Testosterone therapy for women with poor ovarian response undergoing IVF: a meta-analysis of randomized controlled trials
The aim of the present systematic review and meta-analysis was to summarize evidence on the effectiveness of testosterone supplementation for poor ovarian responders (POR) on IVF outcomes. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos.
This meta-analysis of randomized controlled trials (RCTs) evaluates the effects of testosterone administration before/during COS compared with a control group in patients defined as POR. The primary outcome was live birth rate (LBR); secondary outcomes were clinical pregnancy rate (CPR), miscarriage rate (MR), total and MII oocytes, and total embryos. Pooled results were expressed as risk ratio (RR) or mean differences (MD) with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroup analysis. All analyses were performed by using the random-effects model.
Women receiving testosterone showed higher LBR (RR 2.29, 95% CI 1.31–4.01, p = 0.004), CPR (RR 2.32, 95% CI 1.47–3.64, p = 0.0003), total oocytes (MD = 1.28 [95% CI 0.83, 1.73], p < 0.00001), MII oocytes (MD = 0.96 [95% CI 0.28, 1.65], p = 0.006), and total embryos (MD = 1.17 [95% CI 0.67, 1.67], p < 0.00001) in comparison to controls, with no difference in MR (p = ns). Sensitivity and subgroup analysis did not provide statistical changes to the pooled results.
Testosterone therapy seems promising to improve the success at IVF in POR patients. Further RCTs with rigorous methodology and inclusion criteria are still mandatory.
KeywordsPoor ovarian responders Testosterone Supplementation IVF outcome Clinical pregnancy rate Live birth rate
M.N., A.V., G.A., and M.C. conceptualized the study; M.N., M.C., and A.V. extracted the data; A.V. and F.C. performed the statistical analysis; M.N., A.V., A.A., and G.A. performed the data interpretation; M.N., A.A., M.C., and G.A. wrote the manuscript; M.B., P.V., E.P., and M.S. performed the manuscript revision for fundamental intellectual content, language revision, and manuscript re-editing.
No financial support was received for this study.
Compliance with ethical standards
All the authors report that they have no conflict of interest.
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