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J Assist Reprod Genet. 2019 Jan 5. doi: 10.1007/s10815-018-1383-2. [Epub ahead of print]

Testosterone therapy for women with poor ovarian response undergoing IVF: a meta-analysis of randomized controlled trials.

Author information

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.

KEYWORDS:

Clinical pregnancy rate; IVF outcome; Live birth rate; Poor ovarian responders; Supplementation; Testosterone

PMID:
30610664
DOI:
10.1007/s10815-018-1383-2

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