Androgen supplementation

Our ratings indicate whether the evidence from studies shows that a treatment add-on is effective at improving treatment outcomes for someone undergoing fertility treatment. Our rating does not tell you how much that treatment add-on improves your chances of having a baby – please discuss this with your clinic.

Rated outcomes for DHEA supplementation
Rated grey for increasing the chances of having a baby for most fertility patients Grey traffic light	We cannot rate the effectiveness of this add-on for improving the chances of having a baby for most fertility patients as there is insufficient moderate/high quality evidence.
Rated grey for increasing the number of eggs retrieved during an IVF cycle for most fertility patients Grey traffic light	We cannot rate the effectiveness of this add-on for increasing the number of eggs retrieved during an IVF cycle for most fertility patients as there is insufficient moderate/high quality evidence.
Rated grey for increasing the ongoing pregnancy rate for most fertility patients Grey traffic light	We cannot rate the effectiveness of this add-on for increasing the ongoing pregnancy rate for most fertility patients as there is insufficient moderate/high quality evidence.
Rated grey for increasing the chances of having a baby for older women Grey traffic light	We cannot rate the effectiveness of this add-on for improving the chances of having a baby for older women as there is insufficient moderate/high quality evidence.
Rated black for increasing the number of eggs retrieved during an IVF cycle in women with poor ovarian response or diminished ovarian reserve Black traffic light	On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the number of eggs retrieved during an IVF cycle for women with poor ovarian response or diminished ovarian reserve.
Rated black for live birth rate in women with poor ovarian response or diminished ovarian reserve Black traffic light	On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on live birth rate for women with poor ovarian response or diminished ovarian reserve.

Rated outcomes for testosterone supplementation
Rated grey for increasing the chances of having a baby for most fertility patients Grey traffic light	We cannot rate the effectiveness of this add-on for improving the chances of having a baby for most fertility patients as there is insufficient moderate/high quality evidence.
Rated grey for increasing the number of eggs retrieved during an IVF cycle for most fertility patients Grey traffic light	We cannot rate the effectiveness of this add-on for increasing the number of eggs retrieved during an IVF cycle for most fertility patients as there is insufficient moderate/high quality evidence.
Rated grey for increasing the chances of having a baby for women with poor ovarian response or diminished ovarian reserve Grey traffic light	We cannot rate the effectiveness of this add-on for improving the chances of having a baby for women with poor ovarian response or diminished ovarian reserve as there is insufficient moderate/high quality evidence.
Rated grey for increasing the number of eggs retrieved during an IVF cycle for women with poor ovarian response or diminished ovarian reserve Grey traffic light	We cannot rate the effectiveness of this add-on for increasing the number of eggs retrieved during an IVF cycle for women with poor ovarian response or diminished ovarian reserve as there is insufficient moderate/high quality evidence.
Rated grey for increasing the chances of having a baby for older women Grey traffic light	We cannot rate the effectiveness of this add-on at for improving the chances of having a baby for older women as there is insufficient moderate/high quality evidence.
Rated grey for increasing the number of eggs retrieved during an IVF cycle for older women Grey traffic light	We cannot rate the effectiveness of this add-on for increasing the number of eggs retrieved during an IVF cycle for older women as there is insufficient moderate/high quality evidence.

---

What do ratings mean?

There are five ratings that indicate whether a treatment add-on is effective at improving treatment outcomes for someone undergoing fertility treatment, according to the evidence from studies. To make it easier to understand the scientific evidence for each treatment add-on we have a range of symbols and colours for each rated add-on below.

All treatment add-ons on our list will have a rating to indicate whether the evidence shows that the treatment add-on is effective at improving the chances of having a baby for most fertility patients. Some treatment add-ons on our list may also have additional ratings for specific treatment outcomes. For example, whether the evidence shows that the treatment add-on reduces miscarriage. There may also be further ratings for specific patient groups, for example whether the evidence shows that the treatment add-on is effective for those who are aged over 40. Please see the individual webpages for each treatment add-on for their ratings.

An agreement between the HFEA and other professional and patient bodies (the 19^th October 2023 consensus statement) states that treatments that have no strong evidence of their safety and/or effectiveness should only be offered in a research setting. Patients should not be charged extra to take part in research, including clinical trials.

---

What’s the evidence for androgen supplementation?

Research in humans and animals has demonstrated that androgens have an essential role in the regulation of ovarian function. Researchers have also investigated the role androgens play in promoting the growth of ovarian follicles and ovulation, although have not yet conclusively identified the scientific mechanisms involved.

Several studies have compared IVF outcomes of patients who have received androgen supplementation (testosterone or DHEA) before and during the ovarian stimulation phase of IVF to similar patients who have not received androgen supplementation. While there were some studies considered to be of high quality, they tended to involve a small number of patients. For example, three high quality studies looking at DHEA use in the general fertility patient population involved a total of less than 300 patients. Other studies identified were not of high quality. For example, none of the eleven studies of testosterone use in women with poor ovarian response or diminished ovarian reserve were considered high quality. For more information on the studies included in the review, please see the SCAAC papers February 2025.

