INHA promoter polymorphisms are associated with premature ovarian failure

Inhibin is an important glycoprotein that is involved in folliculogenesis. INHA, the gene encoding the inhibin alpha subunit, was recently proposed as a candidate for premature ovarian failure (POF), a syndrome that leads to the cessation of ovarian function under the age of 40 years. 70 POF patients and 70 controls were screened for the previously identified INHA -16C>T transition mutation. The T allele was found in 31/70 (44.3%) of controls, but only 18/70 (25.7%) of POF patients. This result indicates that the T allele is significantly underrepresented in the POF patient population (Fisher's exact test, two-tail: P = 0.033). Sequence analysis of the INHA promoter in 50 POF patients and 50 controls identified a highly polymorphic imperfect TG repeat at approximately -300 bp, that consisted of four common haplotypes (A, B, C and D). The -16T allele is linked to the shortest repeat haplotype (haplotype C). Despite the association between haplotype C and POF, no significant difference was found between the promoter activity of a luciferase reporter construct containing haplotype C, and most of the other haplotypes tested. Interestingly, haplotype B failed to show any promoter activity. We conclude that the inheritance of specific INHA promoter haplotypes predispose to the development of premature ovarian failure.     

Basal FSH, estradiol and inhibin B concentrations in women with a previous Down's syndrome affected pregnancy.

BACKGROUND: Two recent studies reported elevated basal FSH concentrations in women with a history of aneuploid conceptions. However, it is not known whether these elevated basal FSH concentrations reflect depletion of the primordial follicle pool, or were caused by an increased secretory drive for FSH. METHODS: Inhibin B and estradiol concentrations were measured as indicators for depletion of the primordial follicle pool in women with a history of a Down's syndrome pregnancy and in controls. RESULTS: In the women with a history of a Down's syndrome pregnancy, there was a significant inverse correlation between basal FSH and inhibin B concentrations (P < 0.0001, 95% CI -0.26 to -0.56). In the control group, this correlation did not reach statistical significance. CONCLUSIONS: Our data indicate that the elevated basal FSH concentrations observed in women with a history of a Down's syndrome pregnancy are likely to reflect early depletion of the primordial follicle pool. Therefore, further research into the ovarian ageing process could provide more insight in the origination of chromosomal abnormalities during pregnancy.     

Circulating follistatin concentrations are higher and activin concentrations are lower in polycystic ovarian syndrome

Familial polycystic ovarian syndrome (PCOS) has been proposed to be linked to a site near the follistatin gene. We studied the concentrations of circulating follistatin, activin A and inhibin B in well-characterized subjects with PCOS (n = 108) and controls without PCOS (n = 20). Mean (+/- SEM) concentrations of follistatin were higher (P < 0.05) in PCOS (0.27 +/- 0.03 ng/ml) than controls (0.15 +/- 0.02 ng/ml) and activin A were lower (P < 0.05) in PCOS (0.20 +/- 0.01ng/ml) than controls (0.24 +/- 0.02 ng/ml). Inhibin B concentrations were not different between the two groups: PCOS (0.06 +/- 0.01ng/ml), and controls (0.06 +/- 0.01ng/ml). It is proposed that higher concentrations of follistatin with lower concentrations of activin A may relate to follicular development not proceeding beyond 8-10 mm and may be partly responsible for the lack of pre-ovular follicle development in PCOS.     

Response to clomiphene citrate in the polycystic ovarian syndrome according to different LH/FSH ratios

Twenty-nine clomiphene tests were carried out, 19 on subjectswith polycystic ovarian syndrome (PCO) who did not wish to conceiveand 10 on women with correct ovarian function (control women).The intention was to determine if the response of the hypothalamic—pituitary—ovaryaxis varies according to different LH/FSH ratios. The resultsindicate that with repeated LH/FSH ratios of <3, the positiveand negative feedback systems are preserved in most subjects,but when the ratio is higher than 3, both systems are significntlyaltered (P < 0.01). In the control group, both systems werepreserved in all subjects. In another group composed of 26 infertilepatients with PCO, the rate of ovulation and pregnancy afteradministration of clomiphene citrate (CC) was correlated accordingto different LH/FSH ratios. A significant (P < 0.0001) redudonin the rate of ovulation and a lesser reduction in pregnancywas found with increasing LH/FSH ratios. In conclusion we suggestthat the LH/FSH ratio is a good marker of this syndrome, andcan be used to give a prognosis on the severity of the syndrome,as well as the ovulatory capacity of the subject after administrationof CC.     

