REPRODUCTIVE PHYSIOLOGY AND DISEASE
The effect of 12-month dehydroepiandrosterone supplementation
on the menstrual pattern, ovarian reserve markers, and safety profile
in women with premature ovarian insufficiency
Queenie Ho Yan Wong
Tracy Wing Yee Yeung
Sofie Shuk Fei Yung
Jennifer Ka Yee Ko
Hang Wun Raymond Li
Ernest Hung Yu Ng
Received: 29 November 2017 / Accepted: 27 February 2018 / Published online: 9 March 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose To evaluate the effect of 12-month DHEA supplementation on menstrual pattern and ovarian reserve markers in women
with premature ovarian insufficiency (POI)
Methods This is a prospective observational study. Women with POI were given DHEA supplements (25 mg three times daily)
for 12 months. Sonographic assessment for ovarian volume and antral follicle count (AFC) and serum measurement for anti-
Mullerian hormone (AMH), follicle stimulating hormone (FSH), estradiol, testosterone, liver function, and hemoglobin level
were performed at baseline and monthly for 13 months after the supplementation. Menstrual pattern, ovarian reserve markers,
and side-effects were recorded.
Results Between August 2011 and July 2014, 38 women with POI were recruited and 31 completed the study. The median age of
women was 36 years, and the median baseline FSH and AMH concentrations were 82.2 IU/L and 0.01 ng/ml, respectively. No
women had resumption of regular menstruation after DHEA supplementation. AMH, FSH, and AFC did not change signifi-
cantly. No serious side effects were reported.
Conclusions Our results do not support any significant improvement in ovarian function by 12-month DHEA supplementation in
women with POI.
Antral follicle count
Premature ovarian insufficiency (POI) occurs in approximately
1% of the population . Problems faced by women with POI
include infertility and long-term risks of estrogen deficiency.
Fertility treatment in these women has been one of the biggest
challenges in the clinical management of these women. Only
about 5–10% of women may become pregnant after being
diagnosed with POI, and there is no effective treatment which
may effectively enhance pregnancy rate in these women .
At birth, there are approximately 700,000 primordial folli-
cles in the ovaries, and the number decreases to 300,000 by
the onset of puberty. Most primordial follicles are kept dom-
inant, and only a proportion will be activated and join the
growing pool of follicles. It takes approximately 270 days
for primordial follicles to reach the pre-antral stage, and this
process is gonadotrophin independent [3, 4]. Under the influ-
ence of pituitary gonadotrophin, antral follicles will further
mature, and one will become a dominant follicle and ovulate.
DHEA has been suggested to reduce follicular atresia 
and to potentiate the effect of gonadotrophin on folliculogenesis
by increasing follicular insulin-like growth factor-1  and up-
regulating the FSH receptor expression in granulosa cells . It
is also an important prohormone for ovarian follicular steroido-
genesis as it is an important substrate in the formation of tes-
tosterone and estradiol in peripheral tissues.
* Queenie Ho Yan Wong
Department of Obstetrics and Gynaecology, Queen Mary Hospital,
The University of Hong Kong, Pokfulam, Hong Kong
Department of Obstetrics and Gynaecology, Princess Margaret
Hospital, Kwai Chung, Hong Kong
Hong Kong Reproductive Health Service, Central, Hong Kong
Journal of Assisted Reproduction and Genetics (2018) 35:857–862