12 December 2013

DHEA supplementation and success rates

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At a recent Medical meeting, in addition to discussing individual patients and strategies, we watched a presentation from Dr Norbert Gleischer, Medical Director of CHR in the USA. 

Known to us already as the chief proponent of the FMR1 gene and its relationship to ovarian reserve, this presentation centred on the use of DHEA supplementation. 

DHEA is converted to testosterone in the ovaries and this has a strong influence on very early follicular recruitment, so much so that a considerable upside in follicular development can be seen in poor responders 6-8 weeks later in their IVF/ICSI cycle. 

The response to DHEA can be measured by assaying for testosterone directly (total testosterone) or free testosterone not bound to SHBG.  Preliminary Data from CHR shows the target values for testosterone to be the upper third of normal for a given age. 

In many respects, however, the higher the testosterone the higher the success rates.  In a brief reference to FMR1 he does say that approximately 15 % of patients will not respond to DHEA and these are usually of a particular FMR1 phenotype.  In these cases direct application of testosterone by patch or gel is recommended and can save several weeks of DHEA therapy which will ultimately be found to be ineffective. 

A nice example of genomic profiling at work, detecting responders or non-responders to a stimulus by genetic means.  We look forward to seeing this data published and more widely accepted.

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