Aim: This study evaluated the impact of age on the hormonal profiles of women diagnosed with infertility in a Fertility Clinic in Abia State, South-East, Nigeria. Methodology: Subjects comprised of 200 females: 150 subjects and 50 controls, aged < 20 and up to 49 years, stratified into age < 20 years (control), age 20 - 29 years (group 1), age 30 - 39 years (group 2) and age 40 - 49 years (group 3). About 5 ml of blood samples for anti-Mullerian, follicle stimulating, luteinizing, estradiol, and prolactin hormones determinations were collected on day 2 - 3 of spontaneous menstrual cycle from all groups and control and analyzed using enzyme-linked immunosorbent assay. The FSH/LH ratio of all groups was also calculated. The data were analyzed statistically and values considered significant at p < 0.05. Result: The means ± SEM of serum anti-Mullerian hormones were 1602.44 ± 54.42 pg/ml (control), 848.06 ± 23.04 pg/ml (group 1), 26.74 ± 1.28 pg/ml (group 2), 10.37 ± 1.26 pg/ml (group 3) values for follicle stimulating hormone in the control subjects was 4.90 ± 0.22 mIU/ml, 12.59 ± 0.79 mIU/ml (group 1), 30.59 ± 1.31 mIU/ml (group 2), and 41.59 ± 1.59 miU/ml (group 3). Similarly, the mean ± SEM of luteinizing hormone of control, group 1, group 2 and group 3 were 5.01 ± 0.22 mIU/ml, 15.02 ± 1.13 mIU/ml, 42.71 ± 1.82 mIU/ml and 58.22 ± 2.62 mIU/ml respectively while for estadiol the values were 63.16 ± 1.95 pg/ml, 94.10 ± 5.56 pg/ml, 58.84 ± 4.01 pg/ml and 36.7 ± 1.59 pg/ml for control, group 1, group 2 and group 3 respectively. The mean ± SEM of FSH/LH ratio for the control and experimental subjects were 0.98 ± 0.01, 0.89 ± 0.02, 0.74 ± 0.03 and 0.75 ± 0.02 for control, group 1, group 2 and group 3 respectively. The comparison of the means showed significant difference (p < 0.0001). The hormonal parameters were also positively and negatively correlated amongst each. Conclusion: The evaluation of levels of the hormonal parameters across the age ranges of the population studied shows that women within the control and experimental group 1 (<20 years and 20 - 29 years) have a better chance of achieving pregnancy naturally.
References
[1]
(2010) National Guideline Clearinghouse Fertility: Assessment and Treatment for People with Fertility Problems. http://www.rcog.org.uk/womens-health/clinical-guidance/fertility-assessment-and-treatment-people-fertility-problems
[2]
Menuba, I.E., Ugwu, E.O., Obi, S.N., Lawani, L.O. and Onwuka, C.I. (2014) Clinical Management and Therapeutic Outcome of Infertile Couples in Southeast Nigeria. Therapeutics and Clinical Risk Management, 10, 763-768. https://doi.org/10.2147/TCRM.S68726
[3]
Okonofua, F.E. and Obi, H. (2009) Specialized versus Conventional Treatment of Infertility in Africa, Time for a Pragmatic Approach. African Journal of Reproductive Health, 13, 9-15.
[4]
Ombelet, W., Cooke, I., Dyer, S., Serour, G. and Devroey, P. (2008) Infertility and the Provision of Infertility Medical Services in Developing Countries. Human Reproduction Update, 14, 605-621. https://doi.org/10.1093/humupd/dmn042
[5]
Okohue, J.E., Onuh, S.O. and Ikimalo, J.I. (2013) Comparison of IVF/ICSI Outcome in Patients with Polcystic Ovarian Syndrome or Tubal Factor Infertility. Nigerian Journal of Clinical Practice, 16, 207-210. https://doi.org/10.4103/1119-3077.110164
[6]
Omoaregba, J.O., James, B.O., Lawani, A.O., Morakinya, O. and Olotu, O.S. (2011) Psychosocial Characteristics of Female Infertility in a Tertiary Health Institution in Nigeria. Annals of African Medicine, 10, 19-24. https://doi.org/10.4103/1596-3519.76567
[7]
Alvarez Nieto, C. (2006) Infertility: The Magnitude of This Problem. Revista de Enfermeria, 29, 56-62.
[8]
Garcia, J.E. and Nelson, L.H. (2019) Infertility. http://www.emedicine.com/med
[9]
Umeora, O.U., Ejikeme, B.N., Sunday-Adeoye, I. and Umeora, M.C. (2008) Sociocultural Impediments to Male Factor Infertility Evaluation in Rural Southeast Nigeria. Journal of Obstetrics and Gynaecology, 28, 23-36. https://doi.org/10.1080/01443610802044908
[10]
van Balen, F. and Bos, H.M. (2009) The Social and Cultural Consequences of Being Childless in Poor-Resource Countries. Facts, Views & Vision in ObGyn, 1, 106-121.
