Letters to the editor |
Effects of transdermal testosterone application on the ovarian response to FSH in poor responders undergoing assisted reproduction technique–a prospective, randomized, double-blind study
The Center for Human Reproduction–New York, New York, NY 10021 and The Foundation for Reproductive Medicine, Chicago, IL 60661, USA
1 To whom correspondence should be addressed. E-mail: ngleicher{at}thechr.com
Sir,
Massin et al. (2006)
reported no significant beneficial effects of testosterone administration on the ovarian response to FSH in poor responders. We, however, would like to caution against preliminary conclusions, which may turn out to be misleading.
Our caution is based on prior experiences: Casson et al. (2000) were the first to attempt treatment with the mild androgen, dehydroepiandrosterone (DHEA), in women with diminished ovarian reserve. Probably because the beneficial effects of DHEA were rather disappointing, nobody pursued such treatment any further, until one of our patients, without our knowledge, started self-treatment with rather startling results (Barad and Gleicher, 2005).
As her case and subsequent experience with larger patient numbers (Barad and Gleicher, in press) well demonstrate, the beneficial effects of DHEA peak only after at least 4 months of treatment (Barad and Gleicher,in press,2005). Casson et al. (2000) had used DHEA, however, for only much shorter time.
The failure of Massin et al. (2006) to detect significant effects on ovarian function after 15–20 days of testosterone application, therefore, should be viewed with caution. In analogy to the DHEA experience, it is possible that longer use would have resulted in different and more pronounced effects.
We would also caution against equating testosterone effects with androgen effects, as the authors have done in the abstract and discussion section of their article. While they well described the physiologic rationale for the potential effects of androgens within the two-cell/two-gonadotrophin theory, different androgens may have varying effects on ovarian physiology and may, therefore, be effective to varying degrees in the treatment of women with diminished ovarian reserve.
References
Barad DH and Gleicher N. (in press) Effect of dehydroepiandrosterone (DHEA) on clinical pregnancy rates, oocyte and embryo yields, embryo grade and cell numbers in IVF. Hum Reprod.
Barad DH and Gleicher N. (2005) Increased oocyte production after treatment with dehydroepiandrosterone. Fertil Steril 84:756.e1–756.e3.
Casson PR, Lindsay MS, Pisarska MD, Carson SA, Buster JE. (2000) Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: a case series. Hum Reprod 15:2129–2132.
Massin N, Cedrin-Durnerin I, Coussieu C, Galey-Fintaine J, Wolf JP, Hugues J-N. (2006) Effects of transdermal testosterone application on the ovarian response to FSH in poor responders undergoing assisted reproduction technique–a prospective, randomized, double-blind study. Hum Reprod 21:1204–1211.
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