Abstract

We aimed to investigate the relationship between testosterone (T) levels and pregnancy outcomes in patients with tubal or male infertility at different times during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Patients with tubal or male infertility and normal androgen levels undergoing IVF/ICSI were consecutively recruited. We performed a longitudinal analysis of T levels at three time points (i.e., T0: baseline, T1: trigger day, and T2: day after the trigger day) in three groups with different pregnancy outcomes (i.e., group 1: no pregnancy; group 2: clinical pregnancy but no live birth; and group 3: live birth) as repeated measurement data using linear mixed-effects models. We also plotted fitted curves depicting the relationship between T levels and a number of oocytes retrieved at different time points and identified the inflection points of the curves. In total, 3,012 patients were recruited. Groups 1 and 3 had improvements in T levels at the three time points. After refitting, the slope in group 3 was significantly higher than that in group 1 (P = 0.000). Curves that reflected the association between T levels and numbers of retrieved oocytes presented an upward trend before a certain inflection point, after which the curves had no obvious changes or fell with increasing T levels. The inflection points for T0, T1, and T2 were calculated as 0.45, 0.94, and 1.09, respectively. A faster upward trend in T levels might be associated with better pregnancy outcomes. Within a range lower than a T level inflection point, more oocytes and embryos could be obtained with increasing T levels.

Highlights

  • Androgens, a category of sex steroid hormones, play an essential role in the endocrine and reproductive systems of women

  • A total of 3,012 patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were recruited for this study

  • We divided the patients into three groups according to pregnancy outcomes as follows: group 1, no clinical pregnancy; group 2, clinical pregnancy but no live birth; and group 3, live birth

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Summary

Introduction

A category of sex steroid hormones, play an essential role in the endocrine and reproductive systems of women. High levels of androgens can prevent follicle maturation and even harm follicle development Hyperandrogenism, such as polycystic ovarian syndrome (PCOS) and congenital adrenal hyperplasia, is a significant cause of female infertility (Dumesic et al, 2015). It is noted that different indexes of androgens, including total T, androstenedione, and free androgen index (FAI), have been proved to be feasible indicator of hyperandrogenism in clinical practice, among which FAI had the best performance (Barth et al, 2010). In this retrospective study, we chose total T levels for analysis due to technical limitation in previous years. We expected to provide appropriate target values for androgen-lowering regimens before IVF in patients with infertility and hyperandrogenism

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