Evaluation of the relationship between follicular fluid oxidative stress, ovarian hormones, and response to gonadotropin stimulation

ObjectiveTo investigate the relationship between oxidative stress and the underlying causes of infertility, preovulatory ovarian hormones, and ovarian response to gonadotropin stimulation in patients undergoing assisted reproductive techniques.DesignProspective, cross-sectional study.SettingAssisted conception unit, university hospital.Patient(s)One hundred thirty women presenting with infertility, of the following types: male factor (n = 56), unexplained (n = 36), tubal factor (n = 16), polycystic ovary syndrome (n = 15), and endometriosis (n = 7).Intervention(s)Follicular fluid (FF) and peripheral blood samples were collected at oocyte retrieval.Main Outcome Measure(s)Blood and FF samples were analyzed for inhibin A, inhibin B, activin A, anti-Müllerian hormone, and E2 by using ELISA. Total antioxidant capacity (TAC) was measured in plasma and FF by using a calorimetric microplate assay.Result(s)There was no significant relationship between plasma or FF TAC and the underlying etiology of infertility. There was a statistically significant positive association between FF E2 levels and TAC (r = 0.26). Higher antral follicle count, delta E2 (day 3 E2 minus day 2 E2), preovulatory serum anti-Müllerian hormone, inhibin B, and E2 were associated with good ovarian response, whereas higher FF E2 was associated with a statistically significant poor response. No significant direct relationship was observed between TAC and ovarian response as well as between TAC or any of the parameters measured and pregnancy outcome.Conclusion(s)Oxidative stress has an impact on the production of granulosa cell steroid hormones, in particular E2, which is an important predictor of ovarian response. The positive association between FF E2 and total antioxidant capacity suggests that E2 may play a role in the ovarian antioxidant–oxidant balance.