Abstract:Purpose To evaluate basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) cycles and examine the association between basal T levels and ovarian response or IVF pregnancy outcome. Methods We retrospectively analyzed 1413 infertile Chinese women undergoing their first IVF treatment at our institution's reproductive center from March 2011 to May 2013. The basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) and the relationship between basal T levels and ovarian … Show more
“…According to their article, PCOS had a different response to stimulation in a wide range, and to the best of knowledge, different phenotypes were not assessed separately. The effect of basal testosterone levels in IVF cycles of patients without PCOS was evaluated in a study by Sun et al ( 22 ) consistent with our results in PCOS patients, the authors concluded that although basal testosterone did not predict pregnancy outcomes, it was associated with the large follicles on human koryonik gonadotropin day, FSH dosage, and also that lower levels of basal testosterone might be related with poor ovarian response ( 22 ) . Embryo cleavage kinetics were studied by Wissing et al ( 23 ) with a small sample size.…”
Objective:The aim of this study was to investigate whether polycystic ovary syndrome (PCOS) phenotype without polycystic ovaries (PCO) differs in terms of in vitro fertilization (IVF) outcomes compared with classic phenotypes.Materials and Methods:This retrospective controlled study included 262 patients who underwent IVF treatment with an indication of unexplained or tubal factor infertility (control group), ovulatory patients with PCO morphology (group 1), PCOS phenotype with oligoanovulation and hyperandrogenemia (group 2), PCOS phenotype with PCO morphology and oligoanovulation (group 3). Outcomes and baseline characteristics of IVF-embryo transfer treatments were compared among all groups.Results:PCOS phenotype without PCO morphology had similar IVF stimulation characteristics compared with classic phenotypes; however, a higher total gonadotropin dose was needed to achieve similar results compared with patients with PCO morphology with or without PCOS. Basal follicle-stimulating hormone level (beta coefficient=0.207, p=0.003), group (beta coefficient=-0.305, p<0.001) and age (beta coefficient=0.311, p<0.001) were significantly associated with the total gonadotropin dose. The number of good quality embryo on transfer day was significantly lower in patients with isolated PCO morphology and PCO morphology with oligoanovulation than in those with PCOS phenotype without PCO morphology.Conclusion:PCO morphology provides easier stimulation, whereas hyperandrogenemia provides better results as good quality embryos. However, the end point is similar in terms of biochemical, clinical, and ongoing pregnancy rates.
“…According to their article, PCOS had a different response to stimulation in a wide range, and to the best of knowledge, different phenotypes were not assessed separately. The effect of basal testosterone levels in IVF cycles of patients without PCOS was evaluated in a study by Sun et al ( 22 ) consistent with our results in PCOS patients, the authors concluded that although basal testosterone did not predict pregnancy outcomes, it was associated with the large follicles on human koryonik gonadotropin day, FSH dosage, and also that lower levels of basal testosterone might be related with poor ovarian response ( 22 ) . Embryo cleavage kinetics were studied by Wissing et al ( 23 ) with a small sample size.…”
Objective:The aim of this study was to investigate whether polycystic ovary syndrome (PCOS) phenotype without polycystic ovaries (PCO) differs in terms of in vitro fertilization (IVF) outcomes compared with classic phenotypes.Materials and Methods:This retrospective controlled study included 262 patients who underwent IVF treatment with an indication of unexplained or tubal factor infertility (control group), ovulatory patients with PCO morphology (group 1), PCOS phenotype with oligoanovulation and hyperandrogenemia (group 2), PCOS phenotype with PCO morphology and oligoanovulation (group 3). Outcomes and baseline characteristics of IVF-embryo transfer treatments were compared among all groups.Results:PCOS phenotype without PCO morphology had similar IVF stimulation characteristics compared with classic phenotypes; however, a higher total gonadotropin dose was needed to achieve similar results compared with patients with PCO morphology with or without PCOS. Basal follicle-stimulating hormone level (beta coefficient=0.207, p=0.003), group (beta coefficient=-0.305, p<0.001) and age (beta coefficient=0.311, p<0.001) were significantly associated with the total gonadotropin dose. The number of good quality embryo on transfer day was significantly lower in patients with isolated PCO morphology and PCO morphology with oligoanovulation than in those with PCOS phenotype without PCO morphology.Conclusion:PCO morphology provides easier stimulation, whereas hyperandrogenemia provides better results as good quality embryos. However, the end point is similar in terms of biochemical, clinical, and ongoing pregnancy rates.
