Transdermal testosterone pretreatment in poor responders undergoing ICSI: a randomized clinical trial

Area of Science:

• Reproductive Endocrinology
• Infertility Treatment
• Ovarian Stimulation Protocols

Background:

• Androgens are implicated in follicular development and ovarian sensitivity to FSH.
• Previous meta-analyses suggested a potential benefit of testosterone pretreatment, but based on limited data.
• Further randomized controlled trials (RCTs) are needed to confirm testosterone's role in poor responders.

Purpose of the Study:

• To investigate if transdermal testosterone pretreatment increases the number of retrieved cumulus-oocyte complexes (COCs) by more than 1.5 in poor responders undergoing ICSI.
• To evaluate the effect of testosterone pretreatment on ovarian response in patients undergoing ICSI with recombinant FSH and GnRHa.

Main Methods:

• A randomized controlled trial involving 50 poor responders fulfilling Bologna criteria.
• Participants were randomized to receive either 21 days of 10 mg transdermal testosterone gel or no pretreatment.
• Both groups underwent a long GnRHa protocol with recombinant FSH stimulation.

Main Results:

• Testosterone pretreatment did not increase the number of COCs retrieved compared to no pretreatment (median difference: 0.0; 95% CI: -1.0 to +1.0).
• No significant differences were observed in fertilization rates or live birth rates between the groups.
• Testosterone levels were significantly higher in the pretreatment group on FSH stimulation day.

Conclusions:

• Pretreatment with 10 mg transdermal testosterone for 21 days does not appear to improve ovarian response by more than 1.5 oocytes in poor responders.
• These findings can aid in counseling patients with poor ovarian response regarding testosterone pretreatment.
• Higher doses or longer durations of testosterone pretreatment warrant further investigation for potential IVF outcome improvements.