Can Inhibin B Reflect Ovarian Reserve of Healthy Reproductive Age Women Effectively?

Jingyi Wen, Kecheng Huang, Xiaofang Du, Hanwang Zhang, Ting Ding, Cuilian Zhang, Wenmin Ma, Ying Zhong, Wenyu Qu, Yi Liu, Zhiying Li, Song Deng, Aiyue Luo, Yan Jin, Jinjin Zhang, Shixuan Wang, Jingyi Wen, Kecheng Huang, Xiaofang Du, Hanwang Zhang, Ting Ding, Cuilian Zhang, Wenmin Ma, Ying Zhong, Wenyu Qu, Yi Liu, Zhiying Li, Song Deng, Aiyue Luo, Yan Jin, Jinjin Zhang, Shixuan Wang

Abstract

Objective: The reference range and potential value of inhibin B are still unclear and controversial. This study aimed to define the variation trend of inhibin B in healthy women with age and explore its value in the reflection of ovarian reserve.

Methods: A total of 2524 healthy reproductive age women from eight medical institutes nationwide were recruited. The variation tendency of inhibin B with age was primarily established in the first group of 948 women and validated in another 605. We evaluated the relationship between inhibin B and classic ovarian reserve and function markers. The potency of inhibin B in predicting AFC <5-7 was also estimated and compared with FSH.

Results: The nomogram showed that serum levels of inhibin B rapidly decreased after the age of 40. Inhibin B was positively correlated with AMH (R = 0.57, P < 0.001), AFC (R = 0.34, P < 0.001) and testosterone (R = 0.10, P = 0.002), and negatively correlated with FSH (R = -0.41, P < 0.001) and LH (R = -0.20, P < 0.001) and FSH/LH (R=-0.18, P < 0.001), while no correlation was found with PRL. Unexpectedly, Inhibin B (AUC = 0.74, P < 0.001 for the establishment population; AUC = 0.78, P < 0.001 for the validation population) had a slightly higher value than FSH (AUC = 0.71, P < 0.001 for the establishment population; AUC = 0.72, P < 0.001 for the validation population) in diagnosing AFC <5-7.

Conclusions: For healthy reproductive age women, the decline of inhibin B can reflect decreased ovarian reserve effectively, having a good consistency with AMH and AFC. More importantly, inhibin B had an advantage in predicting AFC <5-7 compared with FSH, which suggested the potential of inhibin B in predicting ovarian response. These results will be helpful to the clinical application of inhibin B in the evaluation of female ovarian reserve and the assessment of their reproductive capacity. Trial registration: https://ichgcp.net/clinical-trials-registry/NCT02294500" title="See in ClinicalTrials.gov">NCT02294500.

Keywords: Inhibin B; anti-Mullerian hormone; antral follicle count; fertility; follicle-stimulating hormone; ovarian reserve.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Wen, Huang, Du, Zhang, Ding, Zhang, Ma, Zhong, Qu, Liu, Li, Deng, Luo, Jin, Zhang and Wang.

Figures

Figure 1
Figure 1
The flowchart of this study.
Figure 2
Figure 2
Nomogram for inhibin B and the variation trend of inhibin B with age. (A) Inhibin B nomogram based on the cubic regression model. Each line represents the value of confidential interval (CI). A rapid decrease of inhibin B value was observed in women after 40 years old. (B) Median value of inhibin B in each age group.
Figure 3
Figure 3
Relationship between serum inhibin B levels and FSH, LH, PRL, and FSH/LH. logInhibin B was significantly negatively correlated with FSH (R = -0.41, P < 0.001) (A) and LH (R = -0.20, P < 0.001) (B). No correlation was found between logInhibin B and PRL (R = 0.05, P =0.15) (C). logInhibin B was significantly negatively correlated with FSH/LH (R = -0.18, P < 0.001) (D).
Figure 4
Figure 4
Relationship between serum inhibin B levels and AMH, AFC, Progesterone, and T. logInhibin B was significantly positively correlated with logAMH (R = 0.57, P < 0.001) (A), AFC (R =0.34, P < 0.001) (B), and T (R = 0.10, P =0.002) (D). No correlation was found between logInhibin B and progesterone (R = -0.05, P =0.13) (C).
Figure 5
Figure 5
The potency of inhibin B and FSH in predicting AFC (A) FSH nomogram based on cubic regression model. Each line represents the value of confidential interval (CI). Rapid increase of FSH value was observed in women after 40 years old. (B) ROC curves evaluating the diagnostic value of inhibin B and FSH in predicting AFC < 5-7. Inhibin B (AUC = 0.74, P < 0.001 for the establishment population; AUC = 0.78, P < 0.001 for the validation population) had a slightly higher value than FSH (AUC = 0.71, P < 0.001 for the establishment population; AUC = 0.72, P < 0.001 for the validation population) in diagnosing AFC<5-7.

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