Increased DHEA linked to Poor Decidualization

A group in Washington recently published an article that links increased DHEA found in patients with PCOS with poor decidualization – the failure to properly prepare the endometrial lining for pregnancy. The article showed that high levels of DHEA found in PCOS patients led to poor decidualization by inhibiting an enzyme necessary for proper development of the decidua, this enzyme is called G6PD. Proper decidualization is determined by measuring levels of markers in the endometrium that were associated with normal development of decidua (PRL and IGFBP1).

DHEA administration lowered the levels of these markers and may be the mechanism by which PCOS affects implantation and leads to the significantly higher rate of miscarriage in this group of patients (it is also interesting to note that Lovenox treatment increases the production of these same markers, and may be the mechanism for its success in PCOS patients not related to its anti-coagulation affect). Metformin treatment has also been shown to reverse this effect of DHEA.

Individuals using DHEA supplements to improve egg quality and to increase egg numbers should also be aware of these issues negative affects on the endometrium as well. This continues to make it clear that a thorough understanding of all the mechanisms of how PCOS syndrome can lead to miscarriages is necessary for the correct treatments to be administered. At our center, we have been successfully treating these complicated cases of PCOS for well over 20 years.