Endocrinology: The effect of growth hormone on granulosa cell function during in-vitro fertilization

The effect of growth hormone addition to human menopausal gonadotrophin(HMG), after pituitary down-regulation, on granulosa cell function,in in-vitro fertilization (IVF) was evaluated. Growth hormoneor placebo were added in a prospective, randomized and double-blindmanner to an existing IVF stimulation protocol. Forty-two normalovulatory women (38 years old) with mechanical factor infertilityand normal male factor were included in the study. Gonadotrophin-releasinghormone agonist (GnRHa) was given from day 21 of the previouscycle until human chorionic gonadotrophin (HCG) administration.Follicular stimulation with HMG was started after pituitarydown-regulation. Growth hormone 12 IU/day or placebo were administeredon alternate days, beginning day 1 until day 7 of HMG treatment.Granulosa cell function was evaluated, in all patients, by follicularfluid levels of ovarian steroids and insulin-like growth factor-I(IGF-I). In 14 patients, chosen arbitrarily granulosa luteincells were cultured in the presence and absence of additionalHCG. Follicular fluid levels of oestradiol, progesterone, testosteroneand IGF-I were similar in both growth hormone and placebo groups.Basal and post-HCG levels of oestradiol and progesterone didnot differ significantly between the two groups of granulosalutein cell cultures. We conclude that after pituitary down-regulation,in-vivo administration of growth hormone with HMG in young ovulatorywomen does not seem to affect granulosa cell function when comparedto the administration of HMG alone.     

Growth hormone does not increase the expression of insulin-like growth factors and their receptor genes in the pre-menopausal human ovary

A growing body of information now supports the existence of a complete intraovarian insulin-like growth factor I (IGF-I) system. Although the precise role of IGF-I in the context of ovarian physiology remains to be determined, it is likely that IGF-I may engage in the amplification of gonadotrophin hormonal action. These facts and experiments with animals establishing the ovaries of multiple species as a site of growth hormone (GH) reception and action have led to the use of recombinant GH (rGH) as an adjunctive agent to potentiate ovulation induction by exogenous gonadotrophins. Whether intraovarian IGF-I plays an intermediary role in GH hormonal action at the ovarian level remains uncertain at present. The aim of this study was to evaluate whether rGH administration to pre-menopausal women could modify the expression of the IGF-I gene in the ovary. The expression of the IGF-I gene was examined in a time-dependent manner in normal pre-menopausal ovaries obtained from nine women treated with rGH and nine control women treated with placebo, using solution hybridization/RNase protection assays. Ovarian tissue samples were obtained 24 h (six women) and 7 days (12 women) following rGH/placebo injection. Total RNA (20 microg) from whole pre-menopausal ovaries (with or without rGH treatment) as well as from human granulosa cells was hybridized with a human IGF-I antisense RNA. IGF-I peptide, but not oestradiol, serum concentrations increased significantly 24 h after rGH injection. IGF-I gene, however, was not expressed in the luteinized granulosa cells and whole pre-menopausal ovaries irrespectively of rGH treatment in ovarian samples analysed both 1 and 7 days following rGH injection. On the contrary, IGF-II mRNA transcribed from the fetal or fetal-neonatal IGF-II promoter and IGF-I receptor mRNA (both used as hybridization control) were both found in whole pre-menopausal ovary and luteinized granulosa cells. Nevertheless, no changes in the hybridization patterns were seen in the absence or presence of rGH. These studies demonstrate that rGH administration to normal premenopausal women does not change the expression of insulin-like growth factors and their receptor genes in the pre-menopausal human ovary. Furthermore, these results provide further evidence against locally produced IGF-I as responsible for any ovarian effects seen in systemic rGH administration.     

Specific gonadotrophin-releasing hormone analogue binding predominantly in human luteinized follicular aspirates and not in human pre-ovulatory follicles

In an attempt to resolve the apparent controversy in the observed effects of gonadotrophin-releasing hormone (GnRH) analogues on the ovary, conventional binding studies were conducted with a GnRH agonist and an antagonist in various ovarian tissues to demonstrate possible GnRH receptor binding. In human luteinized granulosa cells derived from unstimulated in-vitro fertilization cycles, high affinity receptor binding was present in 17 out of 24 patients, while binding was not observed in any of the six pre-ovulatory follicles removed during abdominal surgery. Apparently contradictory observations on the direct ovarian effects of GnRH analogues may be the result of the intermittent presence of high affinity GnRH receptors. Our observations indicate that in the human, high affinity ovarian GnRH receptors are present predominantly in ovarian tissue after the luteinizing hormone surge. We also propose the possibility of regulation and activation of a human follicular GnRH receptor in the ovary as a physiological process which may be influenced pharmacologically.      