Basal and day 12 inhibin concentrations in the prediction of ovarian response to gonadotrophins in women with PCOS

BACKGROUND: In this study, we aimed to investigate whether basal and day 12 serum total inhibin concentrations in women with polycystic ovarian syndrome (PCOS) were of predictive value for the estimation of the ovarian response to gonadotrophins. METHODS: Ovulation induction with a very low dose gonadotrophin protocol, starting with 37.5 IU/day, was performed for 40 cycles on 35 patients with PCOS. Day 3 (basal) serum total inhibin, FSH and oestradiol concentrations; day 12 dominant follicle diameter, inhibin and oestradiol concentrations and midluteal serum progesterone concentrations were measured during the 40 cycles. The correlations between basal and day 12 inhibin concentrations and some critical ovulation monitoring parameters were investigated. RESULTS: Ovulation was obtained in 14 out of 40 cycles: 21% of cycles with basal inhibin <1.0 IU/ml; 33.3% of cycles with basal inhibin between 1.0-1.9 IU/ml; and 83.3% of those with inhibin concentrations > or =2 IU/ml were ovulatory (P < 0.05). Ovulation was achieved in 91.6% of the cycles with a day 12 inhibin concentration > or =4 IU/ml. CONCLUSIONS: Basal inhibin concentrations may determine poor and good responders to ovulation induction with very low dose gonadotrophin protocol in patients with PCOS. The day 12 inhibin concentration was found to be a more sensitive parameter than the oestradiol concentration in the prediction of follicular maturation.     

Peripheral blood concentrations of inhibin B are elevated during gonadotrophin stimulation in patients who later develop ovarian OHSS and inhibin A concentrations are elevated after OHSS onset

Ovarian hyperstimulation syndrome (OHSS) is a serious side-effect of controlled ovarian stimulation. Inhibin A and inhibin B, as putative predictors of OHSS development in the same stimulation cycle, were evaluated. A cohort of 428 in-vitro fertilization (IVF) patients was followed. Fifteen patients with severe OHSS were compared with matched (age, follicle number) controls. Serum samples were obtained at five time points from the start of ovarian stimulation until >/= 3 days post-embryo transfer and analysed with specific enzyme-linked immunosorbent assays. Inhibin A in the OHSS group showed a continuous increase with a significant elevation 3 days prior to oocyte aspiration (ASP-3) and onwards. Maximal concentrations were detected at embryo transfer and the concentrations remained high at >/= 3 days post-embryo transfer. Inhibin A concentrations in the control group showed a transient elevation (significant increase at ASP and embryo transfer). Inhibin A in the OHSS group was significantly higher than in controls only at the time point where OHSS had developed (>/= 3 days post-embryo transfer), and declined during OHSS treatment. Overall, there was a positive correlation between the number of follicles and inhibin A concentrations at ASP-3 until embryo transfer in the control group but not in the OHSS group. The concentrations of inhibin B in both groups increased from the start of ovarian stimulation, with peak values at ASP-3, and then a decline. Inhibin B was significantly higher in OHSS patients at ASP-3 and at ASP. Inhibin B at ASP-3 was correlated with the total number of follicles in both the OHSS group and the control group.     

Functional analysis of the human inhibin alpha subunit variant A257T and its potential role in premature ovarian failure

