Low basal serum testosterone level is detrimental to the embryo implantation in the patients with severe endometriosis

Abstract

Aim Androgens have been reported to be associated with female fertility. The mean serum testosterone concentration in the patients with endometriosis was reported to be significantly lower than that without endometriosis. Our study was designed to investigate the influence of basal serum testosterone levels on the clinical outcome of in vitro fertilization (IVF) in the patients with III‐IV stage endometriosis. Methods This retrospective cohort study included 407 patients with III‐IV stage endometriosis diagnosed by laparoscopic surgery. We studied the association of the basal serum testosterone level and the reproductive outcome of IVF. Results The basal serum testosterone concentration was significantly higher in the pregnant group of patients with III‐IV stage endometriosis. The further analyses demonstrated that the implantation rate of the basal serum testosterone concentration < 0.305 ng/mL group was significantly lower than the testosterone ≥ 0.305 ng/mL group (24.1% vs. 32.7%, p = 0.007). The clinical pregnancy and live birth rate of the basal serum testosterone < 0.305 ng/mL group were also lower than that of the testosterone ≥ 0.305 ng/mL group. Both initial and total dose of gonadotropins in the testosterone <0.305 ng/mL group are significantly higher than that of the testosterone ≥0.305 ng/mL group. Conclusions Our study demonstrated, for the first time, that the basal serum testosterone <0.305 ng/mL had an adverse impact on pregnancy outcomes of IVF‐embryo transfer in the patients with III‐IV stage endometriosis. Besides, the basal serum testosterone is also helpful in making individual stimulation protocol for the patients with advanced endometriosis before entering IVF cycles.

Prenatal Origins of Endometriosis Pathology and Pain: Reviewing the Evidence of a Role for Low Testosterone

“… 8 , 9 Testosterone is essential for folliculogenesis, 80 and low levels of testosterone are associated with both apoptosis of follicular granulosa cells, 81 and reduced implantation success of embryos. 82 …”

“…8,9 Testosterone is essential for folliculogenesis, 80 and low levels of testosterone are associated with both apoptosis of follicular granulosa cells, 81 and reduced implantation success of embryos. 82 A shorter AGD, representing low androgen levels during fetal development, is directly related to a set of fertility correlates including higher risk of premature ovarian insufficiency, 23,83 and poor ovarian response to controlled ovarian stimulation, 22 consistent with roles in folliculogenesis. Moreover, by a recent meta-analysis, testosterone therapy increased IVF success in women with a poor response to ovarian stimulation.…”