Immune Regulation: The Possible Mechanism by which Dehydroepiandrosterone Improves Ovarian Reserve in Patients Having Diminished Ovarian Reserve (Dor)

Diminished ovarian reserve (DOR) or poor ovarian reserve (POR) is becoming a worldwide problem and becoming an important cause of infertility. There has been concentration on this subject by the laboratories of Gleicher et al and to some extent Solano ME et al who found importance of androgenic steroids in DOR. For the last decade role of DHEA has been studied, be it their secretion getting reduced with age from the adrenal gland or importance of improving results in in vitro fertilization in cases of DOR. It has a proinflammatory effect on immune function which opposes cortisol. It acts as an immune regulator in various tissues including ovaries. In mammals it also improves Th1 immune response. Treatment with DHEA selectively increases T lymphocytes, upregulating CD8+T lymphocyte population in ovaries while down regulating CD4+T lymphocyte population and thus balance of the CD4+/CD8+ population is maintained. Further Gleicher et al studied regarding the disturbed autoimmune status along with studying triple CGG repeats in fragile X mental retardation 1(FXMR1) gene besides role of autoimmune antibodies in case of premature ovarian insufficiency (POI). Still very few studies are available and more work needs to be done regarding the mechanism by which DHEAS is efficacious in improving IVF results in DOR or POI.

Keywords: DHEA; DHEAS; immunefunction; HPA axis;cortisol; Th1/Th2 cytokines; CD4+/CDB+ Balance in ovaries; FXMR1.