[11]
Dyer, S.J., Abraham, N., Mokoena, N.E., Lamard, C.J. and van der Spury, Z.M. (2005) Psychological Distress among Women Suffering from Couple Infertility in South Africa: A Quantitative Assessment. Human Reproduction, 20, 1938-1943. https://doi.org/10.1093/humrep/deh845
[12]
Cong, J., Li, P., Zheng, L. and Tan, J. (2016) Prevalence and Risk Factors of Infertility at a Rural Site of Northern China. PLoS ONE, 11, e0155563. https://doi.org/10.1371/journal.pone.0155563
[13]
Unuane, D., Tournaye, H., Velkeniers, B. and Poppe, K. (2011) Endocrine Disorders and Female Infertility. Best Practice & Research Clinical Endocrinology & Metabolism, 25, 861-873. https://doi.org/10.1016/j.beem.2011.08.001
[14]
te Velde, E.R. and Pearson, P.L. (2001) The Variability of Female Reproductive Ageing. Human Reproduction Update, 8, 141-154. https://doi.org/10.1093/humupd/8.2.141
[15]
Menken, J., Trusell, J. and Larsen, U. (1986) Age and Infertility. Science, 233, 1389-1394. https://doi.org/10.1126/science.3755843
[16]
O’Conner, K.A., Holman, D.J. and Wood, J.W. (1998) Declining Fecundity and Ovarian Ageing in Natural Fertility Populations. Maturitas, 30, 127-136. https://doi.org/10.1016/S0378-5122(98)00068-1
[17]
Naing, L., Winn, T. and Rusli, B.N. (2006) Practical Issues in Calculating the Sample Size for Prevalence Studies. Archives of Orofacial Sciences, 1, 9-14.
[18]
Broer, S.L., Eijkemans, M.J.C., Scheffer, G.J., van Rooij, I.A.J., de Vet, A. and Themmen, A.P.N. (2011) Anti Mullerian Hormone Predicts Menopause: A Long-Term Follow-Up Study in Normovulatory Women. The Journal of Clinical Endocrinology & Metabolism, 96, 2532-2539. https://doi.org/10.1210/jc.2010-2776
[19]
Smotrich, D.B., Widra, E.A. and Gindoff, P.R. (1995) Prognostic Value of Day 3 Estradiol on in Vitro Fertilization Outcome. Fertility and Sterility, 64, 1136-1140. https://doi.org/10.1016/S0015-0282(16)57974-6
[20]
Rehman, R., Jawaid, S., Gul, H. and Khan, R. (2014) Impact of Peak Estradiol Levels on Reproductive Outcome of Intracytoplasmic Sperm Injection. Pakistan Journal of Medical Sciences, 30, 986-991. https://doi.org/10.12669/pjms.305.5175
[21]
Al-Fahham, A.A. and Al-Nowainy, H.Q. (2016) The Role of FSH, LH, and Prolactin Hormones in Female Infertility. International Journal of PharmTech Research, 6, 110-118.
[22]
Sudha, G. and Reddy, K.S.N. (2013) Causes of Female Infertility: A Cross Sectional Study. International Journal of Latest Research in Science and Technology, 2, 119-123.
[23]
Huang, K.E., Bonfiglio, T.A. and Muechler, E.K. (1991) Transient Hyperprolactinaemia in Infertile Women with Luteal Phase Deficiency. Obstetrics & Gynecology, 78, 651-655.
