The improvement effect of androgen priming on fertility in patients with diminished ovarian reserve and its impact on in vitro fertilization outcomes: a systematic review and meta-analysis

Objective Evaluate the effect of using androgen supplements (including transdermal testosterone gel and dehydroepiandrosterone (DHEA)) to priming androgens in the body and improve fertility in patients with diminished ovarian reserve (DOR). Methods Electronic searches were conducted on seven databases, including Scopus, Web of Science, PubMed, Springer, VIP Information, Wanfang, and China National Knowledge Infrastructure (CNKI), to search for studies published as of July 5, 2026. Randomized controlled trails (RCTs) and non-randomized controlled trails of using androgen supplements (i.e. dehydroepiandrosterone (DHEA) and transdermal testosterone gel (TTG)) to intervene in improving fertility and IVF outcomes in patients with DOR were embodied. The study applied systematic review and meta-analysis methods to systematically summarize the main outcome measures, including FSH, AMH, AFC, retrieved oocytes, and clinical pregnancy rate. In addition, indicators such as the number of fertilized embryos, top-quality day-3 embryos, live birth rate and miscarriage rate were also evaluated. Results The meta-analysis included 14 studies with 2132 participants. Analyses of RCTs and non-randomized controlled trials were conducted separately. A comprehensive analysis of existing evidence indicated that androgen supplementation, including DHEA and TTG, can improve count of retrieved oocytes [RCTs (MD = 0.79, 95% CI [0.50,1.09], p <0.00001)]. A retrospective analysis of non-randomized controlled trials showed that androgen supplementation can significantly increase the number of Top-quality day-3 embryos (MD 0.47, [95% CI: [0.28, 0.66], p < 0.00001), the count of fertilized embryos (MD 0.78, [95% CI: [0.49, 1.06], p < 0.00001), and clinical pregnancy rate (OR = 2.23, 95% CI [1.49,3.36], p = 0.0001). Besides, androgen supplementation showed Intervention with androgen supplements for 2 months was beneficial for retrieving more oocytes ( p < 0.05) through the results in RCT. And also showed a more significant improvement in retrieved oocytes and metaphase II oocytes in DOR patients with an average age of over 40 years ( p < 0.05). The subgroup analysis results indicated that the application of GnRH antagonists as IVF stimulation protocol was more beneficial in increasing the number of retrieved oocytes than the adopt of GnRH agonists.The sensitivity analysis concludes that our conclusion is robust. Conclusions Androgen priming (including DHEA and TTG) may be beneficial for improving the fertility of DOR patients undergoing IVF, enhancing their ovarian response, mainly manifested as an increase in oocyte retrieval. However, whether this therapy can improve the clinical pregnancy rate and other outcome indicators of DOR women undergoing in vitro fertilization remains to be further determined by more randomized controlled trials. More high-quality and large sample RCTs are still needed in the future to clarify whether they have an auxiliary effect on improving the fertility outcomes of DOR. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261438943.