1. Ovigyn - D
DHEA - Infertility
Evidence speaks

2. The j our ney which couples
begin wit h love, hope …

3. dr eams
someone t o hold in ar ms
wit h
Of

4. omeone t o car ess,
love
heir own Bundle of j oy

5. I nf er t ilit y
Shat t er s t heir
But

7. According to
American Pregnancy Association.

10. Then comes
Tr ials
Test s
Q uest ions
Examinat ions
Tr eat ment
Hope and despair
And all t his is called
I nf er t ilit y

12. hen Tears
and
a never ending journey of
Wait begins …
…

13. Increasing Incidence of Infertility
Over
recent
years,
worldwide there has been a
trend
of
increased
marriageable age of the
women
and
delayed
motherhood
By the time a woman
reaches 30, she’s lost 90
percent of her ovarian eggs.
Globally average maternal age has
increased

14. According to a new study, published by the University of St. Andrews
and Edinburgh University in Scotland found that
95 %of women have less than 12 %of their ovarian egg
reserve left by age 30 and only 3% by 40.
Despite major advances in medical technology, there is
currently no ART treatment strategy that can fully
compensate for the natural decline in fertility with increasing
female age.

15. DHEA
It was just a few years ago - 2005 to be exact - that a
study published in the journal Fertility & Sterility found
that supplements of a hormone known as
DHEA (dehydroepianodrostone) could help older women
undergoing IVF treatments make more and possibly
better quality eggs.
Now new research shows it may not just be older
women who can benefit from this supplement - but all
women trying to get pregnant.
So
What is DHEA ?
Is this Hope for Millions?
Can it fulfill the dreams and desire to hold that some
one special in one’s arms?

16. DHEA
• DHEA is produced naturally and is known for its properties
that can slow the effects of aging. DHEA is at its peak levels at
age 25 and then begin a long steady decline.
• DHEA can help millions of people to achieve their dream
of motherhood by its actions. DHEA
–
–
–
–
–
–
–
Increases Fertility by Threefold or 300%
Increases Quality Eggs
Rejuvenates Ovaries
Treats previously unexplained infertility
Doubles IVF Pregnancy Rates especially in Women above Age 40
Decreases aneuploidy
Reduces miscarriages

19. Increases Fertility by 300 %
In the first controlled study recently published in AYALA, the journal of
the Israeli Fertility Association on the effects of the DHEA
Prof. Adrian Shulman of Tel Aviv University’s Sackler Faculty of Medicine and
the Meir Medical Center, found that women being treated for infertility who also
received a DHEA supplement were three times more likely to
conceive than women being treated without the supplement - that
is a 300 percent improvement.
Women were given 75 mg of the DHEA supplement daily for 40 days
before starting fertility treatments, and continued for up to five months.
Not only were women given DHEA more likely to conceive, they were
also more likely to experience a healthy pregnancy and delivery.

20. “In the DHEA group, there was a 23 percent live birth rate as opposed
to a 4 percent rate in the control group,”
“More than that, of the pregnancies in the DHEA group, all but one ended in
healthy deliveries.”

21. Rejuvenates Ovaries
The investigators at Centre for Human Reproduction (CHR) USA
have been using the mild DHEA now for a number of years very
successfully in women with diminished ovarian reserve (DOR),
whether their ovarian impairment is due to advanced age or
premature ovarian aging (POA).

22. They have demonstrated and summarized DHEA’ s
rejuvenating ovarian function properties.
•Increases egg (oocyte) and embryo counts
•Improves egg and embryo quality
•Increases number of embryos available for embryo transfer
•Increases euploid (chromosomally normal) embryos available
•Speeds up time to pregnancy in fertility treatment
•Increases spontaneously conceived pregnancies
•Improves IVF pregnancy rates
•Improves cumulative pregnancy rates in patients under treatment
•Decreases spontaneous miscarriage rates
•likely reduces aneuploidy (chromosomal abnormalities ) in embryos

23. Increases Quality Eggs
In a study conducted at CHR where women with diminished ovarian reserve
where given 25mg tds of DHEA daily for an average of 17.6 ± 2.13 weeks
undergoing IVF cycles it was found that DHEA supplementation
significantly increased
•fertilized oocytes,
•normal day 3 embryos,
•embryos transferred
•average embryo scores per oocyte .

24. Increases Fertility by 300 %
In the first controlled study recently published in AYALA, the journal of
the Israeli Fertility Association on the effects of the DHEA
Prof. Adrian Shulman of Tel Aviv University’s Sackler Faculty of Medicine and
the Meir Medical Center, found that women being treated for infertility who also
received a DHEA supplement were three times more likely to
conceive than women being treated without the supplement - that
is a 300 percent improvement.
Women were given 75 mg of the DHEA supplement daily for 40 days
before starting fertility treatments, and continued for up to five months.
Not only were women given DHEA more likely to conceive, they were
also more likely to experience a healthy pregnancy and delivery.

