Abstract
Background: Delayed pregnancy in women and marked increase in the numbers of older women who fail to respond to ovarian stimulation had been a significant issue. This study aims to assess the value of basal serum testosterone level as a predictor of ovarian response for induction of ovulation in women with unexplained infertility undergoing IVF (in vitro fertilization) cycle. Patients and Methods: A prospective study was conducted in Ain Shams University Maternity hospital Infertility Center during a period of time from October 2016 to June 2017. This study recruited 89 women. On day 2 or 3 of a spontaneous menstrual cycle of the included women within 3 months before fresh IVF cycle, basal hormonal (FSH, LH, estradiol, total testosterone) concentrations, AFC (antral follicle count) were performed. Using the Long-protocol for induction of ovulation, serial monitoring of ovarian response was assessed by transvaginal ultrasound. When the expected ovarian response was reached (at least three oocytes ≥ 17 mm), we gave trigger dose of HCG. Ultrasound guided oocyte aspiration was performed 34 - 36 hours later. Two to three days after oocyte aspiration, we transferred the embryos according to the patient’s age and the condition of embryos available. Biochemical pregnancy was considered if serum B-hCG test was positive at day 14 from embryo transfer, where all the data were correlated with serum testosterone level and ovarian response as 1 ry outcome. Results: There were significant positive correlations between testosterone and LH, Prolactin, AFC, Number of oocytes & Number of Embryos (0.014, 0.032, 0.023, 0.004, 0.033, p 0.001 respectively). Poor responders versus good responders as regards testosterone level (0.81 ± 0.47 versus 1.08 ± 0.45) Fertilized & pregnant cases had significantly higher testosterone than non-fertilized & non pregnant had (1.20 ± 0.45, 0.92 ± 0.47 p value 0.035, 0.021 respectively). Yet, testosterone had significant low diagnostic performance in prediction of poor response and pregnancy (AUC 0.654, 0.676 respectively), (p value 0.015, 0.022 respectively). Conclusion: Basal T levels are helpful for predicting ovarian response, hence the dosage of gonadotropins used in induction. But it can’t be used as single marker for prediction of ovarian response.
Highlights
Two to thirty percent of women undergoing induction of ovulation experience poor response which results in cycle cancellation and reduced pregnancy rate [1]
This study aims to assess the value of basal serum testosterone level as a predictor of ovarian response for induction of ovulation in women with unexplained infertility undergoing IVF cycle
Biochemical pregnancy was considered if serum B-hCG test was positive at day 14 from embryo transfer, where all the data were correlated with serum testosterone level and ovarian response as 1 ry outcome
Summary
Two to thirty percent of women undergoing induction of ovulation experience poor response which results in cycle cancellation and reduced pregnancy rate [1]. Several studies showed that response to induction in poor responders might become better with androgen supplementation. These products are cheap and available, yet their use remains controversial. This study aims to assess the value of basal serum testosterone level as a predictor of ovarian response for induction of ovulation in women with unexplained infertility undergoing IVF (in vitro fertilization) cycle. Biochemical pregnancy was considered if serum B-hCG test was positive at day 14 from embryo transfer, where all the data were correlated with serum testosterone level and ovarian response as 1 ry outcome.
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