Could Serum Testosterone Level be a Predictive Marker for Poor Ovarian Response in Women Undergoing in Vitro Fertilization Cycle?

Abstract

The ovarian response to exogenous gonadotrophins is highly variable, with a certain proportion of women exhibiting an unexpected poor response to controlled ovarian hyper-stimulation (COH)(Broekmans et al., 2006). Poor ovarian response (POR) is associated with treatment cancellation and reduced live-birth rates, being a significant psychological and financial burden for the couple especially in developing countries (Pu et al., 2011). According to the two-cell two-gonadotrophin theory, androgens play an essential role in ensuring adequate follicular steroidogenesis in humans (Hillier et al., 1994). Guo et al. (2014) implies the importance of an androgenicenvironment, especially testosterone, in improving pregnancyoutcome. This assumption is concordant with Gleicher andBarad (2011) and Weghofer et al. (2012), which also suggestnormal androgenic ovarian endocrine microenvironmentswould positively influence pregnancy chances with IVF. It was concluded by the Bologna ESHRE criteria that poor ovarian responders should be considered patients having at least two of the following criteria: A previous episode of poor ovarian response (≤3 oocytes) with a standard dose of medication. An abnormal ovarian reserve with AFC<5–7 follicles or AMH <0.5 ng/mL. Advanced maternal age or presenting other risk factors for poor response such as previous ovarian surgery, genetic defects, chemotherapy,radiotherapy, and autoimmune disorders(Ferraretti et al., 2011). 117 women were eligible for this study, who attended Ain shams university maternity hospital during October 2015 to March 2016. 89 women underwent the long ovarian stimulation protocol & oocyte aspiration, where 55 women (61.8%) hav been good responders, while 34 women (38.2%) have been poor responders,comparing serum testosterone level in relation to number of follicles in both ovaries(AFC),number of actual oocyte retrieved, number of embryos fertilized, positive pregnancy test among two groups. This study aimed to assess the value of serum testosterone level as a predictor of ovarian response for induction of ovulation in women undergoing IVF cycle.