Androgens and Controlled Ovarian Stimulation Outcomes
Keywords:
androgens, IVF, PCOSAbstract
Androgens play are an integral part in normal follicular development and in the pathogenesis of conditions such as polycystic ovary syndrome (PCOS), decreased ovarian reserve and poor ovarian response. Besides indirectly mediating the growth of early phases of follicular development, through their actions on FSH (follicle-stimulating hormone) and IGF1(insulin-like growth factor 1), androgens are also the source of estrogens. Hyperandrogenism in PCOS leads to excessive growth of preantral follicles and follicular arrest. Low levels of androgens are responsible for abnormal folliculogenesis and rapid depletion of the ovarian pool. The poor ovarian response is encountered in up to a third of patients undergoing controlled ovarian stimulation, and androgens have been used as a prediction tool and as a treatment intervention. Although the results are not unanimous, serum DHEAS (dehydroepiandrosterone sulfate) appears to anticipate the type of response encountered in controlled ovarian stimulation and the possibility of achieving a live birth after ART (assisted reproduction technique) treatment. Similarly, testosterone could help in the optimization of stimulation protocols. Whether systemically administered androgens could influence the intra-follicular environment is not certain. Still, treatment with both testosterone and DHEA appears to have beneficial effects on both surrogate endpoints, such as embryos quantity and quality, as well as definitive endpoints such as clinical pregnancy rate and live birth rate.
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