Baiju dhea 15.11.12

DHEA in Oocyte Yield and QualityDHEA in Oocyte Yield and Quality

BAIJU P ABAIJU P ANCARE IVF CENTRENCARE IVF CENTREPARAPPANANGADI, PARAPPANANGADI,

MALAPPURAMMALAPPURAM

Dr Neeko

Baiju

DHEA - Hype or Hope…???DHEA - Hype or Hope…???

Follicular Dynamics

Androgen in Follicular Dynamics

What is DHEA?

Role of DHEA in Failing Ovaries

Side effects of DHEA

Literature Search

Other Adjuvants

8 million

4 million

4,00,000

25,000

1000

300-400 cycles in reproductive age 1000 follicles recruited/cycle

AMH as a predictive marker in ART: Lamarca et al: HR Update; Vol 16, No: 2, Pages 113-130; 2010

Biological Plausibility of Biological Plausibility of Androgens in Androgens in

Folliculogenesis Folliculogenesis

Greatest Challenge in Greatest Challenge in ART…!!!ART…!!!9-25% 9-25%

Poor Responders

Current trends of marriage and pregnancy

Maria et al. Ann. N.Y. Acad. Sci. 2008; 1127: 27–30, Gianaroli et al. Hum Reprod. 2010;25: 2374–2386, Schoolcraft et al. Fertil Steril. 2011 Sep; 96(3):638-40.

Mild therapeutically well tolerated male hormone (85% in Adrenals & 15% in Ovaries)

Wild Yam Extract Wild Yam Extract

• Adrenal Insufficiency• SLE• Depression• Obesity

• Alzheimer’s Disease• Cervical Cancer• Infertility• Sexual Dysfunction• Chronic Fatigue

Syndrome• HIV/AIDS• RA• Psoriasis• Schizophrenia

•Recruitment of Dormant Follicles from Pool•Reduction of Apoptosis

•Direct Effect on Granulosa Cells•Improved Mitochondrial Function

New Concept in Oocyte AgingNew Concept in Oocyte Aging(Barad & Gliecher – Submitted for Publication 2012)

Recruitment of more “young “ – chromosomally competent oocytes by altering internal follicular milieu

Quality of oocytes Quantity of oocytesQuality of embryos

Decreased Miscarriage RatesImproved LBR

Age

Low Androgen Levels

Poor Meiotic Competence

Poor Quality Ooocytes

DHEA

IGF-1

Normal oocyte maturation

Reduction of ApoptosisActivation of GC & TC Function

Improved Mitocondrial FunctionImproved Steroidal Milieu

Recruitment of young oocytes

Most common side effects…!!!

More energized… Improved sexual drive…

Since first-trimester placenta produces DHEA , maternal DHEA exposure at Since first-trimester placenta produces DHEA , maternal DHEA exposure at moderate dosages in very early pregnancy should not constitute significant riskmoderate dosages in very early pregnancy should not constitute significant risk

(Loganath, A., Peh, K.L., Wong, P.C., 2002. Evidence for the biosynthesis of DHEA from cholesterol by first trimester human placental tissue: source of androgens.

Horm. Metab. Res. 34, 116–120.)

1. Is there a scientifically explainable basis?

2. Does it harm?3. Do we have robust evidence in

other alternatives?4. Does it cause financial burden?5. What are deleterious effects of 3-

4 months delay in Rx ?

Questions to be

asked???

Other Adjuvants

Pre-Ovulatory Pre-Ovulatory Over-ripeness Over-ripeness

OvopathyOvopathy(PrOO Concept) (PrOO Concept)

MTHFR gene polymorphisms resulting in suboptimal oocyte maturation: a discussion of folate status, neural tube defects, schizophrenia, and vasculopathy ,Piet H et al;

Jr of Experimental & Clinical Assisted Reproduction 2008, 5:5

•Delayed child bearing is the most important precipitating factor which

increases the number of poor responders

•Physiological rise in itnra-ovarian testosterone can be achieved with DHEA

supplementation

•Improved Ovarian Response to treatment can be expected with 3-4

months of DHEA in DOR

•Robust evidences in terms of increasing LBR with DHEA treatment is still lacking

•“ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE”

•Role of CoQ10 & Folic acid in improving oocyte quality has to explored further

Baiju dhea 15.11.12

Health & Medicine

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