Pedro Montoya-Botero1,2, Jorge Rodriguez-Purata1, Nikolaos P Polyzos1,3,4. 1. Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain. 2. Conceptum - Unidad de Fertilidad del Country, Bogotá, Colombia. 3. Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. 4. Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Abstract
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of androgen supplementation in ART with the most updated evidence, from animal studies to its clinical applications in poor ovarian responders (POR) and the future studies to be published. RECENT FINDINGS: Animal studies, has shown that testosterone supplementation, can be an option to increase the recruitable follicular pool in POR. However, the potential mechanism of action, dose, and duration of treatment is still under investigation. Early studies in humans reported promising results in favor of androgens [dehydroepiandrosterone (DHEA) or testosterone] in POR. Nevertheless, recent evidence does not appear to follow the initial results, whereas the type, dose, and duration of testosterone administration appear to be crucial for treatment effect. SUMMARY: Testosterone seems to play an essential role in regulating ovarian function. However, it is worrisome that androgens are used off-label, despite that the available evidence is weak. Although testosterone supplementation may be beneficial in POR, published studies have used inconsistent doses and duration of administration. An ongoing trial (T-TRANSPORT trial) for the first time aims to provide conclusive evidence on whether transdermal testosterone administration can improve the reproductive outcomes in patients undergoing IVF/ICSI.
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of androgen supplementation in ART with the most updated evidence, from animal studies to its clinical applications in poor ovarian responders (POR) and the future studies to be published. RECENT FINDINGS: Animal studies, has shown that testosterone supplementation, can be an option to increase the recruitable follicular pool in POR. However, the potential mechanism of action, dose, and duration of treatment is still under investigation. Early studies in humans reported promising results in favor of androgens [dehydroepiandrosterone (DHEA) or testosterone] in POR. Nevertheless, recent evidence does not appear to follow the initial results, whereas the type, dose, and duration of testosterone administration appear to be crucial for treatment effect. SUMMARY:Testosterone seems to play an essential role in regulating ovarian function. However, it is worrisome that androgens are used off-label, despite that the available evidence is weak. Although testosterone supplementation may be beneficial in POR, published studies have used inconsistent doses and duration of administration. An ongoing trial (T-TRANSPORT trial) for the first time aims to provide conclusive evidence on whether transdermal testosterone administration can improve the reproductive outcomes in patients undergoing IVF/ICSI.
Authors: Kristine Løssl; Nina la Cour Freiesleben; Marie Louise Wissing; Kathrine Birch Petersen; Marianne Dreyer Holt; Linn Salto Mamsen; Richard A Anderson; Claus Yding Andersen Journal: Front Endocrinol (Lausanne) Date: 2020-09-04 Impact factor: 5.555