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PubMed2005

Pituitary-ovarian axis during lactational amenorrhoea. II. Longitudinal assessment of serum FSH polymorphism before and after recovery of menstrual cycles.

BACKGROUND: The association of normal serum levels of immunoassayable gonadotrophins with anovulation during lactational amenorrhoea (LA) has not been fully explained. METHODS: Serum FSH polymorphism was analysed in 10 women during LA between days 60 and 70 post-partum and again, in the mid-follicular phase (MFP), after resuming menstrual cyclicity. FSH microheterogeneity was characterized according to charge, using preparative isoelectric focusing, and according to the inner structure of carbohydrate chains, using lectin chromatography. RESULTS: A significantly higher proportion of FSH charge isoforms isolated below pH 4.10 and a lower proportion of FSH isoforms bearing highly branched oligosaccharides were observed during LA when compared to MFP. Further analysis with higher resolution showed that FSH charge isoforms, isolated in the lower pH range in LA, corresponded to FSH molecules bearing highly branched and biantennary oligosaccharides. FSH isoforms bearing hybrid-type oligosaccharides were only present during LA. The circulating FSH isoform mix was significantly less bioactive in LA than in MFP. LA is characterized by a more acidic mix of FSH isoforms, containing hormone bearing less processed oligosaccharides, with decreased biopotency in comparison with the follicular phase. CONCLUSIONS: This FSH microheterogeneity may be one of the critical factors contributing to incomplete follicular development and anovulation during LA.

Amenorrhea↗
PubMed2006

Nutrition and reproduction in women.

Malnutrition is a major problem in developing countries, and obesity and eating disorders are increasingly common in developing as well as developed countries. The reproductive axis is closely linked to nutritional status, especially undernutrition in the female, and inhibitory pathways involving detectors in the hind brain suppress ovulation in subjects with weight loss. Recovery may occur after minimal reacquisition of weight because energy balance is more important than body fat mass. Anorexia nervosa and bulimia nervosa affect up to 5% of women of reproductive age causing amenorrhoea, infertility and, in those who do conceive, an increased likelihood of miscarriage. Obesity can affect reproduction through fat cell metabolism, steroids and secretion of proteins such as leptin and adiponectin and through changes induced at the level of important homeostatic factors such as pancreatic secretion of insulin, androgen synthesis by the ovary and sex hormone-binding globulin (SHBG) production by the liver. WHO estimates that 9 to 25% of women in developed countries are severely obese, and obese mothers are much more likely to have obese children, especially if they have gestational diabetes. Obesity-associated anovulation may lead to infertility and to a higher risk of miscarriage. Management of anovulation with obesity involves diet and exercise as well as standard approaches to ovulation induction. Many obese women conceive without assistance, but pregnancies in obese women have increased rates of pregnancy-associated hypertension, gestational diabetes, large babies, Cesarean section and perinatal mortality and morbidity. Among contraceptors, the fear of weight gain affects uptake and continuation of hormonal contraceptives, although existing trials indicate that any such effects are small. For all methods of hormonal contraception, weight above 70 kg is associated with increased failure rates.

Female↗
PubMed1991

Low-dose gonadotrophin therapy for induction of ovulation in 100 women with polycystic ovary syndrome.

Women with anovulation due to polycystic ovary syndrome are likely to develop multiple follicles during gonadotrophin therapy and therefore have a high risk of multiple pregnancy. We have developed a low-dose regimen for use in these women; 100 women with clomiphene-resistant polycystic ovary syndrome were treated. Ninety-five of the women ovulated at least once, 72% of the 401 cycles induced were ovulatory and the majority (73%) of these were uni-ovulatory. The overall cumulative conception rate was 55% at 6 months with only two multiple pregnancies. The rate of early pregnancy loss was 32%, which is similar to that reported by other groups. The prevalence of complications was low with no cases of severe hyperstimulation and less than 5% of cycles were abandoned because of development of multiple follicles. Analysis of baseline and mid-follicular luteinizing hormone levels showed that a raised baseline and/or mid-follicular luteinizing hormone level was associated with a poor response to treatment, i.e. anovulation, ovulation but no conception, or early pregnancy loss. There were no successful pregnancies in the women whose luteinizing hormone levels were persistently raised during ovulatory cycles. Low-dose gonadotrophin therapy is a safe and effective method of inducing ovulation; it is associated with a high incidence of single follicular development and a very low multiple pregnancy rate.

