title: Follistatin during pregnancy and its potential role as an ovarian suppressing agent.
abstract: OBJECTIVE
  Ovarian quiescence is a common condition during pregnancy. In vitro, follistatin, an antagonist of follicle-stimulating hormone, blocks follicular development at early stages, and its serum levels increase during pregnancy. A possible surrogate biomarker of ovarian arrest during pregnancy is a decrease in anti-mullerian hormone (AMH) levels followed by an increase in these levels on the second day after labor. The purpose of this study was to determine whether follistatin could act as an ovarian-suppressing agent during pregnancy. Follistatin levels and AMH levels were determined at various stages of pregnancy and postpartum.
  
  
  METHODS
  The follistatin and AMH levels of 69 patients were retrospectively determined with the AMH Gen II ELISA and with the Human Follistatin Quantikine ELISA Kit. For 49 patients, samples were available from various trimesters for cross-sectional analysis; for the other 20, samples were available longitudinally from day one before labor and then daily on days 1 through 4 after labor. Statistical significance was determined with linear regression, the Friedman rank sum test and the Wilcoxon-Nemenyi-McDonald-Thompson post hoc test.
  
  
  RESULTS
  The behavior of follistatin levels was exactly opposite that of AMH levels: Follistatin levels increased significantly during pregnancy and on the first day after parturition but declined afterwards, whereas AMH levels decreased significantly during pregnancy and increased after labor.
  
  
  CONCLUSIONS
  Follistatin can induce ovarian arrest during pregnancy.
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. Electronic address: angela.koeninger@uk-essen.de.
authors.forename: Angela
authors.initials: A
authors.lastname: Köninger
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Börge
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Damaske
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Cahit
authors.initials: C
authors.lastname: Birdir
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Enekwe
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kimmig
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, University of Heidelberg, Voßstrasse 9, 69115 Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Strowitzki
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gellhaus
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005640:Follicle Stimulating Hormone / Q000037:antagonists & inhibitors*; D038681:Follistatin / Q000097:blood*; D006801:Humans; D049590:Postpartum Period / Q000097:blood; D011247:Pregnancy / Q000097:blood*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D038681:Follistatin; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
keywords: Anti-mullerian hormone; Follistatin; Ovarian quiescence; Pregnancy