Androgens in the management of poor responders (and others)

Norbert Gleicher's lecture addresses why, and in which clinical situations, androgens become part of the preparation of patients with a poor ovarian response to stimulation. The point is not hormone replacement, but a pharmacological attempt to act on the pool of growing follicles before the protocol even begins, and in doing so to improve both the number and the quality of the oocytes retrieved.

The starting point is the physiological role of androgens in early folliculogenesis. Testosterone and its precursors take part in the transition of primordial and preantral follicles toward gonadotropin-sensitive stages, increase the expression of FSH receptors in granulosa cells, and amplify the local response to stimulation. It is on this mechanism that the hypothesis rests: a temporary rise in the intraovarian androgen concentration may enlarge the antral follicle cohort in women with a diminished reserve.

The speaker examines the two principal approaches to androgen priming — dehydroepiandrosterone (DHEA) given as a prohormone, and transdermal testosterone. He stresses that the evidence for both strategies remains contradictory: some studies show a gain in the number of antral follicles and oocytes, while others fail to confirm any meaningful effect on live birth rates. This heterogeneity reflects differences in patient selection, dosing, priming duration, and in how the very concept of a poor responder is defined.

Particular attention is paid to exactly whom androgen priming is meant for. The classic candidate is a patient with a diminished ovarian reserve (low AMH and antral follicle count), including within the POSEIDON groups. Yet the qualifier and others in the title is deliberate: the lecture also considers using androgens beyond the narrow poor-responder group, where the evidence base is even more limited and calls for cautious interpretation.

The presenter openly declares a conflict of interest connected with patented developments in the field of androgen priming. This point is placed in a separate block on purpose: it lets the audience weigh the data presented against an institutional position and is a reminder that clinical decisions should rest on the body of independent evidence rather than on any single source.