Serum Follicular Fluid Growth Differentiation Factor 9 (GDF-9) and Bone Morphogenic Protein 15 (BMP-15) as Markers of Ovarian Reserve

Background: Growth differentiation factor (GDF-9) and bone morphogenic protein (BMP-15) (GDF-9 co-factor) are proteins that are released by oocytes and control key stages of follicular development and growth.Objectives: To determine the ability of serum follicular fluid GDF-9 and BMP-15 in predicting ovarian reserve represented by their correlations with female age, traditional markers; antral follicle count (AFC) and anti-mullerian hormone (AMH).Materials and Methods: In this prospective cohort study, 114 infertile females from the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Baghdad, Iraq, were included. Their age was 18-43 years old and their body mass index (BMI) was 19-30 Kg/m2. All were assessed on the second day of the menstrual cycle. Serum was taken to measure GDF-9 and BMP-15 using a special Kit by ELIZA. Following oocyte retrieval, follicular fluid was collected for measuring GDF-9 and BMP-15.Results:The serum and follicular fluid GDF-9 and BMP-15 showed a significant correlation with the age of the patient, while there was no such association with AMH. Significant positive correlations were found between serum and follicular fluid GDF-9 and AFC, while only follicular fluid GDF-9 exhibited a significant positive correlation with mature II (MII) oocytes number. While, significant positive correlations were found between follicular fluid BMP-15 and the total number of oocytes.Conclusions: Serum follicular fluid GDF-9 and BMP-15 can be good predictors of ovarian reserve due to their significant negative correlations with age (oocyte quality) and significant positive correlations with AFC (quantity). Follicular fluid GDF-9, serum and follicular fluid BMP-15 can predict oocyte maturity.