Relationship between antiMüllerian ovarian hormone, activin-A, and follistatin hormones levels with pregnancy rate following intrauterine insemination


Background:Recently the reproductive hormones, Anti-Mullerian hormone (AMH), activin A, and follistatin (FS) have been found to play an important role in folliculogenesis, oocyte maturation and corpus luteum function by changing the pattern of granulosa cell expression which in turn affects the success of fertilization potential.Objectives:To examine the relation of in vivo concentrations of AMH, activin A, and FS hormones on the ovaries status in the phases of menstrual cycle and to elucidate the relationship of these hormones with pregnancy rate following intrauterine insemination(IUI).Materials and methods:Seventy seven infertile couples were recruited from infertility clinic population at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies through the period from September 2011 to May 2012. Those infertile couples were divided to 3 groups according to the infertility cause (male factors causes, anovulatory causes and unexplained causes of infertility). Measurements of AMH, activin A, and FS hormones levels were done at cycle day (CD25-). Then measurements of activin A, and FS hormones levels were done only at preovulatory cycle(CD1214-) when the size of the Graffianfolliclerangebetween1824-mm and at least one follicle was present and before hCG injection and at day 28 of the cycle(CD28) . IUI was performed 3640- hours after hCG injection then measurement of the three hormones was performed after successful IUI. The result of successful pregnancy was recorded and statistical relation with AMH, activin A and FS hormones was assessed.Results:There was a positive significantcorrelationbetweenendometrialthickness(ET)andpregnancyrate and the best ET to predict pregnancy is more than 7mm. There was no significantrelation(P>0.05) between AMH level and pregnancy rate. A significantcorrelationwasfoundbetweenfollistatin levels in preovulatory (CD 1214-) with a cutoff value 0.20ng/ml to predict pregnancy. There was a significantrelationbetweenactivin-Alevelandpregnancyratewithapredictivecutoff value 397.5 ng/ml on (CD 28) only.Conclusions:Activin-A can be regarded as a biomarker candidate for diagnosing very early pregnancy at luteal phase following IUI. Follistatin preovulatory (average CD13) has the most predictive value for pregnancy following IUI.