***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: STUDY QUESTION What are the direct effects of and rogens on primate follicular development and function at specific stages of folliculogenesis ? SUMMARY ANSWER And rogen addition altered primate  follicle survival , growth , steroid and anti-Müllerian hormone ( AMH ) production , and oocyte quality in vitro , in a dose- and stage-dependent manner . WHAT IS KNOWN ALREADY And rogens have local actions in the ovary , particularly in the developing follicles . It is hypothesized that and rogen promotes early follicular growth , but becomes detrimental to the antral follicles in primates . STUDY DESIGN , SIZE , DURATION In vitro follicle maturation was performed using rhesus macaques . Secondary ( 125 - 225 µm ) follicles were mechanically isolated from 14 pairs of ovaries , encapsulated into alginate ( 0.25 % w/v ) , and cultured for 40 days . PARTICIPANTS / MATERIAL S , SETTING , METHODS Individual follicles were cultured in a 5 % O2 environment , in alpha minimum essential medium supplemented with recombinant human FSH . Follicles were r and omly assigned to experiments of steroid ablation by trilostane ( TRL ) , testosterone ( T ) replacement and dihydrotestosterone ( DHT ) replacement .  Follicle survival and growth were assessed . Follicles with diameters ≥500 μm at Week 5 were categorized as fast-grow follicles . Pregnenolone ( P5 ) , progesterone ( P4 ) , estradiol ( E2 ) and AMH concentrations in media were measured . Meiotic maturation and fertilization of oocytes from recombinant human chorionic gonadotrophin-treated follicles were assessed at the end of culture . MAIN RESULTS AND THE ROLE OF CHANCE Compared with controls , TRL exposure reduced ( P < 0.05 ) follicle survival , antrum formation rate and follicle diameters at Week 5 . While P5 concentrations increased ( P < 0.05 ) following TRL treatment , P4 levels decreased ( P < 0.05 ) in fast-grow follicles at Week 5 . Few healthy oocytes were retrieved from antral follicles developed in the presence of TRL . T replacement with TRL  increased ( P < 0.05 ) follicle survival and antrum formation at Week 5 , compared with TRL alone , to levels comparable to controls . However , high-dose T with TRL decreased ( P < 0.05 ) diameters of fast-grow follicles . Although P4 concentrations produced by fast-grow follicles were not altered by T in the presence of TRL , there was a dose-dependent increase ( P < 0.05 ) in E2 levels at Week 5 . High-dose T with TRL decreased ( P < 0.05 ) AMH production by fast-grow follicles at Week 3 . More healthy oocytes were retrieved from antral follicles developed in TRL+T compared with TRL alone . DHT had the similar effects to those of high-dose T , except that DHT replacement decreased ( P < 0.05 ) E2 concentrations produced by fast-grow follicles at Week 5 regardless of TRL treatment . LIMITATION , REASONS FOR CAUTION This study reports T and DHT actions on in vitro-developed individual primate ( macaque ) follicles , which are limited to the interval from the secondary to small antral stage . WIDER IMPLICATION OF THE FINDINGS The above findings provide novel information on the role(s ) of and rogens in primate follicular development and oocyte maturation . We hypothesize that and rogens promote pre-antral follicle development , but inhibit antral follicle growth and function in primates . While and rogens can act positively , excess levels of and rogens may have negative impacts on primate folliculogenesis . STUDY FUNDING /COMPETING INTERESTS NIH U54 RR024347/RL1HD058294/PL1EB008542 ( Oncofertility Consortium ) , NIH U54 HD071836 ( SCCPIR ) , NIH ORWH/NICHD 2K12HD043488 ( BIRCWH ) , NIH FIC TW/HD-00668 , ONPRC 8P51OD011092 . There are no conflicts of interest CONTEXT Changes in and rogen levels across the adult female life span and the effects of natural menopause and oophorectomy have not been clearly established . OBJECTIVE The objective of this study was to document the effects of age on and rogen levels in healthy women and to explore the effects of natural and surgical menopause . DESIGN , SETTING , AND PARTICIPANTS A cross-sectional study was conducted of 1423 non-healthcare-seeking women , aged 18 - 75 yr , r and omly recruited from the community over 15 months . MAIN OUTCOME MEASURES Serum levels by age of total testosterone ( T ) , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione in a reference group of women free of confounding factors . Women in the reference group had no usage of exogenous steroid therapy ; no history of tubal ligation , hysterectomy , or bilateral oophorectomy ; and no hyperprolactinemia or polycystic ovarian syndrome . The effects of natural and surgical menopause on sex steroid levels were also examined . RESULTS In the reference population ( n = 595 ) , total T , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione declined steeply with age ( P < 0.001 ) , with the decline of each being greater in the earlier than the later decades . Examination of serum and rogen levels by year in women aged 45 - 54 yr showed no independent effect of menopausal status on and rogen levels . In women aged 55 yr or older , those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group . CONCLUSIONS We report that serum and rogen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production . These significant variations in and rogens with age must be taken into account when normal ranges are reported and in studies of the role of and rogens in women Background : In this study , the effect of testosterone gel administration during ovulation induction on the fertility rate was examined in women with a poor ovarian response in in vitro fertilization ( IVF ) cycles . Material s and Methods : The current study is a single-blinded , r and omized clinical trial . Patients who met inclusion ( Bologna ) criteria were placed in the antagonist cycle group . The patients were r and omly divided into two groups each included 25 participants treated with