Dehydroepiandrosterone enhances decidualization in women of advanced reproductive age

Objective: To investigate the impact of the androgen precursor dehydroepiandrosterone (DHEA) on the decidualization of human endometrial stromal cells isolated from women of advanced reproductive age. Design: In vitro study. Setting: University research institute. Patient(s): Proliferative phase primary human endometrial stromal fibroblasts (hESFs) were isolated from women of advanced reproductive age (n = 16; mean age, 44.7 +/- 2.3). None of the women were receiving hormone therapy or had endometriosis. Intervention(s): Isolated hESFs were decidualized in vitro by incubation with P (1 mu M) and cAMP (0.1 mg/mL) in the presence, or absence, of DHEA (10 nM, 100 nM). Main Outcome Measure(s): Secretion of androgens was assessed by ELISA. Expression of decidualization markers and endometrial receptivity markers was assessed by quantitative polymerase chain reaction and ELISA. Result(s): Decidualization responses were retained in hESF isolated from women of advanced reproductive age. Supplementation with DHEA increased androgen biosynthesis and concentrations of T and dihydrotestosterone were similar to 3x greater after coincubation with DHEA compared with hESF stimulated with decidualization alone. Addition of DHEA to decidualized hESF increased expression of the decidualization markers IGFBP1 and PRL and the endometrial receptivity marker SPP1. DHEA enhanced secretion of IGFBP1, PRL, and SPP1 proteins maximally by day 8 of the decidualization time course concomitant with peak androgen concentrations. Conclusion(s): These novel results demonstrate DHEA can enhance in vitro decidualization responses of hESF from women of advanced reproductive age. Supplementation with DHEA during the receptive phase may augment endometrial function and improve pregnancy rates in natural or assisted reproductive cycles. (C) 2018 The Authors. Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine.