Assessment of theca cell function: A prerequisite to androgen or luteinizing hormone supplementation in poor responders

The absence of scientific evidence for a beneficial effect of adjuvant androgens in poor responders is likely related to the lack of accurate assessment of theca cell function.


Jean Noel Hugues, M.D., Ph.D.

Volume 99, Issue 2, Pages 333-336, February 2013


Poor responders are a heterogeneous population with patients displaying a diminished ovarian reserve while others experienced a poor ovarian reserve with preserved granulosa cell function. Androgen and LH/hCG supplementation has been advocated for poor responders, mainly over the age of 40 yrs. While androgens synergistically act with FSH to support folliculogenesis and ovarian androgen secretion declines with age, there is still no evidence that androgen therapy is actually effective to improve ovarian FSH sensitivity. The main reason seems to be that theca cell function has not been so far appropriately assessed specifically in patients at risk of poor response. The definition of theca insufficiency is hampered by methodological shortcomings in routine bioassays. Provocative tests for theca cells might help to identify those patients who could benefit from androgen supplementation. Nowadays, the lack of data regarding the theca cells in these patients might contribute to explain the absence of evidence for a positive effect of androgen therapy.

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