A Proper Increasing in the Testosterone Level May Be Associated With Better Pregnancy Outcomes for Patients With Tubal or Male Infertility During in vitro Fertilization/Intracytoplasmic Sperm Injection

Abstract

We aimed to investigate the relationship between testosterone (T) levels and pregnancy outcomes in patients with tubal or male infertility at different times during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Patients with tubal or male infertility and normal androgen levels undergoing IVF/ICSI were consecutively recruited. We performed a longitudinal analysis of T levels at three time points (i.e., T0: baseline, T1: trigger day, and T2: day after the trigger day) in three groups with different pregnancy outcomes (i.e., group 1: no pregnancy; group 2: clinical pregnancy but no live birth; and group 3: live birth) as repeated measurement data using linear mixed-effects models. We also plotted fitted curves depicting the relationship between T levels and a number of oocytes retrieved at different time points and identified the inflection points of the curves. In total, 3,012 patients were recruited. Groups 1 and 3 had improvements in T levels at the three time points. After refitting, the slope in group 3 was significantly higher than that in group 1 (P = 0.000). Curves that reflected the association between T levels and numbers of retrieved oocytes presented an upward trend before a certain inflection point, after which the curves had no obvious changes or fell with increasing T levels. The inflection points for T0, T1, and T2 were calculated as 0.45, 0.94, and 1.09, respectively. A faster upward trend in T levels might be associated with better pregnancy outcomes. Within a range lower than a T level inflection point, more oocytes and embryos could be obtained with increasing T levels.