Increased intrafollicular androgen levels affect human granulosa cell secretion of anti-müllerian hormone and inhibin-B

Objective

To evaluate whether the follicular fluid concentrations of anti-müllerian hormone (AMH), inhibin-B, and P become affected by androgen priming before controlled ovarian hyperstimulation and IVF/intracytoplasmic sperm injection (ICSI) treatment, extending our previous study.

Design

Prospective nonrandomized clinical study.

Setting

University hospital.

Patient(s)

Patients (N = 45) undergoing IVF/ICSI treatment received androgen priming before controlled ovarian hyperstimulation.

Intervention(s)

All patients received cetrorelix, 3 mg SC, on cycle day 2 and 5. Group I (n = 15) received no other pretreatment. Group II (n = 15) received 2.5 mg once daily of letrozole from cycle day 2 through 8. Group III (n = 15) received letrozole as group II plus 1,250 IU hCG on cycle day 2.

Main Outcome Measure(s)

Follicular fluid concentrations of AMH, inhibin-B, and steroids.

Result(s)

Follicular fluid concentrations of AMH were significantly higher in group III than in groups I and II (2.6 ± 0.3 vs. 1.6 ± 0.2 and 1.5 ± 0.4 ng/mL. Concentrations of inhibin-B were significantly lower in group II and III as compared with group I (27 ± 4, 27 ± 3 versus 46 ± 6 ng/mL, respectively). Follicular fluid P concentrations remained similar in all groups.

Conclusion(s)

Granulosa cell production of AMH was significantly augmented and inhibin-B production was significantly reduced by a highly specific pharmacologically induced increase in the intrafollicular androgen levels, suggesting a dual action of androgen on follicular growth and development.

Key Words: Follicular fluid, AMH, inhibin-B, aromatase inhibitor, ovarian stimulation