Role of decreased androgens in the ovarian response to stimulation in older women

Meldrum, David R.; Chang, R. Jeffrey; Giudice, Linda C.; Balasch, Juan; Barbieri, Robert L.

doi:10.1016/j.fertnstert.2012.10.011

Cited by 33 publications

(23 citation statements)

References 41 publications

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“…Aging was shown to have a negative effect on clinical pregnancy and live birth, as calculated by logistic regression. This finding is in agreement with previous studies showing that advancing age may increase oxidative stress as well as impair ovarian reserve and cytoplasmic quality due in part to decreased androgen levels [41]. Oxidative stress is related to increased granulosa cell apoptosis, which may account for inferior embryo quality and reduced live birth [42].…”

Section: Discussionsupporting

confidence: 93%

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

et al. 2020

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Background: Women with endometriosis and previous cystectomy may respond less well to gonadotropin stimulation, which results in fewer oocytes retrieved and poor pregnancy outcomes. Choosing an appropriate protocol for such populations is essential. This study involved an analysis of the effect of different controlled ovarian stimulation (COS) protocols on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with diminished ovarian reserve (DOR) who underwent ovarian endometrioma cystectomy. Methods: A total of 342 patients that underwent IVF-ET treatment at the Beijing Obstetrics and Gynecology Hospital from January 1, 2013 to April 30, 2018 were included in this retrospective study. The patients were distributed into three groups according to the COS protocols, namely prolonged GnRH-agonist (Group A, n = 113), GnRH-antagonist (Group B, n = 121), and long GnRH-agonist (Group C, n = 108). The clinical and laboratory parameters of the three protocols were analyzed and a logistic regression of clinical pregnancy and live births was conducted. Results: There were no significant differences in the age, infertility duration, basic follicle stimulation hormone (FSH), luteinizing hormone (LH), or estradiol (E 2 ) levels as well as other baseline characteristics among groups (P > 0.05). The total gonadotrophin (Gn) dosage and duration tended to be less in the GnRH-antagonist group than in the others (P < 0.05). No significant differences were found in the implantation rate and clinical pregnancy rate among the groups, but the prolonged GnRH-agonist group showed the highest rates. In addition, no significant differences were present in the number of retrieved oocytes, oocyte fertilization rate, embryo utilization rate, live birth rate, abortion rate, ectopic pregnancy rate, or multiple pregnancy rate in the three groups (P > 0.05). Age had a significant effect on both clinical pregnancy and live birth. Conclusion:For those DOR patients who had undergone ovarian endometriosis cystectomy, the prolonged GnRHagonist protocol may achieve better clinical IVF-ET outcomes, but there were no significant differences from the other groups. The GnRH-antagonist protocol may reduce the cost and time of drug treatment. Age should be considered for its influence on pregnancy outcome. However, a larger sample size may be needed for further study.

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Section: Discussionsupporting

confidence: 93%

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

et al. 2020

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“…Under physiological conditions, serum concentrations of dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), and testosterone (T) have been found to steadily decline in women with age, which parallels the agerelated decline in reproductive ability [3,4]. However, the few studies conducted to date addressing the relationship between androgen and IVF outcomes have yielded conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Low testosterone levels in women with diminished ovarian reserve impair embryo implantation rate: a retrospective case-control study

Lü

Shen

Yang

et al. 2014

J Assist Reprod Genet

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Objective To investigate the association of basal testosterone (T) levels with the outcome of in vitro fertilization (IVF) in women with diminished ovarian reserve (DOR). Methods Complete clinical data on the first 223 IVF cycles in women with DOR were retrospectively analyzed. The associations of basal follicle stimulating hormone, luteinizing hormone, estradiol, and T levels with ovarian response and IVF outcome were studied. Results Basal T levels were significantly different between pregnant and non-pregnant women. However, basal T levels showed no correlation with controlled ovarian hyperstimulation parameters after adjusting for age. The association of basal T levels with pregnancy rate was significant after adjusting for other impact factors. Using receiver operating characteristic (ROC) analysis, the basal T level of 1.115 nmol/ L for predicting pregnancy outcome had a sensitivity of 82.80 % and specificity of 58.09 %. The women were divided into two groups based on this value; although the clinical characteristics and ovarian stimulation parameters were similar, the clinical pregnancy (16.18 % (11/68) vs. 40.15 % (53/ 132), respectively, p=0.000) and implantation rates (10.07 % (15/149) vs. 22.41 % (65/290), respectively, p=0.002) were significantly different in the low and high T level groups. Conclusion In women with DOR, the basal T level presented a positive association with pregnancy outcome in IVF. The poor reproductive outcome observed in women with lower basal T levels may be due to the decreased implantation rate.

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“…Based on the above studies, DHEA supplementation seems to improve the ovarian environment where follicle maturation takes place, and appears to function by acting on the androgen receptors that are expressed on the granulosa cells and ovarian stroma, resulting in increasing antral follicle counts and AMH levels, and therefore ovarian reserve. While the criticism of the dearth of studies and lack of adequately powered randomized prospective placebo-controlled trials is valid [4,5,47], we agree with Gleicher and Barad that these studies will be extremely hard if not impossible to perform [48]. While DHEA's use is considered experimental, until (and if) such studies are published, and considering the absence of significant side effects, the low cost, and the increase in spontaneous pregnancies, we suggest that utilization of DHEA in suitable, consented, and well informed patients may improve ovarian reserve, response to ovarian stimulation, and potentially pregnancy outcome.…”

Section: Discussionmentioning

confidence: 99%

Is there a role for DHEA supplementation in women with diminished ovarian reserve?

Fouany

Sharara

2013

J Assist Reprod Genet

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Purpose Poor ovarian reserve and poor ovarian response presents a challenge to IVF centers. Dehydroepiandrosterone (DHEA) supplementation is increasingly being used by many IVF centers around the world in poor responders despite the lack of convincing data. We therefore examined the rationale for the use of DHEA in poor responders, address the relevant studies, present new data, and address its potential mechanisms of action. Methods All published articles on the role of DHEA in infertile women from 1990 to April 2013 were reviewed. Results Several studies have suggested an improvement in pregnancy rates with the use of DHEA. Potential mechanisms include improved follicular steroidogenesis, increased IGF-1, acting as a pre-hormone for follicular testosterone, reducing aneuploidy, and increasing AMH and antral follicle count. While the role of DHEA is intriguing, evidencebased recommendations are lacking. Conclusions While nearly 25 % of IVF programs use DHEA currently, large randomized prospective trials are sorely needed. Until (and if) such trials are conducted, DHEA may be of benefit in suitable, well informed, and consented women with diminished ovarian reserve.

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Role of decreased androgens in the ovarian response to stimulation in older women

Cited by 33 publications

References 41 publications

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

Low testosterone levels in women with diminished ovarian reserve impair embryo implantation rate: a retrospective case-control study

Is there a role for DHEA supplementation in women with diminished ovarian reserve?

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