Gleicher, N., Weghofer, A., & Barad, D. H. (2010). Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS). Reproductive biology and endocrinology : RB&E, 8, 140. https://doi.org/10.1186/1477-7827-8-140
Gleicher N, Weghofer A, Barad DH. Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS). Reproductive biology and endocrinology : RB&E. 2010;8:140. doi:10.1186/1477-7827-8-140
Gleicher, Norbert, et al. "Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS)." Reproductive biology and endocrinology : RB&E, vol. 8, 2010, pp. 140.
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Women with low ovarian reserve on DHEA had fewer abnormal embryos
Women with diminished ovarian reserve who took DHEA had fewer chromosomally abnormal (aneuploid) embryos in IVF. A 2010 matched case-control study at one New York center compared 22 women on DHEA with 44 control cycles in women with normal reserve. On average, about 4 out of 10 embryos were aneuploid on DHEA, and about 6 out of 10 in controls.
Key Findings
Controls had more aneuploid embryos than the DHEA group (4.5 ± 3.1 vs. 2.8 ± 2.5; P = 0.03).
The percentage of aneuploid embryos was 61.0 ± 22.4 in controls and 38.2 ± 24.4 in the DHEA group (P < 0.001).
The difference stayed significant after adjustment for age, FSH dose and indication for PGS (F = 13.2, df 1, p = 0.001).
The biggest drop in aneuploidy came with 4 to 12 weeks of DHEA (21.6%, 95%CI -2.871-46.031).
Embryo grades were similar in the DHEA and control groups (3.4 ± 0.4 vs. 3.5 ± 0.3).
Interpretation
A matched case-control study compares two groups using existing records, so it shows an association. Researchers did not assign DHEA at random. All 22 women came from one center. The controls were women with normal ovarian reserve. No diminished-reserve women went without DHEA. The DHEA group had lower anti-Müllerian hormone and higher body mass index than controls. Only seven chromosomes were screened. The confidence interval for the short-term result includes zero, and the authors say faster conception among favorable patients could distort the timing result. Two authors hold patent applications on DHEA for diminished ovarian reserve, and one owns the center. The study reports no pregnancy or birth outcomes.
RRM Context
The embryos were screened inside IVF cycles. The authors call that screening only rarely indicated for women with diminished ovarian reserve. IVF bypasses the question of why reserve is low. Restorative reproductive medicine asks that question first and evaluates both partners. Counting embryo chromosomes after IVF stimulation leaves the question open.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
Dehydroepiandrosterone (DHEA) has been reported to improve pregnancy chances in women with diminished ovarian reserve (DOR), and to reduce miscarriage rates by 50-80%. Such an effect is mathematically inconceivable without beneficial effects on embryo ploidy. This study, therefore, assesses effects of DHEA on embryo aneuploidy.
Methods
In a 1:2, matched case control study 22 consecutive women with DOR, supplemented with DHEA, underwent preimplantation genetic screening (PGS) of embryos during in vitro fertilization (IVF) cycles. Each was matched by patient age and time period of IVF with two control IVF cycles without DHEA supplementation (n = 44). PGS was performed for chromosomes X, Y, 13, 16, 18, 21 and 22, and involved determination of numbers and percentages of aneuploid embryos.
Results
DHEA supplementation to a significant degree reduced number (P = 0.029) and percentages (P < 0.001) of aneuploid embryos, adjusted for relevant covariates. Short term supplementation (4-12 weeks) resulted in greatest reduction in aneuploidy (21.6%, 95% CI -2.871-46.031).
Discussion
Beneficial DHEA effects on DOR patients, at least partially, are the likely consequence of lower embryo aneuploidy. DHEA supplementation also deserves investigation in older fertile women, attempting to conceive, where a similar effect, potentially, could positively affect public health.
