Follicular fluid insulin-like growth factor-I and insulin-like growth factor-binding protein-1 and -3 vary as a function of ovarian reserve and ovarian stimulation

Purpose: Follicular fluid concentrations of insulin-like growth factor (IGF )-I, IGF-II, IGF-binding protein (BP)-I, and IGFBP-3 in 57 women undergoing in vitro fertilization and embryo transfer were examined to determine whet her levels reflected differences in patients' exposure to gonadotropin stim ulation and a diminished ovarian reserve. Methods: Preovulatory follicular fluid was obtained from both gonadotropin- stimulated and unstimulated cycles. Subjects were grouped according to norm al or decreased ovarian reserve and whether or not they received gonadotrop in stimulation. Results: The mean follicular fluid concentrations of IGF-I and IGFBP-1 were significantly lower in the "decreased" ovarian reserve group compared with the "normal" ovarian reserve group, with no change in estradiol or IGF-II levels. This resulted in a decreased molar IGF-I: BP ratio and art increase d molar IGF-II:IGFBP-1 ratio. In unstimulated cycles, mean follicular fluid concentrations of IGFs did not differ significantly compared with those in stimulated cycles, whereas concentrations of IGFBP-1 and IGFBP-3 were sign ificantly lower; leading to higher molar ratios of the IGFs to the binding proteins. Conclusions: Follicular fluid IGF and binding proteins vary as a function o f ovarian reserve and gonadotropin stimulation. This may reflect either dif ferences in oocyte quality or a suboptimal follicular fluid environment.