Clomiphene↗
PubMed2003

In utero through lactational exposure to ethinyl estradiol induces cleft phallus and delayed ovarian dysfunction in the offspring.

Most of the attention currently focused on endocrine-active chemicals is directed to their effects on the development of offspring exposed to them in utero or during the neonatal period. Pregnant Crj:CD(SD)IGS rats were given ethinyl estradiol (EE) orally in doses of 0.5-50 microg/kg/day from gestational day 7 to postnatal day 18, and their offspring were examined for its effects. Our previous study according to a similar protocol demonstrated the occurrence of cleft phallus in the female offspring exposed to 50 microg/kg of EE in utero and during the lactation period. The present study was designed to assess (1) the reproducibility of the induction of cleft phallus, (2) the fertility of female rats with cleft phallus, and (3) whether any delayed effects, possibly delayed anovulation, were induced. At 50 microg/kg cleft phallus was observed in almost all of the female offspring, and slight retardation of body weight gain was detected in both sexes. At 15-17 weeks of age the animals with cleft phallus could copulate and had fertility comparable to the control group. At 6 months of age, on the other hand, 6/8 of the female offspring at 50 microg/kg exhibited abnormal cyclicity, including persistent estrus, and histological examination revealed follicular cysts and absence of corpora lutea in the ovaries of the rats with persistent estrus. These findings are consistent with delayed anovulation syndrome. The results suggest that observation of cyclicity at 6 months old is able to detect possible delayed ovarian dysfunction induced by perinatal exposure to chemicals.

Abnormalities, Drug-Induced↗
PubMed1993

Mammary somatosensory pathways are not required for suckling-mediated inhibition of luteinizing hormone secretion and delay of ovulation in cows.

Four experiments were conducted to evaluate endocrine, lactational, and reproductive features of an experimental animal model employing complete neural disconnection of the udder in beef cows and then to utilize the validated model to study the role of mammary somatosensory pathways in suckling-mediated anovulation. For experiment 1, crossbred beef cows (n = 16) were randomly assigned to suckled/sham-operated control, weaned (calf removed)/sham-operated control, and suckled/mammary-denervated groups between Days 14 and 18 postcalving. Ten additional cows were randomly divided into weaned or suckled unoperated control groups (experiment 2). Complete mammary anesthesia was attained in all denervated cows (experiment 1), but sensory perception was not affected in sham-operated controls. Prolactin release patterns were markedly depressed by denervation; however, oxytocin release, milk production, and calf growth rates were not affected. Although acute sham surgery attenuated weaning-induced increases in LH pulse and ovulation frequency (experiment 1), normal responses to weaning were observed in unoperated controls (experiment 2) as well as in sham-operated cows 1 yr later (experiment 3). Finally, denervated-suckled cows (n = 22) that had been denervated before conception (experiment 4) exhibited LH secretion patterns and mean postpartum intervals to luteal activity similar to those of intact-suckled cows (n = 16). In contrast, the intact-weaned group (n = 16; calves weaned at birth) responded within 2 wk postcalving with an increased frequency of LH pulses, and intervals to onset of luteal activity were shortened compared to those in the other groups. Suckling-mediated anovulation is not dependent upon mammary somatosensory cues.

Animals↗
PubMed2000

Ovulation induction.

In the woman with anovulation and polycystic ovarian syndrome, there are many options for ovulation induction. Treatment should be individualized, but clomiphene citrate is an excellent first-line agent. In the woman resistant to clomiphene citrate, combination therapy often results in pregnancy. Some women with PCOS only respond to gonadotropin therapy. These women are at a higher risk for multiple pregnancy and ovarian hyperstimulation syndrome. In the woman with anovulation and hypothalamic amenorrhea, the options for ovulation induction are limited. The luteal phase must be supported. The hypothalamus is unable to support the corpus luteum or early pregnancy.

Clomiphene↗
PubMed2004

Polycystic ovary syndrome.

