Gonadotropin requirements of the developing follicle.
OBJECTIVE
To evaluate follicular FSH and LH requirements during suppression of endogenous gonadotropins with the GnRH antagonist Nal-Glu and whether LH-like activity could be supplied by administering subcutaneous hCG.


METHODS
Randomized clinical trial.


METHODS
Thirty-two normally cycling females in the late follicular phase (dominant follicle mean diameter > or = 14 mm).


METHODS
Twelve normal women were randomized to receive 150 IU IM FSH with or without 75 IU SC hCG; 11 subjects were randomized to receive 225 IU FSH with or without 50 IU SC hCG; 9 women received 150 or 225 IU IM hMG. Subjects returned the next day for repeat blood sample and ultrasound.


RESULTS
Continued follicular maturation, as evidenced by rising E2 levels, correlated with serum immunoactive and bioactive FSH levels and was unrelated to bioactive LH-hCG. Two hundred twenty-five international units of exogenous FSH consistently supported follicular maturation. There was a similar increase in mean follicular diameter in women with an E2 rise versus those with a plateau or fall. In subjects receiving SC mini-dose hCG, serum bioactive LH-hCG levels were increased significantly and were similar to levels before Nal-Glu.


CONCLUSIONS
During administration of a GnRH-a, the maturing follicle appears to require only FSH support. In markedly hypogonadotropic women, mini-dose hCG may be a more practical alternative to recombinant LH to promote normal follicle maturation.
Center for Advanced Reproductive Care, Redondo Beach, California.
K A
KA
Thompson
P S
PS
LaPolt
J
J
River
G
G
Henderson
K D
KD
Dahl
D R
DR
Meldrum
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D008596:Menotropins / Q000627:therapeutic use
D006063:Chorionic Gonadotropin; C057805:LHRH, N-Ac-2-Nal(1)-4-Cl-Phe(2)-3-Pal(3)-Arg(5)-Glu(6)-AlaNH2(10)-; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone