Women with reduced ovarian reserve or advanced maternal age have an altered follicular environment

Objective: To determine whether altered follicular environment is associated with ovarian reserve or maternal age. Design: Prospective study examining follicular fluid (FF) composition and follicular cell metabolism. Setting: University research department and private IVF clinic. Patient(s): Women (n = 54) undergoing routine IVF treatment were allocated to one of three groups based on ovarian reserve and maternal age. Intervention(s): Surplus FF, granulosa cells (GC), and cumulus cells (CC) were collected. Main Outcome Measure(s): Follicular fluid concentrations of carbohydrates, hormones, and selected ions. Metabolic analysis and gene expression of GCs and CCs. Result(s): Compared to women <35 years with normal ovarian reserve, FF glucose levels were significantly decreased and lactate and progesterone (P4) concentrations significantly increased in women with reduced ovarian reserve or advanced maternal age, whereas GC and CC glucose uptake, lactate production, and phosphofructokinase platelet gene expression were significantly increased. Granulosa cell P4 production from women with reduced ovarian reserve or advanced maternal age was decreased; however, in CCs the reverse was observed with increased gene expression in P4 receptor, prostaglandin E receptor-2, cytosolic phospholipase A2, and tumor protein 53. Conclusion(s): Women with either reduced ovarian reserve or advanced maternal age have altered follicular cell metabolism, FF metabolites, and P4 production. This perturbed environment may be responsible for impaired oocyte developmental competence and subsequent embryo development. (Fertil Steril (R) 2012;98:986-94. (C)2012 by American Society for Reproductive Medicine.)