Expression of insulin-like growth factor-II (IGF-II) messenger ribonucleic acid (mRNA), but not IGF-I mRNA, in human preovulatory granulosa cells

Increasing evidence suggests that insulin-like growth factors(IGFs) play an important role as intra-ovarian regulators inseveral mammalian species. Recently, we and others have reportedthe presence of both IGF-I and IGF-II in human follicular fluid.The source of these follicular IGFs, however, has not been determined.In this study, we have evaluated the possibility that humanovarian granulosa cells are a production site of IGFs in vivo.We used cDNA probes to analyse directly IGF-I and IGF-II geneexpression at the level of mRNA content in granulosa cells frompreovulatory follicles of women undergoing either gamete intra-Fallopiantransfer or in-vitro fertilization. Samples of granulosa cellRNA enriched for polyadenylated RNA [poly(A)⁺RNA] were hybridizedwith probes for human IGF-I, human IGF-II and human actin (asa control). Transfer blot analysis revealed that the enrichedpoly(A)⁺RNA of human granulosa cells from preovulatory folliclescontained no detectable IGF-I mRNA. In contrast, three speciesof IGF-II mRNA of -6.1, 4.9 and 2.1 kb were detected. Thesedata suggest that IGF-II mRNA, but not IGF-I mRNA, is expressedin human granulosa cells collected immediately before ovulation.Our results support the concept that human ovarian IGF-II isproduced locally and may function in an autocrine or paracrinefashion in the human ovary in vivo.     

颗粒细胞上促卵泡素受体与体外受精-胚胎移植的相关研究

目的探讨颗粒细胞上促卵泡素(FSH-R)的含量与体外受精胚胎移植(IVF-ET)结果的关系.方法在38个IVF周期中,将受精后获得的颗粒细胞,采用流式细胞测定仪测定其表面FSH-R的含量,并与IVF结果进行比较.结果颗粒细胞上FSH-R的含量与获卵个数无显著的相关关系(P>0.05).受精率、卵裂率随颗粒细胞上FSH-R的含量增加而增加(r=0.57 P<0.01,r=0.61 P<0.01).妊娠组与非妊娠组的颗粒细胞上FSH-R含量有显著性差异(P<0.0001).结论卵泡液中FSH与颗粒细胞膜上FSH-R相互作用共同促进卵母细胞的成熟和发育.     

Is there a difference in the function of granulosa-luteal cells in patients undergoing in-vitro fertilization either with gonadotrophin-releasing hormone agonist or gonadotrophin-releasing hormone antagonist?

Gonadotrophin-releasing hormone (GnRH) regulates gonadotrophin release. It has been shown that GnRH may have a direct effect on the ovary, as the addition of GnRH to granulosa cell cultures inhibits the production of progesterone and oestradiol. Specific GnRH receptors have been found to be present in rat and human granulosa cells. Desensitization of the pituitary by GnRH agonist has become common in in-vitro fertilization (IVF) treatment, usually by a long protocol of 2-3 weeks. With the introduction of GnRH antagonists, which produce an immediate blockage of the GnRH receptors, a much shorter exposure is needed of 3-6 days. The aim of this study was to evaluate the effect of a GnRH agonist (buserelin) and a GnRH antagonist (cetrorelix) on the function of granulosa cells cultured in vitro from IVF patients. Women were treated by IVF randomized either to have buserelin nasal spray from the luteal phase in the previous cycle or cetrorelix from day 6 of the cycle. Both groups had ovarian stimulation with human menopausal gonadotrophin (HMG) 150 IU daily, i.e. HCG was administered when the follicles were larger than 17 mm, and aspirated 36 h later. Granulosa cells, separated and washed from large follicles containing ova, were pooled. After 48 h of pre-incubation, the granulosa cells were cultured for 4 days in medium with either added testosterone or cAMP with or without HCG, with change of medium after 2 days. The progesterone and oestradiol concentrations in the culture medium were measured by immunological assay, and cellular protein was measured by microprotein assay. The results showed that granulosa cells from women treated with GnRH antagonist (cetrorelix) responded earlier to the in-vitro hormone stimulation in terms of progesterone accumulation than women treated with the GnRH agonist (buserelin). This may have been due to difference in time of exposure to the analogue. The results may indicate that the luteal function is less impaired in GnRH antagonist treatment than in GnRH agonist treatment.     

