Open AccessSequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study
Author(s) -
Sathya Balasubramanyam
Publication year - 2017
Publication title -
international journal of infertility and fetal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.102
H-Index - 6
eISSN - 2229-3833
pISSN - 2229-3817
DOI - 10.5005/jp-journals-10016-1139
Subject(s) - medicine , antral follicle , transdermal , testosterone (patch) , in vitro fertilisation , assisted reproductive technology , intracytoplasmic sperm injection , hormone , live birth , pregnancy rate , pill , gynecology , pregnancy , ovarian reserve , follicle stimulating hormone , andrology , infertility , luteinizing hormone , biology , pharmacology , genetics
Poor responders have suboptimal outcomes following conventional in vitro fertilization/intracytoplasmic sperm injection treatment. There is some evidence that transdermal testosterone and growth hormone may help in improving live birth rates in this group. Aim To present a case series of women who had sequential transdermal testosterone and growth hormone treatment in view of their being expected poor responders or with a history of previous poor oocyte or embryo quality. Setting Private assisted reproduction clinic. Materials and methods A total of 24 women underwent 30 cycles of controlled ovarian stimulation. Ten patients out of 24 had previous poor assisted reproductive technology outcomes, of which 4 were poor responders. Fourteen were expected poor responders. The women used approximately 1.2 gm of transdermal testosterone from day 5 to 25 along with a standard oral contraceptive pill. Growth hormone was given at 8 units/day subcutaneously from day 2 along with the gonadotropins in the antagonist protocol. Results The mean age of the women was 34.92 years (±3.6). The average duration of subfertility was 7.54 (±4.005) years. The mean antral follicle count was 9 (±3.28) and the mean anti-Mullerian hormone level was 1.2 ng/mL (±0.56). The mean number of eggs collected was 8 (±5.45). Number of mature (M2) eggs was 6.6 (±4.5) Mean number of eggs fertilized was 5.04 (±4.03); clinical pregnancy rate was 8/24 (33.3%) and ongoing pregnancy rate was 4/24 (16.6%). Conclusion This case series shows an encouraging clinical pregnancy rate. The reduced ongoing pregnancy rate probably reflects the suboptimal gamete quality. Further randomized controlled trials (RCTs) are needed to assess the efficacy of sequential transdermal testosterone and growth hormone therapy in poor responders. Clinical significance The ongoing pregnancy rate in this group with poor prognosis seems encouraging, and further well-designed RCTs would help in assessing the merits of this sequential therapy. How to cite this article Balasubramanyam S. Sequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study. Int J Infertil Fetal Med 2017;8(1):1-4.