Can DHEA improve pregnancy rates in women with low ovarian reserve?
Were you told that you may have reduced ovarian reserve?
What is ovarian reserve?
Ovarian reserve is the medical term to describe the number and quality of eggs that remain in the ovaries. It is an indicator of women's fertility potential and is used by doctors to predict how many eggs a woman may get if she goes through IVF treatment. Ovarian reserve is currently predicted by counting the number of antral follicles (an AFC or 'antral follicle count') in the ovary and or by measuring the levels of anti-Müllerian in your blood (an 'AMH test'). The antral follicles produce AMH and each one contains an egg. The eggs cannot be seen, but the follicles contain fluid and are easily identified on an ultrasound scan.
Women with low ovarian reserve typically respond less well to the drugs used to stimulate the ovary during IVF treatment and produce fewer eggs and, as a result, are less likely to fall pregnant either naturally or after fertility treatment.
Can ovarian reserve be improved?
Unfortunately, probably not. The number of eggs in each ovary is determined at birth and gradually reduces through childhood, puberty and the subsequent reproductive years. This continues until the time of the menopause, which signals that there are no more eggs left in the ovary. The rate of decline is different for all women and even varies within the same family. External factors, such as surgery, smoking, and endometriosis, can speed up the rate of decline but nothing, so far, can slow it down. Recent studies have, however, given some hope and suggested that Dehydroepiandrosterone (DHEA) may be helpful in specific groups of women. This study aims to see if this is true.
What is Dehydroepiandrosterone (DHEA)?
DHEA is a natural hormone produced by the adrenal glands, the glands that sit on top of the kidneys and produce hormones in response to stress. They also produce androgens, or male hormones, in both men and women and DHEA is one of these. One of its functions is to act as a precursor for the production of the predominant female sex hormone, oestrogen: DHEA is converted to oestrogen by the ovaries. You can see how closely related the hormones and glands are. The levels of DHEA decline with age and this may be linked with diminishing ovarian reserve and ovarian function. DHEA replacement can increase the levels in the blood and potentially have an effect on the growing follicles in the ovaries to be converted to the female sex hormone, oestrogen.
Will DHEA be helpful for me?
Our laboratory research study has shown that DHEA enhances follicle and egg development, which can potentially increase the number of follicles in the ovary. A few clinical studies have demonstrated that DHEA taken prior to IVF treatment may improve ovarian reserve and therefore the response to ovarian stimulation leading to an increase in the number and quality of eggs collected. This in turn may improve the number and quality of embryos created and therefore the chances of pregnancy. Some studies also suggest it reduces the risk of miscarriage through the same pathway. These studies, however, are far from definitive and most have limitations in how they were conducted and interpreted. They also have only involved a small number of women. The evidence is far from clear therefore but there is some hope, at least, that DHEA may be of benefit in women with reduced ovarian reserve. We would like to test this and have designed, this clinical study, which we feel addresses the problem with the other studies and will provide clear proof of whether DHEA works or not. We believe it will and hypothesize that women with reduced ovarian reserve taking DHEA supplements will get more eggs and that these will be of better quality leading to better quality embryos and an increased chance of pregnancy than if they were not taking DHEA.
What do I need to do if I want to take part?
Once you agree to take part in the study, you will be requested to sign relevant consent forms. The doctors will go through this with you. You will then be allocated to receive either DHEA or a placebo. Both are given as capsules that you swallow. Your treatment selection will be randomly decided by computer. Neither you nor your doctor will know which treatment you have been allocated to until the whole study is completed. This is essential to avoid potential bias seen in the other studies.
You need to take the capsules for approximately 10-12 weeks prior to ovarian stimulation and then continue them until the day of egg collection. The decision to take part in this study may delay commencement of your egg collection by about six weeks therefore. The delay is important and necessary, as DHEA needs time to work as eggs take 12 weeks to develop.
The study will not increase the number of visits required or change any other aspect of your treatment.
Your decision to participate or not will not affect your standard of treatment or care.
If you are interested and would like to know more, please contact Nurture on 0115 8961900 for further information. Alternatively email Amarin Narkwichean, the trial coordinator at Mzxan@Nottingham.ac.uk