title: The follicular hormonal profile in low-responder patients undergoing unstimulated cycles: Is it hypoandrogenic?
abstract: OBJECTIVE
  What is the final hormonal milieu of pre-ovulatory follicles of low-responder (LR) patients undergoing unstimulated cycles?
  
  
  CONCLUSIONS
  Neither androgen secretion nor LH was impaired in pre-ovulatory follicles of LR women.
  
  
  BACKGROUND
  Therapies currently used to improve ovarian response in LR women have an impact on the final hormonal follicular milieu, and these changes are believed to be partially responsible for determining the success rate in these women. Surprisingly, as far as we know, there is no report of the final hormonal profile of LR women undergoing unstimulated cycles or evidence that follicular androgen secretion in LR women is impaired.
  
  
  METHODS
  A prospective case-control study including 94 women, 36 normal controls and 58 LR patients (19 Young ≤ 35 years LR and 39 Aged >35 years LR) from 2009 to 2011.
  
  
  METHODS
  Fifty-eight LR women were divided into two groups: Young LR (age ≤ 35; n = 19) and Aged LR (ALR; age >35; n = 39). The control group (group C) comprised 36 egg donors undergoing an unstimulated cycle in our IVF unit. Serum and follicular fluid hormonal concentrations for estradiol (E₂), progesterone, testosterone and androstendione were measured. The spindle parameters of metaphase II oocytes generated from these groups were also analysed.
  
  
  RESULTS
  Pre-ovulatory follicles from LR patients had similar androgenic and LH concentrations to those observed in the control group. However, higher intrafollicular concentrations of FSH and progesterone were observed in ALR. Moreover, no differences were found for the spindle evaluation of oocytes between groups by the Oosight technology.
  
  
  CONCLUSIONS
  The controls were younger and had a lower BMI than the LR women. The sample size available restricted statistical power.
  
  
  CONCLUSIONS
  This study suggests that the problem with LR women is not the final pre-ovulatory follicular androgen concentration since this is similar to normal responders, but in the ability to respond to controlled ovarian stimulation protocols. Therefore, efforts should be focused on long-interval androgen priming to potentially increase the recruitment of small antral follicles rather than increasing the intraovarian androgen levels within the current cycle.
  
  
  BACKGROUND
  The present project has been supported by the R+D programme from the Generalitat Valenciana (Regional Valencian Government) IMPIVA MIDTF/2010/95. The authors have no conflict of interest to declare.
authors.affiliation: Clinical Embryology Laboratory,  IVI Valencia, Institut Universitari IVI, Plaza de la Policía Local, 346016 Valencia,  Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: de los Santos
authors.forename: V
authors.initials: V
authors.lastname: García-Laez
authors.forename: D
authors.initials: D
authors.lastname: Beltrán
authors.forename: E
authors.initials: E
authors.lastname: Labarta
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Zuzuarregui
authors.forename: P
authors.initials: P
authors.lastname: Alamá
authors.forename: P
authors.initials: P
authors.lastname: Gámiz
authors.forename: J
authors.initials: J
authors.lastname: Crespo
authors.forename: E
authors.initials: E
authors.lastname: Bosch
authors.forename: A
authors.initials: A
authors.lastname: Pellicer
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000032:analysis / Q000097:blood / Q000378:metabolism; D015571:Follicular Fluid / Q000737:chemistry / Q000378:metabolism*; D005498:Follicular Phase / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D007986:Luteinizing Hormone / Q000032:analysis / Q000097:blood / Q000378:metabolism*; D008677:Metaphase; D018587:Oocyte Donation; D009865:Oocytes / Q000473:pathology; D006080:Ovarian Follicle / Q000187:drug effects / Q000378:metabolism*; D010062:Ovulation Induction; D011374:Progesterone / Q000032:analysis / Q000097:blood / Q000378:metabolism; D011446:Prospective Studies; D008941:Spindle Apparatus / Q000473:pathology; D045165:Testosterone Congeners / Q000032:analysis / Q000097:blood / Q000378:metabolism*
chemical_list: D005300:Fertility Agents, Female; D045165:Testosterone Congeners; D011374:Progesterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone