Why We're Writing This
A large number of our patients arrive already taking DHEA for fertility. Most have read It Starts With the Egg by Rebecca Fett, sourced the supplement themselves, and worked out their own dose.
They are not doing anything unreasonable. The book is careful, it is widely read for good reason, and DHEA is one of the few things offered to women told they have diminished ovarian reserve.
But it means a lot of people are taking an androgen without anyone walking them through what the trials actually found. So here it is — the full evidence on DHEA for fertility, including the parts that are less encouraging than the reputation.
What Is DHEA for Fertility
DHEA or Dehydroepiandrosterone is an androgen precursor made by the adrenal glands and the ovaries. Levels fall steadily with age.
The reasoning for supplementing it in fertility: androgens are involved in early follicle recruitment, so restoring them might increase the pool of follicles available in a cycle. It is used mainly in diminished ovarian reserve and poor ovarian response.
The Protocol Most People Are Actually Following
The commonly used regimen, and the one behind most of the research:
75 mg daily — usually 25 mg three times a day, micronized — for three menstrual cycles before an IVF cycle.
Reported ranges run 50–100 mg/day, most often 60–80 mg. Three months is the standard duration, which reflects how long follicles take to develop from the recruitable pool to retrieval.
What the Research Found
The most useful analysis is a 2023 meta-analysis of 32 studies — 14 randomized controlled trials, 11 self-controlled, 7 case-controlled — published 2006 to 2022.
Randomized trials only, which is the fairest test:
| Outcome | Result | Significant? |
|---|---|---|
| Antral follicle count | +1.18 follicles (95% CI 0.17–2.19) | ✅Yes — p=0.022 |
| Baseline FSH | −1.99 (95% CI −2.52 to −1.46) | ✅Yes — p<0.001 |
| Gonadotropin dose needed | −382 IU (95% CI −645 to −120) | ✅Yes — p=0.004 |
| Days of stimulation | −0.90 days | ✅Yes — p<0.001 |
| Miscarriage rate | RR 0.46 (95% CI 0.29–0.73) | ✅Yes — p=0.001 |
| AMH | +0.1 (95% CI −0.14 to 0.34) | ❌No — p=0.416 |
| Oocytes retrieved | No significant difference | ❌No — p=0.123 |
| Clinical pregnancy rate | RR 1.18 (95% CI 0.98–1.41) | ❌No — p=0.081 |
| Live birth rate | RR 1.59 (95% CI 0.87–2.93) | ❌No — p=0.134 |
The authors of the 2023 meta-analysis put it plainly:
DHEA treatment didn’t significantly improve the live birth rate of women with DOR or POR undergoing IVF/ICSI in the subgroup analysis of only RCTs.
And in their discussion, more directly:
Based on these data, DHEA adjuvant therapy could not be recommended in those poor ovarian responders for improving IVF outcome.
How to Read the Research
DHEA appears to make the cycle easier. It has not been shown to produce more babies.
Everything that improved describes the process — fewer stimulation days, less gonadotropin, one more antral follicle, a lower starting FSH. Those are real, and they matter if you are paying for drugs and injecting them.
Everything describing the outcome — eggs collected, pregnancies, live births — did not reach statistical significance.
And +1.18 antral follicles is worth sitting with. It is genuine and statistically significant. It is also one follicle.
What "RR 0.46" Means — and Why We Won't Lean On It
Risk ratio 0.46 means the DHEA group had 46% of the miscarriage risk of the comparison group. A 54% reduction, in relative terms.
But that is a relative number, and relative numbers are often flattering.
A 54% reduction sounds transformative. Whether it is depends entirely on the starting risk, and the analysis doesn’t give us the baseline miscarriage rates to convert it. If the underlying rate were low, halving it changes little. If it were high, halving it changes a great deal.
Without the absolute figures, “half the risk” is a shape, not a size. Any source quoting RR 0.46 without that caveat is telling you less than it appears to.
That said — this is the most clinically interesting finding in the dataset, it is the one Fett’s book highlights, and it is not what DHEA is generally marketed for. It deserves its own trial with miscarriage as the pre-specified primary endpoint.
One caution: it was one outcome among many measured. That is exactly the situation where a real effect and a statistical artifact look identical until someone replicates it.
What We See Clinically
A couple who visited us reported a good outcome at 45 years of age, which is well into the range where expectations are usually low.
That is a single anecdote and we present it as nothing more. One couple cannot tell you whether DHEA worked, whether it would have happened anyway, or whether something else in their care mattered more. We mention it because DHEA was the main change they made before conceiving naturally.
It is exactly the kind of story that circulates in fertility communities and makes a supplement feel more proven than it is.
The Problems With the Evidence
The meta-analysis authors are candid:
- “Poor ovarian response” is defined differently in nearly every study, which makes pooling them questionable
- Most trials are small
- Non-randomized studies carry high risk of bias; self-controlled designs overestimate treatment effect
- Most studies were not blinded
- Several may have run DHEA too briefly relative to how long follicle recruitment takes
On Safety, Which Is Under-Reported
DHEA is an androgen. Acne, unwanted hair growth, scalp hair thinning, oily skin and voice changes are recognized at androgenic exposures. The trials generally did not monitor for these systematically, so the absence of reported side effects is not the same as an absence of side effects.
It also raises testosterone and, in women, lowers HDL (“good”) cholesterol. This is not a benign vitamin, and self-dosing without baseline bloods means nobody knows where you started.
If you are taking it, at minimum someone should be checking your androgen levels.
What Would Change the Picture
- A randomized trial with live birth as the pre-specified primary endpoint
- A single agreed definition of poor ovarian response
- Adequate duration — at least three months, matched to follicle biology
- A dedicated trial of the miscarriage finding
This page summarizes published research. It is not medical advice and recommends no product. DHEA is an androgen with dose-dependent effects; decisions about it belong with the clinician managing your care.
Sources
- Efficacy of dehydroepiandrosterone priming in women with poor ovarian response undergoing IVF/ICSI: a meta-analysis. 2023. PMC10288189 — 32 studies, 14 RCTs
- The Effect of DHEA Supplementation on IVF or ICSI: A Meta-Analysis of Randomized Controlled Trials. PubMed 31303658
- Therapeutic management in women with a diminished ovarian reserve: systematic review and meta-analysis of RCTs. Fertility and Sterility, 2025
- DHEA improves follicular fluid BMP-15 and accumulated embryo score in DOR patients undergoing IVF: a randomized controlled trial. PMC4210503
- Effects of DHEA supplementation on the lipid profile: a systematic review and dose-response meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases, 2020 — HDL fell in women, not in men
- Impact of DHEA supplementation on testosterone and estradiol levels in postmenopausal women: a meta-analysis of randomized controlled trials. Diabetology & Metabolic Syndrome, 2025
- Fett R. It Starts With the Egg — source of the 75 mg / three-cycle protocol most patients follow
FAQs
Who should not take DHEA?
Not recommended for women with PCOS, who often already have elevated testosterone. Also cautioned with hormone-sensitive conditions, since DHEA converts partly into estrogen.
How long does DHEA take to work?
Three menstrual cycles is the standard duration in the research, matched to how long follicles take to develop. Some clinics report effects accumulating up to four or five months.
Should I get tested before taking DHEA?
Yes. DHEA-S and testosterone should be checked before starting and monitored during use, with the dose adjusted to the results.
Does DHEA increase the number of eggs retrieved?
Not in the randomized trials — oocytes retrieved showed no significant difference (p=0.123). Antral follicle count improved by about one, which measures something different.
Can DHEA cause hair loss or acne?
Both are recognized at androgenic exposures, along with unwanted hair growth and oily skin. Most reverse on lowering or stopping the dose.
Is DHEA worth taking if I'm not doing IVF?
The evidence is almost entirely IVF and ICSI cycles in women with diminished ovarian reserve. There’s little to draw on outside that group.
Who Am I?
Dr. Mark Chern (Ph. D) is a Chinese Medicine practitioner in Singapore, trained in Taipei and active in women’s health since 2011. With over a decade of expertise in treating fertility, pregnancy and various women’s health conditions, Dr Mark is always faced with questions about supplements for fertility and hormone regulation.
He has researched deeply into Melatonin, Inositol and CoQ10 for fertility. This article summarizes what the DHEA trials actually found.
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