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

Thread starter #1
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.







Conclusions
Pre-treatment with testosterone seems promising to improve the success of IVF in POR patients. Specifically, available data support a positive impact of transdermal testosterone on LBR, CPR, and other COS parameters (total number of oocytes and MII oocytes retrieved, total embryos obtained). Due to the limitations of available studies, further RCTs on larger populations, with rigorous methodology and inclusion criteria, are still mandatory in order to finally confirm or not its real clinical effectiveness as well as to establish the best timing, dose, and duration of testosterone administration before IVF.
 

Attachments

Top