baiju dhea 15.11.12
DESCRIPTION
DHEATRANSCRIPT
Page 1
DHEA in Oocyte Yield and QualityDHEA in Oocyte Yield and Quality
BAIJU P ABAIJU P ANCARE IVF CENTRENCARE IVF CENTREPARAPPANANGADI, PARAPPANANGADI,
MALAPPURAMMALAPPURAM
Page 2
Dr Neeko
Baiju
Page 3
Page 4
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
Page 5
8 million
4 million
4,00,000
25,000
1000
300-400 cycles in reproductive age 1000 follicles recruited/cycle
Page 6
Page 7
Page 8
AMH as a predictive marker in ART: Lamarca et al: HR Update; Vol 16, No: 2, Pages 113-130; 2010
Page 9
Biological Plausibility of Biological Plausibility of Androgens in Androgens in
Folliculogenesis Folliculogenesis
Page 10
Page 11
Page 12
Page 13
Greatest Challenge in Greatest Challenge in ART…!!!ART…!!!9-25% 9-25%
Page 14
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.
Page 15
Page 16
Page 17
Mild therapeutically well tolerated male hormone (85% in Adrenals & 15% in Ovaries)
Page 18
Page 19
Wild Yam Extract Wild Yam Extract
Page 20
• Adrenal Insufficiency• SLE• Depression• Obesity
• Alzheimer’s Disease• Cervical Cancer• Infertility• Sexual Dysfunction• Chronic Fatigue
Syndrome• HIV/AIDS• RA• Psoriasis• Schizophrenia
Page 21
•Recruitment of Dormant Follicles from Pool•Reduction of Apoptosis
•Direct Effect on Granulosa Cells•Improved Mitochondrial Function
Page 22
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
Page 23
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
Page 24
Page 25
Most common side effects…!!!
More energized… Improved sexual drive…
Page 26
Page 27
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.)
Page 28
Page 29
Page 30
Page 31
Page 32
Page 33
Page 34
Page 35
Page 36
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???
Page 37
Page 38
Other Adjuvants
Page 39
Page 40
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
Page 41
Page 42
Page 43
•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
Page 44