This document discusses the potential role of DHEA supplementation in improving oocyte yield and quality in women with diminished ovarian reserve or poor ovarian response. It provides biological plausibility for how DHEA may act on granulosa cells and follicles to reduce apoptosis and recruit more developmentally competent oocytes. The document reviews literature on DHEA's effects and side effects, and discusses using it as an adjuvant treatment in IVF, noting while some studies show benefits to oocyte quantity and quality, robust evidence of improved live birth rates is still lacking. It raises questions that need answering before widespread use and stresses that lack of evidence is not evidence of lack of effect.

1. DHEA in Oocyte Yield and Quality
BAIJU P A
NCARE IVF CENTRE
PARAPPANANGADI, MALAPPURAM Page 1

2. Dr Ba
Ne iju
ek
o
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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
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5. 8 million
300-400 cycles in reproductive age
1000 follicles recruited/cycle
4,00,000
25,000
4 million
1000
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8. AMH as a predictive marker in ART:
Lamarca et al: HR Update; Vol 16, No: 2, Pages 113-130; 2010
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9. Biological Plausibility of
Androgens in Folliculogenesis
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13. Greatest Challenge in ART…!!!
9-25%
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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.
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17. Mild therapeutically well tolerated male hormone
(85% in Adrenals & 15% in Ovaries)
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19. Wild Yam Extract
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20. • Alzheimer’s Disease
• Cervical Cancer
• Infertility
• Adrenal Insufficiency • Sexual Dysfunction
• SLE • Chronic Fatigue
• Depression Syndrome
• Obesity • HIV/AIDS
• RA
• Psoriasis
• Schizophrenia
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21. •Recruitment of Dormant Follicles from Pool
•Reduction of Apoptosis
•Direct Effect on Granulosa Cells
•Improved Mitochondrial Function
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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
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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
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25. Most common side
effects…!!!
More energized… Improved sexual drive…
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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.)
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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 ?
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38. Other Adjuvants
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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

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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
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