The follicular hormonal profile in low-responder patients undergoing unstimulated cycles: is it hypoandrogenic?
Authors: de los Santos, M.J.; García-Laez, V.; Beltrán, D.; Labarta, E.; Zuzuarregui, Jose Luis; Alamá, P.; Gámiz, P.; Crespo, J.; Bosch, E.; Pellicer, A.
Source: Human Reproduction, Volume 28, Number 1, 28 January 2013 , pp. 224-229(6)
Publisher: Oxford University Press
What is the final hormonal milieu of pre-ovulatory follicles of low-responder (LR) patients undergoing unstimulated cycles?
Neither androgen secretion nor LH was impaired in pre-ovulatory follicles of LR women.
WHAT IS KNOWN ALREADY
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.
STUDY DESIGN, SIZE AND DURATION
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.
PARTICIPANTS/MATERIALS, SETTING AND 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.
MAIN RESULTS AND THE ROLE OF CHANCE
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.
LIMITATIONS, REASONS FOR CAUTION
The controls were younger and had a lower BMI than the LR women. The sample size available restricted statistical power.
WIDER IMPLICATIONS OF THE FINDINGS
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.
STUDY FUNDING/COMPETING INTEREST
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.
Document Type: Research Article
Publication date: 28 January 2013
- Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.