Lectures

Starting and resulting testosterone levels after androgen supplementation determine in all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR)

Lecture Type: Research in Brief

Starting and resulting testosterone levels after androgen supplementation determine in all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR)

Norbert Gleicher, MD, FACOG

Medical Director and Chief Scientist, Center for Human Reproduction, New York, NY, USA

Dr. Norbert Gleicher founded the Center for Human Reproduction (CHR) in 1981. He is a graduate of Tel Aviv Medical School, Israel, and completed his residency at the Mount Sinai School of Medicine in New York. Dr. Gleicher was appointed to the facility as an Assistant Professor in charge of student and resident education in Obstetrics and Gynecology, and became Chief of the Section for Reproductive Immunology. Two years later, he moved to Chicago when he was offered the position of Chairman of Obstetrics and Gynecology at the Mount Sinai Hospital Medical Center, Professor of Obstetrics and Gynecology and Associate Professor of Immunology/Microbiology at Rush Medical College. He held his position as Chairman for 10 years, until his resignation in 1990. Since then, he has held a variety of academic and administrative positions. Dr. Gleicher is currently Medical Director and Chief Scientist of CHR-New York. Dr. Gleicher has published hundreds of peer-reviewed scientific papers, abstracts and book chapters in the areas of reproductive endocrinology and infertility, as well as in areas of medical complications in pregnancy. He has edited some of the most prestigious textbooks in these specialties and has served as the Editor-in-Chief for the American Journal of Reproductive Immunology and Microbiology and the Journal of In Vitro Fertilization and Embryo Transfer, which was renamed the Journal of Assisted Reproduction and Genetics in 1992. Dr. Gleicher serves as ad hoc reviewer and editorial board member for many other medical journals. He is a Fellow of the American College of Obstetricians and Gynecologists and, in addition to many other societies and professional organizations, a member of the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE). He was chosen by Chicago magazine and other organizations as being amongst the ‘best physicians’ in reproductive endocrinology and infertility, as well as obstetrics and gynecology, as designated by his peers. In January 2009, Dr. Gleicher was invited to give the prestigious Patrick Steptoe Memorial Lecture to the British Fertility Society, as a recognition of his lifelong contribution to the advancement in reproductive endocrinology and infertility.

Context

Dr. Gleicher discusses a recent publication in Journal of Assisted Reproduction and Genetics that suggests testosterone levels after androgen (DHEA) supplementation as predictor of IVF pregnancy rates. J Assist Reprod Genet 2013;30(1):49-62.
Abstract PURPOSE: To investigate whether androgen conversion rates after supplementation with dehydroepiandrosterone (DHEA) differ, and whether differences between patients with diminished ovarian reserve (DOR) are predictive of pregnancy chances in association with in vitro fertilization (IVF).
METHODS: In a prospective cohort study we investigated 213 women with DOR, stratified for age (? 38 or >38 years) and ovarian FMR1 genotypes/sub-genotypes. All women were for at least 6 weeks supplemented with 75 mg of DHEA daily prior to IVF, between initial presentation and start of 1st IVF cycles. Levels of DHEA, DHEA-sulfate (DHEAS), total T (TT) and free T (FT) at baseline ((BL)) and IVF cycle start ((CS)) were then compared between conception and non-conception cycles.
RESULTS: Mean age for the study population was 41.5 ± 4.4 years. Forty-seven IVF cycles (22.1 %) resulted in clinical pregnancy. Benefits of DHEA on pregnancy rates were statistically associated with efficiency of androgen conversion from DHEA to T and amplitude of T gain. Younger women converted significantly more efficiently than older females, and selected FMR1 genotypes/sub-genotypes converted better than others. FSH/androgen and AMH/androgen ratios represent promising new predictors of IVF pregnancy chances in women with DOR.
CONCLUSIONS: DOR at all ages appears to represent an androgen-deficient state, benefitting from androgen supplementation. Efficacy of androgen supplementation with DHEA, however, varies depending on female age and FMR1 genotype/sub-genotype. Further clarification of FMR1 effects should lead to better individualization of androgen supplementation, whether via DHEA or other androgenic compounds.

VIDEO: Starting and resulting testosterone levels after androgen supplementation determine in all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR)


Recorded on: Wednesday, January 30, 2013

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