Starting and resulting testosterone levels after androgen supplementation determine at all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR)

Wang

et al. 2014

J Assist Reprod Genet

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 response or IVF pregnancy outcome were determined. These patients did not have polycystic ovary syndrome (PCOS) or endometriosis, and were treated with a long luteal down-regulation protocol. Subjects were divided into 2 groups according to basal testosterone (T) levels: Group 1, basal T values <20 ng/dl (n=473), and Group 2, basal T values >20 ng/dl (n=940). We evaluated the association of basal T levels with ovarian response and IVF outcome in the two groups. Results In this study, BMI, basal follicle-stimulating hormone (FSH) levels, basal luteinizing hormone (LH) levels, antral follicle count (AFC), days of stimulation, total gonadotrophin dose, basal FSH/LH ratio, and the number of follicles >14 mm were significantly different (P<0.05) between the two groups. Basal T level positively correlated with ovarian reserve function, number of follicles >14 mm on human chorionic gonadotrophin (HCG) day, and total gonadotropin dose. However, basal T levels play no role in predicting IVF pregnancy outcome. Conclusion Basal T level can be used as a good predictor for ovarian response and the number of large follicles on HCG day. Additionally, we may use basal T level as a marker to predict FSH dosage. In general women, lower level of T might relate with potential poor ovarian response. However, based on our data, basal T levels do not predict pregnancy outcome.

Section: Discussionmentioning

confidence: 99%

Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF

Wang

et al. 2014

J Assist Reprod Genet

Proc. Natl. Acad. Sci. U.S.A.

“…As we show that preovulatory androgens can promote follicle development and increase ovulation rates, whereas androgen excess is well established as one of the major causes of PCOS, we propose that there exists a critical balance between the essentiality of androgens in normal follicular development and the detrimental effects of androgens in the setting of androgen excess. In fact, the concept that androgens can promote follicle development is supported by the reported positive effects of androgen treatment in animals (7) as well as in patients with diminished ovarian reserve (22,23,50), in whom androgen priming is now being used in clinical settings to enhance ovulation (51,52).…”

Section: Nonspecific) (D-f)mentioning

confidence: 99%

Androgens regulate ovarian follicular development by increasing follicle stimulating hormone receptor and microRNA-125b expression

Sen

Prizant

Light

et al. 2014

Self Cite

249

186

Although androgen excess is considered detrimental to women's health and fertility, global and ovarian granulosa cell-specific androgen-receptor (AR) knockout mouse models have been used to show that androgen actions through ARs are actually necessary for normal ovarian function and female fertility. Here we describe two AR-mediated pathways in granulosa cells that regulate ovarian follicular development and therefore female fertility. First, we show that androgens attenuate follicular atresia through nuclear and extranuclear signaling pathways by enhancing expression of the microRNA (miR) miR-125b, which in turn suppresses proapoptotic protein expression. Second, we demonstrate that, independent of transcription, androgens enhance follicle-stimulating hormone (FSH) receptor expression, which then augments FSHmediated follicle growth and development. Interestingly, we find that the scaffold molecule paxillin regulates both processes, making it a critical regulator of AR actions in the ovary. Finally, we report that low doses of exogenous androgens enhance gonadotropin-induced ovulation in mice, further demonstrating the critical role that androgens play in follicular development and fertility. These data may explain reported positive effects of androgens on ovulation rates in women with diminished ovarian reserve. Furthermore, this study demonstrates mechanisms that might contribute to the unregulated follicle growth seen in diseases of excess androgens such as polycystic ovary syndrome. O ther than the obligatory role of androgens as estrogen precursors in steroidogenesis (1), little is known about the direct involvement of androgens in the female ovary. For many decades, excess androgens in women have been considered detrimental to women's health, as diseases such as polycystic ovary syndrome (PCOS) are associated with reduced fertility. In the past, these negative effects of androgens on female fertility were thought to occur primarily at the level of the hypothalamus and pituitary (2, 3), although important data across different species (4-7) suggested that androgens could also directly promote follicle growth (8, 9). Attitudes about androgen actions in female fertility changed with the development of global androgenreceptor knockout (ARKO) mice (10-12). The female ARKO mice had considerable reproductive defects, with decreased fertility, defective follicular development, reduced ovulation, and premature ovarian failure. In other words, the phenotype of these ARKO mice suggested that androgen signaling might actually be important for normal female reproductive health. Intriguingly, through the generation of granulosa cell (GC)-specific ARKO mice, we (13) and then others (14) demonstrated that essentially all the observed reproductive phenotypes in the complete AR-null mice are caused by androgen actions in GCs. These results highlighted that, with regard to fertility, androgen signaling in the ovary is at least as important as androgen signaling in the pituitary or hypothalamus. By using this GC-specific ARK...

“…A deficit of DHEA/T conversion has been identified in a subset of impaired ovarian reserve patients [34,35].…”

Section: How Fmr1 Mutations Influence Different Phenotypesmentioning

confidence: 99%

The impact of FMR1 gene mutations on human reproduction and development: a systematic review

Noto

Harrity

Walsh

et al. 2016

J Assist Reprod Genet

Purpose This is a comprehensive review of the literature in this field attempting to put the FMR1 gene and its evaluation into context, both in general and for the reproductive health audience. Methods Online database search of publications with systematic review of all papers relevant to ovarian reserve and assisted reproduction was done. Results Relevant papers were identified and assessed, and an attempt was made to understand, rationalize and explain the divergent views in this field of study. Seminal and original illustrations were employed. Conclusions FMR1 is a highly conserved gene whose interpretation and effect on outcomes remains controversial in the reproductive health setting. Recent re-evaluations of the commonly accepted normal range have yielded interesting tools for possibly explaining unexpected outcomes in assisted reproduction. Fragile X investigations should perhaps become more routinely assessed in the reproductive health setting, particularly following a failed treatment cycle where oocyte quality is thought to be a contributing factor, or in the presence of a surprise finding of diminished ovarian reserve in a young patient.