Effects of growth hormone releasing hormone on rat ovarian steroidogenesis

During the last decade, it has been shown that each part ofthe somatotrophic axis can influence granulosa cell function.Growth hormone releasing hormone (GHRH) may be effective throughthe release of hypophyseal growth hormone (GH) and the subsequentincrease of insulin-like growth factors (IGF). There is alsosome evidence that GHRH could act directly on ovarian function.The aim of this study was to determine the mechanism throughwhich GHRH affects granulosa cell steroidogenesis in the ovary.Granulosa cells were obtained from immature, oestrogen-treatedrats supplemented with or without follicle stimulating hormone(FSH) in vivo and were cultured for 48 h to evaluate steroidproduction. GHRH was administered either in vivo at the sametime as FSH, or in vitro in the presence or absence of testosteroneand FSH. Our results show that co-treatment with GHRH and FSHin vivo induced significant increases in plasma IGF-I concentrationsand steroid production by cultured granulosa cells. The additionof GHRH to culture medium did not significantly alter steroidproduction by either non-differentiated (no FSH in vivo) ordifferentiated (FSH in vivo) granulosa cells. In contrast, treatmentin vitro with IGF-I significantly increased steroidogenesisha both cases. Our results suggest that any physiologicallysignificant effect of GHRH on ovarian function is probably tobe exerted via activation of the somatotrophic axis and thesubsequent amplification of ovarian FSH responsiveness by IGF-I.     

Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment

Anti-Müllerian hormone (AMH) is a member of the transforming growth factor-beta superfamily, which plays an important role in both ovarian primordial follicle recruitment and dominant follicle selection in mice. However, the role of AMH in folliculogenesis in humans has not been investigated in detail. In the present study, AMH expression was assessed using immunohistochemistry in ovarian sections, obtained from healthy regularly cycling women. To this end, a novel monoclonal antibody to human AMH was developed. AMH expression was not observed in primordial follicles, whereas 74% of the primary follicles showed at least a weak signal in the granulosa cells. The highest level of AMH expression was present in the granulosa cells of secondary, preantral and small antral follicles 相似文献   

实验性肝硬化肝细胞生长激素受体的表达与动态变化

目的:探讨实验性肝硬化细胞生长激素受体的表达变化。方法:采用硫代乙酰胺腹腔注射复制大鼠肝硬化模型,采用放射配体法、RT-PCR、图像分析检测不同阶段肝硬化肝组织和肝硬化肝细胞中生长激素受体及其mRNA的表达水平,并分别与正常肝组织和正常肝细胞比较。结果:大鼠肝硬化肝组织表达生长激素受体,其表达数量明显少于正常肝组织,并且随着肝硬化的进展、肝组织胶原纤维相对含量的增加而进一步减少;大鼠肝硬化肝细胞生长激素受体的位点数量明显少于正常肝细胞,大鼠肝硬化肝组织生长激素受体mRNA的表达量也明显少于正常肝组织。结论:大鼠肝硬化肝细胞表达生长激素受体,其表达水平降低;肝硬化越严重,该表达减少越明显。大鼠肝硬化肝组织生长激素受体表达下调的机制可能是肝硬化肝组织生长激素受体mRNA的表达明显减少。     

Spontaneous pregnancies in two women with Laron-type dwarfism: are growth hormone and circulating insulin-like growth factor mandatory for induction of ovulation?

It has recently been claimed that growth hormone (GH) and insulin-like growth factors have a role in follicular development; different mechanisms of action have been proposed. Of late, many investigators have been led by these findings to use GH and growth hormone-releasing hormone (GHRH) for induction of ovulation, in combination with human menopausal gonadotrophins. It is, however, still doubtful whether or not growth hormones and/or insulin-like growth factors are mandatory for follicular development and fertility. In this study we describe two women with Laron-type dwarfism who lacked insulin-like growth factors and who had spontaneous pregnancies. We also discuss different natural defects in the production and metabolism of growth hormone and insulin-like growth factors in humans, and the fertility performance of the affected females. It is our assumption that GH and systemic insulin-like growth factors may modulate follicular development, but that they are not necessarily mandatory for ovarian follicular development.     