“…In normal cycling women, there is a positive correlation between free androgen index and total ovarian follicle count following ovarian hyperstimulation (Dickerson et al 2010). Similarly, serum testosterone levels have been described to positively correlate with ovarian response (Barbieri et al 2005, Sun et al 2014, Xiao et al 2016 and pregnancy outcomes (Frattarelli & Peterson 2004, Lu et al 2014 in IVF, inferring that a lower level of testosterone may relate with a poorer ovarian response (Sun et al 2014, Xiao et al 2016 and a decreased success in achieving a pregnancy. However, studies often do not report a consistent correlation between serum androgen levels and IVF reproductive outcomes (Lu et al 2014, Sun et al 2014, Xiao et al 2016.…”
Section: Clinical Evidence Indicating the Need For Optimized Androgenmentioning
In the last decade, it has been revealed that androgens play a direct and important role in regulating female reproductive function. Androgens mediate their actions via the androgen receptor (AR), and global and cell-specific Ar-knockout mouse models have confirmed that AR-mediated androgen actions play a role in regulating female fertility and follicle health, development and ovulation. This knowledge, along with the clinical data reporting a beneficial effect of androgens or androgen-modulating agents in augmenting in vitro fertilization (IVF) stimulation in women termed poor responders, has supported the adoption of this concept in many IVF clinics worldwide. On the other hand, substantial evidence from human and animal studies now supports the hypothesis that androgens in excess, acting via the AR, play a key role in the origins of polycystic ovary syndrome (PCOS). The identification of the target sites of these AR actions and the molecular mechanisms involved in underpinning the development of PCOS is essential to provide the knowledge required for the future development of novel, mechanism-based therapies for the treatment of PCOS. This review will summarize the basic scientific discoveries that have enhanced our knowledge of the roles of androgens in female reproductive function, discuss the impact these findings have had in the clinic and how a greater understanding of the role androgens play in female physiology may shape the future development of effective strategies to improve IVF outcomes in poor responders and the amelioration of symptoms in patients with PCOS.
“…Serum T levels have been suggested to be positively associated with ovarian response 43 , 44 and even pregnancy outcomes 44 , 45 in women undergoing IVF cycles. Although some conflicting studies have shown that serum T levels do not predict IVF outcomes 43 , 46 , available data have indicated that T supplementation may improve ovarian response and IVF outcomes in PORs 47 , 48 . In a randomized controlled trial of 110 PORs undergoing IVF cycles, Kim et al reported that pretreatment with transdermal T gel significantly increased AFC and reduced the day of stimulation and total dosage of gonadotropins.…”
Anti-Mullerian hormone (AMH) and testosterone (T) both play distinct roles in the early stages of folliculogenesis. However, the relationship between serum T and AMH levels is poorly understood. This study aimed to investigate the association between serum T and AMH levels in infertile women. A total of 1935 infertile women aged 20–46 years were included in the cross-sectional study and divided into four quartile groups (Q1 to Q4) based on serum T levels. Compared to the subjects in the highest T quartile (Q4), those in the lowest T quartile (Q1) showed significantly lower AMH levels. After adjustment for age, body weight, body mass index and FSH, increasing T quartile categories were associated with higher AMH levels. Binary logistic regression analyses revealed that the odds for the risk of diminished ovarian reserve (DOR) were 11.44-fold higher in Q1 than in Q4 and the odds for the risk of excess ovarian reserve (EOR) were 10.41-fold higher in Q4 than in Q1. Our data show that serum T levels are positively associated with serum AMH levels and suggest that androgen insufficiency may be a potential risk factor for DOR; androgen excess may lead to EOR in infertile women.
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