In It Starts with the Egg, one of the egg-quality supplements I discuss for the advanced plan is DHEA. Here, I’m answering reader’s most common questions about DHEA and fertility.
1. Should I take DHEA To Improve My Egg Quality?
By far the most common issue people struggle with is whether adding a DHEA supplement is warranted in their particular case. DHEA has shown an incredible ability to improve egg quality and quantity in some women preparing for IVF, but DHEA is a hormone precursor and you should not take it without talking to your doctor about whether it is right for you.
In addition, it is important to test your DHEA-S and testosterone levels to determine whether supplementing with DHEA may help in your individual case, and to continue testing regularly to monitor whether you are taking the correct dose. (You can also order these tests yourself through Life Extension (US) or Medichecks (UK). See below for a discussion of the optimal level of DHEA for fertility).
2. How Does DHEA Help With Fertility?
DHEA is typically recommended to those with diminished ovarian reserve, whether as a result of age or premature ovarian insufficiency. In both cases, the aim is to restore DHEA to normal levels seen in young fertile women. As explained by Dr. Norbert Gleicher, from The Center for Human Reproduction in New York,
“DHEA supplementation for women with diminished ovarian reserve (or DOR) has revolutionized the practice of in vitro fertilization. It has vastly improved pregnancy outcomes for women who suffer from premature ovarian aging (or POA) as well as women over 40 whose ovarian reserve is declining as a part of the natural aging process.”
As discussed in my book, studies have found that women with diminished ovarian reserve (as indicated by a low AMH and low follicle count on ultrasound) often have low levels of DHEA and testosterone. By supplementing with DHEA, it is possible to raise both to normal levels, and in doing so, dramatically increase the number and the quality of eggs retrieved in IVF.
Clinical studies show that supplementing with DHEA significantly increases the pregnancy rate and live birth rate in IVF. (There is much stronger evidence for this now than when I wrote the book in 2014 and I will be updating the book soon with the latest studies.)
*If your doctor claims there is no evidence that DHEA is effective, please direct them to my updated list of studies here: Does DHEA Improve Egg Quality? *
There is also new research indicating that for young women with premature ovarian insufficiency (POI), supplementing with DHEA is likely make the most difference, by actually getting at the root cause of the problem. Studies are finding that POI is often caused by the adrenal glands failing to produce sufficient DHEA. (E.g. Gleicher 2016, Ayesha 2016, ). Poor adrenal function is in turn typically caused by autoimmunity and is particularly common in women with thyroid autoimmunity or endometriosis (See my post on Endometriosis, Egg Quality, and DHEA ).
But just because you have diminished ovarian reserve or a low number of eggs retrieved in previous IVF cycles, that does not automatically mean that DHEA is going to help. To get a clearer answer, it is useful to test for both DHEA and testosterone levels.
3. What are Normal Levels of DHEA and Testosterone for Women?
The level of DHEA in the bloodstream fluctuates widely, so it is more accurate to measure the sulfated version, DHEA-S. Another way to check whether DHEA levels are adequate is to measure testosterone in the blood. (Because the body uses DHEA to produce testosterone when and where it is needed).
The Normal Range for DHEA-S for women TTC is:
- 95-270 mcg/dL
The optimal DHEA-S level for fertility is likely around 180 mcg/dL,
- a level within 90-180 mcg/dL is not a problem if your testosterone level is normal.
The Normal range for total testosterone for women is:
- 10-55 ng/dL
The optimal total testosterone level for female fertility is around 25 to 45 ng/dL
4. Do I Need DHEA if My Level is DHEA-S Level is 100 ? 150? 200?
A DHEA supplement is most likely to be helpful if your DHEA is below 90 mcg/dL. If it is over 90 mcg/dL but below 180mcg, DHEA may be helpful if your total testosterone is below 25 ng/dL.
5. Can DHEA be Harmful?
DHEA is not right for everyone. It can potentially interact with some medications, can worsen PCOS (which is associated with higher testosterone levels), and could theoretically enhance the growth of fibroids or hormone-sensitive cancers (just like any supplemental hormone).
If the dose is too high for too long, it may also potentially interfere with the final stage egg development. For this reason, if you are taking DHEA, you should re-test your DHEA-S and testosterone levels every month or two. Most women need to reduce the dose if it will be taken for more than two months.
Anecdotally, it seems that the dose typically used in IVF studies (25 mg, 3 times per day, for a total of 75mg) is too high for most women. 25 mg once per day may be a better starting point.
DHEA is available in very high dose capsules (such as 100mg) so you need to make sure you are buying the right supplement.
6. What Are the Common Side Effects of DHEA?
The most common side effects of DHEA are oily skin, acne, and unwanted hair growth (these signs may suggest you are taking too much, although that is still uncertain). For those who begin with low levels of DHEA, there can actually be beneficial “side effects,” including improved energy, mood, sexual function, cognitive function and exercise tolerance. (People without fertility problems take DHEA for all of these reasons). In very rare cases, DHEA may cause voice changes.
7. How Much DHEA Should I Take and When To Stop before IVF?
The standard dose used in clinical trials is 25 mg, three times per day (for a total dose of 75mg). Unless your DHEA-S and testosterone are very low to begin with, this dose may be too high. 25 mg once per day is often a better starting point, but I recommend working with a knowledgeable physician who can advise on whether DHEA is right for you, and the appropriate dose.
It is also helpful to retest each month to ensure you are taking the correct dose.
You can stop taking DHEA when you start medication for an IVF cycle, or when you get pregnant naturally.
8. What If My DHEA-S is Too High?
High DHEA-S is most often caused by PCOS. If your DHEA is elevated because of supplements rather than PCOS, it is best to take a break and then restart at a lower dose after several weeks, carefully monitoring both your DHEA-S and testosterone at that point to make sure you have the right dose.
If your DHEA-S is high but your testosterone is in the optimal range, the high level of DHEA-S may not have much impact. On the other hand, if testosterone is very high in the weeks before IVF, that can compromise the final stages of egg development and in some cases it may be worth postponing your IVF cycle. High testosterone is good for early stage follicles, but not late stage follicles.
If your testosterone is high but you have not been taking DHEA supplements, the cause is most often high insulin, for which myo-inositol can be very helpful.
9. Where Can I get DHEA in the UK/ Australia/ Canada?
Outside the U.S., DHEA is a prescription medication. But it can be ordered online and shipped internationally from BioVea and iHerb.
10. What is the Best DHEA for Fertility?
Recommended brands include:
11. Where can I get further guidance ?
See Chapter 9 of It Starts with the Egg and the supplements Q & A section within the membership program. The membership also includes private discussion groups where you can ask me further questions. Click here to join or learn more.