OVARIAN RESPONSE TO RECOMBINANT HUMAN FOLLICLE-STIMULATING-HORMONE INLUTEINIZING HORMONE-DEPLETED WOMEN - EXAMINATION OF THE 2 CELL, 2 GONADOTROPIN THEORY
A. Benchetrit et al., OVARIAN RESPONSE TO RECOMBINANT HUMAN FOLLICLE-STIMULATING-HORMONE INLUTEINIZING HORMONE-DEPLETED WOMEN - EXAMINATION OF THE 2 CELL, 2 GONADOTROPIN THEORY, Fertility and sterility, 65(4), 1996, pp. 711-717
Objective: To evaluate the relative contribution of FSH to ovarian est
rogen production. Design: Nonrandomized, prospective study. Setting: U
niversity of Toronto teaching hospital reproductive biology unit. Pati
ents: Five women who had been treated with depot GnRH agonist with hor
monal add-back for 4 to 48 months and who were confirmed to be gonadot
ropin depleted by both bioassay and RIA. Interventions: Subjects recei
ved 75 IU SC recombinant human FSH daily for 7 days followed by 150 IU
daily for 7 days and 225 IU daily for the third week. Main Outcome Me
asure: Serum steroid determination and vaginal sonography for follicle
size and endometrial thickness were performed serially and follicular
fluid hormone levels were measured in two subjects. Results: Bioactiv
e LH and FSH activity were less than the detection limit of the assay
(0.1 mIU/mL; conversion factor to SI units, 1.00 for LH and FSH) befor
e recombinant FSH treatment in all five women. In al subjects, at leas
t one preovulatory follicle developed by the end of two to three weeks
. Endometrial thickness increased to between 7 and 9 mm in four women.
Mean serum E(2) in the five subjects increased from 17 pg/mL (range:
5 to 33 pg/mL; conversion factor to SI unit, 3.671) at baseline to 230
pg/mL (range: 37 to 489 pg/mL) at the end of the study. Follicular fl
uid E(2) concentrations ranged from 44,296 to 69,367 pg/mL in the four
follicles aspirated. Conclusion: Our results indicate that LH is not
necessary for ovarian E(2) production. We speculate that the granulosa
cells, in the absence of detectable LH bioactivity, can use circulati
ng adrenal androgens or constitutive or FSH-stimulated thecal androgen
s, to produce intrafollicular E(2).