Women with polycystic ovarian syndrome have chronic anovulation and androgen excess not attributable to another cause. This condition occurs in approximately 4% of women. The fundamental pathophysiologic defect is unknown, but important characteristics include insulin resistance, hyperandrogenism, and altered gonadotropin dynamics. Inadequate follicle-stimulating hormone is hypothesized to be a proximate cause of anovulation. Obesity frequently complicates polycystic ovarian syndrome but is not a defining characteristic. The diagnostic approach should be based largely on history and physical examination, thus avoiding numerous laboratory tests that don't contribute to clinical management. Women with polycystic ovarian syndrome typically present because of irregular bleeding, hirsutism, and/or infertility. These conditions can be treated directly with oral contraceptives, oral contraceptives plus spironolactone, and ovulation induction, respectively. However, women with polycystic ovarian syndrome also have a substantially higher prevalence of diabetes and increased risk factors for cardiovascular disease. They should also be screened, therefore, for these conditions and followed closely if any risk factors are uncovered. For obese women with polycystic ovarian syndrome, behavioral weight management is a central component of the overall treatment strategy.

Decision Trees↗
PubMed1986

Studies of prolactin secretion in polycystic ovary syndrome.

In order to investigate the postulated relationship between hyperprolactinaemia and polycystic ovary syndrome (PCOS) we have studied 62 patients with PCOS. Only two patients had persistent prolactin (PRL) concentrations greater than the normal range on both random sampling and after blood sampling from intravenous cannula over 2 hours. Twenty-eight of the remaining patients had basal PRL secretion studied in more detail. Samples were collected at 15 min intervals during a 6 h period in all 28 patients and hourly samples were collected overnight from four patients. Results failed to demonstrate differences from control subjects in mean basal PRL concentrations, in spontaneous fluctuations or in increments related to stress, food or sleep. Lactotroph response to thyrotrophin releasing hormone, luteinising hormone releasing hormone and insulin stress testing in PCOS were determined. Results confirm a previous observation that normal PRL increments occur after ovulation and a blunted response follows a period of anovulation. This study has failed to find a consistent abnormality of lactotroph function in patients with PCOS other than that associated with anovulation.

Adolescent↗
PubMed1990

The independent effects of hyperandrogenaemia, hyperinsulinaemia, and obesity on lipid and lipoprotein profiles in women.

We performed this study to clarify the independent effects of hyperandrogenaemia, hyperinsulinaemia, and obesity on lipid and lipoprotein levels in women with hyperandrogenaemia (HA) and anovulation which we designated as the polycystic ovary syndrome (PCO). We examined fasting lipid, lipoprotein, sex hormone and insulin levels in 38 women (21 obese (ob), 17 non-obese (nob] with HA and anovulation (PCO) and 38 normal ovulatory women (21 obese, 17 non-obese), matched for age and weight. The women with PCO had significantly increased androgen levels compared to the normal women. However, total oestradiol levels were similar in the PCO and normal women. Mean fasting insulin levels and 2-h glucose levels (both P less than 0.001) were significantly higher in ob PCO women. There were significant decreases (P less than or equal to 0.01) in high-density lipoprotein (HDL) levels in both the obese groups (ob PCO and ob normal) compared to the non-obese (nob PCO and nob normal) groups. Otherwise, mean lipid and lipoprotein levels did not differ in the ob or the nob PCO women compared to the control groups. The correlations between sex hormone, lipid and lipoprotein levels differed in the four groups of women. After statistical adjustment for potential hormonal interactions, nob PCO women had significant positive correlations between testosterone and LDL levels (R = 0.51, P less than 0.05) and insulin and TTG levels (R = 0.61, P less than 0.01). Ob normal women had a significant positive correlation between oestrone and TTG levels (R = 0.44, P less than or equal to 0.05). We conclude that (1) PCO women are in a low to risk for CVD primarily because of the increased prevalence of obesity rather than the reproductive hormone abnormalities associated with this disorder. However, by their lipid profiles, the PCO women were still in a low to intermediate risk group for CVD.

Adolescent↗
PubMed1992

Follow-up of ovarian endocrine function in premenopausal women after hysterectomy by daily measurements of salivary progesterone.

