Androgenicity and fertility treatment in women with unexplained infertility

In a randomized cohort of women with unexplained infertility, biochemical and clinical measures of androgens did not predict live birth rate after treatment with gonadotropin, clomiphene, or letrozole.

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Volume 113, Issue 3, Pages 636–641


Erica T. Wang, M.D., M.A.S., Michael P. Diamond, M.D., Ruben Alvero, M.D., Peter Casson, M.D., Gregory M. Christman, M.D., Christos Coutifaris, M.D., Ph.D., Karl R. Hansen, M.D., Ph.D., Fangbai Sun, M.P.H., Richard S. Legro, M.D., Randal D. Robinson, M.D., Rebecca S. Usadi, M.D., Margareta D. Pisarska, M.D., Nanette F. Santoro, M.D., Heping Zhang, Ph.D. for the National Institute of Child Health and Human Development (NICHD) Reproductive Medicine Network



To determine whether biochemical or clinical markers of androgenic activity predict live birth rate with ovarian stimulation in the unexplained infertility population.


Secondary analysis of the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial.


Multicenter university-based clinical practices.


Nine hundred couples with unexplained infertility were included. Women were 18–40 years old with regular menses, a normal uterine cavity, at least one patent fallopian tube, and a male partner with ≥5 million motile sperm. Women were randomized to receive gonadotropin, clomiphene, or letrozole with IUI for four or fewer four treatment cycles. Women were evaluated for biochemical (total testosterone, DHEAS, and free androgen index) and clinical markers of androgenic activity (sebum, acne, and hirsutism). Multivariable logistic regression models adjusting for treatment group, maternal age, and body mass index were performed.



Main Outcome Measure(s)

The primary outcome was live birth. Secondary outcomes included conception, clinical pregnancy, and pregnancy loss.


When comparing 900 women in the AMIGOS trial based on quartiles of serum TT, women were of younger age, higher body mass index, and higher waist circumference with increasing TT. Increasing quartiles of TT also showed increasing DHEAS and free androgen index values. Serum androgens were not associated with outcomes of live birth, conception, clinical pregnancy, or pregnancy loss. Clinical androgen markers were not associated with pregnancy outcomes.


In a randomized cohort of women with unexplained infertility, biochemical and clinical measures of androgens did not predict live birth rate after ovarian stimulation treatment.

Clinical Trial Registration Number

NCT 01044862.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.