Pretreatment with transdermal testosterone may improve ovarian response to gonadotrophins in poor-responder IVF patients with normal basal concentrations of FSH.
BACKGROUND
Treatment of poor-responder patients to controlled ovarian stimulation for assisted reproduction, who have normal basal FSH concentrations, is one of the most difficult challenges in reproductive medicine. This study investigated the usefulness of testosterone pretreatment in such patients.


METHODS
Prospective, therapeutic, self-controlled clinical trial including 25 consecutive infertile patients who had a background of the first and second IVF treatment cycle cancellations due to poor follicular response, in spite of vigorous gonadotrophin ovarian stimulation and having normal basal FSH levels. In the third IVF attempt, all patients received transdermal testosterone treatment (20 microg/kg per day) during the 5 days preceding gonadotrophin treatment.


RESULTS
Twenty patients (80%) showed an increase of over fivefold in the number of recruited follicles, produced 5.8+/-0.4 (mean+/-SEM) oocytes, received two or three embryos and achieved a clinical pregnancy rate of 30% per oocyte retrieval. There were 20% cancelled cycles.


CONCLUSIONS
Pretreatment with transdermal testosterone may be a useful approach for women known to be low responders on the basis of a poor response to controlled ovarian stimulation but having normal basal FSH concentrations.
Balasch
Juan
J
Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain. jbalasch@ub.edu
Fábregues
Francisco
F
Peñarrubia
Joana
J
Carmona
Francisco
F
Casamitjana
Roser
R
Creus
Montserrat
M
Manau
Dolors
D
Casals
Gemma
G
Vanrell
Juan A
JA
D000279:Administration, Cutaneous; D000328:Adult; D000735:Androstenedione / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D043373:Follicle Stimulating Hormone, Human / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007986:Luteinizing Hormone / Q000097:blood; D009865:Oocytes; D006080:Ovarian Follicle / Q000187:drug effects / Q000254:growth & development; D010053:Ovary / Q000187:drug effects / Q000502:physiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000008:administration & dosage* / Q000097:blood; D020858:Tissue and Organ Harvesting / Q000379:methods
D043373:Follicle Stimulating Hormone, Human; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D000735:Androstenedione; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D007986:Luteinizing Hormone