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.     

Gonadotrophin-releasing hormone agonist and ovarian hyperstimulation syndrome in assisted reproduction

The available literature concerning the association betweengonadotrophin-releasing hormone agonist and ovarian hyperstimulationsyndrome has been reviewed and the different patterns by whichthis agent may contribute to the development of such iatrogeniccomplication has been elicited, and guidelines have been presentedfor prevention of this malady. Gonadotrophin-releasing hormoneagonist acts directly on human granulosa cells, probably inits own dose-dependent manner. The extent of this action isprobably subjected to follicular maturation stage and to thedegree of gonadotrophin pre-treatment. Various agonist effectsin assisted reproduction may be implicated in the developmentof ovarian hyperstimulation syndrome: a higher amount of menotrophin;premature luteinization prevention; ‘flare-up’ effect;and a higher pregnancy rate. Different methods for preventionof ovarian hyperstimulation syndrome may be attempted: (i) allembryo cryopreservation with luteal phase reinitiation of agonist;(ii) avoidance of ovulatory human chorionic gonadotrophin (HCG)and continuation of agonist; (iii) cancellation of ovulatoryHCG, prolongation of agonist and later recommencement of menotrophin;(iv) pre-ovulatory LH surge triggering by agonist instead ofthe conventional HCG. Gonadotrophin-releasing hormone agonistmay affect the steroidogenic ovarian stroma directly and suchinteraction may aggravate the development of ovarian hyperstimulationsyndrome.     

Serum inhibin levels in gonadotrophin stimulated in-vitro fertilization/gamete intra-fallopian transfer cycles.

Serum inhibin concentrations of 64 cycles of in-vitro fertilization--embryo transfer (IVF-ET) or gamete intra-Fallopian transfer (GIFT) have been analysed retrospectively. No significant difference was observed in serum inhibin levels of cycles stimulated with buserelin and human menopausal gonadotrophin (HMG) or HMG alone. During the late follicular phase, serum inhibin was higher in cycles resulting in pregnancy than in cycles without a pregnancy (peak values on day +1: 8.3 versus 6.4 IU/ml, respectively). The same difference was found between stimulation cycles resulting in a viable or a non-viable pregnancy (peak values on day +1: 8.3 versus 7.5 IU/ml). However, these differences were not significant. During the early luteal phase, serum inhibin values were similar in these groups of patients. Our results indicate that the use of the gonadotrophin-releasing hormone (GnRH) analogue buserelin, in combination with HMG, for ovarian stimulation does not affect inhibin production by granulosa cells in vivo. The late follicular and early luteal concentrations of serum inhibin have to be considered unsuitable as predictors in IVF/GIFT cycles with respect to pregnancy and pregnancy outcome.     

case report: Ovarian stimulation in an infertile patient with growth hormone-deficient Oliver-Mcfarlane syndrome

Several authors have suggested that growth hormone may augmentovarian responses to follicle stimulating hormone in women (Homburget al., Clin. Endocrinol., 29, 1988; Ibrahim et al., Fertil.Steril., 55, 1991), and that this effect may be mediated byinsulin-like growth factor I (IGF-I) (Davoren and Hsueh, Endocrinology,118, 1986). Menashe et al. (Hum. Reprod., 6, 1991) reportedspontaneous pregnancies in women with a deficiency in growthhormone receptors and, consequently, low serum concentrationsof IGF-I. In this report, we present the case of a patient witha rare syndrome first described by Oliver and Mcfarlane (Arch.Ophthalmol., 74, 1965). The patient was shown to be growth hormonedeficient, with hypopituitarism as part of the syndrome. Adjuvantgrowth hormone did not influence her ovarian responses to exogenousgonadotrophins during assisted conception treatment, as reflectedby the required total number of ampoules of human menopausalgonadotrophin, the number of developing follicles, the rateof follicular growth and the serum oestradiol concentrations.     

转化生长因子β信号通路对卵泡刺激素调节卵巢颗粒细胞功能的影响

目的 探讨大鼠卵巢颗粒细胞中卵泡刺激素(FSH)和转化生长因子β(TGF-β)信号通路之间的相互作用.方法 取21 dSD大鼠卵泡分离的颗粒细胞原代培养,实验分为对照组、FSH处理组和转化生长因子β Ⅱ型受体(TGF-β R Ⅱ)中和组.通过免疫细胞化学和Western blotting定位和检测TGF-β R Ⅱ以及...     

