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


METHODS
This study was a prospective cohort.


METHODS
The setting was an institutional practice.


METHODS
Eleven PCOS and 30 normoandrogenic ovulatory women were included.


METHODS
All subjects received GnRH analog/FSH therapy after basal serum hormone determinations.


METHODS
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.


CONCLUSIONS
Hyperandrogenic follicles with mature oocytes from PCOS women receiving GnRH analog/recombinant human FSH therapy for IVF show sufficient glucose utilization for normal luteinization.
Reproductive Medicine and Infertility Associates, 2101 Woodwinds Drive, Woodbury, Minnesota 55125, USA.
Shu C
SC
Foong
David H
DH
Abbott
Michael A
MA
Zschunke
Timothy G
TG
Lesnick
Jennifer L
JL
Phy
Daniel A
DA
Dumesic
D000328:Adult; D015992:Body Mass Index; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D017588:Hyperandrogenism / Q000503:physiopathology*; D016729:Leuprolide / Q000627:therapeutic use*; D034461:Luteinization; D006080:Ovarian Follicle / Q000502:physiology*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D011974:Receptors, LH / Q000235:genetics
D012333:RNA, Messenger; D011974:Receptors, LH; D016729:Leuprolide