Steroidogenesis in human follicles approaching ovulation as judged from assays of follicular fluid

IVF: The women who helped make it happen

In this paper I pay tribute to four named women and 280 unidentified women patients for their essential roles in supporting Bob Edwards and Patrick Steptoe during the pioneering early days of IVF. The four named women are Jean Purdy, Muriel Harris, Lillian Lincoln Howell and Ruth Fowler.

The Oldham Notebooks: an analysis of the development of IVF 1969-1978. III. Variations in procedures

A survey is presented of the various technical and scientific challenges that had to be met during the 10-year period before the first successful live birth after IVF and embryo transfer was achieved, and the approaches used to meet these challenges is discussed. Records dated from January 1969 to July 1978 indicate that a minimum of 282 women were involved in 495 cycles scheduled for laparoscopic oocyte recovery, of which 457 cycles (92%) proceeded to attempted egg collection. A total of 1361 eggs were recovered over 388 cycles, of which 1237 (91%) are recorded as having been inseminated in 331 (85%) of these cycles. Approximately 221 embryos were described in 165 (43%) of the 388 cycles. A total of 112 embryo transfers were attempted, which resulted in five clinical pregnancies with two live births. This paper discusses the ways in which hormonal stimulation of follicle growth to the pre-ovulatory stage was varied, and the endocrine monitoring of these variations in blood, urine and follicular fluid, as well as their influence on egg recovery and fertilization rates. Variations in media composition and preparation are also described. It is concluded that, whilst driven by scientific reasoning, the approach adopted in trying to achieve successful IVF was empirical rather than evidence-driven.

In vitro effect of dehydroepiandrosterone sulfate on steroid receptors, aromatase, cyclooxygenase-2 expression, and steroid hormone production in preovulatory human granulosa cells

OBJECTIVE

To examine the effect of a low concentration of DHEAS on the expression of the androgen receptor, estrogen receptor alpha and beta, progesterone receptor, aromatase, 3-beta-hydroxysteroid dehydrogenase, and cyclooxygenase-2 in human preovulatory granulosa cells, and to measure their production of steroid hormones (estrone, estradiol, progesterone, androstenedione, and testosterone).

DESIGN

Analysis of cultured primary human preovulatory granulosa cells by real-time reverse-transcriptase polymerase chain reaction and assays of hormone production.

SETTING

Osaka City University Postgraduate School of Medicine.

INTERVENTION(S)

Preovulatory granulosa cells were collected from follicular fluid obtained from patients undergoing transvaginal oocyte retrieval with ultrasound guidance. The cells were cultured in the absence or presence of a low concentration of DHEAS. Real-time reverse-transcriptase polymerase chain reaction was performed to quantify the RNA expression of the investigated genes, and steroid hormone (estrone, estradiol, progesterone, androstenedione, and testosterone) levels were measured in the culture medium.

MAIN OUTCOME MEASURE(S)

Changes in [1] the levels of mRNAs encoding androgen receptor, estrogen receptor alpha, estrogen receptor beta, progesterone receptor, aromatase, 3-beta-hydroxysteroid dehydrogenase, and cyclooxygenase-2; and [2] the levels of steroid hormones (estrone, estradiol, progesterone, androstenedione, and testosterone) in the culture medium.

RESULT(S)

Treatment of granulosa cells with 20 ng/mL DHEAS increased the expression of androgen receptor, aromatase, 3-beta-hydroxysteroid dehydrogenase, and cyclooxygenase-2, reduced the expression of estrogen receptor beta, and increased estrone and estradiol levels, but had no effect on progesterone, androstenedione, or testosterone levels.

CONCLUSION(S)

DHEAS may be an essential trigger of ovulation.

Time to revolutionize the triggering of ovulation

Methods used for ovarian stimulation constantly change with advances in gonadotrophin therapy. In this Commentary, an appeal is made for more attention to the use of LH for the induction of ovulation. Its typical characteristics during the LH surge are finely balanced to induce normal ovulation and luteinization. It does not induce ovarian hyperstimulation, for example. The recent commercial availability of recombinant LH (LHr) offers a chance of escaping from the use of urinary human chorionic gonadotrophin (HCG) and its varied forms such as those with a shorter half-life. It should also avoid the weakly effective bursts of FSH and LH and weak luteal phases released associated with the use of gonadotrophin-releasing hormone agonists. Currently, large dosages of LHr are needed to match the endocrine events typical of inducing ovulation by the endogenous LH surge. In the interests of patients' safety and improved forms of luteal phase endocrinology, research should be devoted to improving the properties of rLH to make it induce surges similar to endogenous discharges. This would replace the current use of HCG to induce ovulation, with its attendant risks of ovarian hyperstimulation and luteal phase anomalies.

Comparison of follicle steroidogenesis from normal and polycystic ovaries in women undergoing IVF: relationship between steroid concentrations, follicle size, oocyte quality and fecundability

Studies of ovarian stimulation for IVF have suggested a relationship between follicle size and pregnancy rates. Furthermore the follicular endocrine environment is correlated with oocyte quality. The aim of this study was first to verify the relationship between follicular steroid content, follicular size, oocyte maturity and fertilization outcome in women with normal ovaries following recombinant human FSH (rhFSH). Secondly this study was extended to women with polycystic ovarian syndrome (PCOS). Fifty-nine patients (31 normal, 28 PCOS) underwent conventional IVF with rhFSH induction. Follicular diameter was classified as small (8-13 mm) or large (>14 mm) and sex steroid content was analysed for each group. Oocyte maturity was studied according to nuclear maturation the day after fertilization. In both ovulation groups, 17 beta-oestradiol and progesterone concentration were significantly higher in large follicles with meiotically competent oocytes compared with those containing meiotically incompetent oocytes. Testosterone levels were increased in PCOS follicles compared with normal patients, with no difference between corresponding sub-groups of follicles with meiotically competent oocytes. The relationship between follicle size and embryo development showed that 14 mm could be a threshold value following rhFSH induction in normal or PCOS women.

Progesterone production in cultured human granulosa cells: correlation with follicular fluid hormone levels

STUDY OBJECTIVE

To examine the progesterone (P) production by cultured granulosa cells and the hormonal content in the follicular fluid (FF) of ovarian-hyperstimulated women.

DESIGN

Retrospective.

SETTING

Private Fertility Clinic and National Research Institute.

PATIENTS

Eighteen patients undergoing in vitro fertilization or gamete intrafallopian transfer programs.

RESULTS

Progesterone levels Measured in the culture medium of granulosa cells decreased sixfold with culture time. Human luteinizing hormone (LH) increased P production only when basal P production was less than 1 microgram/mL. Granulosa cell P production in culture was negatively correlated with FF LH-human chorionic gonadotropin (hCG) levels. Follicular fluid follicle-stimulating hormone (FSH) levels were positively correlated with FF P and 17 beta-estradiol (E2) concentrations. Similar results were found between FF LH (hCG) and E2 levels, but there was no relationship between FF LH (hCG) and FF P values.

CONCLUSION

The high dose of hCG administered during gonadotropin treatment could induce a decrease in the in vitro granulosa cell P production.

Are estrogen assays essential for monitoring gonadotropin stimulant therapy?

Ovarian responses to human menopausal gonadotropin (hMG) are conventionally monitored by urinary estrogen or serum estradiol (E2) concentration. E2 can also be measured in saliva but this is rarely used. With ultrasound (USS) however, follicular development is assessed directly and we have previously shown that USS is superior to urinary estrogens for monitoring. We have now compared salivary and serum E2 with USS during hMG therapy in 48 women over 101 cycles. Salivary and serum E2 correlated significantly with each other and with the number of mature follicles. The manufacturers of hMG state that hCG should be given only when E2 is between 100 and 3000 pmol/l. However, there were no mature follicles in 40% of the cycles where E2 lay within this range. USS is the most accurate method of monitoring responses to hMG and, where this is available, estrogen assay provides no additional useful information.

