Download PDF
Semin Reprod Med 2005; 23(4): 354-362
DOI: 10.1055/s-2005-923393
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Coordination of Antral Follicle Growth: Basis for Innovative Concepts of Controlled Ovarian Hyperstimulation

Renato Fanchin1 , Luca M. Schonäuer1 , João Sabino Cunha-Filho1 , Daniel H. Méndez Lozano1 , René Frydman1
  • 1Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital Antoine Béclère, Clamart, France
Further Information

Publication History

Publication Date:
29 November 2005 (online)

    Permissions and Reprints

ABSTRACT

Among the key objectives of controlled ovarian hyperstimulation (COH) is the achievement of adequate coordination of multiple follicular growth to trigger ovulation when most of follicles have reached concomitant maturation. However, during the early follicular phase, early antral follicles present noticeable size heterogeneities that may be amplified during COH. To challenge the hypothesis that this phenomenon results, at least in part, from the early exposure of antral follicles to gradient follicle-stimulating hormone (FSH) levels during the preceding late luteal phase, we conducted three clinical studies. First, we artificially lowered luteal FSH levels by administering estradiol (E2) and measured follicular characteristics on the subsequent day 3. Second, we verified whether luteal E2 administration could promote the coordination of follicular growth during COH and improve its results. Third, we assessed the effects of premenstrual gonadotropin-releasing hormone (GnRH) antagonist administration on follicular characteristics during the early follicular phase. Our results showed that luteal FSH suppression by either E2 or GnRH antagonist administration reduces the size and improves the homogeneity of early antral follicles during the early follicular phase, an effect that persists during COH. Coordination of follicular development may optimize ovarian response to short GnRH agonist and antagonist protocols, and constitutes an attractive approach to improving their outcome.

KEYWORDS

Follicular synchronization - FSH - estradiol - GnRH antagonist - early antral follicles - controlled ovarian hyperstimulation

