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Many different things can cause early or premature menopause and indeed early or premature menopause
is only the last ultimate step of early ovarian aging or premature ovarian aging as we have
come to call it. Therefore one does not necessarily have to wait until this end stage of menopause.
The vast majority of women who have this problem in association with infertility are fortunately
enough in premature aging stages and it is very important to differentiate between those
two conditions. Because while still prematurely aging but not yet in early menopause we can
still help most women, once in menopause it becomes very difficult. Many of our colleagues
believe that diminished ovarian reserve is untreatable. Our center really does not believe
that, hasn't believe in that for a good number of years, principally based on our experience
with DHEA. Our center was instrumental in bringing dhea into the infertility treatment,
and today based on a recent survey approximately one third of all IVF centers around the world
have started using dhea and I wouldn't be surprised if by now the number is even bigger.
Through our DHEA experience we have come to a new understanding of ovarian aging. One
of the interesting observations that we have made in our DHEA treated patients with very
very severely diminished ovarian reserve is that not only are we getting a surprising
number of pregnancies but once these women get pregnant our miscarriage rates are surprisingly
low. Such low miscarriage rates could not be achieved if indeed the eggs these women
were born with, aged and declined in quality. Because once an egg is of poor quality no
DHEA or no drug that I know about can reverse that kind of a process, it would seem irreversible.
And as we recognize that we started thinking about what could really explain our observation
of low miscarriage rates in these DHEA treated patients. And then it came to us, that what
likely is happening, is that the very immature egg, the egg in storage if I may call it that,
the egg that has not yet been recruited into maturation, that's the egg a woman was born
with. We think that egg, at this very immature stage, actually does not age, it is suspended
in time. What is aging is the ovarian environment in which this egg, once it is recruited into
maturation, goes through the maturation process because if this environment in an older women
is lacking DHEA and if DHEA has an important function in this environment, then supplementing
DHEA can improve the environment and therefore an initially perfect immature egg allows a
much healthier and much better maturation process.