Has testosterone passed the test in premenopausal women with low libido? A systematic review

Beverly G Reed, Laurice Bou Nemer, Bruce R Carr Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of Texas Southwestern Medical Center, Dallas, TX, USA Background: There are limited evaluation and treatment options for low libido in premenopausal women. This review sought to evaluate the available evidence supporting the evaluation of testosterone serum levels and testosterone treatment of premenopausal women with low libido. Methods: MEDLINE, PubMed, and ClinicalTrials.gov were searched for articles that referenced the evaluation of testosterone serum level and/or testosterone treatment on premenopausal women with low libido from 1995 to 2015. Additional references were obtained from the reference sections of other papers and from peer review. Studies that included only postmenopausal women were excluded. A total of 13 studies were reviewed in detail. Nine studies examined the relationship between testosterone serum levels and sexuality, an additional three studies examined the effect of testosterone treatment on premenopausal women with low libido, and one study examined both the topics. Results: Six of the ten testosterone serum evaluation studies failed to show a significant association between testosterone serum level and libido. Only one out of four studies examining testosterone treatment in premenopausal women was able to show any clear improvement in libido; however, the effect was limited to only the intermediate dose of testosterone, with the low and high doses of testosterone not producing any effect. Conclusion: The currently available evidence does not support testosterone serum evaluation or treatment in premenopausal women with low libido. Hence, further studies are warranted. Keywords: androgens, hypoactive sexual desire disorder, HSDD, ovary, testis, sexual dysfunction, sexual interest, arousal disorde

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In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older

The objective of this study was to compare clinical pregnancy rates (PRs) and pregnancy outcomes (POs) in patients undergoing in vitro fertilization (IVF) and a specific controlled ovarian hyperstimulation (mild-stimulation or mini-stim) and intrauterine insemination (IUI) protocol in women older than 40. It is a retrospective chart review of 770 cycles of all women aged 40 and older who underwent a first cycle of either IVF or mini-stim IUI between the years 2007 and 2012 at a single infertility center. The PR in all women aged 40 and above was 12% (65/531) for IVF and 5% (13/239) for mini-stim IUI ( P = .004). When divided into age-groups, the PR of IVF at age 40 was superior to that at age 41 and above (15% vs 7%, P = .002), while the PR of mini-stim IUI remains similar (3% vs 7%, P = .307). When comparing the outcomes of the 2 treatments in the different age-groups, it showed that in women aged 40, IVF PR was superior to that of mini-stim IUI (15% vs 3%, P = .032); while in women aged 41 and above, IVF and mini-stim IUI have similar PR (7% vs 7%, P = .866). When POs were compared, the rate of live birth per cycle initiated was 9.2% for IVF versus 1.28% for mini-stim IUI ( P < .001). While IVF and mini-stim IUI were found to have similar PRs in women aged 41 and above, POs are significantly better in IVF. A larger study is required to clarify the above results