effect of increased testosterone level on woman`s fertility

Transcription

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Preliminary Communication
Nada Polyclinic, Po‘ega, Croatia
School of Medicine, University of Zagreb, Zagreb, Croatia
Received: April 15, 2004
Accepted: June 16, 2004
EFFECT OF INCREASED TESTOSTERONE LEVEL ON
WOMAN’S FERTILITY
@arko Šperanda1, Zvonimir Papiæ2
Key words: FSH–LH disorder, FSH/LH ratio,
polycystic ovary syndrome, septate uterus, fertility
associated with fertility, and to suggest the possible
infertility management spontaneously or by
insemination at a polyclinic of this type.
SUMMARY
INTRODUCTION
Preliminary results obtained in women treated for
infertility, who were divided into two groups with
normal and increased testosterone level as measured in
serum on the fourth day of their cycles, are presented.
Study population included 50 women, 25 of them with
normal and 25 with increased testosterone level. The
aim of the study was to investigate the interaction of
serum testosterone level with ultrasound finding of
septate uterus (indicating minor uterus abnormality),
ultrasound diagnosis of the presence or absence of
polycystic ovary, hormonal parameters, and spontaneous or stimulated pregnancies. Study results
revealed ten (40%) women with normal testosterone to
have pathologic levels of FSH, LH and FSH/LH ratio;
nine (36%) had polycystic ovary syndrome; and seven
(28%) had septate uterus. The results showed an
increased rate of FSH/LH inversion, polycystic ovary
syndrome and septate uterus in the group of women
with elevated testosterone. Although performed in
quite a small group of subjects, the aim of the study
conducted at Nada Polyclinic in Po‘ega, Croatia, was to
show the effect of testosterone on some disorders
Diabetologia Croatica 33-2, 2004
Testosterone is usually mentioned in gynecologic
literature in connection with the polycystic ovary
syndrome (PCOS) (1-5) or a PCOS-like syndrome as
one of its indicators. In practice, however, such a
disorder is noticed in a number of women in whom an
increased level of testosterone has been established,
otherwise without any other sign of ovary function
disorder.
That is why we decided to test the effect of serum
testosterone level on other disorders of the woman’s
genital system. Therefore, the aim of the study was to
assess the following:
•
ultrasound and hormone findings indicating the
existence of polycystic ovary, or a disorder of the
pituitary gland - ovary axis;
•
ultrasound finding of septate uterus (indicating
minor uterus abnormality) (6); and
•
the beginning of spontaneous and stimulated
pregnancies (with particular individual or other
tested symptoms).
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@. Šperanda, Z. Papiæ / EFFECT OF INCREASED TESTOSTERONE LEVEL ON WOMAN’S FERTILITY
SUBJECTS AND METHODS
The study included 50 women in whom serum
testosterone level was measured on the fourth day of
the cycle. According to the results, they were divided
into two groups: group A including women with normal
serum testosterone level (n=25), and group B with
increased serum testosterone level (n=25). The
normal and increased testosterone level was
determined according to the upper reference
testosterone values used at respective laboratories.
Figure 1. Frequency of other infertility factors in
patients excluded from further treatment at Nada
Polyclinic.
The following parameters were observed in both
subject groups (7,8):
increased serum LH level,
FSH/LH inversion in serum,
presence of one or more symptoms of polycystic
ovary established by ultrasound, and
anovulation without any signs of polycystic ovary
established by ultrasound.
The following signs of PCOS were observed by
ultrasound:
Figure 2. Testosterone, FSH and LH levels in group A
(n=25).
typical configuration of tiny microcystic structures
on the ovary periphery,
enlarged ovary volume,
presence of an increased amount or density of
stroma with characteristic arterial blood flow, and
tunica albuginea ovarii thickness exceeding normal
by 50%.
The rate of septate uterus was observed in both group
A and group B (19). The disorder was found on several
ultrasound examinations, the septum being wider than
7 mm.
The subjects who had other infertility factors such as
severe husband’s oligoasthenospermia, obstructed
fallopian tubes, large myomas associated with uterus
cavum deviation, uterus abnormalities, and age over 40
were excluded from the study, considering that in our
institution only insemination is used (Fig. 1).
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RESULTS
In group A consisting of women with normal serum
testosterone levels, there was no case of increased
serum LH level; FSH/LH inversion was found in 10
(40%) women, whereas the remaining 15 (60%) women
had normal FSH and LH level (Fig. 2). Three (12%)
women had PCO signs, while anovulation without PCO
signs was not found. Septate uterus was found in three
(12%) women (Fig. 3). Other infertility factors were
recorded in 11 (44%) women who did not undergo
infertility treatment. Fourteen (56%) women with
normal testosterone level underwent treatment and
eight of them (32%) got pregnant (Fig. 4).
Analysis of successful pregnancies in group A women
(Fig. 5) reveals that pregnancy failed to occur in
subjects with FSH/LH inversion or PCOS. Appropriate
therapy resulted in pregnancy in one (4%) woman with
PCOS-like syndrome, five (20%) got pregnant
spontaneously, and three (12%) conceived with the
help of homoinsemination.
Figure 5. Conception profile in group A (n=25).
Figure 6. Successful pregnancies in group B (n= 25).
Figure 3. Serum testosterone, and rate of polycystic
ovary syndrome frequency and septate uterus on
ultrasound examination in groups A and B.
Figure 4. Success of infertility treatment in women
with normal serum testosterone level, group A
(n=25).
In group B including women with elevated serum
testosterone levels, FSH/LH findings were not
obtained in four (16%) subjects; FSH/LH inversion or
increased serum LH level was found in 13 (52%)
subjects (Fig. 2); PCOS was found in nine (36%) (Fig.
6), and anovulation in two (8%) subjects. Thus,
ultrasound revealed impaired ovary appearance in 11
(44%) women (Fig. 3). Septate uterus was found in
seven (28%) women, all with impaired FSH/LH ratio
(Fig. 3). Other infertility factors were identified in 15
(60%) women (Fig. 6), and ten (40%) of them
underwent treatment for infertility. Five (20%) women
got pregnant: three of them (12%) conceived
spontaneously (Fig. 7), one (4%) woman conceived by
homoinsemination and another one (4%) by IVF
procedure at another institution, as the procedure is
not performed at this polyclinic.
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Figure 7. Successful pregnancies in group B
according to study parameters (n=25).
Figure 8. Relation of serum testosterone, FSH and LH
with polycystic ovary syndrome and septate uterus
on ultrasound.
DISCUSSION
Although the present study could not yield a
statistically significant pattern of the parameters
observed because of the relatively small number of
subjects included, we believe it pointed to a
connection between some of the parameters. In the
group with increased serum testosterone, there was a
significantly higher rate of impaired FSH/LH ratio
(Fig. 8), PCOS determined by ultrasound (Fig. 8) and
septate uterus (Figs. 8 and 11). The relation of all
variables in both groups is illustrated in Figure 8,
showing that in group A (subjects with normal serum
testosterone level) the existence of polycystic ovaries
and septate uterus was confirmed in 12% and impaired
FSH/LH ratio in 40% of cases. At the same time, in
group B the existence of polycystic ovaries was
confirmed in 36%, septate uterus in 28% and impaired
FSH/LH ratio in 52% of cases.
The search of MEDLINE index revealed some 230
articles on septate uterus, however, the possible
connection of minor and major uterus abnormalities
with androgenic metabolism has, to date been only
considered by Sorenson in his article published as early
as 1978 (6), yet observing no other correlation.
If we now compare the pregnancy frequencies with
testosterone level (Fig. 9), it is obvious that there were
by far more successful pregnancies in the group with
normal testosterone level, which corresponds to the
results published elsewhere. The subjects with
FSH/LH inversion had the lowest rate of successful
pregnancies, only 15% of cases (Fig. 10), which may be
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Figure 9. Rate of pregnancy.
Figure 10. Successful pregnancies: relation of
successful pregnancies and FSH/LH inversion,
increased testosterone and polycystic ovary
syndrome.
an important indicator in the treatment of infertility. A
similar rate of successful pregnancies was achieved in
patients with PCO and increased testosterone level,
i.e. about 38%. The results are consistent with
literature data (1,2).
FSH/LH inversion was also found in 70% of the
women with septate uterus (Fig. 11), while the finding
of polycystic ovary was recorded in 60% of the same
subjects.
Figure 11. Women with septate uterus.
CONCLUSION
This article shows the results of the analyses
performed in 50 women treated for infertility, divided
into two groups according to serum testosterone level
on the fourth day of their cycles: group A with normal
and group B with elevated serum testosterone. Study
results showed an increased rate of FSH/LH inversion,
PCO syndrome and septate uterus in the group with
elevated testosterone level. It is necessary to conduct a
detailed research on the connection of septate uterus
with the hypothalamus – pituitary gland – ovary axis,
indicated by the results presented. The results of
infertility treatment at smaller clinics like this one are
very successful, along with the fact that such
institutions are very accessible to patients.
We would like to point out that in this way, an
expensive and more complicated in vitro procedure
could be obviated, at least in some patients.
Acknowledgment. The authors wish to thank
Academician Zdenko škrabalo for his precious help and
advice on writing the article.
REFERENCES
1. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New
approach to polycystic ovary syndrome and other
forms of anovulatory infertility. Obstet Gynecol
Surv 2002;57:755-767.
5. Gilling-Smith C, Story H, Rogers V, Franks S.
Evidence for a primary abnormality of thecal cell
steroidogenesis in the polycystic ovary syndrome.
Clin Endocrinol (Oxf) 1997;47:93-99.
2. Kousta E, White DM, Cela E, McCarthy MI, Franks
S. The prevalence of polycystic ovaries in women
with infertility. Hum Reprod 1999;14:2720-2723.
6. Sorensen SS. Hysteroscopic evaluation and
endocrinological aspects of women with mullerian
anomalies and oligomenorrhea. Int J Fertil
1987;32:445-452.
3. Katulski K, Bornstein S, Figiel M, Wand D,
Warenik-Szymankiewicz A, Trzeciak WH. Typical
hormonal profiles are accompanied by increased
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Endocrinol Invest 1998;21:304-309.
4. Liddell HS, Sowden K, Farquhar CM. Recurrent
miscarriage: screening for polycystic ovaries and
subsequent pregnancy outcome. Aust N Z J Obstet
Gynaecol 1997;37:402-406.
7. Carmina E, Wong L, Chang L, et al. Endocrine
abnormalities in ovulatory women with polycystic
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8. Šimuniæ V, et al. Poremeæaji menstruacijskoga
ciklusa (amenoreja, oligomenoreja i kroniène
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9. Šimuniæ V, et al. Poremeæaji menstruacijskoga
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effect of increased testosterone level on woman`s fertility

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