OBJECTIVE: The effect of hysterectomy on ovarian endocrine function of premenopausal women was studied. DESIGN: The patients collected daily salivary samples during one preoperative cycle (1), the cycle of operation (2), the subsequent period of 30 days (3) and the cycle 6 months after operation (4). PATIENTS: Forty-one premenopausal women (aged 33-48 years) undergoing hysterectomy were studied; their preoperative cycles served as controls. The patients were also compared with a reference group of 17 younger fertile women. MEASUREMENTS: Salivary progesterone levels were measured by radioimmunoassay. RESULTS: Cycle 1 was more frequently short (P less than 0.01), with short luteal phase (P less than 0.01) and low progesterone secretion (P less than 0.05), than the cycles of younger women. Cycle 2 was longer than the other cycles (P less than 0.01), due to prolonged follicular phase (P less than 0.01). Cycle 3 differed from cycle 1 by the lesser frequency of short cycles (P less than 0.01). Cycle 4 and its follicular phase were longer than those measured in cycle 1 (P less than 0.05). Of the women with normal cycle 1, 39% (P less than 0.01) presented with luteal insufficiency (LPD, low luteal progesterone secretion) or anovulation (8%) in at least one of cycles 2 to 4. The frequency of LPD or anovulation was significantly higher in cycle 3 (P less than 0.05) but not in cycle 4, compared to 1. CONCLUSIONS: Acute luteal progesterone deficiency after hysterectomy in premenopausal women is common but in most cases reversible.

Adult↗
PubMed2005

The peroxisome proliferator activated receptor gamma Pro12Ala polymorphism is associated with a lower hirsutism score and increased insulin sensitivity in women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and chronic anovulation. The genetic background of the insulin resistance frequently associated with PCOS is unclear. OBJECTIVES: To examine the influe nce of the Pro12Ala polymorphism of the peroxisome proliferator activated receptor gamma (PPARgamma), which is thought to play a role in the regulation of insulin sensitivity, on endocrine and metabolic parameters in PCOS patients. METHODS: PPARgamma alleles were analysed in 102 PCOS patients (age 27 +/- 5.3 years) and 104 age matched control women. PCOS was defined by the NIH-criteria as the presence of chronic oligo- or anovulation and hyperandrogenism. Family history and clinical parameters were evaluated by personal interview and physical examination, parameters of insulin resistance [homeostasis model assessment (HOMA) and Matsuda-index] were evaluated with a glucose tolerance test. RESULTS: Seventy-nine (77.5%) PCOS patients were carriers of the wild-type PPARgamma allele (Pro/Pro), while 23 (22.5%) had at least one Ala allele (X/Ala), with an equal distribution in controls. X/Ala PCOS women were more insulin-sensitive, evidenced by lower fasting insulin, HOMA index and insulin secretion. Differences in insulin resistance did not depend on body mass index. The genotype had no influence on lipid status, leptin, adiponectin, ghrelin, or family history of type 2 diabetes. A significantly lower proportion of Pro/Ala patients had hirsutism and they had on average lower hirsutism scores than Pro/Pro patients. No relationship was found between the Pro/Ala polymorphism and other signs of hyperandrogenism. CONCLUSION: The Pro12Ala polymorphism of the PPARgamma gene is associated with increased insulin sensitivity and lower hirsutism scores in PCOS women.

Adult↗
PubMed1995

Loss of reproductive competence at an earlier age in female rats exposed prenatally to ethanol.

Previous studies have shown that prenatal ethanol exposure can partially masculinize or defeminize neurobehavioral development of female rats. An early age of onset of anovulation is one of the primary characteristics of partial defeminization. Consequently, we examined the occurrence of anovulation in fetal alcohol-exposed (FAE) female rats at 2, 6, and 12 months of age using both vaginal cytology as well as wheel-running behavior. We assessed the ability of estrogen and progesterone to elicit proprioceptive behaviors and lordosis at 2 and 17 months of age. Female subjects were derived from Sprague-Dawley dams administered an ethanol liquid diet (35% ethanol-derived calories), a pair-fed isocaloric liquid diet, or fed lab chow from days 14 to 22 of gestation. Litter representatives were placed in a computer-monitored wheel-running apparatus under a 12-hr lighting schedule from 49 to 60 days of age. Vaginal smears were taken from littermates during this same period. This same procedure was conducted again from 180 to 196 and from 380 to 396 days of age, except that vaginal cytology was examined in the same animals immediately after wheel-running behavior was studied. At approximately 2 months of age, a normal cyclical pattern of wheel-running, characteristic of 4- to 5-day estrus cycles, was observed in all animals. No differences were detected in mean activity levels during the wheel-running period. This was accompanied by normal cyclic vaginal cytology and normal proprioceptive behaviors and lordosis. At 6 months of age, FAE females exhibited significantly reduced wheel-running.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1999

Endocrinology and metabolism after premature pubarche in girls.

