Endocrine Abstracts

Purpose: Androgens promote early follicular development and granulosa cell proliferation by augmenting follicle-stimulating hormone (FSH) receptor expression in granulosa cells. Several retrospective studies have evaluated the association between basal androgen concentrations and follicular development in women undergoing ovarian stimulation for in vitro fertilization (IVF) with conflicting results. The aim of this study was to investigate whether basal androgen concentrations are associated with the number of follicles on the day of triggering final oocyte maturation in poor responders undergoing IVF.

Methods: This prospective study was performed between 02/2020 and 01/2022 in 103 poor responders according to the Bologna criteria. Androgens, including total testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), Δ4-androstenedione and 17-OH progesterone (17-OHP), were measured at the initiation of ovarian stimulation. Ovarian stimulation was performed using a fixed dose of 300 IU of recombinant gonadotrophins and gonadotrophin releasing hormone (GnRH) analogues. Triggering of final oocyte maturation was performed in the presence of three follicles of ≥ 17 mm. Primary outcome measure was the number of follicles ≥ 11 mm on the day of triggering final oocyte maturation. The association between androgen concentrations and the number of follicles ≥ 11 mm on the day of triggering was evaluated using generalized estimating equations, accounting for female age and body mass index (BMI). Values were expressed as a coefficient (coef) or mean (95% confidence interval).

Results: Female age was 41.9 (41.2-42.6) years, while BMI was 26.1 (24.9-27.3) kg/m². The number of follicles ≥11 mm on the day of triggering final oocyte maturation was 6.1 (5.3-7.0). The number of COCs retrieved was 3.9 (3.2-4.6), the number of MII oocytes was 3.4 (2.8-3.9) and the number of 2pn oocytes was 2.5 (2.1-2.8).

No significant association was found between basal testosterone (coef: -0.008, -0.019 to +0.003, P=0.17), 17-OHP (coef: -0.044, -0.391 to +0.303, P=0.80), SHBG (coef: -0.002, -0.007 to +0.002, P=0.25), Δ4-androstenedione (coef: -0.101, -0.306 to +0.104, P=0.33) concentrations and the number of follicles ≥11 mm. In contrast, a significant negative association was found between basal DHEAS (coef: -0.011, -0.019 to -0.003, P=0.007) concentrations and the number of follicles ≥11 mm on the day of triggering final oocyte maturation.

Conclusions: Higher DHEAS concentrations were associated with the development of fewer follicles ≥ 11 mm. Given the significant negative association between DHEAS concentrations and the number of follicles on the day of triggering final oocyte maturation, future studies on DHEA supplementation should consider basal DHEAS concentrations.