Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in day 3 follicle-stimulating hormone

Objective: To test the hypothesis that women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B levels before a rise i n day 3 serum FSH levels. Design: Case-control study. Setting: Tertiary care fertility center. Patient(s): One hundred nine women with nonovarian infertility (tubal facto r or male factor) and 37 women with declining ovarian reserve who underwent assisted reproductive techniques. Intervention(s): None. Main Outcome Measure(s): Serum inhibin B and FSH levels, number of ampules of gonadotropins administered, E-2 levels on the day of hCG administration, number of oocytes retrieved, clinical pregnancy rate, and cycle cancellati on rate. Result(s): Women who had declining ovarian reserve as demonstrated by an in creased gonadotropin requirement, a decreased E-2 response, fewer retrieved oocytes, a lower clinical pregnancy rate, and a higher cycle cancellation rate had lower day 3 serum inhibin B levels despite having nonelevated day 3 FSK levels similar to those of women with nonovarian infertility. Conclusion(s): Women with declining ovarian responsiveness and clinical out comes consistent with declining ovarian reserve had decreased day 3 serum i nhibin B levels despite having nonelevated day 3 serum FSH concentrations. Declining ovarian reserve may be demonstrated by a decrease in day 3 inhibi n B levels before a rise in day 3 FSH levels. (Fertil Steril(R) 1999;72:63- 5. (C)1999 by American Society for Reproductive Medicine.).