Skip to main content
SpringerLink
Log in

Inhibin B levels on cycle day 3 to predict the ovulatory response in women with PCOS undergoing ovulation induction via low dose step-up gonadotropin protocol

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

In this prospective clinical single blind study, we aimed to investigate whether day 3 serum inhibin B levels in women with polycystic ovarian syndrome(PCOS) are of predictive value for the estimation of the ovarian response to gonadotropins.

Methods

Ovulation induction with low dose step-up gonadotropin protocol, starting with 75 IU/day, was performed for 30 cycles on 25 patients with PCOS. Day 3 serum inhibin B, follicle-stimulating hormone(FSH) and estradiol, and midluteal serum progesterone levels were measured during each cycle. The correlations between day 3 inhibin B levels and day 3 FSH, day 3 estradiol and midluteal progesterone measurements, as well as the amount of gonadotropin required to provide an ovulatory cycle were investigated.

Results

Five (27.8%) out of 18 cycles with day 3 inhibin levels <50.0 pg/ml; and 11 (91.7%) out of 12 cycles with levels ≥ 50.0 pg/ml were ovulatory (χ2=9.38, p<0.01). Moreover, day 3 inhibin B levels had statistically significant negative correlation with the gonadotropin used; and significant positive correlation with the midluteal progesterone levels (p<0.05). There wasn't any significant relation between day 3 FSH and estradiol levels with the gonadotropin used and progesterone levels.

Conclusions

It has been observed that as day 3 serum inhibin B levels increased in women with PCOS, the ovulatory response to gonadotropins and the rate of ovulatory cycles increased significantly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson RA, Groome NP, Baird DT (1998) Inhibin A and inhibin B in women with polycystic ovarian syndrome during treatment with FSH to induce mono-ovulation. Clin Endocrinol 48(5):577–584

    Article  CAS  Google Scholar 

  2. Balasch J, Creus M, Fabregues F, Carmona F, Casamitjana R, Ascaso C, Vanrell JA (1996) Inhibin, follicle-stimulating hormone, and age as predictors of ovarian response in in vitro fertilization cycles stimulated with gonadotropin-releasing hormone agonist-gonadotropin treatment. Am J Obstet Gynecol 175(5):1226–1230

    CAS  PubMed  Google Scholar 

  3. Buckler HM, Robertson WR, Sun JG, Morris ID (1992) Immunoreactive inhibin levels during ovarian stimulation may predict granulosa cell maturity. Clin Endocrinol 37:552–557

    CAS  Google Scholar 

  4. Danforth DR (1995) Endocrine and paracrine control of oocyte development. Am J Obstet Gynecol 172:747–752

    CAS  PubMed  Google Scholar 

  5. Eldar-Geva T, Robertson DM, Cahir N, Groome N, Gabbe MP, Maclachlan V, Healy DL (2000) Relationship between serum inhibin a and b and ovarian follicle development after a daily fixed dose administration of recombinant follicle-stimulating hormone. J Clin Endocrinol Metab 85:607–613

    CAS  PubMed  Google Scholar 

  6. Elting MW, Korsen TJM, Rekers-Mombarg LTM, Schoemaker J (2000) Women with polycystic ovarian syndome gain regular menstrual cycles when ageing. Hum Reprod 15:24–28

    Article  CAS  Google Scholar 

  7. Elting MW, Kwee J, Schats R, Rekers-Mombarg LT, Schoemaker J (2001) The rise of estradiol and inhibin B after acute stimulation with follicle-stimulating hormone predict the follicle cohort size in women with polycystic ovary syndrome, regularly menstruating women with polycystic ovaries, and regularly menstruating women with normal ovaries. J Clin Endocrinol Metab 86(4):158915–95

    Google Scholar 

  8. Erickson GF, Danforth DR (1995) Ovarian control of follicle development. Am J Obstet Gynecol 172:736–747

    CAS  PubMed  Google Scholar 

  9. Gill S, Taylor AE, Martin KA, Welt CK, Adams JM, Hall JE (2001) Spesific factors predict the response to pulsatile gonadotropin-releasing hormone therapy in polycystic ovarian syndrome. J Clin Endocrinol Metab 86:2428–2436

    CAS  PubMed  Google Scholar 

  10. Gökyar D, Kökçü A, Yanik F, Cetinkaya MB, Alper T, Malatyalioglu E (2001) Basal and day 12 inhibin concentrations in the prediction of ovarian response to gonadotrophins in women with PCOS. Hum Reprod 16(10):2079–2083

    Article  PubMed  Google Scholar 

  11. Groome NP, Illingworth PJ, O'Brien M, et al (1996) Measurement of dimereic inhibin B throughout the human menstrual cycle. J Clin Endocrinol Metab 81:1401–1405

    Google Scholar 

  12. Hayes FJ, Hall JE, Boepple PA, Crowley WF (1998) Differential control of gonadotropin secretion in the human: Endocrine role of inhibin. J Clin Endocrinol Metab 83(6):1835–1841

    CAS  PubMed  Google Scholar 

  13. Hershlag A, Peterson CM (2002) Endocrine disorders. In: Berek JS (ed) Novak's gynecology. Lippincott Williams and Wilkins, Philadelphia, pp 871–930

  14. Imani B, Eijkemans MJ, de Jong FH, et al (2000) Free androgen index and leptin are the most prominent endocrine predictors of ovarian response during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 85:676–682

    CAS  PubMed  Google Scholar 

  15. Klein NA, Illingworth PJ, Groome NP, et al (1996) Decreased inhibin secretion is associated with the monotrophic FSH rise in older ovulatory women. J Clin Endocrinol Metab 81:2742–2745

