The effect of intra-ovarian androgen priming on ovarian reserve parameters in Bologna poor responders

Vuong, Lan N.; Ho, Tuong Vinh; Ha, Anh N.; Pham, Toan D; Le, Tam T.N.; Andersen, Claus Yding; Humaıdan, Peter

doi:10.1016/j.rbmo.2019.11.005

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…45 The same result was observed in this study where no difference in serum AMH was observed after T therapy (0.51 versus 0.53). Vuong LN et al 46 performed long-term intraovarian androgen priming but also did not find any significant effect on AMH level. However, despite androgens improving recruitment and activation of prenatal follicles and the fact that AMH is synthesised in GC, there are insufficient studies observing the effect of testosterone on AMH.…”

Section: Discussionmentioning

confidence: 93%

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The Benefits of Testosterone Therapy in Poor Ovarian Responders Undergoing In Vitro Fertilisation (IVF)

2020

EMJ

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Introduction: Poor ovarian responders are the most challenging patients in reproductive medicine and no successful treatment has been proposed. Androgens are thought to play an important role during early folliculogenesis and diminished levels are associated with decreased ovarian sensitivity to follicle-stimulating hormone. This study aimed to determine whether pretreatment with testosterone improves the results in poor responders undergoing in vitro fertilisation (IVF). Materials and methods: This observational pilot study enrolled 33 poor responders undergoing IVF. Eleven patients were pretreated with 250 mg intramuscular testosterone and compared to a control group of 22 patients. The participants were tested for free testosterone, dehydroepiandrosterone sulfate, sex hormone binding globulin, and anti-mullerian hormone (AMH). Results: The two groups had similar baseline characteristics. Significant improvement was reached in the hormones free testosterone, dehydroepiandrosterone sulfate, and sex hormone binding globulin in the testosterone-pretreatment group. No difference was detected in antral follicle count (5.06 versus 4.24); AMH (0.51 versus 0.53), mature oocytes (2.2 versus 2.32), and the number of embryos (1.2 versus 1.33) between the study and control groups, respectively. There was a slow improvement in fertilisation rate but without any significance (62.97% versus 57.61%). However, the cancellation rate of the ovarian stimulation was much greater in the control group (18.18%) in comparison with the study group (0.0%). Pregnancy rate (PR) in the testosterone group was higher than controls (PR per cycle: 27.3% versus 4.6; p=0.09). Conclusion: Based on the limited number of patients studied, pretreatment with testosterone seems to improve PR and cancellation rate in poor responders but failed to affect antral follicle count, AMH, and the number of mature oocytes and embryos. Given these results, further research would provide more certainty.

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Section: Discussionmentioning

confidence: 93%

“…In the literature, the most common route of administration was transdermal and only one other study reported an alternative method: intraovarian priming. 46…”

Section: Limitation and Strengths Of The Studymentioning

confidence: 99%

The Benefits of Testosterone Therapy in Poor Ovarian Responders Undergoing In Vitro Fertilisation (IVF)

2020

EMJ

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“…Unfortunately, this protocol was performed in a small number of < 40 yrs old women, preventing any firm conclusion. Further to previous observations from women with normal ovarian function, a “long-term intra-ovarian androgen priming” was proposed in order to boost the recruitment of small pre-antral follicles ( 56 ). For that purpose, during 2 months of hypophyseal desensitization induced by GnRH agonist (Depot formulation 3,75 mg every 4 weeks), a small dose of recombinant HCG (260 IU every second day) was administered subcutaneously in addition to oral letrozole 2.5 mg daily for 8 weeks.…”

Section: Therapeutic Strategies In Women Classified As Poseidon Groupmentioning

confidence: 99%

Subtle perturbations of ovarian steroidogenesis in patients classified as Poseidon Group 3. Which consequences for therapeutic strategy?

Hugues

2024

Front. Endocrinol.

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The optimal strategy for stimulation of young women with a low ovarian reserve is still a challenging issue because the physio-pathogeny of this disorder is often unknown. As androgen production by the ovary plays a crucial role in folliculogenesis, it was tempting to speculate that subtle perturbations in ovarian steroidogenesis might participate to the low responsiveness to gonadotrophins. Indeed, in vitro analysis of human luteinized granulosa cells has recently provided evidence for some enzymatic deficits in steroidogenesis and altered response to gonadotrophins. Therefore, improving androgen environment of women classified in Poseidon Group 3 should be considered. In this clinical situation, the potential benefit of androgen supplementation or stimulation of theca cells by LH-activity products are respectively discussed.

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“…Priming stopped on the 1st day of OS. The primary endpoint was circulating concentration of AMH after 8 weeks of priming, while secondary endpoints included antral follicle count (2-10 mm), and serum hCG, testosterone and progesterone levels (71). However, the intervention did not produce any significant improvements, and the resulting androgen production was lowered compared to the natural situation.…”

Section: Long-term Low Dose Hcg Priming: Local Increased Androgen Levelsmentioning

confidence: 99%

“…A first attempt to achieve this has recently been published ( 71 ) in which low responder women ( n = 30) received 260 IU hCG every 2nd day for 8 weeks to augment intra-ovarian androgen levels. Simultaneously women received 2.5 mg letrozole daily to prevent androgens from being converted into estrogens, and in addition women were down regulated with a GnRH agonist to prevent FSH from rising in response to low levels of estradiol.…”

Section: Long-term Low Dose Hcg Priming: Local Increased Androgen Levmentioning

confidence: 99%

Biological and Clinical Rationale for Androgen Priming in Ovarian Stimulation

et al. 2020

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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.

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The effect of intra-ovarian androgen priming on ovarian reserve parameters in Bologna poor responders

Cited by 6 publications

References 18 publications

The Benefits of Testosterone Therapy in Poor Ovarian Responders Undergoing In Vitro Fertilisation (IVF)

The Benefits of Testosterone Therapy in Poor Ovarian Responders Undergoing In Vitro Fertilisation (IVF)

Subtle perturbations of ovarian steroidogenesis in patients classified as Poseidon Group 3. Which consequences for therapeutic strategy?

Biological and Clinical Rationale for Androgen Priming in Ovarian Stimulation

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