Background: Granulosa cells produce most ovarian function indicators in infertile women. FSH, estradiol, AMH, and inhibin B are these indicators. Female peptide hormone insulin-like factor 3 is novel. INSL3 was formerly considered a male hormone. It is produced by Leydig cells and is a biomarker of their performance.

Aim: to investigate how INSL3 levels may be linked to the number and quality of oocytes, fertilization rate, embryo quality, and the success of pregnancy in women undergoing fertility treatments.

Materials, and Method: In this cross-sectional study, 75 infertile couples were chosen in advance based on certain criteria at Al-Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies from October 2022 to April 2023. For the ICSI cycle, the antagonist protocol was used to control how much the ovaries were stimulated. Based on the levels of INSL3 in the serum on the second day of the menstrual cycle and in the follicular fluid on the day of oocyte retrieval, a comparison was made with other markers of ovarian reserve (AFC, FSH, E, and AMH) and ICSI cycle outcomes, such as the number and quality of oocytes retrieved, the number and quality of embryos, the pregnancy rate, and other things.  Researchers looked at the connection between INSL3 levels in serum and follicular fluid, I. A test called an Enzyme-Linked Immunosorbent Assay was used to find out how much INSL3 there was.

Results: The study involved 75 infertile Iraqi women undergoing intracytoplasmic sperm injection (ICSI), and 28.0% of them achieved pregnancy. INSL3 was detected in both serum and follicular fluids of all patients. Positive significant correlations were found between serum INSL3 levels and anti-mullerian hormone (AMH) and testosterone. Moreover, significant positive correlations were observed between serum INSL3 levels and antral follicle count,. However, there was no significant difference in follicular fluids INSL3 levels according to body mass indices.There was a positive but insignificant correlation between serum INSL3 and follicular fluids INSL3. The study did not find significant differences in serum and follicular fluids INSL3 levels between females with primary and secondary infertility. Serum INSL3 levels significantly differed among patients with different causes of infertility, but there was no association between follicular fluids INSL3 and causes of infertility.

In conclusion: The study provides compelling evidence for the significant role of INSL3 in female fertility and its association with the success of intracytoplasmic sperm injection (ICSI) in infertile Iraqi women. The presence of INSL3 in both serum and follicular fluids underscores its importance in the reproductive process, particularly in the context of assisted reproductive techniques like ICSI. Positive correlations between serum INSL3 levels and anti-mullerian hormone (AMH) and Antral follicle count AFC indicate its potential involvement in ovarian reserve and hormonal regulation, further highlighting its relevance to female reproductive health.

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Keywords: Theca Cell Marker Insulin-Like Factor 3; ICSI; Follicular