DHEA and Low Ovarian Reserve
At birth, as women we are born with approximately 1 million eggs, unfortunately by the time we hit puberty, only about 300,000 remain. And of those 300,000, it is estimated that we only ovulate an average of 300-400 of those eggs during our reproductive years. This is simply an estimation because, in reality, there is no definitive way to test exactly how many eggs you have left at any given time. You may have completed a serum anti-müllerian hormone (AMH) test or had your cycle day 3-5 FSH and LH levels checked, however, again these are not definitive tests when it comes to your ovarian reserve, they simply give us an estimate. Not only do we know that unfortunately the number of eggs we have is limited and declines as we age but, the quality of our eggs also declines naturally. This is not to say that it isn’t possible to get pregnant after 35 or even in your 40s, but it does bring to attention that our focus isn’t simply to help you ovulate but to do everything we can to support healthy and mature eggs. Diminished ovarian reserve, known as DOR, is not only a difficulty condition to face for patients, but it has become a primary cause of female infertility and has been associated with lower pregnancy rates, as well as can be a daunting obstacle in in vitro fertilization (IVF) leading to poor ovarian response, high cancellation rates, and overall poor IVF outcomes. With the average cost of one IVF cycle being upwards of $20,000, maximizing your chance of success is critical. So when researchers got excited about the use of a natural supplement called DHEA, I knew I had to share!
What is DHEA?
Dehydroepiandrosterone or DHEA, is an endogenous steroid hormone made by both men and women in the adrenal glands predominantly, and to a lesser degree in the brain and gonads (testis and ovaries). It is important not to confuse DHEA with DHEA-s. DHEA-s is the sulfate ester of DHEA. DHEA is synthesized from cholesterol and stored as DHEA-S until it is needed to make steroid sex hormones, including estradiol and testosterone, as well as other sex steroid precursor molecules. Our production of DHEA appears to peak somewhere between 25 and 30 years old, however, researchers have found that certain medications including birth control (hello, most of us), Pulmicort, Seroquel, dexamethasone and Metformin are all known to lower DHEA, so we may never get our full potential of DHEA, especially if we have been on these types of medications for a long period of time.
How can DHEA Help Ovarian Reserve?
It is thought that diminished ovarian reserve (DOR) can be associated with abnormal immune function and since DHEA has a proinflammatory function that opposes cortisol, it is thought that supplementation of DHEA could not only reduce cortisol but would improve immune function and in turn ovarian reserve. A number of clinical case control studies and several prospective randomized clinical trials have documented a positive effect of DHEA supplementation in women with DOR. However, the underlying mechanism by which DHEA improves ovarian reserve is still not completely understood. DHEA functions really as an immune regulator and also plays an important role in regulating the immune response, specifically in the ovaries. DHEA is also the precursor for many important hormones including testosterone and estrogen and may also be the reason why supplementation of DHEA may improve ovarian reserve. Although DHEA may be helpful for women struggling to conceive, always consult your doctor before starting any new supplement, especially DHEA. Remember DHEA is a steroid and although it is currently available over the counter, it may interfere with your current fertility protocol or even certain health conditions, including Polycystic Ovarian Syndrome (PCOS) as DHEA can raise the level of total testosterone in your body. There is also limited understanding of the long term effects of DHEA supplementation, and when given, it is generally given for short periods of time. This is where working with your naturopathic or functional medicine doctor can be necessary.
How Do I Optimize my DHEA levels?
If you have been struggling to conceive, chances are you have heard a doctor, friend or random stranger, talk about the importance of stress management. And although, “just relax and you will get pregnant” rarely works, there is research showing us the connection between our stress whether acute or chronic and it’s important on our hormones. In fact, researchers have found that exposure to the new onset of stress, like in a workplace, could decrease DHEA-S levels in as little as 3 weeks in otherwise healthy women. Other studies have found that long term, low grade stress, like that of modern life, have also been associated with a market decrease in DHEA-S levels. While it is nearly impossible to avoid all stress in our lives, identifying sources of stress and developing stress management techniques is an important way to optimize your DHEA levels. Setting boundaries with people, places, and things that take up too much of our time is important, whether that be our buzzing phone, social media or our mother-in-law. Setting positive boundaries is an important way to protect our energy and support our hormone health.
Using Food as Medicine
Food is not simply calories in and calories out but an important way we provide information to our body on a cellular level. Researchers have found that one of the best ways to naturally support DHEA production is by incorporating foods high in omega-3 fatty acids. Some of my favorite omega-3 fatty acids foods to include for our fertility patients include avocados, wild caught salmon, flaxseeds, cod liver oil and chia seeds. In fact, one single serving of chia seeds contains 5 grams of omega-3s!
Eliminating inflammatory oils is also an extremely important way to use food as medicine. Some of the most common inflammatory oils you will want to avoid include: corn, Canola, Soybean, Safflower, sunflower, vegetable oil and vegetable shorteners. Instead opting for extra virgin olive oil, extra virgin coconut oil, avocado oil and ghee.
Daily Movement
We all know we “should” exercise regularly, but how important is exercise for ovarian reserve? Well, I am glad you asked! Researchers have found that regular physical activity not only improved ovarian reserve but assisted reproductive technology (ART), like IVF outcomes, especially in overweight and obese women. Moving your body every day for 15-20 minutes can be a great way to not only improve blood flow and circulation but actually improve ovarian reserve. If you are new to exercise or struggling to be consistent with exercise, I always suggest taking a few moments to open up your calendar and make physical time for your exercise routine. Remember, meetings with yourself are truly the most important and allow you to hold space for others as well. Making yourself a priority isn’t selfish, but a way to show self love.
Environmental Toxins
Similar to the way we can’t avoid all stress in our life, it can be difficult to avoid all of the environmental toxins we are exposed to. However, researchers have found that particular chemicals, known as endocrine disruptors (commonly found in our favorite beauty and home products) may accelerate the genetically predetermined rate of oocyte (egg) loss. Which means that the products we use every day not only impact our hormones but can turn “on” or “off” particular genes and therefore may reduce our ovarian reserve. Making sure to reduce your exposure to endocrine disrupting chemicals is an important way to support ovarian reserve. The most important endocrine disrupting chemicals to avoid include:
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BPA (and “BPA-Free”) plastics
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Dioxin
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Phthalates
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Fire retardants
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Perfluorinated chemicals (PFCs)
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Organophosphate pesticides
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Fragrances
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Lead (commonly found in red lipstick)
About the Author: Meet Dr. Zen
Alissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...
