Abstract
BackgroundTo evaluate basal testosterone (T) levels during follicular phase of the menstrual cycle as a predictor for ovarian response and in vitro fertilization (IVF) outcome.MethodWe analyzed data retrospectively from hospital-based IVF center including one thousand two hundred and sixty Chinese Han women under their first IVF cycle reached the ovum pick-up stage, without polycystic ovary syndrome (PCOS) or endometriosis undergoing long IVF protocol. Patients were divided into 2 groups. Group 1: patients with diminished ovarian reserve (basal FSH >10 IU/L) (n = 187); Group 2: patients with normal ovarian reserve (basal FSH < = 10 IU/L) (n = 1073). We studied the association of basal T levels with ovarian response and IVF outcome in the two groups. Long luteal down-regulation protocol was used in all patients, that is, the gonadotropin releasing hormone agonist was administered in the midluteal phase of the previous cycle and use of recombinant FSH was started when satisfactory pituitary desensitization was achieved.ResultsBasal T levels were markly different between pregnant and non-pregnant women in Group 1; whereas not in Group 2. A testosterone level of 47.85 ng/dl was shown to predict pregnancy outcome with a sensitivity of 52.8% and specificity of 65.3%; and the basal T was correlated with the numbers of large follicles (> 14 mm) on HCG day in Group 1. Significantly negative correlations were observed between basal T, days of stimulation and total dose of gonadotropins after adjusting for confounding factors in both groups.ConclusionIn women with diminished ovarian reserve, basal T level was a predictor for the number of large follicles on HCG day and pregnancy outcome; but could not in those with normal serum FSH. Basal T levels were associated with both days of stimulation and total dose of gonadotropins, indicating that lower level of T might relate with potential ovarian poor response.
Highlights
To evaluate basal testosterone (T) levels during follicular phase of the menstrual cycle as a predictor for ovarian response and in vitro fertilization (IVF) outcome
Primarily testosterone (T) and androstenedione, are noteworthy to enhance follicular recruitment [2], promote follicular growth and development [3,4], and increase insulin like growth factor 1 (IGF-1) expression in the primate ovary which plays an essential role in regulating follicular development [3,5]
In the pearson rank correlation analysis, the characteristics associated with number of follicles >14 mm on HCG day were age, body mass index (BMI), antral follicle count (AFC), basal T levels, basal follicle stimulating hormone (FSH) levels, basal LH levels and starting dose of gonadotropins, respectively
Summary
To evaluate basal testosterone (T) levels during follicular phase of the menstrual cycle as a predictor for ovarian response and in vitro fertilization (IVF) outcome. The recruitment and development of multiple follicles followed by gonadotropins, is a key factor for in vitro fertilization (IVF) treatment cycle. The prediction of ovarian response before undertaking the expensive IVF treatment is important. Recent clinical reports with encouraging results demonstrated that cotreatment with androgen, such as dehydroepiandrosterone (DHEA) and Androderm (transdermal testosterone), could increase both quantity and quality of oocytes and embryos, and improve pregnancy outcomes in women with diminished ovarian function or even premature ovarian failure [6,7,8,9]. Improved controlled ovarian hyperstimulation (COH) and pregnancy outcomes by supplementation with aromatase inhibitors may be the consequence of increased intraovarian androgen, followed by the induction of FSH receptors on granulosa cell [10,11]. Controversy exists as to whether these protocols improve cycle outcome [12,13]
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