Effect of human follicular fluids from pregnant and nonpregnant patients on the development of mouse zygotes in vitro

Mouse zygotes were cultured in medium containing follicular fluid from patients who had follicles containing oocytes which fertilized, did not fertilize, or were atretic and who did or did not become pregnant after in vitro fertilization and embryo replacement. The inhibitory effect was least with the follicular fluid from follicles in which the oocytes subsequently fertilized, greater when the oocytes did not fertilize, and most inhibitory when the follicle contained an atretic oocyte. More mouse zygotes developed to blastocysts when culture medium was supplemented with follicular fluid from patients who became pregnant compared to those who did not become pregnant. There was no difference in pregnancy outcome when an oocyte which subsequently fertilized was obtained from the follicle. These results indicate that follicles contain a substance(s) which inhibits mouse zygote development in vitro and that the inhibitory activity is related to the developmental potential of the oocyte in the follicle.

Correlation between follicular fluid content and the results of in vitro fertilization and embryo transfer. I. Sex steroids

The steroid content of 72 follicular fluids (FF) obtained from 42 women subjected to ovulation induction with the luteinizing hormone-releasing hormone analogue D-Trp6 and human menopausal gonadotropin was studied in terms of the evolution of in vitro fertilization (IVF) and embryo transfer (ET) results. The FF were classified into several categories based on oocyte evolution. Individual values of FF estrone and estradiol (E2), as well as androstenedione and testosterone could not be correlated with ET outcome. However, FF progesterone (P) levels for follicles leading to pregnancy were significantly lower when compared with those in the other categories. The correlation between the E2/P ratio and E2 permitted the definition of a band wherein IVF-ET outcome was successful and enabled the characterization of different functional follicular maturational states.

Effects of progesterone and a progesterone antagonist (RU486) on germinal vesicle breakdown in the mouse

The possibility that ovarian steroids may participate in the inhibition of meiosis has not been rigorously examined. Since progesterone levels are extremely high in follicular fluid prior to ovulation, we tested the possibility that this steroid may be involved in oocyte maturation. To this end, we collected follicular oocytes and cultured them in the presence of dibutyrl cAMP (Bt2), progesterone, and/or the progesterone antagonist RU486 and assessed maturation evidenced by germinal vesicle breakdown (GVBD). Denuded oocytes or cumulus masses collected in the presence of 1 mM Bt2 and subsequently cultured in 25 microM progesterone did not undergo GVBD. However, denuded oocytes and cumulus masses collected in the presence of progesterone and not Bt2 did undergo GVBD (93%). Concentrations of Bt2 (150 microM) that would not inhibit GVBD were inhibitory when used in the presence of progesterone (1-25 microM). Competition experiments using increasing concentrations of the progesterone antagonist RU486 (1-100 microM) did not block the ability of progesterone to enhance the activity of Bt2. We conclude that progesterone alone does not block GVBD; however, in the presence of low concentrations of cAMP it is extremely effective in blocking GVBD. The synergistic activity of progesterone does not appear to be mediated by the progesterone receptor. The data suggest that progesterone and cAMP may operate cooperatively to inhibit meiosis in the ovarian follicle.

Androgen metabolites in bovine follicular fluid

The values of C21-steroids, Delta4-androgens, estrogens as well as 5alpha-reduced steroids have been determined in follicular fluid obtained from superovulated and untreated cows. In the three cows treated with a hormone regimen to induce superovulation, the levels of progesterone and estradiol determined in 3 to 6 follicles per cow ranged from 65 to 448 ng/ml and 1.9 to 8.6 ng/ml, respectively while the concentrations of androstenedione and testosterone varied between 1.5 to 2.5 ng/ml. Low levels of dihydrotestosterone and androstane-3alpha, 17beta-diol (approximately 30 to 50% of Delta4-androgens) were found in the bovine follicular fluid. In untreated cows, the follicular steroid concentrations were divided into two groups on the basis of the ratio between estrogen and Delta4-androgen concentrations. In estrogen-rich follicles, the ratio of estrogens Delta4- androgens was higher than 1 and in estrogen-poor follicle, the ratio of estrogens Delta4- androgens was lower than 1. Pregnenolone, dehydroepiandrosterone, androst-5-ene-3beta, 17beta-diol, progesterone, androstenedione and testosterone levels were not significantly different in the two groups while the levels of estradiol and estrone were approximately 100-fold higher in the estrogen-rich group. The concentrations of 5alpha-reduced steroids particularly, dihydrotestosterone, androstane-3alpha, 17beta-diol and androsterone as well as their glucuronides which were found at values extremely low (under 1 ng/ml) were not significantly different in both groups. The results indicate that low levels of 5alpha-reduced steroids and their glucuronides are present in bovine follicular fluid and their concentrations remained fairly stable either in estrogen-rich or estrogen-poor groups.

