Inhibin B as Marker of Androgen Insufficiency in Women of Reproductive Age With Sexual Dysfunction

Abstract

According to the Princeton Consensus, female sexual dysfunction can be a sign of androgen deficiency (AD) in women of reproductive age, which necessitates the inclusion of appropriate therapy in fertility rehabilitation protocols for patients with biochemically confirmed AD. Most often, AD is associated with ovarian dysfunction. With ovarian hypofunction of autoimmune origin, an increase in inhibin B production occurs, in contrast to ovarian insufficiency of another etiology, which is due to selective damage to theca interna cells, while granulosa cells synthesizing inhibin B remain intact. Aim of the research. The study of the value of inhibin B as a prognostic marker of fertility recovery in women with androgen deficiency and sexual dysfunction. Materials and methods. The study design included 77 women of reproductive age of the main group with sexual dysfunction and androgen deficiency: 45 women with sexual dysfunction and the presence of thyroperoxidase Ak (I-a group), I-b group of 32 women with sexual dysfunction without antibodies to any organism tissues. Control group – 31 healthy women of reproductive age. Diagnostic laparoscopy was performed on anOLYMPUS device using a standard technique. Hormone testing was performed using a Johnson & Johnson Vitros automated system. Blood samples for the study were taken in the morning (8–11) on an empty stomach with venipuncture of the ulnar vein in the 1st phase of the menstrual cycle. Ultrasound test was performed on an Aloka Hitachi apparatus (Japan) with a sensor frequency of 7 MHz. Sexual dysfunction was determined by the Skindex-16V questionnaire. The diagnosis of the examined “Violation of female sexual desire / arousal” was done according to the classification DSM-5. Clinical manifestation of sexual dysfunction was >6 months. Results. The average age of the examined main group was 32.3±1.7 years, in the control group – 33.9±1.6 years. The average age of menarche for women of both groups was 13–14 years (in the main 13.3±0.34, in the control – 13.0±0.23 (p>0.05). The study of the hormonal background showed a pronounced, statistically significant in compare with healthy women, a decrease in the concentrations of not only estradiol, but also androgens, total testosterone, free testosterone, as well as dehydroepiandrosterone sulfate. Concentrations of sex steroids directly and statistically significantly correlated with the I-a group with concentrations of gonadotropins (luteinizing hormone (LH) and estradiol r=0.67; follicle-stimulating hormone (FSH) and estradiol r=0.64; LH and total testosterone r=0.47; FSH and total testosterone r=0.42; for all p <0.001). LH and DHEA-S p=0 <33 (p=0 <02), FSH and DHEA-S p=0<27 (p=0 <03). In group I-b, LH correlation and total testosterone r=0.58 p<0.001 were noted. Diagnostic laparoscopy with ovarian biopsy was performed in 12 women of group I-a and group 23 of group I-b. At the same time, the presence of lymphoid infiltration, autoantibodies and complement on growing follicles was established, with primordial and primary follicles intact. Tissue fibrosis, the presence of activated B and T lymphocytes: CD8+, CD4+, natural killer cells (NK), polyclonal plasmocytes, macrophages of primordial and primary follicles were characteristic for group I-b. Conclusions. The level of inhibin B can serve as an early marker of autoimmune ovarian damage in women of reproductive age with female sexual dysfunction. Therapy of androgen deficiency should be carried out taking into account the pathogenesis of the disease.