Inhibin is an important hormone for male and female reproductive health. It is involved in the development of reproductive organs, fertility, pregnancy, and menopause, to name a few. It also serves as a diagnostic marker for a variety of body functions and conditions. Read on to learn more about the roles of inhibin and conditions associated with high and low levels of this hormone.
What Is Inhibin?
In turn, inhibin ultimately suppresses the production and release of FSH from the pituitary gland .
Reproductive organs are the main source of inhibin, although it can also be found in the prostate, brain, and adrenal glands .
Activin is another sex hormone that increases FSH and gonadotropin-releasing hormone (GnRH) production. Inhibins suppress this increase in FSH and GnRH by blocking the binding of activin to its receptors .
There are two forms of inhibin, inhibin A and B .
Inhibin A and B
Inhibins are protein complexes with two units linked to each other. These are called inhibin A and B .
Blood inhibin A and B levels vary throughout the menstrual cycle. Inhibin A levels are highest during the late follicular and luteal phases of a normal menstrual cycle, whereas inhibin B dominates in the early and mid follicular phases and declines in the late follicular phase [11, 12].
In contrast, males only produce inhibin B, which is produced in the testis by the Sertoli cells. Inhibin B production and secretion changes during the development of testis, and inhibin B increases or decreases the secretion of FSH depending on the sperm production process [R, R].
FSH stimulates the production of inhibin by the granulosa cells of the ovaries and the Sertoli cells of the testes .
Other factors that increase inhibin production include:
Factors that reduce inhibin production include:
Roles of Inhibin
1) Inhibin Maintains Male Reproductive Function
Inhibin B, which is produced in the testis by the Sertoli cells, is the active form of inhibin in men. As blood inhibin B levels increase, FSH levels decrease. Higher blood levels of inhibin B increase the number of Sertoli cells and sperm production in healthy fertile males [19, 9].
2) Inhibin Increases Sperm Production
In a study with nearly 1,800 fertile men, elevated blood inhibin B levels were associated with increased sperm count and concentration .
3) Normal Ebb and Flow of Inhibin is Important for Fertility
In women, inhibins A and B have a different pattern of secretion throughout the menstrual cycle .
Also, inhibin levels during pregnancy are higher than those during a normal menstrual cycle .
Because inhibins are produced by the placenta and fetal membranes, they may be used to diagnose fertility problems and early pregnancy .
A mutation in inhibin gene is associated with premature ovarian failure (POF). This causes a reduction in inhibin B activity, and thus, inhibin B levels are used to detect POF and ovarian recovery in women with hypothalamus-associated problems [26, 27].
Additionally, both inhibin A and B can be used to assess the function of the ovaries in patients with Turner syndrome, a genetic disorder .
4) Inhibin Increases Ovarian Health
Ovarian reserve is the ability of the ovaries to produce egg cells capable of fertilization for a successful pregnancy. Decreased inhibin B levels were seen in women with declining ovarian reserve [28, 29].
Women with low blood inhibin B levels also showed a reduced response to ovulation stimulation and a decreased chance of becoming pregnant, naturally or with assisted reproduction .
Inhibins enhance the health and development of ovarian follicles. Higher levels of inhibin A and B in the follicular fluid also increase pregnancy rates .
5) Inhibin May Be Involved in Eye Development
In the developing mouse eye, inhibin was seen in the lens and the cells between the lens and optic disc. It was also found in various cell layers of the retina. These results suggest that inhibin may be involved in the development of the retina .
Similarly, in the adult rat eye, a subunit of inhibin (α-subunit) was detected in cells of the retina that respond to light .
6) Inhibin May Reduce Blood Cell Production
Inhibins reduce human blood cell production by suppressing the activity of human bone marrow cells .
Decreased production of bone marrow and splenic cells was seen after inhibin injection (in the vein) in mice .
Conditions Associated with Low Inhibin Levels
1) Inhibin in Ectopic Pregnancy
An ectopic pregnancy occurs when the fertilized egg attaches itself to sites other than the uterus. Reduced maternal blood inhibin levels were seen in ectopic pregnancies compared to normal pregnancies .
Similarly, another study found lower blood inhibin A levels in patients with ectopic pregnancies and abnormal pregnancies involving miscarriage. These results indicate that inhibin levels may be used as a marker for the ectopic or abnormal pregnancies .
2) Inhibin Plays a Role in Menopause
In women over 40 years with periods, high levels of FSH were only linked to reduced blood inhibin B levels but not inhibin A levels .