BACKGROUND: A nucleotide substitution in the inhibin alpha subunit (INHA 769G>A, A257T) has been associated with premature ovarian failure (POF). We hypothesize this mutation causes a reduction in inhibin bioactivity, removing its suppression on the pituitary FSH secretion. The aim of this study is to establish if A257T inhibin has reduced bioactivity. METHODS: Mouse LbetaT2 pituitary gonadotrope, human granulosa (COV434) and human embryonic kidney (HEK293) cells were co-transfected with an activin-responsive reporter and increasing amounts of wild-type or variant A257T inhibin alpha subunit, and the degree of inhibin antagonism of activin signalling determined. RESULTS: A 5-fold inhibition was observed with wild-type inhibin alpha subunit overexpression (P < 0.001) (confirmed in HEK293 cells), while the A257T inhibin showed no inhibitory activity. In human ovarian COV434 transfected cells, while wild-type and A257T inhibin A had similar bioactivities, there was a significant reduction in the bioactivity of A257T inhibin B compared with wild-type inhibin B (P < 0.005). In all the three cell systems, overexpression of wild-type and A257T alpha subunit resulted in a 2- to 6-fold increase in secretion of dimeric inhibin indicating the reduced inhibin response was not due to a failure of dimerization. CONCLUSIONS: This study supports the hypothesis that the INHA 769G>A variant may increase susceptibility to POF with impaired inhibin B bioactivity and provides insight into the complex aetiology of POF.     

In-vivo ovarian androgen responses to recombinant FSH with and without recombinant LH in polycystic ovarian syndrome

BACKGROUND: Effects of exogenous LH on ovarian androgen secretion during ovulation induction have not been clearly characterized in polycystic ovarian syndrome (PCOS). The purpose of this study was to compare androgen secretion in PCOS women during ovarian stimulation with either recombinant FSH (rFSH) alone or combined with recombinant LH (rLH). METHODS: Clomiphene-resistant women with PCOS were allocated, in a factorial study design, to receive either daily injections of rFSH (n = 24) or rFSH + rLH (n = 24) in a 1:1 ratio starting: (i) on day 2-3 of progestogen-induced menses (n = 8); (ii) after 6 weeks of GnRH agonist treatment (nafarelin, 400 micro g twice daily; n = 8); or (iii) after nafarelin treatment as in (ii) plus dexamethasone (n = 8). The effects of rFSH with rFSH + rLH under these three hormone conditions on serum LH, 17alpha-hydroxyprogesterone (17-OHP), androstenedione (DeltaDelta(4)) and testosterone were contrasted by analysis of variance with specific treatment days as a repeated measures factor. RESULTS: Pre-study hormone levels were similar for all groupings. Nafarelin significantly suppressed LH levels, which remained at the lower limit of assay sensitivity (0.5 IU/l) during stimulation with rFSH but increased significantly to >1 but <2 IU/l when rLH was added. As expected, 17-OHP, DeltaDelta(4) and testosterone levels fell following nafarelin treatment. Dexamethasone further suppressed 17-OHP, DeltaDelta(4) and testosterone levels and unmasked a small but significant rise in these ovarian steroids 24 h following the first dose of rFSH + rLH, a rise that was absent with rFSH alone. Secretion of these steroids then appeared to 'catch-up' after 5 days of rFSH stimulation. CONCLUSIONS: Despite profound LH, 17-OHP, DeltaDelta(4) and testosterone suppression, comparable E(2) response, follicle development and successful pregnancies in PCOS subjects receiving rFSH alone to those receiving rFSH + rLH would argue that circulating LH at levels as low as 0.5 IU/l are sufficient to sustain adequate follicle development and function when FSH is present in abundance. Whether the observed dichotomy between rFSH and rFSH + rLH treatment in temporal secretion patterns reflects a greater reliance on evolving paracrine mechanisms as the follicles mature under profound LH suppression remains to be explored but may influence the optimal LH threshold for ovulation induction in PCOS.     

Ovarian response and pregnancy outcome related to mid-follicular LH levels in women undergoing assisted reproduction with GnRH agonist down-regulation and recombinant FSH stimulation

BACKGROUND: The effect of LH levels on stimulation day 8 on ovarian response and pregnancy outcome were evaluated in women receiving pituitary down-regulation with GnRH agonists (0.8 mg Suprefact) s.c. daily until pituitary down-regulation and 0.4 mg/day during ovarian stimulation) and ovarian stimulation with recombinant FSH. METHODS: Blood samples were prospectively collected from a total of 207 normal women undergoing assisted reproduction and analysed retrospectively. Based on LH levels on stimulation day 8 patients were divided into four groups: <0.5, 0.51-1.0, 1.01-1.5, >1.51 IU/l. RESULTS: Estradiol levels on day 8 and estradiol per oocyte retrieved showed a highly significant correlation with LH concentrations on day 8. The total consumption of exogenous FSH and duration of gonadotrophin stimulation was inversely related to LH levels on day 8 (P < 0.002). The frequencies of fertilization and clinical pregnancies were superior in the two middle groups. Only 12% of the patients showed LH levels <0.5 IU/l, which, however, may be explained by the particular mode and doses of GnRH agonist used. CONCLUSIONS: Circulating levels of LH on day 8 have a significant impact on ovarian response and pregnancy outcome. LH should neither be too high nor too low. The mode of administration and the dose of the GnRH agonist used may determine the number of women who experience LH levels below 0.5 IU/l.     

Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF

BACKGROUND: The significance of suppressed LH levels in GnRH antagonist cycles for IVF outcome is currently unknown. The purpose of this study was to evaluate prospectively the association between LH levels and ongoing pregnancy achievement after GnRH antagonist initiation in IVF cycles. METHODS: Ovarian stimulation with a fixed dose of 200 IU recombinant FSH and daily GnRH antagonist (ganirelix) 0.25 mg from day 6 of stimulation was initiated in 116 women. Patients were not pretreated with an oral contraceptive. Induction of final oocyte maturation was performed with HCG 10,000 IU as soon as three follicles of > or =17 mm were present in ultrasound, and was followed by oocyte pick-up, conventional IVF or ICSI, and embryo transfer. The luteal phase was supplemented with vaginal progesterone. RESULTS: A significant decrease of both ongoing pregnancy rate and implantation rate was present across groups of patients with increasing LH levels. The highest implantation rate and ongoing pregnancy rate was present in those patients with LH levels on day 8 of stimulation < or =0.5 IU/l. CONCLUSIONS: Profound suppression of LH on day 8 of stimulation is associated with a significantly higher chance of achieving an ongoing pregnancy. More studies are necessary to evaluate this phenomenon further.     

LH serum levels during ovarian stimulation as predictors of ovarian response and assisted reproduction outcome in down-regulated women stimulated with recombinant FSH

BACKGROUND: There has been much debate about the effect of 'residual' LH levels in normogonadotrophic women undergoing assisted reproduction with GnRH agonist down-regulation and recombinant FSH ovarian stimulation. The aim of this prospective study, where receiver-operating characteristic (ROC) analysis was used, was to assess further the usefulness of serum LH levels as predictors of ovarian response, assisted reproduction treatment outcome, and the outcome of pregnancy when measured throughout the ovarian stimulation period in a large cohort of such assisted reproduction treatment women. METHODS: A total of 246 consecutive women undergoing their first cycle of IVF or ICSI treatment were included in this study. Blood samples for hormone analyses were obtained on day S0 (the day when pituitary suppression was evidenced) and every other day from stimulation day 5 (S5) until the day of hCG injection. RESULTS: LH serum levels throughout ovarian stimulation treatment were similar for cancelled (n =32) versus non-cancelled (n = 214) cycles, non-conception (n = 132) versus conception (n = 82) cycles, and ongoing pregnancy (n = 66) versus early pregnancy loss (n = 16) groups. There was no correlation between LH serum levels in non-cancelled cycles and parameters of ovarian response and assisted reproduction treatment outcome. ROC analysis showed that serum LH concentration during ovarian stimulation was unable to discriminate between cancelled and non-cancelled cycles, conception versus non-conception cycles, or early pregnancy loss versus ongoing pregnancy groups. CONCLUSIONS: Serum LH measurements during ovarian stimulation with recombinant FSH under pituitary suppression in normogonadotrophic women undergoing assisted reproduction treatment cannot predict ovarian response, IVF/ICSI outcome, implantation, and the outcome of pregnancy. Thus, there is little underlying physiological support for the addition of LH in stimulation protocols if daily doses of an appropriate GnRH agonist (leuprolide or triptorelin having lower potency than buserelin) and a step-down regimen of recombinant FSH administration are used.     

Suppression of LH during ovarian stimulation: effects differ in cycles stimulated with purified urinary FSH and recombinant FSH

There has been much debate about the role of luteinizing hormone (LH) during follicle stimulating hormone (FSH)-treated ovarian stimulation for assisted reproduction, where the endogenous LH is suppressed using a gonadotrophin-releasing hormone analogue. The requirement for LH in oestradiol biosynthesis is established, but other effects of 'insufficiency' are less clear, and little attention has been paid to the specific origin of the FSH used. The aim of this study was to examine the roles of profoundly suppressed circulating LH concentrations in cycles of ovarian stimulation for IVF, which were affected in two large separate cohorts of patients undergoing assisted reproduction. They were stimulated by either purified urinary FSH (MHP) or recombinant human FSH (rFSH). Within each dataset, outcomes were examined with respect to the circulating concentrations of LH in the mid-follicular phase, as plasma samples were stored prospectively, and assayed retrospectively. Patients with profoundly suppressed LH showed much reduced oestradiol concentrations at mid-follicular phase and at human chorionic gonadotrophin administration in cycles treated with either MHP or rFSH. However, gross ovarian response, as became evident by FSH dose demands, duration of stimulation, and also oocyte and embryo yields and embryo cryopreservation were influenced only in cycles treated with MHP. Furthermore, no effect upon pregnancy survival was observed. Thus, it is concluded that there is a demand for additional exogenous LH treatment only in cycles treated with purified urinary FSH where the LH is profoundly suppressed.     

Pregnancy: Testosterone and androstenedione in premature ovarian failure pregnancies: evidence for an ovarian source of androgens in early pregnancy

Numerous anecdotal reports but few scientific approaches havesuggested an increase in androgens in early pregnancy. In thisstudy we have compared the concentration of serum androgens,testosterone and androstenedione in early pregnancy, startingwithin the cycle of conception. We have taken the opportunityto study women with premature ovarian failure where pregnancydevelops in the virtual absence of ovarian functions. This studydemonstrates that the concentration of testosterone (0.29 ±0.04 ng/ml) and androstenedione (1.770 ± 0.136 ng/ml)in these subjects is as low as, if not lower than, non-pregnantwomen (0.39 ± 0.02 and 2.170 ± 0.025 ng/ml), significantlyincreased in normal pregnancies (1.190 ± 0.118 and 3.920± 0.297 ng/ml; P < 0.05) and even further increasedin human menopausal gonadotrophin-treated cycles (1.990 ±0.230 and 8.19 ± 0.72 ng/ml; P < 0.05). These studiesdemonstrate that the ovary is a contributor to the circulatingconcentrations of testosterone and androstenedione startingwithin the cycle of conception.     

Suppression of LH during ovarian stimulation: analysing threshold values and effects on ovarian response and the outcome of assisted reproduction in down-regulated women stimulated with recombinant FSH

BACKGROUND: It has been recently suggested that gonadotrophin-releasing hormone agonist down-regulation in some normogonadotrophic women may result in profound suppression of LH concentrations, impairing adequate oestradiol synthesis and IVF and pregnancy outcome. The aims of this study, where receiver-operating characteristic (ROC) analysis was used, were: (i) to assess the usefulness of serum LH measurement on stimulation day 7 (S7) as a predictor of ovarian response, IVF outcome, implantation, and the outcome of pregnancy in patients treated with recombinant FSH under pituitary suppression; and (ii) to define the best threshold value, if any, to discriminate between women with 'low' or 'normal' LH concentrations. METHODS: A total of 144 infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment were included. Seventy-two consecutive patients having a positive pregnancy test (including 58 ongoing pregnancies and 14 early pregnancy losses) were initially selected. As a control non-pregnant group, the next non-conception IVF/ICSI cycle after each conceptual cycle in our assisted reproduction programme was used. RESULTS: The median and range of LH values in non-conception cycles, conception cycles, ongoing pregnancies, and early pregnancy losses, clearly overlapped. ROC analysis showed that serum LH concentration on S7 was unable to discriminate between conception and non-conception cycles (AUC(ROC) = 0.52; 95% CI: 0.44 to 0.61) or ongoing pregnancy versus early pregnancy loss groups (AUC(ROC) = 0.59; 95% CI: 0.46 to 0.70). To assess further the potential impact of suppressed concentrations of circulating LH during ovarian stimulation on the outcome of IVF/ICSI treatment, the three threshold values of mid-follicular serum LH proposed in the literature (<1, < or =0.7, <0.5 IU/l) to discriminate between women with 'low' or 'normal' LH were applied to our study population. No significant differences were found with respect to ovarian response, IVF/ICSI outcome, implantation, and the outcome of pregnancy between 'low' and 'normal' S7 LH women as defined by those threshold values. CONCLUSIONS: Our results do not support the need for additional exogenous LH supplementation in down-regulated women receiving a recombinant FSH-only preparation.     

Immunology: Human leukocyte antigen typing and associated abnormalities in premature ovarian failure

A case-controlled study was designed to assess the distributionof human leukocyte antigens (HLA) A, B, Cw, DR and DQ, and associatedabnormalities in patients with premature ovarian failure (POF).A total of 37 patients in a tertiary care centre were diagnosedas having POF; all were <37 years old. A subset was HLA-typed.The occurrence of associated diseases in patients with POF wasrecorded. A comparison of HLA typing was made between patientswith POF and 100 organ donors from the same population. No statisticallysignificant difference in the distribution of A, B, Cw, DR andDQ antigens was found between the study and control groups whencorrected for the number of antigens tested. The commonest associatedabnormality was positive autoimmune screen (43.3%). Abnormalthyroid function tests were detected in 23.3% of the patients.The observed high frequency of associated autoimmune phenomenain patients with POF points to an underlying autoimmune disorderin POF and warrants further studies to unravel the pathologyof this condition.     

Evidence of differential control of FSH and LH responses to GnRH by ovarian steroids in the luteal phase of the cycle

BACKGROUND: It is known that during the follicular phase of the cycle, estradiol sensitizes the pituitary to GnRH. The aim of this study was to determine the role of ovarian steroids in the control of GnRH-induced gonadotrophin secretion in the luteal phase of the cycle. METHODS: Eighteen normally cycling women were studied during the week following bilateral ovariectomy plus hysterectomy performed in early to mid-luteal phase. Six of the women received no hormonal treatment post-operatively (group 1, control), six received estradiol through skin patches (group 2) and the remaining six received estradiol plus progesterone (group 3). In all women the response at 30 min of LH (deltadeltaLH) and FSH (deltadeltaFSH) to GnRH (10 microg i.v.) was investigated on a daily basis. RESULTS: In group 1, serum FSH, LH and deltadeltaFSH values increased progressively following ovariectomy, while in groups 2 and 3 this increase was postponed or abolished. In contrast to deltadeltaFSH, deltadeltaLH values showed the same pattern of changes in all three groups with a significant decline up to post-operative day 4 and a gradual increase thereafter. CONCLUSIONS: These results demonstrate, for the first time, that in the early to mid-luteal phase of the cycle, estradiol and progesterone participate in the control of GnRH-induced FSH, but not LH, secretion. It is possible that in the luteal phase, the response of LH to GnRH is partly regulated by gonadotrophin surge attenuating factor.     

Comparison of LH concentrations in the early and mid-luteal phase in IVF cycles after treatment with HMG alone or in association with the GnRH antagonist Cetrorelix

Luteinizing hormone (LH) is mandatory for the maintenance of the corpus luteum. Ovarian stimulation for IVF has been associated with a defective luteal phase. The luteal phases of two groups of patients with normal menstrual cycles and no endocrinological cause of infertility were retrospectively analysed in IVF cycles. Thirty-one infertile patients stimulated with human menopausal gonadotrophins (HMG) for IVF to whom the gonadotrophin-releasing hormone (GnRH) antagonist Cetrorelix 0.25 mg was also administered to prevent the LH surge (group I) were compared with 31 infertile patients stimulated with HMG alone (group II). Despite differences in the stimulation outcome, luteal LH serum concentrations were similar in the two groups. LH values dropped from 2.3 +/- 1 IU/l on the day of human chorionic gonadotrophin (HCG) administration to 1.1 +/- 0.7 IU/l on day HCG +2 in group I (P < 0.0001) and from 5.1 +/- 3 to 1.2 +/- 1.7 IU/l (P < 0.0001) in group II. In the mid-luteal phase, LH concentrations were low in both groups. Our results suggest that suppressed LH concentrations in the early and mid-luteal phase may not be attributed solely to the GnRH-antagonist administration. Pituitary LH secretion may be inhibited by supraphysiological steroid serum concentrations via long-loop feedback and/or by the central action of the exogenously administered HCG via a short-loop mechanism.     