Induction of macrophage migration inhibitory factor in human ovary by human chorionic gonadotrophin

The role of macrophage migration inhibitory factor (MIF) in human ovarian function remains obscure. The aim of this study was to investigate how MIF was related to ovulation by quantitative analysis of serum, follicular fluid and culture medium of granulosa cells obtained from in-vitro fertilization (IVF) and embryo transfer patients. Serum MIF concentrations in ovarian stimulation cycles for IVF-embryo transfer were higher at day 1 (median 92.6 ng/ml), which took place 35 h after human chorionic gonadotrophin (HCG) administration and just before the retrieval of oocytes, than those before day -6 (12.1 ng/ml), at day -5 to about day 0 (17.5 ng/ml) or at day 2 to about day 14 (8.2 ng/ml). MIF concentrations in the follicular fluid (113.4 ng/ml) obtained in ovarian stimulation cycles for IVF-embryo transfer were significantly higher than in serum (72.0 ng/ml) collected at the same time. MIF concentrations in the follicular fluid in natural cycles were higher in the ovulatory phase (51.6 ng/ml) than in the late follicular phase (13.8 ng/ml). MIF concentrations in the culture media of granulosa cells increased from 3.2 ng/ml to 7.2 ng/ml with HCG stimulation, and decreased from 2.4 ng/ml to 1.2 ng/ml when stimulation was withheld. These results indicate that HCG can induce the elevation of serum and follicular fluid MIF concentrations through the stimulation of ovarian cells, and that MIF is probably involved in the mechanism of ovulation.     

Expression of receptors for insulin-like growth factor-I and transforming growth factor-beta in human follicles

The in-vitro growth of immature oocytes in early follicles from cryopreserved human ovarian tissues is a new concept in in-vitro fertilization programmes for the treatment of infertile and cancer patients. To better understand the regulatory mechanism of follicular development, immunohistochemistry was used to study the expression of insulin-like growth factor (IGF) type I receptor (IGF-IR) and transforming growth factor-beta (TGFbeta) type I (TbetaR-I) and type II (TbetaR-II) receptors in fresh and frozen ovarian tissues from 14 women. Immunoreactivities for IGF-IR and TbetaR-I were present simultaneously in the oocytes of primordial, pre-antral and antral follicles. Staining for both IGF-IR and TbetaR-I was also observed in granulosa cells of primordial, pre-antral and antral follicles. IGF-IR and TbetaR-I also stained in thecal cells of pre-antral and antral follicles. Stromal cells in surrounding ovarian tissue expressed IGF-IR and TbetaR-I at various follicular stages. Unlike TbetaR-I, TbetaR-II was expressed only in the oocytes of primordial and primary follicles, and with weak staining intensity in thecal cells. No significant staining for TbetaR-II was found in oocytes and granulosa cells of antral follicles. There was no difference in staining patterns for IGF-IR, TbetaR-I and TbetaR-II between fresh and frozen ovarian tissues, indicating that cryopreservation might not significantly alter the immunoreactivities of these receptors in frozen ovarian tissue. The results suggest that IGF-I and TGFbeta may participate in the regulation of follicular growth by binding to their receptors through an autocrine or paracrine mechanism. IGF-I and TGFbeta may be useful in regulating the in-vitro or in-vivo maturation of oocytes not only in later follicles but also very early follicles, from cryopreserved ovarian tissues for clinical use in the future.     

Evidence for a Local Action of Growth Hormone in Embryonic Tooth Development in the Rat

