Intrafollicular Activin-A, Inhibin-B, and Follistatin may predict invitro fertilization outcomesin subfertile women.

Purpose Follicular microenvironment influence soocyte and embryo quality and therefore plays a critical role in assisted reproduction therapy outcomes. This study prospectively evaluated the association between follicular fluid (FF) concentrations of activin-A, follistatin,and inhibin-B and in vitro fertilization (IVF) outcome parameters. Methods Couples with primary infertility attending an Assisted Conception Unit in Athens, Greece, were recruited as part of an ongoing prospective cohort study evaluating the impact of dietary and lifestyle patterns on fertility. FF levels of activin-A, follistatin, and inhibin-B were measured in 86 women undergoing IVF/ICSI cycles, along with assessments of oocyte yield and quality, embryo number and quality, implantation success, clinical pregnancy, and live birth rates. FF samples were collected at oocyte retrieval from follicles ≥ 18 mm in diameter and analyzed using enzyme-linked immunosorbent assay. Associations between FF biomarkers and IVF outcomes were assessed using correlation analyses and multivariable-adjusted regression models. Results FF activin-A concentrations were positively correlated with both follistatin and inhibin-B levels (P < 0.001), while FF follistatin and inhibin-B levels were significantly associated with oocyte and embryo number and quality (P < 0.05). Multivariable-adjusted relative risk analyses demonstrated that higher FF activin-A levels were independently associated with improved reproductive outcomes. Specifically, each 10 pg/mL increase in FF activin-A was associated with a 58% higher likelihood of successful implantation [relative risk (95% confidence intervals) = 1.58 (1.03–2.45)] and a 69% higher likelihood of achieving a clinical pregnancy [1.69 (1.08–2.62)]. Conclusion In conclusion, FF activin-A, follistatin and inhibin-B levels may serve as predictive biomarkers of IVF outcomes in women undergoing assisted reproductive treatment.