Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hum Reprod Update. 2012 Mar-Apr;18(2):127-45. doi: 10.1093/humupd/dmr051. Epub 2012 Feb 3.
The aim of this meta-analysis was to evaluate the role of androgens or androgen-modulating agents on the probability of pregnancy achievement in poor responders undergoing IVF.
Medline, EMBASE, CENTRAL, Scopus and Web of Science databases were searched for the identification of randomized controlled trials evaluating the administration of testosterone, dehydroepiandrosterone (DHEA), aromatase inhibitors, recombinant luteinizing hormone (rLH) and recombinant human chorionic gonadotrophin (rhCG) before or during ovarian stimulation of poor responders.
In two trials involving 163 patients, pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy [risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%] and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. No significant differences in clinical pregnancy and live birth rates were observed between patients who received DHEA and those who did not. Similarly, (i) the use of aromatase inhibitors, (ii) addition of rLH and (iii) addition of rhCG in poor responders stimulated with rFSH for IVF were not associated with increased clinical pregnancy rates. In the only eligible study that provided data, live birth rate was increased in patients who received rLH when compared with those who did not (RD: +19%, 95% CI:+1 to +36%).
Based on the limited available evidence, transdermal testosterone pretreatment seems to increase clinical pregnancy and live birth rates in poor responders undergoing ovarian stimulation for IVF. There is insufficient data to support a beneficial role of rLH, hCG, DHEA or letrozole administration in the probability of pregnancy in poor responders undergoing ovarian stimulation for IVF.
本荟萃分析的目的是评估雄激素或雄激素调节剂对接受 IVF 的卵巢反应不良者妊娠成功率的作用。
检索 Medline、EMBASE、CENTRAL、Scopus 和 Web of Science 数据库，以确定评估睾酮、脱氢表雄酮（DHEA）、芳香化酶抑制剂、重组促黄体生成激素（rLH）和重组人绒毛膜促性腺激素（rhCG）在卵巢反应不良者接受卵巢刺激前或期间给药的随机对照试验。
在两项涉及 163 名患者的试验中，预处理经皮睾酮与临床妊娠率增加相关[风险差异（RD）：+15%，95%置信区间（CI）：+3 至 +26%]和活产率（RD：+11%，95% CI：+0.3 至 +22%）在接受卵巢刺激进行 IVF 的卵巢反应不良者中。接受 DHEA 和未接受 DHEA 的患者之间，临床妊娠率和活产率无显著差异。同样，（i）在接受 rFSH 刺激的卵巢反应不良者中使用芳香化酶抑制剂，（ii）添加 rLH 和（iii）添加 rhCG 与增加的临床妊娠率无关。在唯一符合条件的研究中，与未接受 rLH 的患者相比，接受 rLH 的患者的活产率增加（RD：+19%，95% CI：+1 至 +36%）。
基于有限的可用证据，经皮睾酮预处理似乎可增加卵巢反应不良者接受 IVF 卵巢刺激的临床妊娠率和活产率。没有足够的数据支持 rLH、hCG、DHEA 或来曲唑给药在卵巢反应不良者接受 IVF 卵巢刺激的妊娠概率中发挥有益作用。
