Association of basal serum testosterone levels with ovarian response and in vitro fertilization outcome
Yingying Qin,#1,2 Zhiyi Zhao,#1,2 Mei Sun,1,2 Ling Geng,1,2 Li Che,3 and Zi-Jiang Chen1,2
1Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, PR China
2Key Laboratory of Reproductive Medicine, Shandong Province, PR China
3Case Western Reserve University, Cleveland, OH 44146, USA
Yingying Qin: firstname.lastname@example.org; Zhiyi Zhao: email@example.com; Mei Sun: firstname.lastname@example.org; Ling Geng: email@example.com; Li Che: firstname.lastname@example.org; Zi-Jiang Chen: email@example.com
Received October 29, 2010; Accepted January 20, 2011.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/2.0
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Other Sections¨
AbstractBackgroundMethodsResultsDiscussionConclusionsAbbreviationsCompeting interestsAuthors' contributionsReferencesAbstractBackground
To evaluate basal testosterone (T) levels during follicular phase of the menstrual cycle as a predictor for ovarian response and in vitro fertilization (IVF) outcome.Method
We analyzed data retrospectively from hospital-based IVF center including one thousand two hundred and sixty Chinese Han women under their first IVF cycle reached the ovum pick-up stage, without polycystic ovary syndrome (PCOS) or endometriosis undergoing long IVF protocol. Patients were divided into 2 groups. Group 1: patients with diminished ovarian reserve (basal FSH >10 IU/L) (n = 187); Group 2: patients with normal ovarian reserve (basal FSH
Basal T levels were markly different between pregnant and non-pregnant women in Group 1; whereas not in Group 2. A testosterone level of 47.85 ng/dl was shown to predict pregnancy outcome with a sensitivity of 52.8% and specificity of 65.3%; and the basal T was correlated with the numbers of large follicles (> 14 mm) on HCG day in Group 1. Significantly negative correlations were observed between basal T, days of stimulation and total dose of gonadotropins after adjusting for confounding factors in both groups.Conclusion
In women with diminished ovarian reserve, basal T level was a predictor for the number of large follicles on HCG day and pregnancy outcome; but could not in those with normal serum FSH. Basal T levels were associated with both days of stimulation and total dose of gonadotropins, indicating that lower level of T might relate with potential ovarian poor response. Other Sections¨
AbstractBackgroundMethodsResultsDiscussionConclusionsAbbreviationsCompeting interestsAuthors' contributionsReferencesBackgroundOvarian response, the recruitment and development of multiple follicles followed by gonadotropins, is a key factor for in vitro fertilization (IVF) treatment cycle. The prediction of ovarian response before undertaking the expensive IVF treatment is important. However, the predictive value of various widely used markers, such as age, antral follicle count (AFC), levels of serum inhibin B, serum anti-M¨ıllerian hormone (AMH), basal serum follicle stimulating hormone (FSH) and estradiol (E2), basal FSH/LH (luteinizing hormone) ratio, still appeared inconsistent and not accurate enough. A large amount of patients may respond poorly to gonadotropins in spite of normal screening parameters . Therefore, it continues to be a challenge for reproductive physicians to identify poor ovarian reserve and the probability of pregnancy beforehand.Androgens, primarily testosterone (T) and androstenedione, are noteworthy to enhance follicular recruitment , promote follicular growth and development [3,4], and increase insulin like growth factor 1 (IGF-1) expression in the primate ovary which plays an essential role in regulating follicular development [3,5]. Recent clinical reports with encouraging results demonstrated that co-treatment with androgen, such as dehydroepiandrosterone (DHEA) and Androderm (transdermal testosterone), could increase both quantity and quality of oocytes and embryos, and improve pregnancy outcomes in women with diminished ovarian function or even premature ovarian failure [6-9]. Improved controlled ovarian hyperstimulation (COH) and pregnancy outcomes by supplementation with aromatase inhibitors may be the consequence of increased intraovarian androgen, followed by the induction of FSH receptors on granulosa cell [10,11]. Nevertheless, controversy exists as to whether these protocols improve cycle outcome [12,13].Prompted by these findings, we hypothesized whether serum testosterone levels could predict ovarian response and IVF outcome. To the best of our knowledge, only a few studies have concerned this question with conflicting results. This might be explained by limited sample size and heterogeneous population mixed by patients with polycystic ovary syndrome (PCOS) and/or endometriosis as PCOS and endometriosis are associated with higher or lower serum T levels [14,15]. No published study focus on the role of basal T levels during stimulation cycle on the ovarian response and reproductive outcomes in women with either diminished or normal ovarian reserve. Thus, conclusive and definite data about the associations of basal serum T levels with ovarian response and IVF outcome are still lacking. The purpose of the present study is to evaluate the predictive value of basal T levels in women with both diminished and normal ovarian reserve on ovarian response and IVF outcome in a large (n = 1260) and homogeneous population undergoing IVF-ET.