[24]
Mutlu, M.F. and Erdem, A. (2012) Evaluation of Ovarian Reserve in Infertile Women. Journal of the Turkish-German Gynecological Association, 13, 196-103. https://doi.org/10.5152/jtgga.2012.28
[25]
Sowers, M.R., Eyvazzadeh, A.D. and McConnell, D. (2008) Antimullerian Hormone and Inhibin B in the Definition of Ovarian Aging and the Menopause Transition. The Journal of Clinical Endocrinology & Metabolism, 93, 3478-3483. https://doi.org/10.1210/jc.2008-0567
[26]
Fang, T., Zheng, S., Wang, L., Yuan, P., Li, P., Ouyang, N., Zheng, L. and Wang, W. (2015) Predictive Value of Age-Specific FSH Levels for IVF-ET Outcome in Women with Normal Ovarian Function. Reproductive Biology and Endocrinology, 13, 63. https://doi.org/10.1186/s12958-015-0056-6
[27]
Orvieto, R., Meltzer, S., Robinson, J., Gerner, O., Anteby, E.Y. and Nahum, R. (2008) Does Day 3 Luteinizing Hormone Level Predict IVF Success in Patients Undergoing Controlled Ovarian Stimulation with GNRH Analogues. Fertility and Sterility, 90, 1297-1300. https://doi.org/10.1016/j.fertnstert.2007.10.058
[28]
Regan, L., Owen, E.J. and Jacobs, H.S. (1990) Hyper Secretion of Luteinizing Hormone, Infertility, and Miscarriage. The Lancet, 336, 1141-1144. https://doi.org/10.1016/0140-6736(90)92765-A
[29]
Reinthaller, A., Deutinger, J., Csaicsich, P., Riss, P., Muller-Tyl, E., Fischl, F. and Janisch, H. (1987) Effect of Serum Prolactin on Cycle Stimulation and Fertilization of Human Oocytes. Geburtshilfe und Frauenheilkunde, 47, 246-248. https://doi.org/10.1055/s-2008-1035816
[30]
Ekwempu, C.C., Ekwempu, I.A., Adinoyi, A.D., Gofwen, D., Surajudeen, A.J. and Okonkwo, P.O. (2017) Relevance of Serum LH/FSH/Prolactin and Anti Mullerian Hormone Estimation in In-Vitro Fertilization. European Journal of Pharmaceutical and Medical Research, 4, 138-142.
[31]
Liu, K. and Greenbalt, E. (2008) Elevated Day 3 Follicle Stimulating Hormone/Luteinizing Hormone Ratio > or = 2 Is Associated with Higher Rates of Cancellation in In Vitro Fertilization, Embryo Transfer Cycles. Fertilization and Sterility, 90, 297-301. https://doi.org/10.1016/j.fertnstert.2007.06.038
[32]
Barbakadze, L., Kristesashvili, J., Khonelidze, N. and Tsagareishvili, G. (2015) The Correlations of Anti-Mullerian Hormone, Follicle-Stimulating Hormone and Antral Follicle Count in Different Age Groups of Infertile Women. International Journal of Fertility and Sterility, 8, 393-398.
[33]
Bala, J., Agrawal, Y., Seth, S., Goyal, V. and Kumar, P. (2014) Correlation between Anti-Müllerian and Follicle-Stimulating Hormone in Female Infertility. International Journal of Health & Allied Sciences, 3, 232-236. https://doi.org/10.4103/2278-344X.143060
[34]
de Vet, A., Laven, J.S., de Jong, F.H., Themmen, A.P. and Fauser, B.C. (2002) Antimullerian Hormone Serum Levels: A Putative Marker for Ovarian Aging. Fertility and Sterility, 77, 357-362. https://doi.org/10.1016/S0015-0282(01)02993-4
[35]
Burger, H.G., Dudley, E.C., Hopper, J.L., Groome, N., Guthrie, J.R. and Green, A. (1999) Prospectively Measured Levels of Serum Follicle-Stimulating Hormone, Estradiol, and The dimeric Inhibins during the Menopausal Transition in a Population-Based Cohort of Women. The Journal of Clinical Endocrinology & Metabolism, 84, 4025-4030. https://doi.org/10.1210/jcem.84.11.6158
[36]
Jamil, Z., Fatima, S.S., Ahmed, K. and Malik, R. (2016) Anti-Mullerian Hormone. Above and Beyond Conventional Ovarian Reserve Markers. Disease Markers, 2016, Article ID: 5246217. https://doi.org/10.1155/2016/5246217
[37]
Broekmans, F.J., Kwee, J., Hendriks, D.J., Mol, B.W. and Lambalk, C.B. (2006) A Systemic Review of Test Predicting Ovarian Reserve and IVF Outcome. Human Reproduction Update, 12, 685-618. https://doi.org/10.1093/humupd/dml034
[38]
Majumdar, A. and Mangal, N.S. (2013) Hyperprolactinaemia. Journal of Human Reproductive Sciences, 6, 168-175. https://doi.org/10.4103/0974-1208.121400
[39]
Mukhejee, T., Copperman, A.B., Lapinski, R., Sandler, B., Bustillo, M. and Grunfeld, L. (1996) An Elevated Day 3 Follicle Stimulating Hormone: Luteinizing Hormoneration (FSH:LH) in the Presence of a Normal Day 3 FSH Predicts a Poor Response to Controlled Ovarian Hyperstimulation. Fertility and Sterility, 65, 588-593. https://doi.org/10.1016/S0015-0282(16)58159-X
[40]
Kofinas, J.D. and Elias, R.T. (2014) Follicle-Stimulating Hormone/Luteinizing Hormone Ratio as an Independent Predictor of Response to Controlled Ovarian Stimulation. Women’s Health, 10, 505-509. https://doi.org/10.2217/WHE.14.31
