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.
(Background for those who haven’t read the book yet: DHEA stands for Dehydroepiandrosterone. This precursor to testosterone and estrogen is one of the most abundant steroid hormones in the body, primarily produced by the adrenal glands. The ovaries use DHEA to produce the hormones needed for proper egg development. Levels decline with age, or with adrenal problems due to autoimmunity. Without an adequate supply, fewer eggs are produced, which causes low AMH and poor response to IVF.)
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. Typically this is seen in women who have had a poor response to prior IVF cycles, due to diminished ovarian reserve.
Before talking in more detail about who might benefit most, I want to emphasize a point made at the start of the DHEA chapter in in the book: DHEA is a hormone precursor and you should not take it without talking to your doctor about whether it is right for you. (This is particularly important if you are taking any other medications).
In addition, testing is helpful and often important. A doctor will typically test your DHEA-S and testosterone levels before recommending this supplement to you.
I’ve learned that many women reading my book are now taking DHEA without their doctors advice, because doctors are simply not familiar enough with DHEA to offer guidance. I do not recommend going solo with DHEA (even though in all honesty, that is what I did). But if you are going to, it is best to get your DHEA-S and testosterone levels tested first. Ideally, you should also re-test every couple of months to make sure you are taking the correct amount. (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 Ranges for DHEA-S for women are:
- Age 18-29 years 44-332 µg/dL (1.19-9.00 µmol/L)
- Age 30-39 years 31-228 µg/dL (0.84-6.78 µmol/L)
- Age 40-49 years 18-244 µg/dL (0.49-6.61 µmol/L)
The normal ranges for testosterone for women are:
- Testosterone (bioavailable): 0.8-10.0 ng/dL (0.03-0.35 nmol/L)
- Testosterone (free): 0.3-1.9 ng/dL (0.01-0.07 nmol/L)
- Testosterone (total): 8-60 ng/dL (0.3-2.1nmol/L)
4. Do I Need DHEA if My Level is DHEA-S Level is 100 ? 150? 200?
This is a question for a knowledgable doctor. At least 1/3 of clinics recommend DHEA so if yours does not, try another local clinic in your area. CHR also provides “second opinion” consultations remotely. I don’t know if this type of consultation could be used for guidance on DHEA, but it is worth a try.
There is no clear cut line as to when a DHEA supplement is warranted, but a 2018 study appears to suggest that supplementing with DHEA is helpful for poor responders when the starting level is less than 180 mcg/dL. A low testosterone level might be even more informative.
When supplementing with DHEA, clinics aim to bring DHEA-S and testosterone levels up to the higher end of the normal range for young women. (See e.g. CHR’s explanation of DHEA for IVF)
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 hormone-sensitive cancers (just like any supplemental hormone). For discussion of what happens if your dose is too high, see Question #8 below.
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).
7. How Much DHEA Should I Take and When To Stop before IVF?
The standard dose used in clinical trials so far is 25 mg, three times per day (for a total dose of 75mg). If your DHEA level is already close to the optimal level, this dose may not be necessary. I recommend working with a knowledgable physician who can advise on whether DHEA is right for you, and the appropriate dose.
When taking DHEA for more than a couple of months, it is best to re-test to ensure you are taking the correct amount to bring your levels into the upper half of the normal range.
Like most other egg quality supplements, doctors typically recommend that you stop taking DHEA shortly before egg retrieval.
8. What If My DHEA-S is Too High?
High DHEA-S is seen in about 20-30% of patients with PCOS. If your DHEA is elevated because of supplements rather than PCOS, it is best to lower your dose or take a break, but there is no need to panic.
DHEA-S is the storage form of DHEA. It is effectively a pool that can be drawn upon to make testosterone and estrogen when needed. The “when needed” part is important. Conversion from DHEA-S to DHEA and then other hormones is regulated by a variety of factors . The body does not automatically make too much testosterone (or estrogen) just because there is a higher than normal level of DHEA-S. If both your DHEA-S and testosterone are high, that is more of an issue. There may be some other factor involved in raising testosterone, such blood sugar problems. (Studies show that Myo-inositol can help with this, significantly reducing excess testosterone.)
9. Where Can I get DHEA in the UK/ Australia/ Canada?
Outside the U.S., DHEA is more tightly regulated (as it probably should be), and is supposed to be available only by prescription. (There are, however, many websites that will ship to addresses in the UK and Canada, even though this is not technically permitted.)
10. What is the Best DHEA for Fertility?
DHEA is best absorbed if it is micronized (i.e. in small particles). This is not absolutely essential though.
Fertinatal is the brand used in the early clinical trials. I also recommend: