Abstract
OBJECTIVE: Older patients and patients with decreased AFCs often receive higher doses of exogenous gonadotropins with stimulation with the assumption that the ovaries are “more resistant.” Yet, no biological evidence for this exists. We sought to determine if serum FSH gets into the follicle at an equal rate or if there is a resistance that develops with age or diminished ovarian reserve. DESIGN: Prospective Cohort Study. MATERIALS AND METHODS: A single dominant follicle was aspirated from patients undergoing a long agonist suppression protocol. Patient serum was also collected on day of egg retrieval. Hormone levels were measured by Immunolyte assay. Predictor variables were dichotomized and data were analyzed using Student's t test. RESULTS: 25 patients have enrolled to date, with a mean age of 35.8 +/- 3.6 (range 28-42) and the mean AFC of 14.0 +/- 6.1 (range 6-34). There was no difference in mean follicular volume between the groups. The ratio of serum FSH to follicular fluid FSH 1:1 and did not differ with age or AFC. The mean follicular fluid FSH to estradiol ratio was higher in patients with lower AFCs, but did not differ by age.TableRatio of Serum FSH: Follicular Fluid FSH +/- SDRatio of Follicular Fluid FSH: Follicular Fluid Estradiol +/- SDAge ≤ 35 (n=11)1.03 +/- 0.420.017 +/- 0.017Age > 35 (n=14)1.01 +/- 0.200.017 +/- 0.013AFC ≤ 12 (n=12)0.94 +/- 0.210.026 +/- 0.015∗p<0.001AFC >12 (n=13)1.10 +/- 0.360.009 +/- 0.007∗p<0.001∗ p<0.001 Open table in a new tab CONCLUSIONS: The ratio of FSH in the serum to follicular fluid is 1:1 and does not vary by age or AFC. However, the response of the somatic cell compartment appears to vary with higher estradiol per unit of FSH in the patients with a higher AFC. This suggests the granulosa cell may show evidence of aging as AFC declines. Enrollment is on-going.
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