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Open Access Highly Accessed Review

Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR)

Norbert Gleicher12* and David H Barad13

Author Affiliations

1 Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, NY, USA

2 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

3 Departments of Epidemiology and Social Medicine and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA

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Reproductive Biology and Endocrinology 2011, 9:67  doi:10.1186/1477-7827-9-67

Published: 17 May 2011

Abstract

Background

With infertility populations in the developed world rapidly aging, treatment of diminished ovarian reserve (DOR) assumes increasing clinical importance. Dehydroepiandrosterone (DHEA) has been reported to improve pregnancy chances with DOR, and is now utilized by approximately one third of all IVF centers world-wide. Increasing DHEA utilization and publication of a first prospectively randomized trial now warrants a systematic review.

Methods

PubMed, Cochrane and Ovid Medline were searched between 1995 and 2010 under the following strategy: [<dehydroepiandrosterone or DHEA or androgens or testosterone > and <ovarian reserve or diminished ovarian reserve or ovarian function >]. Bibliographies of relevant publications were further explored for additional relevant citations. Since only one randomized study has been published, publications, independent of evidence levels and quality assessment, were reviewed.

Results

Current best available evidence suggests that DHEA improves ovarian function, increases pregnancy chances and, by reducing aneuploidy, lowers miscarriage rates. DHEA over time also appears to objectively improve ovarian reserve. Recent animal data support androgens in promoting preantral follicle growth and reduction in follicle atresia.

Discussion

Improvement of oocyte/embryo quality with DHEA supplementation potentially suggests a new concept of ovarian aging, where ovarian environments, but not oocytes themselves, age. DHEA may, thus, represent a first agent beneficially affecting aging ovarian environments. Others can be expected to follow.