OVARIAN HYPERSTIMULATION AUGMENTS ADRENAL DEHYDROEPIANDROSTERONE-SULFATE SECRETION

Objective: To determine if factor(s) secreted by the ovaries during hy perstimulation potentiate basal and ACTH-stimulated adrenal androgen s ecretion. Design: Retrospective and prospective clinical study. Settin g: University tertiary care center infertility clinic. Participants: T wo hundred thirteen hyperstimulation cycles in endocrinologically norm al women were identified from 92 patients with ovulatory infertility, aged 25 to 45 years. Further, seven endocrinologically normal infertil e women, aged 22 to 37 years, who were undergoing empiric ovarian hype rstimulation for infertility were identified and studied. Intervention s: In the previously performed cycles, basal and peak serum DHEAS and cortisol (F) levels were assayed and compared with each other and to t he extant E(2) levels. Additionally, at the baseline and the peak of o varian hyperstimulation cycles, a standard ACTH test was performed and serum was assayed for DHEAS, DHEA, and F. Main Outcome Measure: Basal and ACTH-stimulated serum DHEAS, DHEA (prospective part only), and F concentrations. Where applicable, mean peak values were generated and compared between the baseline and the peak of stimulation with or with out a correction for intrapatient variability in F secretion. Results: Basal serum DHEAS levels rose with ovarian hyperstimulation independe nt of F. Post-ACTH mean peak value concentrations rose with ovarian hy perstimulation for DHEAS but not DHEA or F. Conclusions: Ovarian hyper stimulation potentiates basal and ACTH perturbed adrenal DHEAS secreti on. This implies the existence of a humoral ovarian factor(s) that med iate this ovarian-adrenal cross-talk.