Ovigyn - DDHEA - Infertility

Evidence speaks

The journey which couples begin with love, hope …

with dreamsOf someone to hold in arms

Someone to caress, loveTheir own Bundle of joy

But Infertility Shatters their dreams

According to

American Pregnancy Association.

Then comes

TrialsTests

QuestionsExaminationsTreatment

Hope and despair And all this is called

Infertility

then Tears and a never ending journey of Wait begins ……

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

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.

DHEAIt 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?

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

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.

“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.”

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).

•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

They have demonstrated and summarized DHEA’ s rejuvenating ovarian function properties.

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 .

Increases Quality Eggs

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.

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 2010DHEA supplementation to a significant degree reduced number (P = 0.029) and percentages (P < 0.001.) of aneuploid embryos

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.

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%.

Reduces miscarriages

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

Significantly Increases Fertility in Diminished Ovarian Reserves

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

In poor responders

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).

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.

DHEA

Testosterone

Estrogen

IGF-1

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

Mode of action

FSH receptors on granulosa cells

Potentiated FSH effects, increases aromatase activity (biosynthesis of estrogen) & ovulation induction

Opinion across the Globe

Dr Elan Been Jeev – Israel –

TelAvivAbout increased Fertility at their

centreMeir Medical

CentreQuality of eggs

Dr Elan Been Jeev – Israel –

TelAvivAbout increased Fertility at their

centreMeir Medical

CentreQuality of eggs

Dr – Mr. Glickson EAIsrael – TelAviv

Dr – Mr. Glickson EAIsrael – TelAviv

Talks about DOI or POFAnd DHEA - CHR USA

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

Ovigyn-D Use

16 weeks Menstruation 2d 5d 8d 12d 16d 18d

GnRH agonist

Norethindrone

HCG

•

•

•

•

Egg retrieval

Ovigyn-D

FSH

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