The effects of progesterone antagonist RU 486 on mouse oocyte maturation, ovulation, fertilization, and cleavage

The antiprogesterone RU 486 was utilized to evaluate the possible role of progesterone in ovum maturation, ovulation, fertilization, and embryo cleavage. After gonadotropin treatment, CD-1 mice received the following experimental agents: group 1, an oil vehicle; group 2, 1 mg progesterone; group 3, 1 mg antiprogesterone (RU 486); group 4, 1 mg RU 486 and 1 mg dexamethasone. Each group of animals was injected simultaneously for 2 days (concomitant with human chorionic gonadotropin and the day after coitus). Ova or embryos were obtained on day 1, 2, 3, or 4 after human chorionic gonadotropin by flushing uteri and tubes. No differences were apparent in number of oocytes ovulated, ovum maturation, or number of oocytes progressing to two-cell embryos. However, on day 3 a marked reduction in embryos retrieved from the oviduct and uterus was apparent in the RU 486-treated groups (group 1, 84; group 3.0; group 4, 17) (p less than 0.001). In addition, few cleavage stage embryos were recovered on day 4 in the RU 486-treated groups (group 1, 74; group 2, 70; group 3, 2; group 4, 0) (p less than 0.0001). Freshly ovulated cumulus masses were recovered from the oviducts on day 4 in groups 3 and 4 (coincident with resumption of the estrous cycle). In conclusion, periovulatory RU 486 injections had no effect on nuclear maturation, ovulation, fertilization, or first cleavage division. Progesterone may not have an obligatory role in these processes. However, RU 486 administration did result in a reduced number of embryos retrieved on days 3 and 4 because of either early expulsion or destruction of the embryos.

Interrelationships between plasma hormone levels and the content of total protein, gonadotropins and steroid hormones in antral fluids of women undergoing in vitro fertilization

Follicle development was induced in 41 women with follicle-stimulating hormone (FSH) and human menopausal gonadotropin. Blood samples were drawn and follicular fluids (FF) were aspirated when two or more follicles attained diameters of 15 to 17 mm. Levels of estradiol (E2), progesterone (P), FSH, and luteinizing hormone (LH) were determined in samples by radioimmunoassay, and relationships between the measured parameters in antral fluids and in serum were examined by least-squares linear regression analysis. Levels of LH in serum correlated with LH and FSH levels in FF (P less than 0.005). Concentrations of FSH in serum were positively related to levels of LH, FSH, E2, and total protein in FF (P less than 0.005). E2 levels in serum were predictive of E2 levels in FF only, and levels of P in serum were directly correlated with P levels in FF (P less than 0.05). With respect to the peculiarly broad range of predictions that could be drawn from the FSH content of serum, peripheral FSH provided a better predictive index of the chemical composition of antral fluid than did the level of any other single hormone measured in serum.

Levels of steroid and protein hormones in antral fluids of women treated with different combinations of gonadotropins, clomiphene citrate, and a gonadotropin-releasing hormone analog

Levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, progesterone (P), and total protein in follicular fluids collected from 18 patients pretreated with a gonadotropin-releasing hormone analog (GnRHa), in association with human menopausal gonadotropin (hMG) and FSH, were compared with values for 69 patients treated with FSH, hMG, FSH/hMG, or clomiphene citrate (CC)/hMG in an in vitro fertilization (IVF) program. The authors have established a number of significant differences in chemical and physical properties of follicular fluids of patients treated by different regimen, and concur with earlier evidence that the volume of a follicle, and its P and total protein content, are related to the maturity of the oocyte nested within the follicle. Overall, however, differences in concentrations of gonadotropins in follicular fluids between groups were not consistent with differences in follicular fluid steroid levels, and levels of immunoactive gonadotropins in follicular fluids were not in accord with dosages of exogenous immunoactive gonadotropin administered during hyperstimulation. The most favorable outcomes of IVF (greater than 70% of oocytes fertilized) were established with oocytes collected from patients treated with FSH only or with CC/hMG, and patients treated with FSH only yielded the highest average number of oocytes which fertilized in vitro (6.2 per patient).