a placebo ( lubricant gel , the controls ) and testosterone gel ( intervention ) . Fertility outcomes were compared between two study groups . Results : The mean ± st and ard deviation ( SD ) age of intervention ( 41.04 ± 3.77 ) versus control group ( 39.69 ± 3.29 ) was not statistically different . The two studied groups were not statistically different in terms of follicle-stimulating hormone ; antral follicle count , IVF , anti-Mullerian hormone , and the duration of infertility . The mean ± SD of oocyte 2.48 ± 1.64 versus 1.17 ± 1.27 and embryo 1.60 ± 1.58 versus 0.39 ± 0.58 in intervention group was significantly higher than control group ( P < 0.01 ) . The rate of pregnancy 16 % versus 0 % and embryo of quality A – B was significantly higher in intervention group than control ( 60 % versus 17.4 % , P < 0.05 ) . Conclusion : The results of the current study showed that the testosterone gel has a significant impact on the fertility rate in women with a poor response in the IVF cycles . Further , r and omized clinical trials with larger sample sized are recommended BACKGROUND Studies in macaques have indicated that and rogens have some synergistic effects with FSH on folliculogenesis . This study investigated the usefulness of pretreatment with transdermal testosterone in low-responder IVF patients . METHODS R and omized clinical trial including 62 infertile women who had a background of the first IVF treatment cycle cancelled because of poor follicular response . Patients were r and omized in two treatment groups in their second IVF attempt . In patients in Group 1 ( n = 31 ) , transdermal application of testosterone preceding st and ard gonadotrophin ovarian stimulation under pituitary suppression was used . In Group 2 ( n = 31 patients ) , ovarian stimulation was carried out with high-dose gonadotrophin in association with a minidose GnRH agonist protocol . The primary end-point was the incidence of low-responder patients . The main secondary outcome was the incidence of patients reaching ovum retrieval . RESULTS The percentage of cycles with low response was significantly lower in Group 1 than in Group 2 ( 32.2 versus 71 % 95 % confidence interval for the difference , 15.7 - 61.6 ; P < 0.05 ) . The number of patients with ovum retrieval tended to be higher in Group 1 than in Group 2 ( 80.6 versus 58.1 % P = 0.09 ) , the difference reaching statistical significance ( 81.2 versus 41.1 % ; P < 0.05 ) when only patients having normal basal FSH levels ( 16 and 17 patients in Groups 1 and 2 , respectively ) were considered . CONCLUSIONS Pretreatment with transdermal testosterone may improve the ovarian sensitivity to FSH and follicular response to gonadotrophin treatment in previous low-responder IVF patients . This approach leads to an increased follicular response compared with a high-dose gonadotrophin and minidose GnRH agonist protocol This study was performed to investigate the effect of of transdermal testosterone gel ( TTG ) on controlled ovarian stimulation ( COS ) and IVF outcomes and ovarian morphology according to pretreatment duration in poor responders . A total of 120 women were recruited for this pilot study . They were r and omized into control , 2 weeks , 3 weeks or 4 weeks TTG treatment groups . For three TTG treatment groups , 12.5 mg TTG was applied daily for 2 weeks , 3 weeks or 4 weeks in preceding period of study stimulation cycle . After 3 weeks of TTG pretreatment , significant increase of antral follicle count ( AFC ) and significant decreases of mean follicular diameter ( MFD ) and resistance index ( RI ) value of ovarian stromal artery were observed ( p=0.026 , p<0.001 , p<0.01 , respectively ) . The total dose of rhFSH administered for COS significantly decreased after 3 and 4 weeks TTG treatment both compared with control group ( p<0.001 , p<0.001 ) . The numbers of oocytes retrieved and mature oocytes were significanty higher in 3 and 4 weeks TTG treatment groups than control group ( p<0.001 , p<0.001 in the number of oocytes retrieved ; p<0.001 , p<0.001 in the number of mature oocytes ) . The clinical pregnancy rate and live birth rate were increased only in 4 weeks TTG treatment group compared with control group ( p=0.030 and p=0.042 , respectively ) . These data demonstrated that TTG pretreatment for 3 to 4 weeks increases AFC and ovarian stromal blood flow , thereby potentially improving the ovarian response to COS and IVF outcome in poor responders undergoing IVF/ICSI BACKGROUND Various experiments suggest that ovarian follicular recruitment and growth may be increased by testosterone priming . Our aim was to determine the effects of exogenous testosterone supplementation in older women on ovarian folliculogenesis and steroidogenesis . METHODS A prospect i ve r and omized double-blind placebo-controlled crossover study was carried out . Twelve regularly menstruating non-obese women aged 38 - 45 years received a 12-day course of transdermal testosterone ( 2.5 mg per patch ) or placebo patch , followed by 7 days of gonadotrophin stimulation . After at least a 1 month washout period , subjects underwent the same protocol using the opposite treatment . The main outcomes were follicular development ( ultrasound measures ) and hormone levels . RESULTS Following gonadotrophin stimulation , there were no differences in average number of follicles over 10 mm diameter in cycles pre-treated with testosterone versus placebo [ 2.10 ( 95 % confidence interval ( CI ) 1.11 , 3.22 ) versus 2.08 ( 95 % CI 1.03 , 3.14 ) , P = 0.55 ] . No crossover , period ( first or second test ) or sequence ( order of treatment ) effects were noted . As expected , total and free testosterone levels were increased following testosterone treatment ( 312.7 + /- 122.4 versus 12.3 + /- 4.5 ng/dl and 45.5+/- 
    Output:
    
Sensitivity and subgroup analysis did not provide statistical changes to the pooled results .
Conclusions Testosterone therapy seems promising to improve the success  at IVF in POR patients .