3) Premature Ovarian Failure (POF) and Inhibin
POF is a condition associated with loss of menstruation, infertility, and increased sex hormone levels in women under the age of 40. In these women, blood inhibin A and B levels are lower, while FSH is higher [41, 42].
4) Inhibin Reduces Bone Activity
The bone activity of removal and replacement of bone takes place throughout the body. Bone mass is maintained by a balance of bone formation and bone loss. Inhibin suppressed both of these activities in mice bone marrow [43, 44].
Low blood inhibin levels were associated with increased markers of bone formation and bone loss in pre- and perimenopausal women .
However, in mice, high levels of inhibin A increased bone mass and strength .
5) Inhibin and Male Infertility
Inhibin B is important for Sertoli cell development and sperm production .
Low levels of inhibin B reduce sperm production and can lead to testicular problems . Thus, inhibin B is useful in predicting male infertility.
In a clinical study of 160 males, blood inhibin B levels were used as a marker for male infertility .
Conditions Associated with High Inhibin Levels
1) Inhibin Detects Ovarian Cancer
Inhibin B is the major form of inhibin secreted by granulosa cell tumors .
Total inhibin levels were elevated in six postmenopausal women with granulosa cell tumors .
Blood levels of inhibins were also raised in women with mucin-producing epithelial cell cancers .
2) Inhibin Can Predict Pregnancy Loss
Blood inhibin A levels increase over the course of pregnancy. They remain low during the first and second trimesters and then rise during the third trimester .
Thus, inhibin A may be useful in predicting spontaneous abortion and early pregnancy loss.
Inhibin A may also predict the survival of the fetus during early pregnancy in women undergoing in vitro fertilization (IVF). Increased pregnancy loss was seen in women with lower blood inhibin A after IVF [58, 59].
3) Inhibin Acts as a Tumor Marker
Inhibin is secreted by all granulosa cell tumors of the ovary and can be used as a tumor marker to determine response to therapy .
However, women with breast cancer that underwent surgery showed a decrease in blood inhibin levels, indicating that these tumors may be secreting inhibins .
Inhibins can be also be used as a marker to diagnose breast cancer in postmenopausal women. In these women, inhibin levels were already very low, thus any changes in inhibin levels were useful in the detection of a tumor .
4) Inhibin Detects Down Syndrome
The risk of having a child with Down syndrome is highest among women over 35 years of age .
Inhibin A is used in the test performed to predict the risk of Down syndrome .
5) Inhibin Detects Preeclampsia
Blood inhibin A levels were increased in women with preeclampsia compared to those with a normal pregnancy .
Elevated maternal inhibin A levels are also associated with increased severity of preeclampsia .
Normal Blood Levels of Inhibin
Inhibin A levels: < 2 pg/ml
Inhibin B levels: Infertile men 78 pg/mL; Fertile men 138 pg/mL 
Inhibin A levels: Premenopausal women 2-80 pg/ml; Postmenopausal women is < 5 pg/ml 
Inhibin B levels: Premenopausal women <200 pg/ml; Postmenopausal women is < 15 pg/ml 
In pregnant women
Inhibin A: 1.8- 2.31 ng/mL (week 8); 2 ng/mL (weeks 8-24); 24-30 ng/mL by (week 38) 
Inhibin B: <12 pg/ml (week 5-16); 19-31 pg/ml (week 36) 
You May Have Too Little of this Hormone if:
- You are in menopause 
- Have hot flashes 
- You have irregular or absent menstrual periods [77, 41]
- Are infertile or have difficulty getting or staying pregnant [24, 29, 57]
*Because inhibin levels vary throughout the menstrual cycle, inhibin levels in premenopausal women should be interpreted carefully.
*It is important to note that these symptoms or conditions do not necessarily indicate lower or higher blood inhibin levels. A blood test must be used to determine these levels and the results should always be discussed with a doctor.
You May Have Too Much of this Hormone if:
- You have pregnancy complications like pre-eclampsia [6, 81]
- You have PCOS (polycystic ovarian syndrome)
- You have ovarian cancer 
For males: Little is known about how higher levels of inhibin affect males 
Ways to Decrease Inhibin
Biological Substances that Decrease Inhibin
Treatments that Decrease Inhibin
- Hypophysectomy: Surgically removing the pituitary gland in rats led to a decrease in blood inhibin levels 
Ways to Increase Inhibin
Biological Substances that Increase Inhibin
Treatments that Increase Inhibin
- Varicocele Treatment: Varicocele (varicose veins on the scrotum) treatment increased blood inhibin b levels in infertile men .
- Human chorionic gonadotropin (hCG) treatment: HCG treatment in healthy men significantly increased blood inhibin levels .