The prevalence of functional ovarian hyperandrogenism, hyperinsulinism and dyslipidaemia is increased in adolescent girls with a history of premature pubarche, defined as the appearance of pubic hair before the age of 8 years. The ovarian hyperandrogenism is characterized by clinical signs of androgen excess and an exaggerated ovarian 17-hydroxyprogesterone response to gonadotrophin-releasing hormone agonist stimulation. The hyperinsulinism and dyslipidaemia are detectable before and during pubertal development, and they are commonly accompanied by low serum levels of insulin-like growth factor binding protein-1 (IGFBP-1) and sex hormone binding globulin, and by an increased prevalence of anovulation from late adolescence onwards. In girls, premature pubarche, hyperinsulinism, low serum levels of IGFBP-1, dyslipidaemia, anovulation and hyperandrogenism (or various combinations of these conditions) have been related to reduced fetal growth, indicating that these constellations or sequences may have a prenatal origin. These findings suggest that premature pubarche in girls should no longer be regarded as merely a normal variant of development, but rather as a childhood marker pointing to an increased risk of a polyendocrine-metabolic disorder of prenatal origin.

Birth Weight↗
PubMed2003

Prepubertal administration of estradiol valerate disrupts cyclicity and leads to cystic ovarian morphology during adult life in the rat: role of sympathetic innervation.

Administration of estradiol valerate (EV) to adult rats leads to anovulation and cystic ovarian morphology. Sympathetic ovarian nerve denervation (SONX) overcomes this disruption. In this study, we determined whether EV administration to juvenile rats prevents achievement of reproductive competence, disrupts cyclicity, and whether this programming is facilitated via activation of the sympathetic nerve input to the ovary. Prepubertal rats were administered 2 mg EV in corn oil or corn oil alone. One half of the animals from each group underwent SONX on d 71 of life. Rats were euthanized on d 91 for determination of serum gonadotropins, progesterone, Delta4 androstenedione, and estradiol concentrations, ovarian norepinephrine (NE), and 3beta-hydroxysteroid dehydrogenase (3beta-HSD) activities and ovarian dynamics. Results revealed that EV administration during juvenile period advanced pubertal onset, suppressed circulating LH, FSH, and Delta4 androstenedione, increased ovarian NE, estradiol, and 3beta-HSD activities, disrupted ovarian dynamics evidenced as absent corpus luteum and presence of ovarian cysts and culminated in anovulation. SONX restored cyclicity in these animals, normalized LH, estradiol, ovarian 3beta-HSD activities, and ovarian dynamics as evidenced by the disappearance of ovarian cysts and appearance of corpus luteum and restored corpus luteum function. These findings provide evidence that EV exposure during juvenile life leads to long-lasting deleterious reproductive consequences via activation of the sympathetic ovarian nerve.

Aging↗
PubMed2005

Developing a model of nutritional amenorrhea in rhesus monkeys.

Nutritional amenorrhea is defined as cessation of menstrual cycles resulting from a chronic negative energy balance. Although it is agreed that nutritional amenorrhea results from reduced secretion of GnRH, the neuroendocrine mechanisms leading to GnRH inhibition are poorly defined. Because the invasiveness of many neuroendocrine experimental approaches precludes its use in the clinical setting, we set out to establish a model of nutritional amenorrhea in rhesus monkeys. Studies were conducted in four normal-weight and one obese female rhesus monkey. Dietary intake was gradually reduced with the goal of achieving a 15-20% weight reduction. Dietary restriction inhibited ovulation in all animals. The weight loss required to inhibit ovulation ranged from 2-11% in the four normal-weight animals and was achieved with a 23% reduction in dietary intake. The time of initiating reduced food intake to first missed ovulation was 62 +/- 13 d. Greater weight loss (46% reduction) over a longer period (10 months) was required to inhibit ovulation in the obese monkey. The onset of anovulation was not preceded by changes in menstrual cycle length or progesterone secretion. Realimentation initiated ovulation at a weight that approximated the animal's weight at the time of the last ovulatory cycle during dietary restriction. By contrast, caloric intake at the return of ovulation during realimentation was 28% greater. This is the first demonstration that chronic dietary restriction can inhibit ovulation in rhesus monkeys. This model will be useful for studying the neuroendocrine mechanisms involved in diet-induced anovulation in primates.

Amenorrhea↗
PubMed1987

Increased bone turnover during gonadotropin-releasing hormone superagonist-induced ovulation inhibition.

