Use of transdermal testosterone in women Poseidon IV group under high complexity assisted reproduction treatment
Authors: Esparza Martha E.E. , Ruvalcaba Jorge L.L. , SALAZAR LOPEZ ORTIZ CARLOS GERARDO , SALAZAR JOSE CARLOS 
Published: January 2024

Poor ovarian reserve (POR) is considered a frequent cause of infertility and is still considered one of the significant challenges in reproductive medicine. Numerous studies have suggested that androgens (dehydroepiandrosterone and testosterone) may play a critical role in follicular development by increasing the number of follicles and, consequently, the number of oocytes, ultimately leading to an increased pregnancy rate. Testosterone is a sex steroid hormone that originates from cholesterol and is considered an obligatory precursor of estradiol biosynthesis. It contributes to greater follicular recruitment, leading to the consideration that exogenous administration could increase the number of recovered oocytes. Methodology A historical, quantitative, observational, longitudinal, retrolective cohort study was carried out in the clinical area of assisted reproduction; 2 groups were formed where all women over 35 with primary or secondary infertility who met the criteria were included. Classification criteria of the POSEIDON IV group (age > 35 years with CFA < 5 follicles and/or AMH < 1.2 ng/mL), during the period from October 2021 to September 2022, the first group of patients had received supplementation with transdermal Testosterone 50mg daily one month before ovarian stimulation, the second group did not receive any treatment before ovarian stimulation. Women with a history of diagnosis of endometriosis, pelvic surgery or oophorectomy were excluded. This study has the approval of the ethics committee of the HISPAREP clinic. Each patient was given an informed consent which they signed before the study. We declare that we have no conflict of interest. The data from the records of all the patients who met the inclusion criteria were collected, including the antral follicle count on the first three days of the menstrual cycle by transvaginal ultrasound one month before ovarian stimulation and after one month of supplementation and without supplementation when starting controlled ovarian stimulation. The number of metaphase II oocytes obtained in each group was also analyzed. Results A total of 20 women were included; 10 underwent controlled ovarian stimulation with prior administration of transdermal testosterone at a dose of 50 mg every 24 hours for one month. The other 10 patients did not receive any supplementation or treatment before ovarian stimulation for highly complex assisted reproduction treatment due to various causes of infertility. The average age of the women was 40.2 ± 2.5 years in the study group and 43.3 ± 2 in the control group; normal weight in 80% of the group with testosterone and 90% without testosterone. The baseline conditions of the patients revealed an average anti-Müllerian hormone (AMH) level of 0.65 ± 0.28 ng/dL in the testosterone group and 0.84 ± 0.49 ng/dL in the non-testosterone group. The infertility factor was ovarian endocrine dysfunction, present in 60% of the testosterone group and 40% of the non-testosterone group; this factor was the predominant cause in both groups. The most common protocol stimulation was with (300/150 U) FSH/LH recombinant (Pergoveris, Merck) and GnRH antagonist (Cetrotide, Merck). The antral follicular count observed by ultrasound in each group after treatment with testosterone was 6.4 ± 2.4, and without testosterone was 6 ± 3.47; p<0.778. Without observing significant differences. The number of metaphase II oocytes obtained (mean ± standard deviation) after testosterone administration was 4.5 ± 2.37 and 1.5 ± 1.62 in participants who did not receive testosterone; p=0.04886, that is p<0.05, so the results were statistically significant in favor of testosterone administration. Conclusions Transdermal testosterone supplementation can be used as an adjuvant in controlled ovarian stimulation treatments in women of the POSEIDON IV group to improve the reproductive prognosis of this group of women. The 50mg dose of transdermal testosterone every 24 hours 1 month prior to the ovarian stimulation in highly complex treatments increases the number of metaphase II oocytes recovered statistically.