Expression of steroidogenesis pathway genes in cumulus cells from women with diminished ovarian reserve after gonadotropin administration: A case-control study.

Background: Women with diminished ovarian reserve (DOR) respond differently to gonadotropin medications.

Objective: This study investigates the relationship between effective gene expression in the steroidogenesis pathway and gonadotropin responsiveness in DOR.

Materials and methods: In this case-control study, cumulus cells were obtained from women with DOR after gonadotropin administration (n = 20) and normal ovarian reserve (n = 20). They were divided into the following groups, oocyte number $<$ 3 and oocyte number $>$ 3. After RNA extraction and cDNA synthesis, quantitative polymerase chain reaction was performed to assess the expression levels of cytochrome P450 aromatase (CYP19A1), protein kinase A(PKA), and glycogen synthase kinase 3 beta (GSK3B)genes.

Results: The women with DOR had statistically significant lower expression of CYP19A1 and PKA genes in their cumulus cells compared to control group (p = 0.04, and p $<$ 0.001, respectively). There was also lower expression of the GSK3B gene in DOR compared to control group, but it was not significant. Although the expression of the CYP19A1, PKA, and GSK3B genes was lower in women with $<$ 3 oocytes compared to women with more oocytes, this difference was not statistically significant.

Conclusion: In conclusion, DOR may be associated with lower expression of CYP19A1 and PKA genes. Also, considering the decrease in the expression of these genes in people with DOR, the expression of these genes can be used as a tool to predict the treatment.