4. DHEA - Hype or Hope…???
Follicular Dynamics
Androgen in Follicular Dynamics
What is DHEA?
Role of DHEA in Failing Ovaries
Side effects of DHEA
Literature Search
Other Adjuvants
Page 4
5. 8 million
300-400 cycles in reproductive age
1000 follicles recruited/cycle
4,00,000
25,000
4 million
1000
Page 5
14. Current trends of marriage and
pregnancy
Poor
Responders
Maria et al. Ann. N.Y. Acad. Sci. 2008; 1127: 27–30, Gianaroli et al. Hum Reprod.
2010;25: 2374–2386, Schoolcraft et al. Fertil Steril. 2011 Sep; 96(3):638-40.
Page 14
21. •Recruitment of Dormant Follicles from Pool
•Reduction of Apoptosis
•Direct Effect on Granulosa Cells
•Improved Mitochondrial Function
Page 21
22. New Concept in Oocyte Aging
(Barad & Gliecher – Submitted for Publication 2012)
Recruitment of more “young “ –
chromosomally competent oocytes
by altering internal follicular milieu
Quality of oocytes
Quantity of oocytes
Quality of embryos
Decreased Miscarriage Rates
Improved LBR
Page 22
23. Age DHEA
IGF-1
Low Androgen
Levels
Reduction of Apoptosis
Poor Meiotic Activation of GC & TC Function
Competence Improved Mitocondrial Function
Improved Steroidal Milieu
Recruitment of young oocytes
Poor Quality
Ooocytes
Normal oocyte
maturation
Page 23
27. Since first-trimester placenta produces DHEA , maternal DHEA exposure at
moderate dosages in very early pregnancy should not constitute significant risk
(Loganath, A., Peh, K.L., Wong, P.C., 2002. Evidence for the biosynthesis of DHEA
from cholesterol by first trimester human placental tissue: source of androgens.
Horm. Metab. Res. 34, 116–120.)
Page 27
36. 1. Is there a scientifically explainable
basis?
2. Does it harm?
3. Do we have robust evidence in Questions
other alternatives? to be
4. Does it cause financial burden?
5. What are deleterious effects of 3- asked???
4 months delay in Rx ?
Page 36
40. Pre-Ovulatory
Over-ripeness
Ovopathy
(PrOO Concept)
MTHFR gene polymorphisms resulting in suboptimal oocyte maturation: a discussion of folate status,
neural tube defects, schizophrenia, and vasculopathy ,Piet H et al;
Jr of Experimental & Clinical Assisted Reproduction
2008, 5:5 Page 40
43. •Delayed child bearing is the most important
precipitating factor which increases the
number of poor responders
•Physiological rise in itnra-ovarian testosterone
can be achieved with DHEA supplementation
•Improved Ovarian Response to treatment can
be expected with 3-4 months of DHEA in DOR
•Robust evidences in terms of increasing LBR
with DHEA treatment is still lacking
•“ABSENCE OF EVIDENCE IS NOT EVIDENCE OF
ABSENCE”
•Role of CoQ10 & Folic acid in improving oocyte
quality has to explored further
Page 43