Abstract

Studies in non-dental embryonic tissues have suggested that an interaction between growth hormone and its receptor may play a role in growth and development before the foetal pituitary gland is competent. This study reports the distribution of growth hormone, its rezceptor and binding protein in developing rat tooth germs from embryonic day 17 to 21 and postnatal day 0 using antibodies specific for each of these proteins. Four foetal rats were processed at each time point (E17, EM, E20/21 and postnatal day 0). Following routine fixation and paraffin embedding, sections were treated with antisera to rat growth hormone, rat growth hormone binding protein and growth hormone receptor. Localization of antibody/antigen complexes was subsequently visualized by addition of biotinylated IgG and reaction with streptavidin peroxidase and diaminobenzidine. Assessment of the level of staining was qualitative and based on a subjective rankings ranging from equivocal to very strong staining. Overall, growth hormone and its binding protein were located both in the cellular elements and throughout the extracellular matrix, whereas the growth hormone receptor showed an exclusively intra-cellular location. All three proteins were detectable in cells of the dental epithelium and mesenchyme at the primordial bud stage (E17) which occurs prior to expression of pituitary growth hormone. At the cap stage of odontogenesis (E18-19), numerous cells in both the dental epithelium and mesenchyme were intensely immunoreactive for growth hormone, its binding protein and receptor. In the succeeding early bell stage (E20-21), most of the mesenchymal cells in the dental pulp were mildly positive for these proteins, while the dental epithelium and adjacent mesenchyme were more immunoreactive. At the late bell stage (postnatal day 0), all three proteins were localized in dental epithelium, differentiating mesenchymal cells the cuspal surface facing the epithelial-mesenchymal interface, preodontoblasts, and odontoblasts forming dentine. From these observations, immunoreactive growth hormone, its receptor and binding protein appear to be expressed in odontogenic cells undergoing histodiierentiation, morphodifferentiation and dentinogenesis in a cell-type and stage-specific pattern throughout embryonic tooth development. This suggests the possibility that growth hormone, or a growth hormone-like protein, plays a paracrindautocrine role in tooth development in utero.     

Adrenomedullin and vascular endothelial growth factor production by follicular fluid macrophages and granulosa cells

BACKGROUND: Human follicular fluid contains several substances, such as cytokines and growth factors, which may affect follicular growth and maturation. The present study examines the relative contribution of macrophages and granulosa cells in the production of vascular endothelial growth factor (VEGF) and adrenomedullin in the human ovulatory follicle. METHODS: Both follicular fluid samples and blood samples were obtained at the time of oocyte retrieval following ovarian stimulation from 20 women undergoing IVF treatment because of male infertility. Human follicular fluid macrophages and luteinized granulosa cells were obtained from pooled follicular fluid of individual patients. Accumulation of VEGF and adrenomedullin in the culture medium of the isolated macrophages and human granulosa cells was determined at variable time intervals ranging from 0 to 48 h. Plasma and follicular fluid concentrations of VEGF and adrenomedullin were also measured. RESULTS: The follicular fluid concentrations of VEGF and adrenomedullin were significantly higher than those found in plasma. After 48 h, accumulation of VEGF in the culture medium of follicular fluid macrophages was significantly higher than that released in the culture medium of luteinized granulosa cells. In contrast, the production rate of adrenomedullin by follicular fluid macrophages was similar to that found in granulosa cells. VEGF secreted by follicular fluid macrophages increased progressively within 48 h of cell culture. A similar response pattern was observed with the culture medium of luteinized granulosa cells, but with lower production rates. CONCLUSIONS: This study suggests for the first time that both luteinized granulosa cells and macrophages actively secrete VEGF and adrenomedullin into follicular fluid in the human ovary.     

Co-treatment with growth hormone of sub-optimal responders in IVF-ET

Several growth factors augment the ovarian response to gonadotrophins and growth hormone is known to regulate the production of insulin-like growth factor-1. With this in mind, 20 women who had previously responded sub-optimally to standard ovarian stimulation regimens for in-vitro fertilization and embryo transfer (IVF-ET) were recruited into a randomized trial to study the effect of co-treatment with growth hormone (Norditropin, Novo Nordisk Gentofte A/S). Intramuscular injections of growth hormone (24 IU) or placebo were given on alternate days concurrently with the same daily dosage of gonadotrophin as administered in the patient's pretreatment cycle. Overall, there was no improvement in the ovarian response to the growth hormone-augmented regimen of stimulation although there was a tendency for the development of more follicles (P = 0.06). When the results from the patients with ultrasound-diagnosed polycystic ovaries were analysed separately, however, more follicles developed (P = 0.04), more oocytes were collected (P = 0.03) and there was a trend towards higher urinary oestrogen production following growth hormone therapy. There was no improvement in the ovarian response in patients with normal ovaries. The treatment was not associated with any adverse effects. We conclude, therefore, that in a subgroup of patients who respond sub-optimally to standard ovarian stimulation regimens for IVF-ET and who have ultrasound-diagnosed polycystic ovaries, systemic growth hormone is an effective adjunctive therapy.