Superactive stimulatory analogs of GnRH inhibit ovulation in women. This investigation was done to assess bone turnover during GnRH agonist-induced anovulation. Particular interest was directed to the effects of smoking, since smokers have an increased risk of osteoporosis. Fasting serum calcium, phosphate, PTH, and bone Gla-protein (osteocalcin) levels, as well as urinary calcium, cAMP, and hydroxyproline excretion and the renal tubular threshold for phosphate were determined before and after 6 months of GnRH superagonist contraceptive treatment in 47 women, 22 of whom smoked more than 10 cigarettes daily. Before treatment the women who smoked had significantly higher serum phosphate concentrations and lower serum PTH concentrations than the women who did not smoke. Fasting serum calcium and the urinary calcium to creatinine ratio increased after treatment in all women, especially in the nonsmokers. The nonsmokers also had more pronounced increases in serum phosphate and osteocalcin concentrations. A decrease in serum PTH during treatment was confined to the nonsmokers. These results suggest increased bone resorption and turnover during GnRH agonist-induced anovulation and indicate that smoking habits should be taken into account in the evaluation of bone disease.

Adult↗
PubMed1991

Naloxone increases the frequency of pulsatile luteinizing hormone secretion in women with hyperprolactinemia.

The ability to change the frequency and amplitude of pulsatile GnRH secretion may be an important mechanism in maintaining regular ovulatory cycles. Hyperprolactinemia is associated with anovulation and slow frequency LH (GnRH) secretion in women. To assess whether the slow frequency of LH (GnRH) secretion is due to increased opioid activity, we examined the effect of naloxone infusions in eight amenorrheic hyperprolactinemic women (mean +/- SE, serum PRL, 160 +/- 59 micrograms/L). After a baseline period, either saline or naloxone was infused for 8 h on separate days, and LH was measured in blood obtained at 15-min intervals. Additional samples were obtained for plasma FSH, PRL, estradiol, and progesterone. Responses to exogenous GnRH were assessed at the end of the infusions. LH pulse frequency increased in all subjects from a mean of 4.0 +/- 0.5 pulses/10 h (mean +/- SE) during saline infusion to 8.0 +/- 1.0 pulses/10 h during naloxone infusion (P less than 0.01). LH pulse amplitude did not change, and mean plasma LH increased from 7.4 +/- 0.8 IU/L (+/- SE) to 11.2 +/- 1.5 IU/L during naloxone (P less than 0.01). A small but significant increase was seen in mean plasma FSH. Plasma PRL, estradiol, and progesterone were unchanged by naloxone infusion. These data suggest that elevated serum PRL reduces the frequency of LH (GnRH) secretion by increasing hypothalamic opioid activity and suggest that the anovulation in hyperprolactinemia is consequent upon persistent slow frequency LH (GnRH) secretion.

Adult↗
PubMed1996

Modulation by insulin of follicle-stimulating hormone and luteinizing hormone actions in human granulosa cells of normal and polycystic ovaries.

Anovulation in polycystic ovary syndrome (PCOS) is associated with hyperinsulinemia and insulin resistance, but it has been unclear whether the ovary is insulin resistant in women with PCOS. The aims of this study were, firstly, to determine whether human granulosa cells respond to physiological concentrations of insulin and, secondly, to investigate insulin and gonadotropin interactions in vitro in granulosa cells obtained from normal (N) and polycystic ovaries (PCO). Granulosa cells were incubated with insulin with or without gonadotropins for 48 h. Insulin augmented not only basal production of estradiol and progesterone, but also LH-stimulated steroid accumulation in granulosa cell cultures from N and PCO. Insulin enhanced FSH-stimulated progesterone production by granulosa cells from N and PCO, but the effect on FSH-stimulated estradiol production was variable, ranging from no effect for granulosa cells from N to synergistic for granulosa cells from PCO of anovulatory subjects. Preincubation with insulin for 48 h increased subsequent basal and LH-induced, but not FSH-stimulated, steroid production. These data demonstrate that granulosa cells from PCO respond to insulin despite the association, in vivo, of PCOS with peripheral insulin resistance. Insulin preincubation enhances the subsequent response of human granulosa cells to LH. We propose that in anovulatory women with PCOS, elevated levels of insulin interacting with LH may contribute to the mechanism of anovulation.

Adult↗