Received July 24, 2020
Accepted January 13, 2021

Objective: To evaluate the influence of LH, LHR, GDF9, FSHR, AMH, AMHR2 and BMP15 polymorphisms, which are related to follicular development, in decreasing the ovarian response in women undergoing controlled ovarian hyperstimulation (COH) for IVF. Methods: A case-control study matched by age with up to three or four controls per case in women undergoing COH. The controls were women with a normal ovarian response (NOR), and the cases were women with a poor ovarian response (POR) in oocyte collection (three 3 or fewer oocytes). We performed DNA extraction of peripheral blood and evaluate the association of gene polymorphisms that were related to follicular development: LH, LHR, GDF9, FSHR, AMH, AMHR2 and BMP15. Results: In total, 66 patients were eligible, including 52 in the NOR group and 14 in the POR group. Two polymorphisms of GDF9 were associated with the follicular response after COH. One was associated with POR: the presence of a mutant polymorphism in heterozygosis and homozygosis of the GDF9 398-39 (C to G) [23% NOR versus 68% POR (OR 4.01, IC 1.52-10.6, P 0.005)]; and the other was associated with a protective response: the presence of normal homozygosis of GDF9 (C447T) [19.2% NOR versus 50% POR (OR 0.34, IC 0.14-0.84, P 0.019)]. There was no association of the other polymorphisms studied with POR. Conclusions This analysis found that GDF9 appears to play an important role in follicular development, whereas polymorphisms in its DNA chain may negatively influence the ovarian reserve as 398-39 (C to G) or positively as C447T.