Biological and Clinical Rationale for Androgen Priming in Ovarian Stimulation

Abstract

Androgen priming has a biological basis for improving poor response during ovarian stimulation. While administration of exogenous androgens may have effects on early stages of follicle development, they are unlikely to affect the androgen concentrations in more mature follicles. Conversely, administration of hormones that increases the intra-follicular androgen concentration may have effects across a broader range of stage of follicle development.

Editorial: Causes of Oocyte Aneuploidy and Infertility in Advanced Maternal Age and Emerging Therapeutic Approaches

“…Several approaches have been attempted and are under development to improve AMA fertility by correcting hormonal deficits. Mixed results have been obtained using therapies that employ growth hormone, dihydroepiandrosterone (DHEA), or testosterone ( 22 , 23 ). As described above, activin receptor pathway blockade in midlife mice by administration of the activin decoy receptor ActRIIB:Fc lowers FSH to young levels, increases egg yield, prevents oocyte chromosome and spindle misalignments, and increases litter sizes ( 1 ).…”

Co-treatment with letrozole during ovarian stimulation for IVF/ICSI: a systematic review and meta-analysis

“…Letrozole changes the balance between the sex-steroids by inhibiting the conversion of androgens to oestrogens. Intraovarian androgens therefore rise, which is believed to increase the FSH receptors and promoting initial recruitment of follicles (Lossl et al, 2020).…”

“…It has also been demonstrated that co-treatment with letrozole increases the precursor androgens that may serve to upregulate FSH receptors. These two factors present a rationale for the use of co-treatment with letrozole in poor ovarian responders (POR) (Weil et al, 1999;Nielsen et al, 2011;Lossl et al, 2020).…”

The Use of Androgen Priming in Women with Reduced Ovarian Reserve Undergoing Assisted Reproductive Technology

“…This involves an interaction between the theca and granulosa cells, known as the two-cell, two-gonadotropin model of follicle function. 15 Studies in mice have shown that the global absence of androgen receptors leads to aberrant folliculogenesis with lower numbers of antral follicles and fewer oocytes after stimulation, subfertility, and premature ovarian insufficiency. 16,17 Mice that specifically lack androgen receptors in ovarian granulosa cells have similarly affected reproduction, but their ovaries demonstrated fewer antral follicles and more pre-antral and atretic follicles compared with wildtype mice.…”