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Ovarian Reserve

Mini-stim IVF

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Androgen Use for Infertility

The use of small amounts of male hormones (DHEA or testosterone) in women is one of the few ways to enhance the fertility of older women or women with decreased ovarian reserve.

The use of testosterone treatment in women is based on observations in women and on experimental animal studies. Both men and women produce testosterone. Women with lower levels of testosterone are less likely to achieve pregnancy than women with higher levels and also respond less well to standard ovulation inductions. Androgen levels decrease with age. Studies in non-human primates suggest that pre-treatment with androgen increases the ability of the cells around the egg to respond to FSH. Androgen pre-treatment in monkeys promotes development in quiescent eggs within the ovaries and increases the number of small follicles within the ovaries. Long term treatment with androgens may induce a PCO-like state in the ovaries which delays atresia (withering away) of eggs that have yet to be stimulated. All of these findings are consistent with the hypothesis that androgen pre-treatment in women increases the number of eggs available for retrieval with IVF in women with decreased ovarian reserve.

There are now three studies demonstrating a benefit of pre-treatment with androgens prior to an IVF cycle in women with decreased ovarian reserve. (These are generally older infertility patients.) Two of these studies were controlled randomized studies and the third used patients as their own controls. The first study by Baraid and Gleicher used DHEA. It involved 25 women with poor response in a prior IVF cycle. They found that in pre-treated patients, an average of one more egg was obtained with IVF. In addition, several parameters associated with IVF success also improved.

The second study by Fabreques, et., randomized 62 women to pre-treatment with transdermal testosterone or routine (micro-flair) IVF. All patients had a prior IVF cycle cancelled for poor follicular response to medications. Pre-treatment with testosterone decreased cycle cancellation by more than 50%. In those patients with eggs retrieved, approximately one extra egg was obtained in women pre-treated with testosterone.

The third study randomized 110 low responders in a prior IVF cycle (defined as getting less than 3 eggs after high dose gonadotropins). The study group received pre-treatment with testosterone gel. The group pre-treated with testosterone gel had about 1.5 extra eggs retrieved with IVF and had about double the clinical pregnancy rate.

Our experience with androgen pre-treatment in women has also been quite positive. We find it especially valuable in the context of minimal stimulation IVF (mini-stim IVF).