Conjugated and unconjugated C-21, C-19 and C-18 steroid concentrations in human follicular fluid from hyperstimulated follicles

Concentrations of unconjugated and glucuronated C-21, C-19 and C-18 steroids have been measured in follicular fluid obtained from women hyperstimulated by a combination of clomiphene citrate, pergonal and hCG. Pregnenolone and its glucuronide are found at approximately 5% of the progesterone values (14,395 +/- 2300 ng/ml). Concentrations of dehydroepiandrosterone glucuronide, androst-5-ene-3 beta, 17 beta-diol glucuronide, dihydrotestosterone glucuronide, androstane-3 alpha, 17 beta-diol glucuronide and androstane-3 beta, 17 beta-diol glucuronide are 2-6-fold higher than those of the related unconjugated steroids, while testosterone glucuronide levels are lower than those of testosterone. The concentrations of androsterone glucuronide reach almost 30-fold those of androsterone (2.56 +/- 0.35 ng/ml). By contrast, estradiol and estrone concentrations are 10-20-fold higher than those of conjugated steroids. Measurement of plasma steroid glucuronides indicated that the concentrations in circulation are markedly lower than those detected in follicular fluid. Our data suggest that the ovary in humans may be a site of glucuronidation.

Androgen and 19-norsteroid profiles in human preovulatory follicles from stimulated cycles: an isotope dilution-mass spectrometric study

Follicular fluid was aspirated from preovulatory follicles of women under ovarian stimulation for in vitro fertilization and analyzed by a highly specific technique based on gas chromatography-mass spectrometry associated with stable isotope dilution. 19-Nortestosterone and 19-norandrostenedione were identified and quantified for the first time in human follicular fluid. There was a strong positive correlation between 19-nortestosterone and estradiol-17 beta and between 19-norandrostenedione and estrone concentrations, thus indicating a common cellular origin. The accumulation of 19-norsteroids in follicular fluid confirms that they are weakly active intermediates in the multistep enzymatic conversion of androgen to estrogen. Testosterone concentrations were significantly lower than those obtained by radioimmunoassay; cross-reaction with substantially higher levels of 19-nortestosterone seems to be at the origin of this discrepancy. Androstenedione concentrations were similar to those reported in the literature and it was therefore confirmed that an estradiol/androstenedione concentration ratio above 20 is favourable for oocyte cleavage. Other and some newly estimated androgens are: testosterone sulfate, 5-androstene-3 beta, 17 beta-diol 3-sulfate and disulfate, dihydrotestosterone sulfate, epitestosterone, 19-hydroxyandrostenedione, 5 alpha-androstane-3 alpha, 17 beta-diol, 5 alpha-androstane-3 beta, 17 beta-diol, 5 alpha-androstane-3,17-dione and androsterone. Dehydroepiandrosterone sulfate was by far the most abundant androgen in this type of follicles.

Estrogen metabolites in equine ovarian follicles: gas chromatographic-mass spectrometric determinations in relation to follicular ultrastructure and progestin content

Equine follicular fluid was aspirated at various developmental stages (viable, preovulatory and atretic) determined by ultrastructural study. Estrogens and progestins were analyzed by gas chromatography-mass spectrometry associated with stable isotope dilution. Progesterone and 17-hydroxyprogesterone were the principal progestins of the preovulatory and viable follicles. Among the catechol estrogens, 2-hydroxy-estradiol was particularly abundant in the preovulatory follicle and its definitive identification was made by the scan of a full mass spectrum.

