The Use of Androgen Priming in Women with Reduced Ovarian Reserve Undergoing Assisted Reproductive Technology

Alison Richardson; Kanna Jayaprakasan

doi:10.1055/s-0041-1735646

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2021; 39(05/06): 207-219
DOI: 10.1055/s-0041-1735646

Review Article

The Use of Androgen Priming in Women with Reduced Ovarian Reserve Undergoing Assisted Reproductive Technology

Alison Richardson

¹Department of Reproductive Medicine and Surgery, University Hospitals of Leicester NHS Trust, Leicester Fertility Centre, Infirmary Square, Leicester, United Kingdom

,

Kanna Jayaprakasan

²Department of Reproductive Medicine and Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom

³CARE Fertility Nottingham, Nottingham Business Park, Nottingham, United Kingdom

› Author Affiliations

Abstract

Androgen priming with either dehydroepiandrosterone (DHEA) or testosterone has been suggested as an adjunct to improve in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR). Numerous studies have investigated the effects of both DHEA and testosterone on IVF outcome. The results were inconsistent, and the quality of most studies is substandard. Meta-analyses have consistently reported that DHEA does appear to significantly improve IVF outcome in women with predicted or proven poor ovarian response (POR), but these have included some normal responders and/or nonrandomized studies. Our meta-analyses including randomized controlled trials (RCTs) incorporating only women with DOR or POR suggest that DHEA confers no benefit. While meta-analyses of RCTs on the use of testosterone in women with DOR or POR showed an improved IVF outcome, most studies included are of low quality with high risk of bias. When analysis of data from studies of only low-risk bias was performed, such a benefit with testosterone was not observed. Although recruitment may well be a challenge, a large, well-designed RCT is, however, still warranted to investigate whether or not androgen priming with either DHEA or testosterone should be recommended as an adjuvant treatment for women with DOR or POR undergoing IVF.

Keywords

DHEA - testosterone - ovarian response - poor responders - IVF - clinical pregnancy

Full Text

References

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