The aim of this study is to assess the association of poor ovarian response with serum inhibin B levels.
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 1st 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 2nd 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 2nd 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.