The main outcomes examined by these studies were number of eggs retrieved, and pregnancy and live birth rates. Studies mostly found the same or similar rates of egg retrieval, pregnancy and live birth for androgen supplemented versus non-supplemented patients. For most outcomes in most patient groups, there were not enough moderate or high-quality studies using DHEA or testosterone to rate the effectiveness of the supplementation.

When the studies of DHEA in women with poor ovarian response or diminished ovarian reserve were analysed, it was concluded that collectively they did not show any impact on egg retrieval or live births.

At the February 2025 meeting of the Scientific and Clinical Advances Advisory Committee (SCAAC), Committee members evaluated the evidence base for androgen supplementation. Details of the evidence considered and the discussions undertaken can be found here: SCAAC papers February 2025 (pages 55-73) and SCAAC minutes February 2025. A 2024 Cochrane review of androgen supplementation may also provide further information as it reviews 28 studies in this area.

---

Is this treatment add-on safe?

Most studies on the use of androgen supplementation in IVF have not addressed safety in great detail. The 2024 Cochrane review noted that information on adverse events occurring in studies was “sparse”. However, as stated on the NHS website, although it is possible to get pregnant if you’re taking testosterone, it's not recommended. This is because taking testosterone in pregnancy may affect the baby's development.

DHEA and testosterone supplementation can have side effects in women including greasier skin and acne, hair loss, excess hair growth, dizziness and voice deepening. Limiting dosage and duration of treatment may help reduce these side effects.

The HFEA’s evidence review on androgen as a treatment add-on looked at fertility treatment outcomes and did not examine long-term outcomes of using androgen supplements. At the February 2025 SCAAC meeting, it was noted that research on the role of androgens in breast cancer is still subject to debate among doctors and researchers.

If you have any questions about the safety and risks, your clinic will be able to discuss the use of a treatment add-on with you, taking into account your specific medical history and circumstances.

---

Studies reviewed for this treatment add-on

The SCAAC have reviewed the following studies for DHEA:

General:	Tartagni 2015	10.1186/s12958-015-0014-3
	Tartagni 2015a	PMID: 24867068
	Yeung 2016	10.1111/1471-0528.13808
	Mostajeran 2018	PMID: 31223318 PMC: 6571446
Poor ovarian reserve:	Kara 2014	10.1016/j.ejogrb.2013.11.008
	Yeung 2014	10.1016/j.fertnstert.2014.03.044
	Zhang 2014	10.1186/s13048-014-0093-3
	Narkwichean 2017	10.1016/j.ejogrb.2017.09.006
	Fu 2017	10.4103/2096-2924.210696
	Kotb 2017	10.1016/j.ejogrb.2016.02.009
	Wang 2022	10.1111/1471-0528.17045
Older women:	Lin 2017	10.1111/jog.13456
	Li 2021	10.3390/nu13072449

The SCAAC have reviewed the following studies for Testosterone:

Poor ovarian reserve:	Kim 2014	10.12717/DR.2014.18.3.145
	Escriva 2015	10.1210/jc.2015-1194
	Bosdou 2016	10.1093/humrep/dew028
	Saharkhiz 2018	10.4103/jrms.JRMS_864_17
	Al-Jeborry 2019	10.36295/ASRO.2019.220925
	Hoang 2021	10.1002/rmb2.12383
	Singh 2021	10.18203/2320-1770.ijrcog20213476

---

What are treatment add-ons?

In vitro fertilisation (IVF) and intrauterine insemination (IUI) are established treatments that have been proven effective for most patients. Treatment add-ons are optional non-essential treatments that may be offered in addition to such proven fertility treatment. Treatment add-ons are:

• Additional treatments (to the core treatment e.g. IVF or IUI) that are being offered to the general patient population in licensed fertility clinics in the UK,
• Where there is published scientific literature which claims to demonstrate that the add-on improves live birth rates or other treatment outcomes rated by the HFEA; but
• where evidence of effectiveness for the use of the treatment in a clinical setting is lacking or absent; and
• where patients need unbiased information about the effectiveness and risks of this treatment

It is important to keep in mind that for most patients, having routine cycles of proven fertility treatment are effective without using any treatment add-ons. If you are paying for your own treatment, you may want to think about whether it might be better to pay for multiple cycles of IVF or IUI, rather than spending large sums of money on a single treatment cycle with treatment add-ons that haven’t been proven to be effective.

We aim to publish clear and reliable information about some of the treatment add-ons that don’t have enough evidence to show that they improve your chances of having a baby and other relevant treatment outcomes. This provides useful information to patients and allows them to question the use of add-ons.

Where next?

Back to Treatment add-ons information

The CMA’s guide for patients paying for fertility treatment

Questions to ask your clinic about treatment add-ons