The use of androgen priming in infertile women with diminished ovarian reserve undergoing assisted reproductive technology (IVF/ICSI)


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Abstract

Objective: To study the effectiveness of androgen priming in infertile women with diminished ovarian reserve (DOR) undergoing assisted reproductive technology (ART) treatment. Materials and methods: A prospective cohort study included infertile women with DOR undergoing in vitro fertilization (IVF) treatment. According to the ESHRE criteria (Bologna Criteria, 2011), the study group included 305 women; among them there were 203 patients who received androgen priming during one month prior to the IVF/ICSI program. The hormonal study including the androgen fractions in the blood serum was carried out using immunochemiluminescent assay (ICMA) in all women. Results: The use of androgen priming in infertile women with DOR led to statistically significant improvements in the parameters of oogenesis and embryogenesis. The use of dehydroepiandrosterone (DHEA) revealed statistically significant differences in the number of oocytes from 2.9 (0.3) to 4.4 (0.3), including mature oocytes from 1.8 (1) to 3.3 (1.05), zygotes from 1.2 (0.6) to 2.1 (0.7), blastocysts from 0.8 (0.4) to 1.4 (0.6), and the frequency of blastula formation from 27.6% to 31.8% (p<0.001). There was an increase in the pregnancy rate from 8.6% to 11.4% (p=0.32). The use of testosterone-containing gel also revealed statistically significant differences in the number of oocytes from 3.0 (0.5) to 4.1 (0.5) and mature oocytes from 1.74 (0.5) to 3.4 (0.6), zygotes from 1.1 (0.4) to 2.2 (0.6), blastocysts from 0.6 (0.3) to 1.5 (0.7), the frequency of blastula formation from 20.0% to 36.6% and pregnancy rate as well (p<0.001); however, pregnancy rate was found to be higher (14%) in this group after receiving therapy compared to the DHEA group. Conclusion: A decrease in the level of androgens in the blood serum is associated with impaired folliculogenesis, oogenesis, embryogenesis and leads to reduced effectiveness of the IVF/ICSI program. The study demonstrated an increase in the number of mature oocytes, the percentage of fertilization and the number of blastocysts of good and excellent quality, which can be the main factors leading to the clinical effectiveness of ART programs; however, there was no statistically significant difference in the pregnancy rate between the groups of patients who received treatment.

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About the authors

Alla A. Gavisova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: gavialla@yandex.ru
Ph.D., Senior Researcher at the lst Gynecological Department.

Nail S. Kamaletdinov

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: sunsh86@mail.ru
Embryologist at the ist Gynecological Department

Tatiana A. Nazarenko

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_nazarenko@oparina4.ru
Dr. Med. Sci., Professor, Director of the Institute of Reproductive Medicine

Natalia V. Dolgushina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: n_dolgushina@oparina4.ru
Dr. Med. Sci., Professor, Deputy Director - Head of the Department of Organization of Scientific Activities

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