title: Associations between peripheral androgens and cortisol in infertile women.
abstract: Testosterone has in recent years been proven essential for normal growth and maturation of small growing follicles. Concomitantly, low functional ovarian reserve (LFOR), characterized by a small growing follicle pool, has been associated with low testosterone levels, which can be of ovarian and/or adrenal origin. In this study we, therefore, investigated whether peripheral sex steroid precursors and testosterone levels potentially reflect on adrenal function. In a retrospective cohort study of 355 consecutive infertile women, who presented to an academically affiliated fertility center in New York City, we investigated in a series of statistical models whether low peripheral sex steroid precursors and testosterone are associated with peripheral cortisol (C) levels, reflecting adrenal function. To determine potential correlations, we investigated the dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), androstenedione (AD), total testosterone (TT), free testosterone (FT); sex hormone binding globulin (SHBG), anti-Müllerian hormone (AMH), thyroid stimulating hormone (TSH) and C in a series of multivariate and logistic regression analyses, utilizing C either as a continuous variable or with cut off <5.0μg/dL, and TT only as a continuous variable. Practically all models demonstrated significant predictability of peripheral sex hormone precursors for C levels, with DHEA demonstrating the strongest and most consistent predictability as an individual parameter and as part of the DHEAS/DHEA ratio. We conclude that in infertile women peripheral sex hormone precursors, especially DHEA, reflect C levels and, therefore, adrenal function. In infertile women, at all ages low levels of sex hormone precursors, therefore, should be considered indications for further adrenal assessments.
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States; The Foundation for Reproductive Medicine, New York, NY, United States; Stem Cell and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, United States. Electronic address: ngleicher@thechr.com.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Seier
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, United States.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States; Department of Obstetrics and Gynecology, Vienna University School of Medicine, Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Weghofer
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States.
authors.forename: Yan-Guang
authors.initials: YG
authors.lastname: Wu
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States; University of Kansas Medical Center, Kansas City, KS, United States.
authors.forename: David F
authors.initials: DF
authors.lastname: Albertini
authors.affiliation: The Center for Human Reproduction (CHR), New York, NY, United States; The Foundation for Reproductive Medicine, New York, NY, United States; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York, NY, United States.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000328:Adult; D000728:Androgens / Q000097:blood*; D054304:Anti-Mullerian Hormone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007247:Infertility, Female / Q000097:blood*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D045165:Testosterone Congeners / Q000097:blood; D013972:Thyrotropin / Q000097:blood
chemical_list: D000728:Androgens; D012738:Sex Hormone-Binding Globulin; D045165:Testosterone Congeners; D054304:Anti-Mullerian Hormone; D013972:Thyrotropin; D006854:Hydrocortisone
keywords: Adrenal function; Androgens; Cortisol; DHEA; Infertility; Sex hormone precursors; Testosterone