New Fertility Boost

"I actually advised her against both of these options, because to freeze eggs and/or embryos at age 43 is not a very good option," says Gleicher, who has published dozens of papers on reproduction and is the editor of the Journal of Assisted Reproduction and Genetics. "As [a woman's] eggs get older, their ability to lead to normal pregnancy greatly declines. And that is a steady decline, but after age 37 or 38 that decline becomes very, very rapid. And after age 40 it's what I call a waterfall."

Gleicher advised Harben to wait until she felt ready to become pregnant, and to use donated eggs from another, younger woman when that time came. But Harben was insistent, and Gleicher's doubts were confirmed: "As I had predicted the first cycle went very poorly. We had only one egg and one embryo," he says. "We froze it, because she wanted to accumulate embryos for future use at some time."

Harben wanted to try again. "He tried to talk me out of it, but I persuaded him that I'd really feel better if I tried at least one more round," she says. "And meanwhile I did what any modern woman does, and I went to the Internet and started doing some research."

image: ABC News

"To cut a long story short, her second cycle was a little better, her third cycle was yet a little better," recalls Gleicher. "And to my big surprise, having expected that as this woman gets older things would get even worse, she really improved from cycle to cycle to cycle. Every cycle she gave us more eggs, and more good-looking embryos for freezing purposes. I was astonished. And after she had done six cycles, she comes in here one day before starting her seventh cycle and says, 'Dr. Gleicher, I have to tell you a secret.'"

Gleicher was skeptical that DHEA could cause such a huge effect (Harben produced 13 eggs during her sixth cycle), but he let her continue taking it and continue her egg retrieval cycles.

"And so then I did another round and I produced 16 eggs," says Harben. "And I did another round and I produced 19."

"Apparently as we learned from this patient, the maximum effect of this DHEA kicks in only after about four months," says Gleicher (which may be why no one took note of the previous study, which only lasted two months). "And indeed if somebody takes it for that long the effect is almost unbelievable. This patient has by now done 11 cycles with us, and in her last two cycles we had to step her [fertility] medication down because she was over-stimulating. In other words, her ovaries were behaving like those of 20-year-old or 25-year-old."

"Fountain of Youth" Yields a Basket of Eggs?

image: ABC News

The National Institute on Aging says, "Overall, the studies that have been done so far do not provide a clear picture of the risks and benefits of DHEA.…In the meantime, people who are thinking about taking supplements of this hormone should understand that its effects are not fully known. Some of these unknown effects might turn out to be harmful."

Andrzej Bartke, a physiologist who studies longevity at Southern Illinois University Carbondale, warns that "unsupervised use may be risky, particularly in individuals who have steroid-responsive tumors or are at high risk (e.g., family history) of developing such tumors."

Cautiously Optimistic

Gleicher is fully aware that this is just one chance discovery, but so far he is hopeful that the implications will be far ranging. "We are very optimistic— cautiously optimistic," he stresses. "But we think that this may represent a way, at least for some women above age 40, to greatly increase the egg yield." He says the only other women he advised to try DHEA so far has already become pregnant with triplets.

It's also important to note that Gleicher thinks that DHEA can only boost egg production when used in combination with prescribed fertility drugs. "In a natural [menstrual] cycle, it doesn't matter how many…eggs she produces. In the end her body will release usually only one," he explains. "When you are on fertility drugs we make the body release more eggs. And so in order to get the full benefit of [DHEA], it is very likely that it will have to be taken in combination with fertility drugs so that the woman does release more than just one egg."

For this reason, he does not advocate women buying and taking DHEA on their own. He does say that older women who are in fertility treatment might want to consider it (that's why he announced Harben's case to the public before having it accepted by a peer-reviewed journal), but that they should only do so with the consent and oversight of a doctor.

He also stresses that he doesn't know why this works; or if DHEA is increasing the quality of the eggs, or just the number. But even if most of the extra eggs are of the typical poor quality for women that age, he thinks this can be beneficial. "Let's say ten percent of embryos at age 42 or 43 are chromosomally normal. If you have two embryos then ten percent is very little. If you have 15 embryos then ten percent is much more and gives us a higher pregnancy chance. Another way to look at it is we're buying more tickets in the lottery, to have a better chance of winning."

But in the end, the most important thing right now is more study into this phenomenon, something Gleicher hopes to start himself as soon as possible. Right now he's awaiting permission from a scientific review board to conduct a controlled, double-blind study that might offer more concrete proof that DHEA can increase egg yield in older women.

As for Harben, she plans to do one more round of egg retrieval and embryo freezing. All told she figures to have about 100 embryos to choose from when she feels ready, and she thinks that time might come in about four years. And even if things don't work out, she says she'll have few regrets: "Even if something goes wrong and I still, after the tremendous number of embryos I've produced, I still don't end up giving birth to at least one daughter that's genetically my own, at least I know that a lot of other women are going to benefit from it."