title: Relationship between ovarian cortisol:cortisone ratios and the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET).
abstract: OBJECTIVE
  Previously, we have reported an association between low levels of intraovarian cortisol metabolism, mediated by 11beta-hydroxysteroid dehydrogenase (11betaHSD), and the establishment of pregnancies by in vitro fertilization and embryo transfer (IVF-ET). The objective of the present study was to investigate the relationship between the clinical outcome of IVF-ET and the intraovarian concentrations of cortisol and cortisone and the cortisol:cortisone ratios in random samples of ovarian follicular fluid (FF).
  
  
  METHODS
  Retrospective, double-blind correlation analyses.
  
  
  METHODS
  FF samples (n = 41) were obtained from 23 women undergoing gonadotrophin-stimulated IVF-ET cycles at the Cardiff Assisted Reproduction Unit.
  
  
  METHODS
  Clinical pregnancy was confirmed by ultrasonography. Intrafollicular steroid concentrations were measured by radioimmunoassays.
  
  
  RESULTS
  Concentrations of both cortisol and cortisone were significantly lower in FF samples obtained from 6 patients that conceived than in samples obtained from 17 patients that did not achieve pregnancy (cortisol (mean +/- SEM) = 304 +/- 29 vs. 407 +/- 26 nmol/l, P = 0. 0411; cortisone = 32 +/- 3 vs. 65 +/- 7 nmol/l, P = 0.0002). Intrafollicular cortisol:cortisone ratios were significantly higher in samples from conception cycles than in those samples obtained from nonconception cycles (9.7 +/- 0.7 vs. 6.9 +/- 0.5, respectively, P = 0.0060). Whereas 5 of 10 women with intrafollicular cortisol:cortisone ratios greater than the outcome-independent mean of 7.7 became pregnant, only 1 of the 13 patients with intrafollicular cortisol:cortisone ratios < 7.7 conceived (chi2 = 5. 247, P = 0.0220).
  
  
  CONCLUSIONS
  Concentrations of both cortisol and cortisone were significantly lower in FF samples obtained from patients that conceived by IVF-ET than in those obtained from nonconception cycles. Conception by gonadotrophin-stimulated IVF-ET was associated with an elevated intrafollicular ratio of cortisol:cortisone, consistent with a low level of intraovarian cortisol oxidation by 11betaHSD.
authors.affiliation: Department of Biochemistry and Molecular Biology, Royal Free and University College Medical School of University College London, London, UK. aemich@rfhsm.ac.uk
authors.forename: A E
authors.initials: AE
authors.lastname: Michael
authors.forename: T D
authors.initials: TD
authors.lastname: Collins
authors.forename: D P
authors.initials: DP
authors.lastname: Norgate
authors.forename: L
authors.initials: L
authors.lastname: Gregory
authors.forename: P J
authors.initials: PJ
authors.lastname: Wood
authors.forename: B A
authors.initials: BA
authors.lastname: Cooke
mesh_terms: D002064:Buserelin / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003348:Cortisone / Q000378:metabolism*; D004311:Double-Blind Method; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D015571:Follicular Fluid / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D006080:Ovarian Follicle / Q000187:drug effects / Q000378:metabolism*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D005640:Follicle Stimulating Hormone; D002064:Buserelin; D003348:Cortisone; D006854:Hydrocortisone