POLYCYSTIC-OVARY-SYNDROME - ANOMALIES IN PROGESTERONE PRODUCTION

The underlying cause of anovulation and miscarriage in polycystic ovar y syndrome (PCOS) is unknown, Progesterone may play an important role in oocyte fertilization and embryo implantation, Therefore, in this st udy we analyse the endocrine function of luteinizing granulosa cells t o synthesize progesterone in vivo and in vitro in PCOS and normal pati ents participating in an in-vitro fertilization programme, Human lutei nizing granulosa cells were obtained from 10 patients with normal ovar ies (controls) and 10 patients with PCOS by follicular aspiration of i ndividual follicles of each patient and pooled in an attempt to obtain three groups: cells from follicle sizes less than or equal to 10, >10 less than or equal to 15 and greater than or equal to 16, Serum conce ntrations of oestradiol and progesterone on the day of human chorionic gonadotrophin (HCG) injection were significantly higher (P < 0.01 and P < 0.05) in PCOS patients than in controls, After HCG stimulation, i n-vitro progesterone production was enhanced in granulosa cells of the control group and concentrations increased with follicular size as ex pected. However, the concentration of progesterone of PCOS patients di d not increase with follicular size and there was a significant differ ence between normal and PCOS groups in follicles >10 less than or equa l to 15 mm (P < 0.05) and greater than or equal to 16 mm (P < 0.01), O estradiol production was increased in follicles greater than or equal to 16 mm in both groups, although this did not reach significance, In summary, it seems that PCOS granulosa cells demonstrate an abnormal ca pacity to synthesize progesterone in vivo and in vitro, The understand ing of granulosa cell function in PCOS may explain the anovulation and miscarriage that occurs in these patients.