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

Abstract

Objective: To detect differences in follicular fluid (FF) levels of amphiregulin (AR), depending on mode of triggering final oocyte maturation.

Design: Prospective randomized trial.

Setting: Three 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.