    CAS  PubMed  Google Scholar 

  16. Lambert-Messerlian G, Taylor A, Leykin L, et al (1997) Characterization of intrafollicular steroid hormones, inhibin, and follistatin in women with and without polycystic ovarian syndrome following gonadotropin hyperstimulation. Biol Reprod 57:1211–1216

    CAS  PubMed  Google Scholar 

  17. Laven JS, Imani B, Eijkemans MJ, de Jong FH, Fauser BC (2001) Absent biologically relevant associations between serum inhibin B concentrations and characteristics of polycystic ovary syndrome in normogonadotrophic anovulatory infertility. Hum Reprod 16(7):1359–1364

    Article  CAS  PubMed  Google Scholar 

  18. Licciardi FL, Liu HC, Rosenwarks Z (1995) Day 3 oestradiol serum concentration as prognostic data of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization. Fertil Steril 64:991–994

    CAS  PubMed  Google Scholar 

  19. Lockwood GM, Muttukrishna S, Groome NP, Matthews DR, Ledger WL (1998) Mid-follicular phase pulses of inhibin B are absent in polycystic ovarian syndrome and are initiated by successful laparoscopic ovarian diathermy: a possible mechanism regulating emergence of the dominant follicle. J Clin Endocrinol Metab 83(5):1730–1735

    CAS  PubMed  Google Scholar 

  20. Magoffin DA, Jakimiuk AJ (1998) Inhibin A, inhibin B and activin A concentrations in follicular fluid from women with polycystic ovary syndrome. Hum Reprod 13(1O):2693–2698

    CAS  PubMed  Google Scholar 

  21. Matson PL, Morris ID, Sun JG, Ibraham ZHZ, Lieberman BA (1991) Serum inhibin as an index of ovarian function in women undergoing pituitary down-regulation and ovarian stimulation in an in-vitro fertilisation program. Horm Res 35:173–177

    CAS  PubMed  Google Scholar 

  22. McLachlan RI, Robertson DM, Healy DL, de Kretser DM, Burger HG (1986) Plasma inhibin levels during gonadotropin induced ovarian hyperstimulation for IVF: A new index of follicular function. Lancet 1:1233–1234

    CAS  PubMed  Google Scholar 

  23. Norman RJ, Milner CR, Groome NP, Robertson DM (2001) Circulating follistatin concentrations are higher and activin concentrations are lower in polycystic ovarian syndrome. Hum Reprod 16(4):668–672

    Article  CAS  PubMed  Google Scholar 

  24. Pellicer A, Mari M, de los Santos MJ, Simon C, Remohi J, Tarin JJ (1994) Effects of aging on the human ovary: the secretion of immunoreactive a-inhibin and progesterone. Fertil Steril 61:663–668

    CAS  PubMed  Google Scholar 

  25. Pigny P, Cortet-Rudelli C, Decanter C, Deroubaix D, Soudan B, Duhamel A, Dewailly D (2000) Serum levels of inhibins are differentially altered in patients with polycystic ovary syndrome: effects of being overweight and relevance to hyperandrogenism. Fertil Steril 73(5):972–977

    Article  CAS  PubMed  Google Scholar 

  26. Scott RT Jr, Hofmann GE (1995) Prognostic assessment of ovarian reserve. Fertil Steril 63:1–11

    PubMed  Google Scholar 

  27. Seifer DB, Charland C, Berlinsky D, Penzias AS, Haning RV Jr , Naftolin F, Barker BE (1993) Proliferative index of human luteinized granulosa cells varies as a function of ovarian reserve. Am J Obstet Gynecol 169:1531–1535

    CAS  PubMed  Google Scholar 

  28. Seifer DB, Gardiner AC, Lambert-Messerlian G, Schneyer AL (1996) Differential secretion of dimeric inhibin in cultured luteinized granulosa cells as a function of ovarian reserve. J Clin Endocrinol Metab 81(2):736–739

    CAS  PubMed  Google Scholar 

  29. Seifer DB, Lambert-Messerlian G, Hogan JW, Gardiner AC, Blazer AS, Berk CA (1997) Day 3 serum inhibin-B is predictive of assisted reproductive technologies outcome. Fertil Steril 67(1):11–15

    Google Scholar 

  30. Van der Meer M, Hompes PGA, De Boer JAM, Schats R, Schoemaker J (1998) Cohort size rather than FSH threshold level determines ovarian sensitivity in polycystic ovary syndrome. J Clin Endocrinol Metab 83:423–426

    PubMed  Google Scholar 

  31. Welt CK, Schneyer AL (2001) Differential regulation of inhibin B and inhibin a by follicle-stimulating hormone and local growth factors in human granulosa cells from small antral follicles. J Clin Endocrinol Metab 86(1):330–336

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, University of Ondokuz Mayıs, Samsun, Turkey

    Arif Kökçü, Elif Turhan, Mehmet B. Çetinkaya, Filiz Yanik, Tayfun Alper & Erdal Malatyalioğlu

  2. Abdülhakhamid Cad., Onursal Ap. No:19/3, 55070, Samsun, Turkey

    Arif Kökçü

Authors
  1. Arif Kökçü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elif Turhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet B. Çetinkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filiz Yanik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tayfun Alper
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erdal Malatyalioğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arif Kökçü.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kökçü, A., Turhan, E., Çetinkaya, M.B. et al. Inhibin B levels on cycle day 3 to predict the ovulatory response in women with PCOS undergoing ovulation induction via low dose step-up gonadotropin protocol. Arch Gynecol Obstet 270, 255–259 (2004). https://doi.org/10.1007/s00404-003-0557-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-003-0557-y

Keywords

Search

Navigation