Marco Noventa1, Amerigo Vitagliano2, Alessandra Andrisani2, Mija Blaganje3, Paola Viganò4, Enrico Papaelo4, Marco Scioscia5, Francesco Cavallin6, Guido Ambrosini2, Mauro Cozzolino7,8. 1. Department of Women and Children's Health, Clinic of Gynecology and Obstetrics, University of Padua, Via Giustiniani 3, 35128, Padova, Italy. marconoventa.md@gmail.com. 2. Department of Women and Children's Health, Clinic of Gynecology and Obstetrics, University of Padua, Via Giustiniani 3, 35128, Padova, Italy. 3. Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia. 4. Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, 20132, Milano, Italy. 5. Department of Obstetrics and Gynecology, Policlinico Hospital of Abano Terme, Padova, Italy. 6. , Solagna, Italy. 7. Instituto Valenciano de Infertilidad, IVI-RMA Global, Avenida del Talgo 68-70, 28023, Madrid, Spain. 8. Department of Gynecology and Obstetrics, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, Madrid, 28922, Spain.
Abstract
PURPOSE: The aim of the present systematic review and meta-analysis was to summarize evidence on the effectiveness of testosterone supplementation for poor ovarian responders (POR) on IVF outcomes. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos. METHODS: This meta-analysis of randomized controlled trials (RCTs) evaluates the effects of testosterone administration before/during COS compared with a control group in patients defined as POR. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos. Pooled results were expressed as risk ratio (RR) or mean differences (MD) with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroup analysis. All analyses were performed by using the random-effects model. RESULTS: Women receiving testosterone showed higher LBR (RR 2.29, 95% CI 1.31-4.01, p = 0.004), CPR (RR 2.32, 95% CI 1.47-3.64, p = 0.0003), total oocytes (MD = 1.28 [95% CI 0.83, 1.73], p < 0.00001), MII oocytes (MD = 0.96 [95% CI 0.28, 1.65], p = 0.006), and total embryos (MD = 1.17 [95% CI 0.67, 1.67], p < 0.00001) in comparison to controls, with no difference in MR (p = ns). Sensitivity and subgroup analysis did not provide statistical changes to the pooled results. CONCLUSIONS: Testosterone therapy seems promising to improve the success at IVF in POR patients. Further RCTs with rigorous methodology and inclusion criteria are still mandatory.
PURPOSE: The aim of the present systematic review and meta-analysis was to summarize evidence on the effectiveness of testosterone supplementation for poor ovarian responders (POR) on IVF outcomes. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos. METHODS: This meta-analysis of randomized controlled trials (RCTs) evaluates the effects of testosterone administration before/during COS compared with a control group in patients defined as POR. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos. Pooled results were expressed as risk ratio (RR) or mean differences (MD) with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroup analysis. All analyses were performed by using the random-effects model. RESULTS:Women receiving testosterone showed higher LBR (RR 2.29, 95% CI 1.31-4.01, p = 0.004), CPR (RR 2.32, 95% CI 1.47-3.64, p = 0.0003), total oocytes (MD = 1.28 [95% CI 0.83, 1.73], p < 0.00001), MII oocytes (MD = 0.96 [95% CI 0.28, 1.65], p = 0.006), and total embryos (MD = 1.17 [95% CI 0.67, 1.67], p < 0.00001) in comparison to controls, with no difference in MR (p = ns). Sensitivity and subgroup analysis did not provide statistical changes to the pooled results. CONCLUSIONS:Testosterone therapy seems promising to improve the success at IVF in POR patients. Further RCTs with rigorous methodology and inclusion criteria are still mandatory.
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