Early follicular androgen levels correlate with oocyte yield in ovarian stimulation cycles
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Key Takeaway
Consider early androgen levels as a potential prognostic marker in ovarian stimulation, but note the moderate predictive accuracy and lack of causal evidence.
This was a retrospective cohort study of 299 controlled ovarian hyperstimulation cycles in women with infertility, comparing 216 cycles with normal ovarian response (NOR) to 83 with poor ovarian response (POR) per Bologna criteria. The study assessed early follicular phase androgen levels (testosterone, DHEAS) as exposures and oocyte yield as the primary outcome.
A significant positive correlation was observed between oocyte yield and both AMH and testosterone levels. The odds of retrieving more than three oocytes were increased for testosterone levels >0.21 ng/mL (OR: 2.67) and DHEAS levels >0.93 ng/mL (OR: 1.37). Predictive performance for poor ovarian response (oocyte yield ≤3) was strong for AMH (AUC: 0.877) but moderate for testosterone (AUC: 0.659) and DHEAS (AUC: 0.610).
No safety or tolerability data were reported. Key limitations include the retrospective, single-center design and that androgen supplementation was not tested. The practice relevance suggests androgen assessment may add prognostic value, but findings are associative only; causation is not established.
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View Original Abstract ↓
IntroductionOvarian response to controlled ovarian hyperstimulation (COH) is commonly predicted by age, ovarian reserve markers, and outcomes of previous stimulation cycles. Androgens play a key role in follicular recruitment, development, and atresia. This study aimed to evaluate circulating androgens as additional, potentially modifiable prognostic markers of ovarian response.Materials and methodsWe conducted a retrospective cohort study analyzing oocyte yield after COH in relation to early follicular phase androgen levels. Expected ovarian response was classified according to the Bologna criteria. Odds ratios (ORs) for androgen levels and oocyte yield were calculated, and receiver operating characteristic (ROC) curves were generated to assess the predictive accuracy of androgen levels for normal versus poor ovarian response (NOR/POR).ResultsA total of 299 stimulation cycles were analyzed (216 NOR and 83 POR). The POR group was characterized by significantly higher median age, lower anti-Müllerian hormone (AMH) levels, reduced oocyte yield, and significantly lower androgen concentrations. A significant positive correlation was observed between the number of retrieved oocytes and both AMH and testosterone levels. The odds of retrieving more than three oocytes were increased for testosterone levels >0.21 ng/mL (OR: 2.67) and for DHEAS levels >0.93 ng/mL (OR: 1.37). While AMH demonstrated the strongest predictive performance for an unfavorable outcome (oocyte yield ≤3; AUC: 0.877), androgen levels showed a moderate predictive ability for poor ovarian response (testosterone AUC: 0.659; DHEAS AUC: 0.610).DiscussionConsidering the observed association between androgen levels and ovarian response, the assessment of androgens prior to COH may provide additional prognostic value. Androgens could represent modifiable biomarkers to identify patients who may benefit from pre-treatment androgen supplementation in the presence of low baseline levels.
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