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Low Androgen Levels Associated with Diminished Functional Ovarian Reserve
In a recent study led by Dr. Norbert Gleicher, Medical Director and Chief Scientist at Center for Human Reproduction in New York City, it was determined that low androgen levels are associated with diminished functional ovarian reserve in women of all ages.
According to Gleicher, the term “diminished functional ovarian reserve” (DFOR) reflects small growing follicles right after recruitment. They are referred to as “functional” because they become available for ovulation two to four months later. This does not represent the total ovarian reserve, but the reserve that is currently actively available.
There is a correlation between how well DHEA converts to testosterone and pregnancy rates in IVF cycles. “We’re able to show that pregnancy with IVF in women who we supplemented with DHEA was directly related to how the DHEA converted to testosterone. We started to understand that DHEA works through its conversion to testosterone and that it works on the small growing follicles.”
All of this raised the question, “If supplementing with testosterone [one of the principal androgens] works on these patients, do they have low levels to begin with?”
Testosterone levels drop when women age. And so while Gleicher expected to find lower testosterone and androgen levels in older women, there was no evidence of what levels they would find in younger women with premature ovarian aging. The outcome was that these women had lower than normal androgen levels as well. This may be why DHEA works well in restoring egg quality.
So what is the takeaway for fertility patients? If you have DFOR, your fertility doctor should check your androgen levels. This is not current practice, according to Gleicher. If testosterone levels are in the lower one-third of the normal range, your doctor should provide testosterone supplementation. Androgen levels of patients who go through fertility treatment should be in the upper one-third of the normal range.
The study raises additional questions, such as, does DFOR cause low androgen levels, or do low androgen levels cause DFOR? There’s still more to study Gleicher says. “We do not have an absolute final answer. What may be the case is that low functional ovarian reserve in an opposing way mimics what we have known for 20 years about another important condition, PCOS. PCOS is often characterized by very high androgens and very active follicle recruitment.” Basically those two conditions represent polar opposites. Like PCOS it appears that DFOR is also a condition of abnormal adrenal and ovarian function.
Half of all androgens are produced in the adrenal gland and half are produced in the ovaries. “Women with low androgens at an advanced age probably represents an insufficiency of the cells in the ovary that produce androgens. However, it appears that in younger women with POA there may be an early insufficiency of androgens produced in the adrenals. These are areas that are currently being studied.