Levels of the epidermal growth factor-like peptide amphiregulin in follicular fluid reflect the mode of triggering ovulation: a comparison between gonadotrophin-releasing hormone agonist and urinary human chorionic gonadotrophin

ObjectiveTo detect differences in follicular fluid (FF) levels of amphiregulin (AR), depending on mode of triggering final oocyte maturation.DesignProspective randomized trial.SettingThree IVF units.Patient(s)Ninety-six patients undergoing IVF–intracytoplasmic sperm injection.Intervention(s)Ovulation triggered with either urinary hCG or GnRH agonist (GnRH-a). Controls: 15 FF samples from small antral follicles (3–9 mm) and 12 FF samples from natural cycle.Main Outcome Measure(s)Follicular fluid concentration of AR, P4, E2, vascular endothelial growth factor, and inhibin B.Result(s)Significantly lower levels of AR were found in FF from the GnRH-a group versus the hCG group, 51 ± 3.5 versus 71 ± 6.0 ng/mL. In FF from natural cycles, levels of AR were significantly higher than those of GnRH-a triggering but significantly lower than those of urinary hCG triggering. In small antral follicles only 5 out of 15 follicles contained measurable amounts of AR. When urinary hCG and GnRH-a triggering were compared, FF P4 was significantly higher after urinary hCG triggering, whereas no difference was seen regarding E2, vascular endothelial growth factor, and inhibin B. A total of 14% more metaphase II oocytes and 11% more transferable embryos were obtained after GnRH-a triggering.Conclusion(s)This study suggests that oocyte competence is linked to granulosa cell AR secretion.