New IVF Technique Puts Pregnancy Within Reach for Many 40-somethings

The chance of pregnancy for women in their early 40s who use traditional IVF techniques is approximately 13 percent. However, an in vitro fertilization (IVF) technique known as complete chromosomal screening (CCS) could raise pregnancy success rates to up to 60 percent. CCS could be particularly effective for women experiencing recurrent, unexplained miscarriages.

Through complete chromosomal screening, doctors take the cells of day-old embryos, called blastocysts, and examine them in detail to see if they have exactly 46 chromosomes – 23 from each parent. Aneupliod, or chromosomally abnormal, embryos often end in miscarriage; therefore, by selecting only the normal embryos, the chances of a successful pregnancy increase significantly. In order to reduce chromosomal abnormalities and prevent miscarriage many women also chose to take DHEA supplements during IVF.

After the normal embryos have been selected, they are frozen for a month to give the patient’s reproductive organs time to return to normal post-IVF treatment. This is done because, according to some scientists, embryos can be harmed if put into the womb while in vitro fertilization drugs are still in the patient’s system. Many researchers also claim that cryopreservation produces healthier babies with similar birth weights to those that are conceived naturally. Meanwhile, embryos that are produced by IVF and not frozen tend to produce babies of a lower weight.

Case study

For a study carried out by Colorado researchers, IVF with CCS was performed on 42 women with recurrent miscarriage. Of that group, nine women had only aneupliod embryos, meaning no normal embryos could be transferred. Of the remaining 33 women with at least one chromosomally normal embryo, nearly 88 percent resulted in pregnancy, and only one miscarriage was recorded.

This makes in vitro fertilization with CCS a viable option for women who have tried other IVF techniques with no success.

Will DHEA Help Me Get Pregnant?

DHEA ( or dehydroepiandrosterone) is a hormonal supplement gaining attention and  momentum  in the infertility community as a new treatment that helps improve female egg quality, and consequently can help improve pregnancy rates via IVF.

Is DHEA just another fad treatment, or can it actually help women with infertility get pregnant?

DHEA use

Fertility specialists mainly use DHEA to treat women with diminished ovarian reserve (also known as DOR).  Diminished ovarian reserve is caused by

  • Premature ovarian aging (in younger women)
  • Natural ovarian aging (in older women)

A woman’s ovarian reserve (how well her ovaries produce mature, high quality eggs) naturally declines with age during menopause. Unfortunately some women experience a decline in their ovarian function during their child bearing years – this is known as premature ovarian aging (or POA).

POA affects around 10% of women and it can be detrimental to pregnancy chances. When a woman has POA she will produce lower quality eggs, which leads to the production of lower quality embryos. Lower quality embryos have a lesser chance of successful implantation via IVF and a higher rate of miscarriage, when compared with high quality embryos.

How DHEA affects fertility

The key to treating POA is improving egg quality.

Once female egg quality improves, so will the quality of the embryo – 95% of embryo quality relies on egg quality. This is where DHEA plays its part.

DHEA is important to egg quality as it helps more follicles make it through to the last stage of egg maturation. When a woman has POA, few follicles make it through to this mature stage. At this stage a woman’s eggs are treated with fertility medications (to improve egg quality) when undergoing infertility treatment; therefore, for optimal treatment, it’s desirable that she a high number of eggs for the medication to work on. One of the most important hormones that facilitate the survival of a woman’s eggs to this mature stage is the hormone androgen – DHEA is a type of androgen.

DHEA  is the lifeboat ensuring that eggs make it through to this last important stage.

In the video below, Dr. Norbert Gleicher, internationally recognized fertility specialist and researcher from CHR New York, explains premature ovarian aging and DHEA use.

Current knowledge about DHEA

Although DHEA is a relatively new infertility treatment, there’s a wealth of clinical research out there to support its use to improve pregnancy chances when used during IVF.  There are also ongoing clinical trials, of which we will see the results in a few years to come. For the moment, from a clinical research point of view, the outlook for DHEA use in premature ovarian aging looks good.

