A prospective evaluation of antral follicle function in women with 46,XX spontaneous primary ovarian insufficiency.
OBJECTIVE
To assess ovarian follicle function in women with 46,XX spontaneous primary ovarian insufficiency.


METHODS
Case-control with nested prospective cohort.


METHODS
Clinical Research Center, National Institutes of Health.


METHODS
Women with primary ovarian insufficiency without estrogen replacement for 2 weeks (N = 97) and regularly menstruating control women (N = 42).


METHODS
Single injection of 300 IU hrFSH.


METHODS
Change in serum estradiol at 24 hours.


RESULTS
Antral follicles ≥3 mm were detected in 73% (69/95) of patients; both serum estradiol and progesterone levels correlated significantly with maximum follicle diameter in these women. Patients with a maximum follicle diameter ≥8 mm had significantly higher serum estradiol and progesterone levels and significantly lower FSH and LH levels compared with patients without such follicles. In controls estradiol levels increased significantly after FSH administration, but in patients this was not the case despite the presence of an antral follicle ≥8 mm.


CONCLUSIONS
Most women with 46,XX spontaneous primary ovarian insufficiency have antral follicles detectable by ultrasound, suggesting that down-regulation of FSH receptors is not the predominant mechanism of follicle dysfunction. Evidence of progesterone secretion by antral follicles ≥8 mm in these patients is consistent with prior histologic evidence that follicle luteinization is the predominant mechanism of follicle dysfunction in this condition. Prospective controlled investigation designed to improve ovulatory function and fertility in these women is indicated.
Hubayter
Ziad R
ZR
Integrative Reproductive Medicine Unit, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
Popat
Vaishali
V
Vanderhoof
Vien H
VH
Ndubizu
Obioma
O
Johnson
Diane
D
Mao
Edie
E
Calis
Karim A
KA
Troendle
James F
JF
Nelson
Lawrence M
LM
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000494:pharmacology; D040181:Genetic Diseases, X-Linked / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D010049:Ovarian Diseases / Q000378:metabolism / Q000503:physiopathology*; D006080:Ovarian Follicle / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology*; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D011962:Receptors, FSH / Q000378:metabolism; D055815:Young Adult
D011962:Receptors, FSH; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone