Dehydroepiandrosterone (DHEA) is a steroid hormone produced naturally by the adrenal glands, ovaries, and brain. DHEA levels peak in early adulthood and significantly decline with age, paralleling the natural decline in female fertility. This decline has led to widespread exploration of DHEA supplementation in reproductive medicine. This article explores the current scientific evidence regarding DHEA supplementation and its use for improving fertility, particularly in women facing Diminished Ovarian Reserve (DOR).
Understanding DHEA and Ovarian Function
DHEA functions as a precursor hormone, which the body converts into potent sex steroids, specifically androgens like testosterone and estrogens. In premenopausal women, this conversion supplements ovarian production of sex hormones. When DHEA levels fall, the availability of these precursor compounds for hormone synthesis decreases, potentially impacting reproductive health.
Testosterone, an androgen, is important for the early growth and maturation of ovarian follicles, which house and nurture eggs. Supplementing with DHEA aims to increase local androgen concentrations within the ovaries. This hormonal boost is thought to create a more favorable microenvironment for developing follicles, potentially resulting in a higher proportion of mature eggs and improving overall egg quality.
This mechanism is relevant for women with DOR or those who are older, who often have naturally lower levels of DHEA and testosterone. The improved follicular environment may lead to a better response to ovarian stimulation medications used during fertility treatments, such as in vitro fertilization (IVF). The effect is hypothesized to help produce chromosomally normal eggs, which is a major factor in successful pregnancy.
Clinical Evidence for Fertility Enhancement
Research into DHEA supplementation largely focuses on women classified as “poor responders” or those with Diminished Ovarian Reserve (DOR). Several studies suggest DHEA may positively affect outcomes in women undergoing assisted reproductive technology. Evidence indicates DHEA can lead to an increased number of retrieved eggs and mature oocytes during IVF cycles.
DHEA supplementation has also been associated with an improvement in the clinical pregnancy rate among women with DOR. A promising reported effect is the reduction in miscarriage rates, which is thought to be due to a decrease in chromosomally abnormal embryos (aneuploidy).
Despite these findings, evidence regarding the primary goal—live birth rate—remains mixed and is often based on moderate-quality studies. While some analyses indicate an improved chance of live birth, particularly in women over 40 with DOR, others show no statistically significant overall increase. The current research is limited by small sample sizes, a lack of standardized treatment protocols, and the inclusion of trials with a higher risk of bias.
Important Considerations for Supplementation
DHEA is typically available as a dietary supplement, meaning it is not regulated by the FDA as a prescription drug. The dosage most commonly used in fertility studies is 75 mg per day, often divided into three doses. Consistent use for three to four months is generally recommended before starting an IVF cycle to allow hormone levels to influence developing follicles.
Because DHEA is a hormone precursor, it can increase androgen levels, potentially leading to side effects. The most frequently reported side effects are mild, including oily skin, acne, and hair loss. These effects are usually reversible upon lowering the dose or discontinuing the supplement.
DHEA supplementation should be initiated and monitored by a medical professional, specifically a reproductive endocrinologist. Baseline hormone testing is necessary before starting to ensure appropriateness. Subsequent monitoring of DHEA and testosterone levels is advised to manage dosing and minimize side effects, as DHEA should only be considered in selected cases under strict medical oversight.