When a woman has been diagnosed as being a poor responder - or has poor ovarian reserve - there is an increased risk that an IVF cycle may be cancelled due to poor response. Cancelled cycles can be very costly and frustrating but a 2011 study (1) has found a new way of predicting which women may have trouble getting to the egg retrieval and embryo transfer stages of IVF. This study discovered that a woman's testosterone level on day three of her menstrual cycle can be very predictive of how her IVF will progress.
The study was extremely large following one-thousand two hundred and sixty Chinese women who were undergoing their first IVF who were free of endometriosis and PCOS. The women were divided into two groups: those who had diminished ovarian reserve (FSH>10 IU/L) comprising one hundred and eighty seven women and those with normal ovarian reserve. All women underwent the same IVF protocol.
In women with poor ovarian reserve a testosterone level greater than 47.85 ng/dl was able to predict pregnancy outcome (with a sensitivity of 52.8% and specificity of 65.3%). Day three testosterone was correlated with the numbers of mature follicles on the day of the hCG trigger and also indicated the total number of days of gonadotropin stimulation and the total dose of gonadotropins that would be required. The study concluded that:
"In women with diminished ovarian reserve, basal T (testosterone) level was a predictor for the number of large follicles on HCG day and pregnancy outcome; but could not in those with normal serum FSH."
"Basal T (testosterone) levels were associated with both days of stimulation and total dose of gonadotropins, indicating that lower level of T might relate with potential ovarian poor response."
Interestingly there have been recent studies showing that women with poor ovarian reserve who receive a pre-treatment phase of testosterone and DHEA (another androgen) have better IVF success rates. Your day three testosterone, if low, may indicate that you may benefit from some form of androgen pre-treatment to help your IVF to be more successful. The study further concludes that:
"Basal T level is a good predictor for pregnancy outcome and number of large follicles on HCG day in women with diminished ovarian reserve. Basal T level is equally helpful in tailoring the dosage of gonadotropins to individual and identifying potential poor ovarian responders, subsequently, making individualized COH (controlled ovarian hyperstimulation) strategy before entering IVF cycles. It also gives evidence to androgen supplementation in infertile women. Those women with lower basal T (testosterone) levels would benefit from T supplementation during COH such as improving response, decreasing the amount of gonadotropins used and the cost accordingly."
Your doctor will usually evaluate your FSH (follicle stimulating hormone) and estradiol on day three to assess ovarian reserve before IVF, asking for a testosterone test too could help to fine-tune your IVF for greater success.
1. Association of basal serum testosterone levels with ovarian response and in vitro fertilization outcome
Qin, Yingying1; Zhao, Zhiyi1; Sun, Mei1; Geng, Ling1; Che, Li2; Chen, Zi-Jiang1
Reproductive Biology and Endocrinology 2011, 9:9
ISSN: 1477-7827, DOI: 10.1186/1477-7827-9-9