26. improves Quality of Eggs by
decreasing aneuploidy
There is a high incidence of embryo chromosomal abnormalities (60–70%) in
patients with a poor outcome after IVF and in cases of unexplained recurrent
miscarriage.
So a decrease in aneuploidy rate should translate into decreases in spontaneous
pregnancy loss.
In a study published in Reproductive Biology and Endocrinology 2010
DHEA supplementation to a significant degree reduced number (P = 0.029) and
percentages (P < 0.001.) of aneuploid embryos

27. Mean length of DHEA supplementation was 7.3 ± 2.2 weeks in the short and 19.1 ±
9.1 weeks in the long treatment group.
Women in the short treatment group demonstrated the greatest reduction in
aneuploidy of up to 12 weeks.

28. Reduces miscarriages
DHEA reduces miscarriages
Two infertility center one in Canada and other in CHR USA independently
conducted research that coincidentally matched combining both data sets yielded
a patient data sample of sufficient size to state that
DHEA has been reported to improve pregnancy chances in women with diminished
ovarian reserve (DOR), and to reduce miscarriage rates by 50-80%.

29. Significantly Increases Fertility in
Diminished Ovarian Reserves
Several studies have been done with women who have decreased ovarian
reserve. The studies followed their IVF attempts both before and after
treatment with DHEA and compared their results to those of a control group
that did not take DHEA. The studies showed that treatment with DHEA (in
women with diminished ovarian reserve) significantly:
-improves the woman's response to medication (more eggs are developed)
-increases the number of eggs that successfully fertilize
-increases the number of normal Day 3 embryos
-increases the number of embryo transfers
-increases the overall cumulative pregnancy rate

30. In poor responders
In women DHEA levels decrease by 50% from age 25-45, and 50% of follicular fluid
T is derived from circulating DHEA. In poor responders there is decrease in FSH
receptors and granulosa cell apoptosis increases.
DHEA supplementation in a study

31. Increases AMH (Anti-Mullerian Hormone )
AMH blood levels are thought to reflect the size of the remaining egg supply - or
"ovarian reserve". Women with higher AMH values will tend to have better response to
ovarian stimulation for IVF and have more eggs retrieved.
In a study AMH was evaluated in 55 women with DOR at IVF,
DHEA 75/d for average of 2 ½ months was given
•
•
•
AMH significantly improved after DHEA. Age and length of DHEA
treatment were independently associated with increasing AMH.
Under age 38 all ages demonstrated higher AMH levels, and improved AMH
proportionally more than females > 38.
Longitudinal, AMH improved by approx. 60% from 0.22 ± 0.22 ng/mL to
0.35 ± 0.03 ng/ml (p<0.0002).

32. Mode of action
FSH receptors on granulosa cells
DHEA
Testosterone
Estrogen
IGF-1
Potentiated FSH effects, increases aromatase
activity (biosynthesis of estrogen) & ovulation
induction
Improved IVF outcome,
Increased Oocyte Number,
Suppression of apoptosis
Follicular Differentiation,
Follicular Recruitment
DHEA: Better oocyte & embryo numbers, improved quality of embryos
produced in each cycle, and significantly improved embryo scores

33. Opinion across the Globe
Talks about DOI or POF
And DHEA - CHR USA
Dr Elan Been Jeev ––
Dr Elan Been Jeev
Israel ––TelAviv
Israel TelAviv
About increased
About increased
Fertility at their centre
Fertility at their centre
Meir Medical Centre
Meir Medical Centre
Quality of eggs
Quality of eggs
Dr ––Mr. Glickson EA
Dr Mr. Glickson EA
Israel ––TelAviv
Israel TelAviv

36. Guidelines for Usage of DHEA
•
DHEA administered 25 mg orally three times a day for approximately 4 months 1
•
16 weeks of DHEA treatment before any post-treatment IVF cycle
•
Patients who conceive are taken off DHEA supplementation once a normal rise
in pregnancy hormone is observed over two measurements
•
Ovulation induction is accomplished using norethindrone acetate tablets (10
mg) for 10 days, starting on day 2 of menses, followed 3 days later by 50 μg of
leuprolide acetate, twice daily, and, after another 3 days, by 450 IU of
recombinant FSH and 150 IU of HMG
•
At least two lead follicle diameters reached 18 mm, follicular maturation is
triggered with the injection of 10 000 IU HCG, with oocyte retrieval taking place
34–35 h later
•
Positive pregnancy test is defined as a serum hCG level of >25 IU/l, at > 14 days
post embryo transfer
1 Fertil Steril 2005: 84,756

37. Ovigyn-D Use
Ovigyn-D
Norethindrone
GnRH agonist
FSH
HCG
16 weeks Menstruation 2d 5d 8d
12d
16d
18d
•
•
•
•
Egg retrieval

38. Centers where DHEA therapy is tried
•
Center for Human Reproduction, New York, NY, USA
•
The Foundation for Reproductive Medicine, Chicago, IL, USA
•
Department of Epidemiology and Social Medicine and Department of Obstetrics and
Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA
•
Department of Obstetrics and Gynecology, Yale University School of Medicine, New
Haven, CT, USA
•
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and
Gynecology, Bayor College of Medicine, Texas, USA
•
IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba,
Israel.
•
Ankara University School of Medicine, Department of Obstetrics and Gynecology,
Ankara, Turkey.
•
3 Kifissias Av., Marousi 15123, Athens, Greece.
•
University of Psa, Italy