Abstract
This is the second of five studies undertaken on women preparing for assisted reproduction, to sequentially examine the relevance of the insulin-like growth factor (IGF) profile (IGF-1, IGFBP-3 and the IGFBP-3/ IGF-1 ratio) which, in children, provides the essential criteria to identify the GH-deficient individual. Whilst our first, published study, focussed on clinical parameters, this study examines its relevance to the two parameters which define the ovarian reserve. The first, that of the antral follicle count (AFC), shows highly significant, sequential changes across 4 age groups ranging from high counts in the younger women <35 years and low counts in the older women, namely those aged 35-39 years, those aged 40-44 years and those aged ≥45 years (p<0.0001). Similarly, the serum levels of anti-Mullerian hormone (AMH), a later introduced marker of ovarian reserve, also showed highly significant sequential changes across the 4 age groups with high levels recorded in the young women and low counts in the older women (p<0.0001). At the higher AFC range, concordance between AFC groups and AMH groups was high at r=0.79 for precise matching and r=0.95 when neighbouring groups were included. The correlation was also clear with inter-quartile AMH levels ranging 27 pmol/L to 50 pmol/L across the higher AFC groups and 8 pmol/L to 10 pmol/L in the lowest groupings. However, IGF profiles showed no significant variations across the entire range, neither for the AFC nor for the AMH groups. Our next study will report on the relevance of the IGF profile to clinical outcomes.
Highlights
In the 42 years since successful livebirths from in vitro fertilization (IVF) the field has progressed rapidly with more than 10 million infants arising from this and related areas of assisted reproductive technology (ART) [1,2]
Whereas our first study examined the insulin-like growth factor (IGF) profile according to clinical parameters including age, body stature and body mass index [10], this second study examines the IGF profile in women attending for ART treatment and compares the measurements against tests for ovarian reserve, as women with lower reserve are considered to have higher likelihood for a poor prognosis
At PIVET in Perth, Australia, we have been undertaking a series of studies examining the IGF profile with a view to determine if there is an underlying clinical problem of adult growth hormone deficiency (AGHD) causing the poor-prognosis outcomes for some women in ART programmes
Summary
In the 42 years since successful livebirths from in vitro fertilization (IVF) the field has progressed rapidly with more than 10 million infants arising from this and related areas of assisted reproductive technology (ART) [1,2]. Most of the successes have been enjoyed by younger women, whilst only a small component of those over age 40 years have achieved the benefits of ART, despite investing a much higher proportion of their time, their finances, and their energies (including emotional, physical and marital energy) into IVF-related attempts [3]. This study is the second in a series of studies to explore the concept of adult growth hormone deficiency (AGHD) underlying infertility with a defined poor-prognosis in current ART management. Whereas our first study examined the IGF profile according to clinical parameters including age, body stature and body mass index [10], this second study examines the IGF profile in women attending for ART treatment and compares the measurements against tests for ovarian reserve, as women with lower reserve are considered to have higher likelihood for a poor prognosis
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