Testosterone levels effect embryo implantation rates in patients with endometriosis

Does testosterone have a key role in endometriosis-related infertility?

Key Points

Highlights:

• Low basal serum testosterone levels negatively affect pregnancy and IVF success rates in patients with III-IV stage endometriosis.

Importance:

• This is the first study examining the levels of testosterone, and its effects on pregnancy rates in advanced-stage endometriosis.

What's done here:

• The data from 1068 patients, with surgically diagnosed endometriosis have been analyzed, 407 with ASRM stageIII-IV endometriosis have been included.
• Patients older than 39 years at the time of IVF/ICSI, who have adenomyosis, polycystic ovarian syndrome, hyperprolactinemia, adrenal disease, irregular menstrual cycles, or underwent preimplantation genetic testing were excluded.
• The IVF protocol has been chosen as either antagonist or long protocol according to the patients, based on the age, weight, ovarian reserve and all triggers have been made with 5000–10000 IU HCG. The fresh or frozen embryo transfer option has been decided according to the patients’ current clinic and no more than 3 embryos at a time have been transferred.
• Serum testosterone levels have been measured on day 2 or 3 of the menstrual cycle along with serum FSH, LH, progesterone, and estradiol levels. 

Key Results:

• The basal serum testosterone was found to be significantly higher in the patients who get pregnant, compared to the non-pregnancy group.
• The pregnant group had higher number of retrieved oocytes and high-quality embryos.
• The basal serum testosterone concentration was negatively correlated with age, initial gonadotropin, and total doses of Human Menomapusal Gonadotropin (HMG).
• The ROC curve demonstrated that basal serum testosterone concentration had a predictive value for the clinical pregnancy of IVF-ET in the patients with III-IV stage endometriosis (p = 0.033).
• The cut-off value for definitive testosterone levels was defined as 0.305ng/ml with a sensitivity of 52.4% and specificity of 62.2%; and the patients with concentrations lower than 0.305 ng/mL had diminished chances of clinical pregnancy.
• When all parameters were balanced except the testosterone levels, the Initial dose of gonadotropins and total dose of gonadotropins was significantly higher when testosterone levels were lower than the cutoff value.

Limitations:

• Retrospective design brought the inability to examine the effect of other androgens rather than testosterone.
• The low sensitivity and specificity levels achieved when defining the cutoff value for testosterone levels require more studies conducted to replicate the results and find more specific outcomes.

Lay Summary

Endometriosis is associated with infertility either causing poor oocyte and embryo qualities or poor endometrial receptivity.

The effect of androgen levels on IVF outcomes has been described earlier, but the present study conducted by Ling Huang et assocates is the first which examined advanced stage endometriosis patients, and is the one that a predictive cutoff value for testosterone levels has been explained. This original article entitled "Low basal serum testosterone level is detrimental to the embryo implantation in the patients with severe endometriosis", has recently been paublsihed in the "Journal of Obstetrics and Gynaecology Research".

The levels of testosterone were initiated with poorer pregnancy and fertility results when it was lower than 0.305ng/ml in serum.

Also, the number of gonadotropins administered, have been found to be higher to achieve the same number of oocytes and embryos in the lower testosterone group patients.

These findings brought a new predictive test to the field, to calculate the gonadotropin doses better, and to foresee the faith of the implantation when the testosterone levels are not enough.

The authors concluded as these predictions would bring a higher value when the results were optimized and replicated with further studies in order to use testosterone not only as a predictive test but also as a drug to be supplied when needed.

Research Source: https://pubmed.ncbi.nlm.nih.gov/33819929/