown that DHEA supplementation improves pregnancy rates. One of those studies found a pregnancy rate of 24% for those supplementing with DHEA and only 4% for those without and the other study (depicted below) found a pregnancy rate of 25% and 7% respectively.
DHEA Supplementation Effect on Miscarriage Rates
DHEA has this effect by reducing the number of eggs with genetic defects. Aneuploidy, AKA genetic abnormalities/mutations in embryos are the leading cause of pregnancy loss. One study that is relatively characteristic of others conducted shows a substantial decrease in miscarriage rates when individuals supplement with DHEA prior to pregnancy. In individuals over 41, the odds of pregnancy loss are halved. While this is substantial in and of itself, what’s even more impressive is that the national data comprises of all pregnancies and the DHEA group is those who specifically had Diminished ovarian reserve and are naturally subject to higher rates of pregnancy loss than a general population.
Summary of how DHEA works for Fertility
- Women with Diminished Ovarian Reserve (DOR) benefit the most from taking DHEA.
- Those with DOR have lower levels of DHEA and Testosterone.
- Testosterone is critically important for the early stages of egg maturation.
- Supplementing with DHEA increases Testosterone levels within the Ovary.
- Newly recruited eggs now develop inside a “hormonally youthful” and healthy ovary and thus develop normally at higher rates.
- Normal, healthy ovaries and eggs lead to a better ovarian response, improved egg quality, higher pregnancy rates, and lower miscarriage rates.
Who Should Take DHEA for Fertility
The consensus on who benefits from taking DHEA has changed over time. Initially, only women who had previously failed at least one IVF cycle and were over 42 were targeted as a candidate for supplementation. By 2005, consensus changed, and DHEA was suggested for all women above 40 who had failed an IVF cycle and displayed evidence of poor ovarian reserve. By 2006, it was determined that women under the age of 40 also benefited if they had elevated FSH levels (above 10 mIU/ml) and had at least one failed IVF cycle.
Currently, most fertility clinics recommend all women over 40 trying to get pregnant and younger women if they have DOR/POF (characterized by high FSH levels and or low AMH levels).
When To Take DHEA Summary
|Age||FSH (tested on day 2-4 of cycle)||AMH (tested any day of cycle)|
|40+||FSH > 10 mlU/mL||AMH <1.0 ng/mL|
At CNY, we generally classify high FSH as over 10 and low AMH as under 1. In most cases, we recommend DHEA for anyone who hits 1 or more of these targets. Women with PCOS are a general exception to this rule and usually should not take DHEA as they often have elevated levels of testosterone naturally.
DHEA for Fertility Dosage
The general recommended dose for using DHEA for fertility is to take 75 mg of Micronized DHEA daily (though morbidly obese may find 100 mg more suitable). Ideally, this 75 mg is split into three 25 mg doses. This keeps a constant and steady supply in the body and helps avoid an upset stomach which can sometimes accompany oral DHEA supplementation. This dosage is set as the standard as it has generally been shown to provide adequate blood level changes of DHEA and testosterone in clinical studies.
How Long does DHEA take to Work for Fertility?
One should aim for at least 6-8 weeks of DHEA supplementation prior to a fertility treatment cycle. That said, the effects of DHEA increase over time and reach their peak after approximately 4-5 months. DHEA supplementation should generally be continued past 4-5 months until pregnancy is achieved.
DHEA Supplementation Side Effects
There are a few potential side effects of females supplementing with DHEA for fertility that one should be aware of before taking the hormone-based supplement.
Positive “Side Effects”
- improved vitality
- improved sex-drive, libido, and general sexual health
Negative “Side Effects”
- Acne and oily skin
- Hair loss
- Upset stomach
- High blood pressure
- Changes in menstrual cycle
- Facial hair
- Nasal congestion
While most of the negative side effects are very rare at doses under 100mg/day, they are important to keep in mind. It is also important to know that most the side effects are quickly reversed simply by lowering the DHEA dosage or stopping supplementation altogether.
Interactions and possible contraindications
As mentioned, small portions of DHEA are converted into estrogen, and as such, estrogen levels are likely to see some increase. If increased levels of estrogen are a problem (as they are in certain types of breast cancers) one should not use DHEA. Similarly, some people, like those with PCOS, already have high levels of DHEA and should not supplement with DHEA unless otherwise specified by their healthcare provider. As with all supplements, there could be other interactions and contraindications so it is advisable to consult with your healthcare provider before taking DHEA.
CNY’s Recommended DHEA
Like most other dietary supplements (but unlike most other forms of hormone therapy) DHEA is sold over the counter in the US. While that makes accessing this fertility enhancing supplement quite easy it also makes it important to be purchasing your DHEA from a trusted source. Fountain DHEA is unique in that all they do and all they care about is producing super high-quality DHEA. It’s also important to note that their DHEA is micronized, in a fertility-friendly 25 mg per dose veggie capsule, and a 90 day supply if using it at the recommended 75 mg dose for fertility. They also offer free shipping.
DHEA is a hormone that has been studied extensively as a dietary supplement and repeatedly been shown to improve fertility outcomes. Along with diet, DHEA is a critical part of improving egg quality after 40 and for anyone with Diminished Ovarian Reserve. If you fit into one of these populations, supplementing with DHEA and CoQ10 prior to pregnancy may be one of the best things you can do to increase your fertility and overall odds of pregnancy.