Will DHEA help you get pregnant?

There’s no such thing as a miracle treatment for infertility that can guarantee pregnancy (even though we’d all love one). If you have diminished ovarian reserve, DHEA supplementation, in addition to careful management by your fertility specialist, could be a great option to help improve your pregnancy chances.

Further reading

Current research supporting DHEA use:

  • Gleicher N and Barad DH,Increased oocyte production after treatment with dehydroepiandrosterone. Fertil Steril 2005;84(3):756.
  • Barad DH and Gleicher N,Effects of dehydroepiandrosterone on oocyte and embryo yields, embryo grade and cell number in IVF. Hum Reprod 2006;21(11):2845-9.
  • Barad DH, et al, Update on the use of dehydroepiandrosterone supplementation among women with diminished ovarian reserve. J Assist Reprod Genet 007;24(12):629-34.
  •  Gleicher N, et al,Miscarriage rates after dehydroepiandrosterone (DHEA) supplementation in women with diminished ovarian reserve: a case control study. Reprod Biol Endocrinol 2009;7(7):108.
  •  Gleicher N, et al,Improvement in diminished ovarian reserve after dehydroepiandrosterone supplementation. Reprod Biomed Online 2010;21(3):440-3.
  •  Gleicher N, et al,Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening (PGS). Reprod Biol Endocrinol 2010;10(8):140.
  •  Gleicher N and Barad DH,Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR). Reprod Biol Endocrinol 2011;17(9):6

Getting Pregnant with DHEA Supplementation and IVF

DHEA came on the infertility scene back in 2005, when a well-known infertility clinic (The Center for Human Reproduction, NYC) pioneered DHEA’s use for diminished ovarian reserve (or DOR).

Over the last decade, DHEA’s use for DOR gained momentum – a survey of IVF centers in 2010 found that about one third of centers around the world use DHEA to improve the pregnancy chances of women with DOR.

DHEA’s particularly effective when combined with IVF treatment – the two together can improve the pregnancy chances of young women with DOR and women of advanced maternal age. Both groups of women tend to have low quality eggs – which drastically damages their chances of conceiving with IVF.

What is DHEA?

DHEA is a hormone every woman naturally has in her body. It’s mainly converted into testosterone – an androgen hormone.

How DHEA Supplementation works

Reproductive researchers found in numerous studies that women with DOR and/or of advanced maternal age have very low androgen levels. Although the exact role that androgen plays in improving ovarian reserve isn’t known, what we do know is that a woman’s eggs that mature in an androgen rich ovarian environment tend to develop into high quality eggs.

High quality eggs are important because they result in creating higher quality embryos (95% of embryo quality relies on the quality of the egg).

When a woman has high quality embryos, she has:

  • Increased pregnancy chances
  • Increased spontaneous conception chances
  • Decreased risk of miscarriage
  • Decreased risk of chromosomal abnormalities

A DHEA supplement (which a woman takes in the form of a pill) can help raise her low androgen levels to a more optimal range – allowing an androgen rich environment to develop in her uterus.

Why DHEA Supplementation with IVF?

A woman is usually put on DHEA supplementation for around 6 weeks prior to her IVF treatment. The reason for this is simple:

  1. During IVF treatment a woman’s ovaries are stimulated with drugs – so she releases a larger number of eggs into her uterus than she would during a regular cycle.
  2. These eggs released are pre-mature, i.e. they haven’t completed the full aging process – they do this in the uterus.
  3. Eggs  that come into full-age in an androgen rich environment develop into higher quality eggs
  4. Eggs that come into full-age in an androgen poor environment develop into lower quality eggs
  5.  DHEA supplementation pre-IVF treatment means the premature eggs will have an androgen rich environment in which to become fully matured high quality eggs.

There’s a wealth of fertility research out there supporting DHEA supplementation for women with infertility. Check out the table on this page, which summarizes it all nicely.

To learn more about DHEA and infertility, here’s a pretty useful Q&A answered by infertility specialists on the subject.