REFERENCES

  • 1 Macnamee M C, Howles C M, Edwards R G, Taylor P J, Elder K T. Short-term luteinizing hormone-releasing hormone agonist treatment: prospective trial of a novel ovarian stimulation regimen for in vitro fertilization.  Fertil Steril. 1989;  52 264-269
    PubMedGoogle Scholar
  • 2 Hazout A, de Ziegler D, Cornel C, Fernandez H, Lelaidier C, Frydman R. Comparison of short 7-day and prolonged treatment with gonadotropin-releasing hormone agonist desensitization for controlled ovarian hyperstimulation.  Fertil Steril. 1993;  59 596-600
    PubMedGoogle Scholar
  • 3 Olivennes F, Fanchin R, Bouchard P et al.. The single or dual administration of the gonadotropin-releasing hormone antagonist Cetrorelix in an in vitro fertilization-embryo transfer program.  Fertil Steril. 1994;  62 468-476
    PubMedGoogle Scholar
  • 4 Diedrich K, Diedrich C, Santos E et al.. Suppression of the endogenous luteinizing hormone surge by the gonadotrophin-releasing hormone antagonist Cetrorelix during ovarian stimulation.  Hum Reprod. 1994;  9 788-791
    PubMedGoogle Scholar
  • 5 Tan S L, Kingsland C, Campbell S et al.. The long protocol of administration of gonadotropin-releasing hormone agonist is superior to the short protocol for ovarian stimulation for in vitro fertilization.  Fertil Steril. 1992;  57 810-814
    PubMedGoogle Scholar
  • 6 Cramer D W, Powers D R, Oskowitz S P et al.. Gonadotropin-releasing hormone agonist use in assisted reproduction cycles: the influence of long and short regimens on pregnancy rates.  Fertil Steril. 1999;  72 83-89
    CrossrefPubMedGoogle Scholar
  • 7 Borm G, Mannaerts B. Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. The European Orgalutran Study Group.  Hum Reprod. 2000;  15 1490-1498
    CrossrefPubMedGoogle Scholar
  • 8 Al-Inany H, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception.  Cochrane Database Syst Rev. 2001;  4 CD001750
    PubMedGoogle Scholar
  • 9 Fanchin R, Cunha-Filho J S, Schonäuer L M, Kadoch I J, Cohen-Bacrie P, Frydman R. Coordination of early antral follicles by luteal estradiol administration provides a basis for alternative controlled ovarian hyperstimulation regimens.  Fertil Steril. 2003;  79 316-321
    CrossrefPubMedGoogle Scholar
  • 10 Fanchin R, Salomon L, Castelo-Branco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pre-treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists.  Hum Reprod. 2003;  18 2698-2703
    CrossrefPubMedGoogle Scholar
  • 11 McNatty K P, Hillier S G, van den Boogaard A M, Trimbos-Kemper T C, Reichert Jr L E, van Hall E V. Follicular development during the luteal phase of the human menstrual cycle.  J Clin Endocrinol Metab. 1983;  56 1022-1031
    PubMedGoogle Scholar
  • 12 Fauser B C, Van Heusden A M. Manipulation of human ovarian function: physiological concepts and clinical consequences.  Endocr Rev. 1997;  18 71-106
    CrossrefPubMedGoogle Scholar
  • 13 Gougeon A, Lefevre B. Evolution of the diameters of the largest healthy and atretic follicles during the human menstrual cycle.  J Reprod Fertil. 1983;  69 497-502
    PubMedGoogle Scholar
  • 14 Gougeon A. Regulation of ovarian follicular development in primates: facts and hypotheses.  Endocr Rev. 1996;  17 121-155
    CrossrefPubMedGoogle Scholar
  • 15 Hillier S G, van den Boogaard A M, Reichert Jr L E, van Hall E V. Intraovarian sex steroid hormone interactions and the regulation of follicular maturation: aromatization of androgens by human granulose cells in vitro.  J Clin Endocrinol Metab. 1980;  50 640-647
    PubMedGoogle Scholar
  • 16 Roseff S J, Bangah M L, Kettel L M et al.. Dynamic changes in circulating inhibin levels during the luteal-follicular transition of the human menstrual cycle.  J Clin Endocrinol Metab. 1989;  69 1033-1039
    PubMedGoogle Scholar
  • 17 Mais V, Cetel N S, Muse K N, Quigley M E, Reid R L, Yen S S. Hormonal dynamics during luteal-follicular transition.  J Clin Endocrinol Metab. 1987;  64 1109-1114
    PubMedGoogle Scholar
  • 18 Chun S Y, Eisenhauer K M, Minami S, Billig H, Perlas E, Hsueh A J. Hormonal regulation of apoptosis in early antral follicles: follicle-stimulating hormone as a major survival factor.  Endocrinology. 1996;  137 1447-1456
    CrossrefPubMedGoogle Scholar
  • 19 Klein N A, Battaglia D E, Fujimoto V Y, Davis G S, Bremner W J, Soules M R. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women.  J Clin Endocrinol Metab. 1996;  81 1038-1045
    CrossrefPubMedGoogle Scholar
  • 20 Devreker F, Pogonici E, De Maertelaer V, Revelard P, Van den Bergh M, Englert Y. Selection of good embryos for transfer depends on embryo cohort size: implications for the ‘mild ovarian stimulation’ debate.  Hum Reprod. 1999;  14 3002-3008
    CrossrefPubMedGoogle Scholar
  • 21 Fanchin R, Castelo Branco A, Kadoch I J, Hosny G, Bagirova M, Frydman R. Premenstrual administration of gonadotropin-releasing hormone antagonist coordinates early antral follicle sizes and sets up the basis for an innovative concept of controlled ovarian hyperstimulation.  Fertil Steril. 2004;  81 1554-1559
    CrossrefPubMedGoogle Scholar
  • 22 Thomas J D, Rubin D N. Tissue harmonic imaging: why does it work?.  J Am Soc Echocardiogr. 1998;  11 803-808
    PubMedGoogle Scholar
  • 23 Sharara F I, McClamrock H D. The effect of aging on ovarian volume measurements in infertile women.  Obstet Gynecol. 1999;  94 57-60
    CrossrefPubMedGoogle Scholar
  • 24 Groome N P, Illingworth P J, O'Brien M et al.. Measurement of dimeric inhibin B throughout the human menstrual cycle.  J Clin Endocrinol Metab. 1996;  81 1401-1405
    CrossrefPubMedGoogle Scholar
  • 25 Levene H. In: Olkin I, et al. Contributions to Probability and Statistics: Essays in Honor of Harold Hotelling. Stanford, CA; Stanford University Press 1960: 278-292
    Google Scholar
  • 26 de Jong D, Macklon N S, Fauser B C. A pilot study involving minimal ovarian stimulation for in vitro fertilization: extending the “follicle-stimulating hormone window” combined with the gonadotropin-releasing hormone antagonist cetrorelix.  Fertil Steril. 2000;  73 1051-1054
    CrossrefPubMedGoogle Scholar
  • 27 Erb K, Klipping C, Duijkers I, Pechstein B, Schueler A, Hermann R. Pharmacodynamic effects and plasma pharmacokinetics of single doses of cetrorelix acetate in healthy premenopausal women.  Fertil Steril. 2001;  75 316-323
    CrossrefPubMedGoogle Scholar
  • 28 le Nestour E, Marraoui J, Lahlou N, Roger M, de Ziegler D, Bouchard P. Role of estradiol in the rise in follicle-stimulating hormone levels during the luteal-follicular transition.  J Clin Endocrinol Metab. 1993;  77 439-442
    CrossrefPubMedGoogle Scholar
  • 29 de Ziegler D, Jaaskelainen A S, Brioschi P A, Fanchin R, Bulletti C. Synchronization of endogenous and exogenous FSH stimuli in controlled ovarian hyperstimulation (COH).  Hum Reprod. 1998;  13 561-564
    CrossrefPubMedGoogle Scholar
  • 30 Skarin G, Nillius S J, Wide L. Early follicular phase luteinizing hormone-releasing hormone agonist administration-effects on follicular maturation and corpus luteum function in women.  Contraception. 1982;  25 31-39
    CrossrefPubMedGoogle Scholar
  • 31 Mais V, Kazer R R, Cetel N S, Rivier J, Vale W, Yen S S. The dependency of folliculogenesis and corpus luteum function on pulsatile gonadotropin secretion in cycling women using a gonadotropin-releasing hormone antagonist as a probe.  J Clin Endocrinol Metab. 1986;  62 1250-1255
    CrossrefPubMedGoogle Scholar
  • 32 Hall J E, Bhatta N, Adams J M, Rivier J E, Vale W W, Crowley Jr W F. Variable tolerance of the developing follicle and corpus luteum to gonadotropin-releasing hormone antagonist-induced gonadotropin withdrawal in the human.  J Clin Endocrinol Metab. 1991;  72 993-1000
    PubMedGoogle Scholar
  • 33 Gonen Y, Jacobson W, Casper R F. Gonadotropin suppression with oral contraceptives before in vitro fertilization.  Fertil Steril. 1990;  53 282-287
    PubMedGoogle Scholar
  • 34 Schoolcraft W, Schlenker T, Gee M, Stevens J, Wagley L. Improved controlled ovarian hyperstimulation in poor responder in vitro fertilization patients with a microdose follicle-stimulating hormone flare, growth hormone protocol.  Fertil Steril. 1997;  67 93-97
    CrossrefPubMedGoogle Scholar
  • 35 Hall J E, Bhatta N, Adams J M, Rivier J E, Vale W W, Crowley Jr W F. Variable tolerance of the developing follicle and corpus luteum to gonadotropin-releasing hormone antagonist-induced gonadotropin withdrawal in the human.  J Clin Endocrinol Metab. 1991;  72 993-1000
    PubMedGoogle Scholar
  • 36 Hall J E, Whitcomb R W, Rivier J E, Vale W W, Crowley Jr W F. Differential regulation of luteinizing hormone, follicle-stimulating hormone, and free alpha-subunit secretion from the gonadotrope by gonadotropin-releasing hormone (GnRH): evidence from the use of two GnRH antagonists.  J Clin Endocrinol Metab. 1990;  70 328-335
    PubMedGoogle Scholar
  • 37 Kettel L M, Roseff S J, Chiu T C et al.. Follicular arrest during the midfollicular phase of the menstrual cycle: a gonadotropin-releasing hormone antagonist imposed follicular-follicular transition.  J Clin Endocrinol Metab. 1991;  73 644-649
    PubMedGoogle Scholar

Renato FanchinM.D. 

Department of Obstetrics and Gynecology and Reproductive Medicine

Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141, Clamart, France

Email: renato.fanchin@abc.ap-hop-paris.fr

      >