DHEA is an endogenous steroid that is produced at the adrenal glands from cholesterol. It is used for the production of testosterone and oestradiol at the peripheral tissues. It is an important precursor to follicular steroids. Its concentration in the body during reproductive age is high and slowly decreases through the years.
In our Centre the first woman that followed a treatment with DHEA was a 37 year old with amenorrhea and FSH at 102mIU/ml. She was referred to our Centre from an endocrinology clinic with poor ovarian response to treatment. We observed that DHEA administration to poor responders during an IVF cycle improved the number and quality of oocytes as well as the endometrium. Therefore, it was decided, for this case, that DHEA should be administered to improve the levels of endogenous oestrogen and of the endometrium. One month after DHEA administration, unexpectedly and after nine months of amenorrhea, the woman’s period was resumed and at the second month of DHEA administration FSH had dropped to 18.9mIU/ml. While still in treatment and 15 days after her second period the woman conceived naturally and delivered a healthy baby boy.
At the same time, in October 2006, a second woman of 35 years, who lived in Switzerland was referred to our Centre for IVF with oocyte donation. She suffered from 12 months of amenorrhea and had an FSH level of 112mIU/ml. She agreed to follow treatment with DHEA. After 3 months of administration FSH levels fropped to 12mIU/ml and conceived naturally. This patient discussed her problems with other women with POF on a web forum and three more women with POF visited our Centre.
The third patient had two previous IUI attempts and one IVF attempt that were all unsuccessful plus six months of amenorrhea. After 45 days of DHEA treatment, her FSH dropped to 12.5mIU/ml, the women had one IUTPI attempt with ovulation induction that was successful.
The fourth patient had four previous unsuccessful IVF attempt and after two months of DHEA administration her FSH dropped and she conceived naturally. Unfortunately, she miscarried at seven weeks gestation.
The case of the fifth woman was more difficult since the woman had to be administered with increased dose of DHEA for six months in order to decrease the FSH to 14mIU/ml. She managed to conceive naturally.
All the above positive results of DHEA administration urged us to continue treatment with DHEA in women with POF and to evaluate the results in a larger cohort of women.
The results were published in an article in the scientific journal Fertility and Sterility of the American Society for Reproductive Medicine in 2009.
A few months later the same authors published a review with focus on the use of DHEA by a high number of scientists in large European and US Centres in the Current Opinion in Obstetrics and Gynecology in August 2009.