Title: ORTs in an Infertile Woman – A Comparative Study

Authors: Virendra Prasad Pandey, Devatwal Kasturi Gabrulal, Deepa Masand Lokwani,  Surabhi Tomar (Sharma)

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.111

Abstract

Background: There exists a lacuna in the assessment of ovarian reserve in an aged infertile woman, which reflects their reproductive potential.

Objective: To compare and evaluate the role of serum FSH, LH, E2, Inhibin B and AMH with the ovarian follicle status in an infertile woman.

Material and Methods:  A comparative observational and cross-sectional study was done in 120 females aged 18 to43 years fulfilling the inclusion and exclusion criteria. Venous blood (5 ml) collected from subjects for measurement of serum FSH, LH, E2, Inhibin B and AMH on day 3rdof menses. Serum FSH, LH, E2 and AMH levels were measured by chemiluminescent immunometric assay. Serum Inhibin B estimated by ELISA method. Antral Follicle count (AFC) and Ovarian volume (OV) was measured by ultrasonography. The serum values of FSH, LH, E2, Inhibin B and AMH were correlated with AFC and OV. P value <0.05 was considered significant.

Results: Our study showed positive correlation exist between the serum levels of FSH, LH, E2 (p< 0.001). Inhibin B values raised in <20yrs and >40yrs age groups. Serum AMH, AFC and OV values showed significant decrease with increasing age(p<0.001). The serum AMH and OV was positively related to AFC status while serum FSH, LH, E2 values was negatively related to the AFC status. Age was negatively related to AFC status.

Conclusion: AMH test predicts the reproductive potential of an aged infertile women (>35 yrs.) and reduce the use of Assisted Reproductive Techniques (ART).

Keywords: Count, ART-Assisted Reproductive Technique, FSH-follicle stimulating hormone, LH-luteinizing hormone, E2-Estradiol, OV- Ovarian volume. ORTs-ovarian reserve tests, AMH-Anti Mullerian Hormone, AFC-Antral Follicle.

References

  1. Jirge Ovarian reserve tests. J Hum Reprod Sci. 2011; 4(3): 108–113.
  2. Scott RT, Jr, Hofmann GE, Oehninger S, Muasher SJ. Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitroFertilSteril. 1990;54:297–302
  3. Kwee J, Schats R, McDonnell J, Lambalk CB, Schoemaker J. Intercycle variability of ovarian reserve tests: Results of a prospective randomized study. Hum Reprod. 2004; 19:590–5. 
  4. Bancsi LF, Broekmans FJ, Mol BW, Habbema JD, teVelde ER. Performance of basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitrofertilization: Ameta-analysis. FertilSteril. 2003;79:1091–100. 
  5. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718. 
  6. Muttukrishna S, McGarrigle H, Wakim R, Khadum I, Ranieri DM, Serhal P. Antral follicle count, anti-Mullerian hormone and inhibin B: Predictors of ovarian response in assisted reproductive technology?  2005;112:1384–90. 
  7. Hendriks DJ, Kwee J, Mol BW, teVelde ER, Broekmans FJ. Ultrasonography as a tool for the prediction of outcome in IVF patients: A comparative meta-analysis of ovarian volume and antral follicle count. Fertil Steril.  2007;87:764–75.
  8. McGee EA, Hsueh AJ 2000 Initial and cyclic recruitment of ovarian follicles. Endocr Rev 21:200-14.
  1. Johnson J, Bagley J, Skaznik-Wikiel M, Lee HJ, Adams GB, Niikura Y et al, Oocyte generation in adult mammalian ovaries by putative germ cells in bone marrow and peripheral blood. Cell 122 (2): 303-315.
  2. Vitt UA, McGee EA, Hayashi M, Hsuch AJ 2000 In vivo treatment with GDF-9 stimulates primordial and primary follicle progression and theca cell marker CYP17 in ovaries of immature rats. Endocrinology 141:3814-20.
  3. Dayal Meena, Sagar Shreshtha, Chaurasi Amrita. Singh Urvashi. Anti-Mullerian Hormone: A New Marker of Ovarian Function The Journal of Obstertrics and Gynecology of India. 2014.64 (2): 130-133.
  4. Hg EH, Yeung Ws, Fong DY et al. Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Human Reprod.2003; 18:2169-74.
  5. Fanchin R, Schonauer LM, Righini C et al. A Serum Anti-Mullerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. HumRepord. 2003; 18:323-7.
  6. Muttukrishna S, Suharjono H, Santhanandam M et al. Inhibin B and Anti-Mullerian hormone: Markers of ovarian response in IVF/ICSI patients. BJOG.2004; 111:1248-53.
  7. Tito SP, Salvatore G, Nicoletta S, Luca L, Antonio P, Bruno F et al. Anti-Mullerian Hormone Serum Values and Ovarian Reserve: Can it predict a decrease in fertility after ovarian stimulation by ART Cycles?2012;7(9):e44571.

Corresponding Author

Virendra Prasad Pandey

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.