THE SIGNIFICANCE OF ELEVATED BASAL FOLLICLE-STIMULATING-HORMONE IN REGULARLY MENSTRUATING INFERTILE WOMEN

Elevated plasma follicle stimulating hormone (FSH) during the reproduc tive life is an early manifestation of ovarian ageing. The presence of elevated basal FSH in young, regularly menstruating women may represe nt a stage of menopausal transition consequent on premature ovarian fa ilure. A total of 48 regularly menstruating, infertile women aged <40 years, with high FSH and aged-matched controls with normal FSH underwe nt detailed monitoring of endocrine and follicle growth during one com plete menstrual cycle. During the same cycle, detailed immunological s creening was performed and the epidemiological features of all subject s were also reviewed. Subjects in the high FSH group had significantly higher basal FSH, luteinizing hormone (LH) and follicular phase LH co ncentrations. Despite their normal preovulatory oestradiol production, the high FSH group showed significantly slower follicular growth, sma ller follicle diameter and lower luteal phase salivary progesterone. A h these features have been described in older women during their menop ausal transition. In addition, the prevalence of autoimmune antibodies was significantly higher in the high FSH group. This study suggests t hat infertile women with elevated FSH are in their perimenopause despi te having regular ovulatory and apparently normal cycles. An autoimmun e basis is suggested as a factor underlying their premature ovarian fa ilure. Further endocrinological and autoimmunological follow-up is rec ommended.