Reduction in the level of dehydroepiandrosterone as an indicator of stress-associated reproductive health disorders. Review

The issue of changes in reproductive steroidogenesis in women of childbearing age arises from disruptions in the ovarian‑menstrual cycle and their consequences (e.g., infertility, miscarriage, premature delivery, decreased libido, and signs of sexual dysfunction). The war in Ukraine has exacerbated the existing demographic crisis, highlighting the strategic importance of reproduction for the country. Under the conditions of martial law, the stress level in the human body increases, leading to an increase in cortisol levels. The relationship between stress and increased cortisol levels and women’s reproductive function has been sufficiently studied. However, the problem of the correlation between stress, hypercortisolemia, and changes in the level of dehydroepiandrosterone (DHEA), as a precursor of steroidogenesis, and the reproductive function of women remains under active investigation. DHEA is considered a precursor to the production of sex hormones (testosterone, estrogen, progesterone), but it is also produced in greater amounts as a moderator of the stress response. Researchers studying the effects of DHEA on the human body note that the ratio of DHEA to cortisol has been associated with increased stress resistance: with DHEA levels higher than cortisol levels, stress resistance increases, and women experience fewer negative consequences from the same stressors compared to individuals with a lower DHEA/cortisol ratio. Researchers of menstrual function in teenagers have reached similar conclusions. When reviewing recent papers on the value of DHEA levels for ovarian reserve, we found numerous studies reporting improvements in IVF outcomes in women with low follicular reserves. It is to the works of reproductive scientists that we owe information about the positive role of pro‑androgenic steroids in improving fertility, especially in the context of using androgens in ovulation stimulation protocols. Taking into account all of the above, we consider the use of DHEA in the pre‑gravid stage to be promising for women with hypoandrogenism, stress‑related menstrual disorders, and functionally increased cortisol levels.