International Journal of Clinical Obstetrics and Gynaecology

Material and Methods: This study was a prospective observational study. A A total of 100 infertile patients attending the infertility clinic at Heritage Institute of Medical Sciences, Varanasi from june 2018-2019 were included in the study. Blood samples were drawn on day 3 of menstrual cycle for assessment of serum Inhibin-B levels. Ovulation induction was done with clomephene citrate 100mg 1OD from day 3 to day 7 and patients followed with serial USG measurements until at least one leading follicle was ≥ 20 mm. Number of dominant follicles (>or =14mm) at the time of HCG administration was counted to analyse the result of ovulation induction. Patients with 3 or more follicles in 1 st cycle were taken in group 1.Patients with less than 3 follicles in 1^st cycle were taken as group 2. Patients with no follicles formation in 1 st cycle had their cycle cancelled. Patients of group 2 who did not conceive or had their cycles cancelled were subjected to 2^nd cycle of ovulation induction. In the second cycle ovulation induction was done with clomephene citrate 100mg from day3 for five days with inj HMG 150 IU given i.m. on day 8 and then every other day until HCG 10,000 IU was administered as a single I.M injection to trigger ovulation when at least one leading follicle was ≥ 20 mm. Patients with more than 3 or more follicles after 2^nd cycle of induction were included in group 2a. Patients developing less than <3 follicles at end of second cycle were considered as poor responders and included in Group 2b.

Results: Out of the100 patients, 55(group 1 + group 2 a) turned out to be good responders while remaining 45(group 2b) were poor responders. Good response rate of those having S. Inhibin values <12.45 pg/ml was lower (13.3%) as compared to that of patients having S. Inhibin 12.45-43.47 pg/ml (54.3%) and >43.47pg/ml (87.5%). Statistically, this association was significant too (p< 0.001). Mean S. Inhibin was higher among good responders (55.4±17.2) as compared to poor responders (17.2±15.5) and the difference was significant statistically too (p< 0.001).

By Receiver operator curve analysis for poor outcome during entire study for selected cut-off value of 21.43 pg/ml, S. Inhibin B had specificity of 81% and sensitivity of 80.3%.

Conclusion: Inhibin B proves to be a novel and promising marker for assessment of poor ovarian reserve. The cut off value of inhibin B to identify poor responders was found to be 21.43pg/ml. Levels of serum inhibin B lower than <21.43pg/ml were associated with higher chances of development of poor response.