Earlier this year, we ran an introductory article about premature ovarian aging. Today, we have managed to score an exclusive Q&A style interview with Dr. David Barad, fertility specialist at the Center for Human Reproduction, New York, regarding the treatment of premature ovarian aging (poor/low ovarian reserve).
Supplements for Premature Ovarian Aging (POA)
Q: â€œWhat is DHEA? What does the latest research tell us about DHEA supplementation and its effect on ovarian reserve?â€
A:Â Dehydroepiandrosterone (DHEA), a relatively new infertility treatment, has proven to be successful in treating POA. Introduced by CHR in 2004, this supplementation is now used in over one-third of fertility clinics around the world. To understand how DHEA works on the ovaries of women with POA, it is important to understand how the ovaries of a woman with POA function.
At birth, a woman has all the eggs she will ever produce. There are thousands and thousands of immature eggs that, in each menstrual cycle, will compete with each other to get through the different stages of egg development until there is just one left for fertilization. When a woman has POA, very few follicles make it through to the antral (mature) stage. It is at this stage that a womanâ€™s eggs are treated with fertility medication when undergoing infertility treatment; therefore, for optimal treatment, it is desirable to have a high number of eggs for the medication to work on. One of the most important hormones that facilitate the survival of follicles to the antral stage is the hormone androgen. This is where the importance of DHEA can be seen.
DHEA is a type of androgen produced in large amounts by the female body.Â Production of DHEA is at its highest during puberty and decreases as a woman gets older. DHEAâ€™s role in fertility is to allow more follicles to make it through to the last stage of egg maturation – therefore, when fertility medication is prescribed by the physician, the patient has more eggs in her body available for IVF treatment. The ovarian reserve of a woman when she is taking DHEA supplementation is greatly improved. Â DHEA also improves not just the quantity but also the quality of the oocyte, which is of great importance, as 95% of embryo quality relies on oocyte quality.
Q:Â â€œAre there any lifestyle behaviors recommended that could increase egg quality for women with low ovarian reserve?â€
A: Experts at CHR recommend following a healthy and balanced lifestyle to keep ovarian reserve in optimal condition. Being over or underweight is not good for ovarian reserve and egg quality. Consequently, nor is eating in excess or too little. Moderate exercise is also suggested (with caution not to over-exercise or under-exercise). Itâ€™s also best to avoid drinking alcohol in excess as well as smoking tobacco or marijuana.Â
Egg quality and POA
Dr. Barad also answered some questions on egg quality with premature ovarian aging.
Q: â€œHow do you choose which eggs to test for quality? Do you test them all?â€
A: Often, even with every available intervention, women with POA yield few eggs per cycle. Therefore, all eggs available are taken and checked for quality.
Q: Â â€œWhat happens if the eggs are all low quality?â€
A: Even if all the eggs present as low quality, they are still inseminated with sperm (because the cost of inseminating an oocyte with sperm is not very high). It is better to work with what the woman has and not discard the precious eggs that a woman with POA produces. Therefore, all eggs extracted are used.
Q: â€œCan the quality of eggs be improved in the lab?â€
A: The best place for an embryo to be is in the womb of the mother. The testing of the oocyte pre-insemination at present cannot be improved in the lab. It is a quality test and the process itself cannot improve the quality of the egg.
Q: â€œWhat are the risks with testing the eggs? Could the testing process have a negative effect on the quality of the eggs?â€
A: The process for testing an oocyte for quality does not test or interfere with the internal cell makeup – only polar bodies are tested; therefore, it does not affect the quality of the egg. Another process that has been proven to affect egg quality is the process of sampling the fluid around the egg to examine the eggâ€™s metabolic process. Although this technique has improved in recent years, there is still controversy surrounding whether or not this process permanently damages the embryos in the lab (and even can cause some embryos not to survive the testing process). However, oocyte quality classification does not follow this process; therefore, there is no damage to the oocyte or subsequent embryo in the method of quality testing.
Q: â€œDoes the quality of the sperm equally affect the quality of the embryo?â€
A: Does the sperm in any way affect how the early embryo develops? The answer to this is probably no, not in a major way. The sperm initiates the fertilization process, initiates cell division and brings its chromosomal complement. All important processes, however – in terms of affecting the quality of the embryo in its early developmental stage – are dependent on the egg.
It is good to remember here the role of DHEA in the fertilization process. The better quality the egg, the more chance it has of surviving and making through this early growth period to make a good quality embryo. Good quality embryos lead to higher rates of pregnancy and lower rates of miscarriage. All this is dependent on the quality of the egg.
The Future of Premature Ovarian Aging
Thankfully, new developments like DHEA supplementation and oocyte quality classification mean that the chance of women with POA conceiving a child with her own eggs is constantly improving. More research is being carried out on an international scale to prove the effectiveness of DHEA in improving low and poor ovarian function. All research results to date have reported positively towards the use of DHEA in premature ovarian aging. The development of egg quality classification also helps a woman with POA carry out a successful IVF cycle, as the selection of a high quality egg helps lead to the development of a high quality embryo (which is shown to have lower miscarriage rates and higher pregnancy rates).