The International Tinnitus Journal

Follicular fluid and serum Prostaglandin D2 level as a biomarker for ovarian reserve and response in IVF protocol

Background: Poor responders are those with poor ovarian reserve test, usually old age group however, there are some young patients with adequate ovarian reserve test are unexpectedly poorly responding to Controlled Ovarian Stimulation protocol ( COS) through In Vitro Fertilization (IVF) program. Follicular fluid and serum Prostaglandin D2 (PGD2) level has a role in ovarian function and response to COS protocol. Aim of study: To find whether follicular fluid and serum PGD2 level is a potential biomarker of ovarian reserve and a predictor of ovarian response to hyper stimulation and to show a possibility in developing a therapeutic factor for poor ovarian responders. Methods: The study included eighty infertile females less than 42 years old, their BMI less than 30 undergone Controlled Ovarian Stimulation (COS) protocol through IVF program. Forty of them with poor ovarian reserve (study group) defined according to ESHRE guidelines 2019; low Ati Mullerian hormones (AMH) and or low Antral Follicle Count (AFC), adding to them in my study Follicular Stimulating Hormone (FSH) level. Other forty with normal ovarian reserve test (control group). A third group extracted from control group, eight in number involving those with adequate ovarian reserve test and young age less than 35 years old, though showed unexpectedly poor response to COS protocol(total oocytes retrieved less than four). In our study we excluded women with endometriosis, immune disorder, endocrine disorders, women with endometriosis, women with polycystic ovarian syndrome and male factor infertility. We analysed PGD2 level using ELISA in both follicular fluid and patients serum on day of ovum pick up in both study group and control group, then we correlated the patients clinical parameters (age, BMI, ovarian reserve test),controlled ovarian stimulation / IVF program outcome (total oocytes retrieved, fertilisation rate and total embryos obtained) with follicular and serum PGD2 level. Finally we did comparison of all parameters mentioned above including follicular and serum PGD2 level among: (1) study group (poor ovarian reserve test) (2) new control group (normal ovarian reserve test and normal response with four oocytes retrieved and above) and (3) unexpected poorly responding group (normal ovarian reserve test, young less than 35 year and total oocytes retrieved less than four). Results: Showed significant lowered PGD2 level in both follicular fluid and patient’s serum in study group (poor ovarian reserve group) in comparison with control group (normal reserve test). When we do the comparison among the three groups, the result showed significant lower follicular fluid PGD2 level, non-significant lower serum PGD2 level in unexpected poor responder group (age less than 35yr, normal ovarian reserve test, and poor response, less than four total oocytes retrieved) in comparison to group(normal ovarian reserve test and normal responder with equal or more than four total oocytes retrieved). There was no significant difference in follicular fluid and serum PGD2 level between study group (poor ovarian reserve test) and the unexpected poor responder group. Conclusion: We suggest that PGD2 is a potential biomarker to aid the tests of ovarian reserve and to enhance the diagnosis of poor ovarian response and this data may show the possibility of developing a therapeutic factor for poor ovarian responders by enhancing follicular function that can be used to establish new individualised COS protocol in women with poor ovarian response