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

Objective: To evaluate whether the follicular fluid concentrations of anti-mullerian 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 B (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.