If you’ve done IVF, your doctor might have recommended DHEA supplementation before your IVF cycle started. Or you might have come across DHEA as a way to improve egg quality in your research.
So does DHEA improve fertility? Research indicates promising results with the use of DHEA supplementation. Some doctors offer it for women with diminished ovarian reserve (DOR) as indicated by low AMH and/or high FSH, premature ovarian aging (POA), poor responders to previous IVF cycles, and for women over 40 whose ovarian reserve is declining due to aging.
What is DHEA?
Dehydroepiandrosterone (DHEA) is a steroid hormone produced mainly in the adrenals and in smaller amounts, in the ovaries, testes, skin, and brain.
The adrenals are small, triangular-shaped glands that sit on top of your kidneys, like Pinocchio's hat. In addition to DHEA, the adrenals produce other important hormones, including adrenaline to help your body deal with stress.
In the inactive form, DHEA-S, the DHEA molecule is bound to a sulfate. This is actually your body’s most abundant circulating steroid hormone, and your egg quality depends on having the right amount.
Unfortunately, DHEA levels drop as you age. The concentration of this hormone peaks in your 20’s and then begins to naturally decline as you get older.
Why is DHEA Important?
DHEA is sometimes called the “mother” hormone because it's a precursor to the major sex steroids (estrogen, progesterone, and testosterone) - all critical for optimal fertility.
DHEA is formed initially from cholesterol, which is converted to pregnenolone, before being transformed to DHEA.
Your body can then use the DHEA to create both androgens (such as testosterone) and estrogens. In women before menopause, 50%–75% of estrogens and the majority of testosterone are produced from DHEA.
Within the ovaries, the androgen hormones play an important role in the immature egg cell being released.
The right amount of DHEA, which creates the right amount of androgen, is important in fertility.
How Does DHEA Work?
Women with PCOS often have elevated levels of DHEA-S, and women undergoing IVF often have decreased DHEA levels.
Over the past two decades, many IVF clinics have studied and used DHEA in their practices. Understanding how DHEA works and for whom it is a good fit will help you decide if it is a good option for you.
One study reports that DHEA helps with premature ovarian aging in two ways:
increasing free IGF-1 (a growth factor hormone) concentrations
increasing Anti-Mullerian Hormone levels. (study)
There have been many clinical trials on DHEA supplementation for women undergoing IVF.
Most of the studies use 75mg/day of DHEA, often broken up into three doses of 25mg each. Trial participants took the DHEA for three to four months before the eggs were harvested.
There have also been trials that did not find a statistically significant increase in the pregnancy rate when using IVF. (study)(study) It is important to note, though, that these studies did not find a negative effect from DHEA.
So why is DHEA supplementation effective for some women undergoing IVF and not for all women? It depends on several factors including age, genetics, and lifestyle. You can’t turn back the clock, but you can investigate your genetic and lifestyle factors.
Decode Your DNA to Know If You are at an Increased Risk of DHEA Deficiency
Genetic studies have shown that women who carry a specific variation in their FMR1 gene are more likely to benefit from DHEA. The variation causes a sequence in the gene to be repeated more times than is normal, and it decreases the conversion rate of DHEA into testosterone. This isn’t something that a direct to consumer genetic test, such as 23andMe, will cover, but it is a variation that is more common in women with POI than in women without fertility challenges. (study)
Most of the DHEA in your body is in the sulfated (DHEA-S) form, and genetic variants related to sulfate absorption are linked to DHEA levels. The gene SLC13A1 codes for a protein called the sodium-sulfate cotransporter that is located in the intestines.
If you have genetic data from 23andMe, you can check to see if you carry the SLC13A1 variant that is associated with decreased DHEA levels. (study)
Check your genetic data for rs28364172:
GG: normal DHEA levels
AG: decreased DHEA levels
AA: decreased DHEA levels
Another genetic variant associated with DHEA-S levels in women is rs182420 in the SULT2A1 gene. This gene codes for a sulfotransferase enzyme that is involved in the conversion of DHEA-S to DHEA. A study found that women carrying the variant had lower DHEA-S levels than women with the normal genotype. (study)
Check your genetic data for rs182420:
CC: normal DHEA-S levels
CT: decreased DHEA-S levels
TT: decreased DHEA-S levels
One final genetic variant involved in DHEA levels is found in the CYP3A7 gene. The variant known as CYP3A7*1C decreases DHEA levels and impacts the conversion to testosterone in the ovaries. The variant isn’t very common – found in less than 3% of the population – but it does make a big impact with one study finding that it decreased DHEA levels by 50%. (study)
Check your genetic data for rs11568825:
AA: normal DHEA levels
AC: significantly decreased DHEA levels
CC: significantly decreased DHEA levels
Testing DHEA levels
As part of your fertility workup, I recommend getting the DHEA-S blood test to measure the amount of DHEA-S in your bloodstream. It's also a valuable test to check how well your adrenal glands are working.
In premenopausal women, 50% of the DHEA in your body is secreted by the adrenals, up to 25% by the ovaries, and the rest by the skin and brain.
Typical normal DHEA-S ranges for females are:
Ages 30 to 39: 45 to 270 µg/dL or 1.22 to 7.29 µmol/L
Ages 40 to 49: 32 to 240 µg/dL or 0.86 to 6.48 µmol/L
Ages 50 to 59: 26 to 200 µg/dL or 0.70 to 5.40 µmol/L
Supplementing with DHEA
How to take DHEA
Recommended dosage: 25 mg, 3 times a day (total of 75 mgs daily)
DHEA should be taken at least 1 month before starting medications to stimulate ovaries, ideally 3 to 4 months.
Lifestyle Factors that Influence DHEA
In addition to the genetic variants that make you unique, your overall lifestyle can also impact your DHEA levels.
By now, you've already experienced how hard chronic stress is on the body. When it comes to your hormones, the adrenal glands are vital. High stress levels can elevate cortisol, which in turn can inhibit the production of the steroid hormones.
In fact, one study found that some women who were diagnosed with having POI actually had adrenal insufficiency, which was contributing to the fertility problems. In some of these cases, DHEA supplementation then helped the patients to conceive. (study)
Even something as common as stress at work can affect your DHEA levels. A study found that women who reported higher levels of stress at work had 23% lower DHEA-S measurements. (study)
This is because, as you age, DHEA decreases while cortisol levels remain constant or even increasing as a response to more lifestyle stress resulting in an increased cortisol/DHEA-S ratio. The unbalanced relationship between the too high cortisol and not enough DHEA-S is serious enough that it can decrease fertility and prematurely aging your eggs.
How long should I supplement with DHEA?
Because DHEA is a hormone that affects the production of other critical fertility hormones, consult your health care provider to ensure that it's appropriate for you. You may want to monitor your DHEA-S blood levels so they don't get too high. If you start getting male characteristics such as more facial or body hair, acne, hair loss, acne, irritability, you should probably stop DHEA supplementation. Stop during pregnancy.
Is DHA the same as DHEA?
DHEA and DHA are two supplements often easily confused by people when trying to get pregnant because of their similar abbreviations. Docosahexaenoic acid (DHA) is an omega-3 fatty acid that's essential for brain development in babies. It can be made from alpha-linolenic acid or obtained directly from maternal milk, fish oil, or algae oil.