Abstract
The objective of the present study was to examine the association between follicular fluid (FF) steroid concentration and oocyte maturity and fertilization rates. Seventeen infertile patients were submitted to ovulation induction with urinary human follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (hCG). A total of 107 follicles were aspirated after hCG administration, the oocytes were analyzed for maturity and 81 of them were incubated and inseminated in vitro. Progesterone, estradiol (E2), estrone, androstenedione, and testosterone were measured in the FF. E2 and testosterone levels were significantly higher in FF containing immature oocytes (median = 618.2 and 16 ng/ml, respectively) than in FF containing mature oocytes (median = 368 and 5.7 ng/ml, respectively; P < 0.05). Progesterone, androstenedione and estrone levels were not significantly different between mature and immature oocytes. The application of the receiver-operating characteristic curve statistical approach to determine the best cut-off point for the discrimination between mature and immature oocytes indicated levels of 505.8 ng/ml for E2 (81.0% sensitivity and 81.8% specificity) and of 10.4 ng/ml for testosterone (90.9% sensitivity and 82.4% specificity). Follicular diameter was associated negatively with E2 and testosterone levels in FF. There was a significant increase in progesterone/testosterone, progesterone/E2 and E2/testosterone ratios in FF containing mature oocytes, suggesting a reduction in conversion of C21 to C19, but not in aromatase activity. The overall fertility rate was 61% but there was no correlation between the steroid levels or their ratios and the fertilization rates. E2 and testosterone levels in FF may be used as a predictive parameter of oocyte maturity, but not for the in vitro fertilization rate.
Highlights
The steroids synthesized by follicular cells during the process of follicle maturation accumulate in follicular fluid (FF)
Since the corona-cumulus-oocyte complex is in close contact with FF, an association is believed to exist between the hormonal content of FF and the quality and degree of oocyte maturity, and FF hormonal content is presumed to be related to fertilization and embryo development and implantation rate [1,2]
Some investigators have tried to determine whether progesterone and estradiol levels in FF or their ratio may be used as parameters to discriminate between ovulatory oocytes and non-ovulatory oocytes, since progesterone, estradiol and testosterone levels in FF are significantly modified during the preovulatory period, especially after the luteinizing hormone (LH) surge [4]
Summary
The steroids synthesized by follicular cells during the process of follicle maturation accumulate in follicular fluid (FF). Since the corona-cumulus-oocyte complex is in close contact with FF, an association is believed to exist between the hormonal content of FF and the quality and degree of oocyte maturity, and FF hormonal content is presumed to be related to fertilization and embryo development and implantation rate [1,2]. Gonadotropin-releasing hormone (GnRH) agonists have been routinely used over the last decade as adjuvants in ovulation induction. These drugs reduce steroidogenesis both in vivo and in vitro in granulosa cells and reduce steroid levels in FF [3]. The use of GnRH agonists in hyperinduced cycles has considerably improved the results of assisted fertilization, causing the association between steroid levels and oocyte maturity to be questioned. The results were contradictory [5,6]
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