Relationship between ovarian cortisol : cortisone ratios and the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET)

OBJECTIVE Previously, we have reported an association between tow levels of intraovarian cortisol metabolism, mediated by 11 beta-hydroxysteroid dehyd rogenase (11 beta HSD), and the establishment of pregnancies by in vitro fe rtilization and embryo transfer (IVF-ET), The objective of the present stud y was to investigate the relationship between the clinical outcome of IVF-E T and the intraovarian concentrations of cortisol and cortisone and the cor tisol:cortisone ratios in random samples of ovarian follicular fluid (FF). DESIGN Retrospective, double-blind correlation analyses, PATIENTS FF samples (n=41) were obtained from 23 women undergoing gonadotro phin-stimulated IVF-ET cycles at the Cardiff Assisted Reproduction Unit, MEASUREMENTS Clinical pregnancy was confirmed by ultrasonography, Intrafoll icular steroid concentrations were measured by radioimmunoassays. RESULTS Concentrations of both cortisol and cortisone were significantly lo wer in FF samples obtained from 6 patients that conceived than in samples o btained from 17 patients that did not achieve pregnancy (cortisol (mean +/- SEM) = 304 +/- 29 vs, 407 +/- 26 nmol/l, P = 0.0411; cortisone = 32 +/- 3 v s, 65 +/- 7 nmol/l, P = 0.0002). Intrafollicular cortisol:cortisone ratios were significantly higher in samples from conception cycles than in those s amples obtained from nonconception cycles (9.7 +/- 0.7 vs, 6.9 +/- 0.5, res pectively, P = 0.0060). Whereas 5 of 10 women with intrafollicular cortisol :cortisone ratios greater than the outcome-independent mean of 7 7 became p regnant, only 1 of the 13 patients with intrafollicular cortisol:cortisone ratios <7.7 conceived (chi(2) = 5.247, P = 0 0220). CONCLUSIONS Concentrations of both cortisol and cortisone were significantl y lower in FF samples obtained from patients that conceived by IVF-ET than in those obtained from nonconception cycles, Conception by gonadotrophin-st imulated IVF-ET was associated with an elevated intrafollicular ratio of co rtisol:cortisone, consistent with a low level of intraovarian cortisol oxid ation by 11 beta HSD.