Follicle luteinization in hyperandrogenic follicles of polycystic ovary syndrome patients undergoing gonadotropin therapy for in vitro fertilization

被引:58
作者
Foong, Shu C.
Abbott, David H.
Zschunke, Michael A.
Lesnick, Timothy G.
Phy, Jennifer L.
Dumesic, Daniel A.
机构
[1] Reprod Med & Infertil Assoc, Woodbury, MN 55125 USA
[2] Univ Wisconsin, Dept Obstet & Gynecol, Madison, WI 53792 USA
[3] Univ Wisconsin, Natl Primate Res Ctr, Madison, WI 53715 USA
[4] Mayo Clin, Dept Obstet & Gynecol, Rochester, MN 55905 USA
[5] Mayo Clin, Dept Biostat, Rochester, MN 55905 USA
[6] Mayo Clin, Dept Expt Pathol, Rochester, MN 55905 USA
关键词
D O I
10.1210/jc.2005-2142
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Context: Polycystic ovary syndrome (PCOS) is a reproductive disorder of ovarian hyperandrogenism and insulin resistance characterized by abnormal luteinization of small follicles. After exposure to GnRH analog/FSH stimulation for in vitro fertilization (IVF), however, it is unclear whether such PCOS follicles remain abnormally luteinized during the resumption of oocyte maturation in vivo. Objective: The aim of this study was to determine whether PCOS follicles exposed to GnRH analog/FSH stimulation for IVF show abnormal luteinization. Design: This study was a prospective cohort. Setting: The setting was an institutional practice. Patients: Eleven PCOS and 30 normoandrogenic ovulatory women were included. Intervention(s): All subjects received GnRH analog/FSH therapy after basal serum hormone determinations. Main Outcome Measure(s): Follicle fluid aspirated at oocyte retrieval from the first follicle of each ovary was assayed for gonadotropins, steroids, insulin, and glucose. LH receptor mRNA expression was determined in granulosa cells of the same follicle. Results: In PCOS patients with basal hyperandrogenemia and hyperinsulinemia, total oocyte number was increased and follicle diameter was decreased, despite normal maximal serum estradiol levels. Within PCOS follicles, progesterone levels were reduced (P < 0.01), despite comparable bioactive LH and insulin levels and granulosa cell LH receptor mRNA expression; estradiol levels were normal, despite diminished FSH availability (P < 0.004). Elevated androstenedione (P < 0.01), testosterone (P < 0.001), and glucose (P < 0.01) levels also occurred. In PCOS follicles containing mature oocytes, however, elevated androgen levels were accompanied by both normal progesterone concentrations and a normal inverse relationship between glucose depletion and lactate accumulation. Conclusion: Hyperandrogenic follicles with mature oocytes from PCOS women receiving GnRH analog/recombinant human FSH therapy for IVF show sufficient glucose utilization for normal luteinization.
引用
收藏
页码:2327 / 2333
页数:7
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