Lymphocyte subsets and serum immunoglobulins in patients with premature ovarian failure before and after oestrogen replacement

We have previously demonstrated that in patients with oestrogendeficiency, there was a significant reduction in the ratio ofCD4⁺ to CD8⁺ lymphocytes. To test our hypothesis that oestrogendeficiency was the cause of the changes in lymphocyte subsets,we have studied the lymphocyte subsets and serum immunoglobulinlevels in 35 patients with idiopathic premature ovarian failurebefore and after oestrogen replacement therapy. Before oestrogenreplacement the lymphocyte subsets in peripheral blood wereenumerated with indirect immunofluorescence techniques usingmonoclonal antibodies. The serum immunoglobulins (Ig) G, A andM were measured with nephelometry. After oestrogen replacementtherapy, the tests were repeated around day 7–11 of the2nd, 4th and 24th month. There was no significant change inany of these parameters by the 2nd or 4th months. After 2 yearsof oestrogen replacement, there was a significant decrease inthe percentage of CD8⁺ cells, a significant increase in theCD4: CD8 ratio and a significant increase in the mean serumIgG concentration. There was no significant change in the otherparameters. Our results support the hypothesis that oestrogendeficiency is the cause for the changes in the lymphocyte subsets.     

Age-dependent changes in the expression of superoxide dismutases and catalase are associated with ultrastructural modifications in human granulosa cells

Limited knowledge exists about changes in follicle quality associated with age. The aim of this work was to investigate whether ageing may cause oxidative stress-mediated alterations in human granulosa cells (GCs) from periovulatory follicles. GCs employed in this study were obtained from follicular aspirates of 20 younger women (range 27-32 years) and 20 older women (range 38-41 years) undergoing an IVF treatment. Results obtained from comparative RT-PCR analysis revealed that the mean relative levels of mRNAs coding for superoxide dismutases, Cu, ZnSOD (SOD1), MnSOD (SOD2) and catalase were significantly decreased in women > or =38 years (P < 0.05, Student's t-test). These changes were associated with a reduced expression of SOD1, SOD2 and catalase at the protein level. When examined at an ultrastructural level, most of the GCs from this group showed defective mitochondria and fewer lipid droplets than those observed in the younger group. These results indicate that GCs from older patients suffer from age-dependent oxidative stress injury and are taken as an evidence for reduced defence against reactive oxygen species (ROS) in GCs during reproductive ageing.     

Treatment with naltrexone in hypothalamic ovarian failure: induction of ovulation and pregnancy

Sixty-six women suffering from various grades of hypothalamicovarian failure were treated with the opiate antagonist naltrexoneat doses ranging from 25 to 150 mg per day. This treatment resultedin complete normalization of the menstrual cycle in 49 of 66patients, as indicated by the pattern of circulating levelsof gonadotrophins and ovarian steroids. Five patients failedto respond, three of whom were suffering from primary hypothalamicamenorrhoea. In patients who responded to the administrationof naltrexone, there was a dramatic increase in the amplitudeand frequency of gonadotrophin pulses, reflecting disinhibitionof the hypothalamic gonadotrophin-releasing hormone (GnRH) pulsegenerator. Eighteen pregnancies were achieved in 16 women whowere also treated for infertility, resulting in a cumulativepregnancy rate closely resembling that of a normal population.There were only minor side-effects that could be attributedto the drug. These data demonstrate that chronic administrationof an opiate antagonist will normalize ovarian function in womensuffering from different grades of hypothalamic ovarian failure.The data therefore support the view that suppression of theactivity of the hypothalamic pulse generator, that directs GnRHrelease, is mediated by endogenous opioids. Also, that hypothalamicovarian failure is the consequence of an inappropriate increasein opioid tone impinging on neurons that release GnRH in a pulsatilemanner into the pituitary portal circulation.