Apoptosis as a function of ovarian reserve in women undergoing in vitro fertilization

Objective: To test the hypothesis that preovulatory follicles from women with diminished ovarian reserve contain fewer numbers of luteinized granulosa cells and have a greater percentage of cells undergoing apoptosis as compared with women with uncompromised ovarian reserve undergoing superovulation for IVF-ET. Design: Comparative study. Setting: Academic clinical practice. Patients: Luteinized granulosa cell counts were determined from follicular aspirates harvested from 19 women with day 3 serum FSH less than or equal to 6 mIU/mL (conversion factor to SI unit, 1.00) and from 15 women with FSH levels greater than or equal to 10 mIU/mL. The second part examined the percent of proliferating and apoptotic cells harvested from nine women with day 3 serum FSH less than or equal to 6 mIU/mL mt and from eight women with FSH levels greater than or equal to 10 mIU/mL. Main Outcome Measures: Cell counts by hemacytometer and percent of proliferating and of apoptotic granulosa cells by flow cytometry. Results: The mean number of viable cells isolated per follicle were 2.7 x 10(5) (95% confidence interval [CI] 2.3 to 3.1 x 10(5)) from the low FSH group and 1.8 x 10(5) (95% CI 1.4 to 2.3 x 10(5)) from the high FSH group. Although the percentage of proliferating cells was the same, the mean percentage of apoptotic cells was 0.5% (95% CI 0.2% to 1.4%) from the low group and 2.0% (95% CI 1.1% to 3.7%) from the high group. Conclusions: Women undergoing TVF with day 3 serum FSH greater than or equal to 10 mIU/mL have preovulatory follicles with fewer luteinized granulosa cells and an increase in the percentage of cells undergoing apoptosis as compared with women with day 3 serum FSH less than or equal to 6 mIU/mL.