Correlation between androgen levels in follicular fluid and granulose cell FSHR expression in poor responder women

Abstract

Androgen levels are involved in folliculogenesis and follicular maturity. The increase of follicular androgen levels in poor responders can increase FSH receptor expression. However, a previous study found that there was no difference in androgenic follicular fluid levels in poor responder. This discovery led to a theory of differences in FSH receptor density. The objective of this research was to investigate the correlation between androgen levels in follicular fluid with granulose cells FSH receptor expression in poor responder women. This cross-sectional study was completed at the Yasmin IVF Clinic, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Forty-two subjects who underwent IVF were asked to participate and their follicular fluid testosterone and DHEA levels were measured. The patients were classified into two groups consisting of 21 poor responder patients and 21 normo-responder patients. Granulose cells were collected from 17 patients in each group to measure the FSH receptor expression. Correlation between androgens in follicular fluid with granulose cells FSH receptor expression was analyzed using the Spearman test. There were significant between-group differences in mean age with poor responders presenting as older and with lower AMH levels. Testosterone levels from follicular fluid were significantly higher in poor responders, but similar findings were not observed with DHEA levels, which did not rise to the level of statistical significance. There were a significantly lower number of oocytes and cleavage embryos in the poor responder group. Granulose cell FSH receptor expression was higher in the poor responder group, although this difference also did not rise to the level of statistical significance. There was no correlation between testosterone follicular fluid level and granulose cell FSH receptor expression. We found the DHEA follicular fluid level was positively correlated with granulose cell FSH expression, even though the difference was not statistically different. There was no significant correlation between intra-follicular androgen levels and fertilization rates in both poor responders and non-poor responders. Additional studies are needed to find correlations between the other factors affecting poor responders.