Dehydroepiandrosterone (DHEA) is a naturally occurring steroid hormone precursor often used as an adjunct treatment in fertility care, particularly for patients undergoing In Vitro Fertilization (IVF). As a precursor to androgens like testosterone, DHEA supplementation optimizes the ovarian environment before stimulation begins. The goal of introducing this supplement is to improve the chances of a successful outcome in an IVF cycle. The timing of when to start and, crucially, when to stop DHEA intake is a specific instruction that patients must follow precisely, as these instructions are highly individualized and determined by a reproductive endocrinologist.
The Purpose of DHEA Supplementation in IVF
DHEA functions as a prohormone, converting into potent sex steroids, including testosterone and estrogen, within the ovaries. This process is thought to improve the microenvironment of developing follicles. The primary target population for DHEA supplementation is women diagnosed with diminished ovarian reserve (DOR) or those who have previously responded poorly to ovarian stimulation.
Maintaining optimal levels of androgens within the ovary is beneficial for the early growth phases of follicles. Follicles require an approximately two-to-three-month maturation period before they are ready to respond to the injectable hormones used during an IVF cycle. Elevated androgen levels during this early phase are believed to increase the expression of Follicle-Stimulating Hormone (FSH) receptors on granulosa cells. This mechanism helps rescue small, growing follicles from atresia, or cell death, ultimately aiming to improve both the quality and quantity of eggs available for retrieval.
DHEA is typically prescribed for a “priming” period of 6 to 12 weeks before the start of the stimulation cycle to ensure the beneficial effects on the early-stage follicles are realized. This ensures the supplement’s positive influence is exerted on the cohort of follicles beginning their maturation journey. Studies suggest that DHEA use may lead to higher clinical pregnancy rates and lower miscarriage rates in certain groups of patients, likely due to an improvement in egg quality.
Critical Timing: When to Cease DHEA Intake
The timing of when to stop DHEA is highly specific to the IVF cycle timeline. In the vast majority of clinical protocols, DHEA is discontinued at or just before the start of the controlled ovarian hyperstimulation (COH) phase. This cessation typically occurs on the day the patient begins gonadotropin injections, which are the medications used to stimulate multiple follicles simultaneously.
Some specialists instruct patients to stop the supplement a few days earlier, such as 2 to 7 days before stimulation begins. This slight variation in timing allows for a brief washout period before the final stages of follicular growth begin in earnest. The overarching principle is that DHEA’s work—optimizing the early follicular environment—is considered complete once the cycle moves into the active stimulation phase. Patients must confirm their specific cutoff date with their fertility specialist, as standardized protocols can vary slightly between clinics and based on individual patient response.
The standard daily dose of DHEA for fertility purposes is often 75 mg, taken in three divided doses. This dosage is monitored with regular blood tests for DHEA-S and testosterone to ensure levels remain within a target range. If a patient’s androgen levels are already satisfactory, the dose may be lower, which may also influence the exact timing of cessation.
Biological Reasons for the Stop Date
The decision to discontinue DHEA at the start of stimulation is rooted in the distinct biological needs of the follicle at different maturation stages. The beneficial effects of DHEA, mediated by its conversion to androgens, are most effective during the initial, gonadotropin-independent stages of follicular development. This early presence of androgens helps recruit and prepare the follicles that will eventually be stimulated.
Once the follicles become responsive to injectable gonadotropins, the hormonal environment must shift. High levels of androgens, which are encouraged by DHEA, can potentially become counterproductive during the later, gonadotropin-dependent phase of growth. Excessive androgen exposure at this later stage may interfere with the final delicate balance of hormones required for optimal egg maturation and quality.
DHEA is also associated with androgenic side effects, such as acne and oily skin, which are directly related to the elevated testosterone levels it produces. Stopping the supplement prevents the continued buildup of these hormones during the stimulation and retrieval period. Halting DHEA allows the body’s endogenous hormonal machinery to support the final growth spurt of the selected follicles under the influence of the prescribed stimulation medications.
DHEA Use After Egg Retrieval and During Pregnancy
Following the cessation of DHEA at the start of stimulation, the supplement is not typically resumed after the egg retrieval procedure. Once the eggs are collected, the primary goal of the IVF cycle shifts to embryo transfer and implantation. The hormonal environment required for supporting an early pregnancy is fundamentally different from the one needed for ovarian priming.
There is insufficient data on the safety and necessity of continuing DHEA during confirmed pregnancy. Due to the lack of extensive studies on fetal safety, and because DHEA’s main therapeutic action—ovarian priming—is complete, the established clinical consensus is to discontinue the supplement entirely once a positive pregnancy test is achieved. Continuation past the stimulation phase is rare and would only be under a highly specific, monitored clinical instruction from a reproductive endocrinologist.
The final decision to permanently stop DHEA supplementation is usually made either at the start of the ovarian stimulation phase or upon confirmation of a viable, ongoing pregnancy. This approach ensures that the supplement is used only during the window where its effects are biologically advantageous, while minimizing any potential risks associated with its continued use during the sensitive phases of embryo transfer and gestation.