Simplification of the method of in vitro fertilization: sonographic measurements of follicular diameter as the sole index of follicular maturity

As a simplification of the in vitro fertilization (IVF) procedure, repeated sonographic scanning of follicular diameters in stimulated cycles was performed, until the largest visible follicle reached a mean diameter of at least 20 mm, at which time human chorionic gonadotropin (hCG) was administered. Follicle puncture was performed either guided by sonography or by laparoscopy 34-36 hr after the hCG injection, and following insemination oocytes were cultured for 48-60 hr before embryo transfer (ET). Serum levels of luteinizing hormone (LH), prolactin (PRL), and estradiol-17 beta (E2) at the time of hCG injection as well as follicular fluid levels of follicle stimulating hormone (FSH), LH, and PRL as well as progesterone (P), testosterone (T), and E2 at the time of puncture were determined in retrospect using specific radioimmunoassay (RIA). It was found that the knowledge of a single value of LH or E2 in serum should have been of little additional value for the decision to give hCG in all stimulation models used: clomiphene + hCG, human menopausal gonadotropin (hMG) + hCG, and clomiphene + hMG + hCG. The concentrations of the three steroids measured in follicular fluid were, in a high proportion of the follicles, within a normal range in all stimulation models. The group receiving clomiphene + hMG + hCG appeared promising through its higher proportion of estrogenic follicles. It is concluded that sonographic measurement of follicular diameters may be used as the sole index of follicular maturity in an IVF program.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoreactive relaxin surge in the peritoneal fluid of women during the midluteal phase

Relaxin was assayed in the peritoneal fluid (PF) of 176 women with normal ovulatory cycles. Validation of the assay in this fluid was carefully established. Relaxin was rarely detected before day 20 of the cycle. From days 21 to 24, all samples contained detectable concentrations of the peptide, ranging between 75 and 775 pg/ml. Apparition of relaxin in the PF was not directly related to the ovulatory follicular rupture. It was also delayed, compared with the postovulatory rise of plasma and peritoneal progesterone. Relaxin is thus present in the PF only during the period propitious to human embryo implantation.

The relationship between follicular fluid steroid concentration and successful fertilization of human oocytes in vitro

Follicular fluids (FF) and their matched oocytes were obtained from 64 follicles of 28 women who failed to conceive after in vitro fertilization ( IVF ) and 33 follicles of 8 women who successfully conceived after the procedure. Ovulation was induced with human menopausal gonadotropin, and follicular aspiration was performed 36 hours after human chorionic gonadotropin administration. The concentration of 17 beta-estradiol, progesterone, testosterone, dihydrotestosterone, and androsterone was correlated with the morphology of the oocyte-corona-cumulus complex ( OCCC ), oocyte fertilization, the rate of cleavage, and the incidence of pregnancy after embryo transfer. In both groups of women, FF progesterone was lowest in follicles containing immature OCCCs . However, follicles aspirated from women who conceived after IVF which contained intermediate and mature OCCCs had significantly higher FF estradiol levels than similar follicles from women who failed to conceive after the procedure. Fertilized oocytes and 4- to 6-cell stage embryos which were obtained from follicles of pregnant women contained significantly higher FF estradiol levels than fertilized oocytes and similar embryos from nonpregnant women. It appears that higher FF estradiol levels correlate well with successful fertilization and an enhanced cleavage rate of oocytes associated with pregnancy following IVF .

Factors influencing the success of in vitro fertilization for alleviating human infertility

The program for in vitro fertilization at Bourn Hall began in October 1980. Various types of infertility have been treated during this time using the natural menstrual cycle or stimulation of follicular growth with antiestrogens and gonadotrophins. Follicular growth and maturation are assayed by urinary estrogens and LH, monitored regularly during the later follicular stage. Many patients had an endogenous LH surge; others needed an injection of HCG to induce ovulation. All oocytes were recovered by laparoscopy. Wide variations occurred in the time interval between the start of the LH surge and oocyte recovery and between oocyte recovery and insemination. Embryos taken between the one- and the eight-cell stage were replaced into their mother, no standard procedure being adopted for all patients. The results of all treatments including patient's responses during the follicular and luteal phases, oocyte recovery, fertilization, cleavage, replacement, implantation, abortion, and birth and the effect of factors such as replacing two or more embryos, maternal age, and previous obstetric history are described in detail. The incidence of implantation after embryo replacement improved from 16.5% initially to 30% currently. More than 118 babies have been born, and many pregnancies are continuing.

Estrogen 2-, 4-, 6- or 16-hydroxylation by human follicles shown by gas chromatography-mass spectrometry associated with stable isotope dilution

Follicular fluid, obtained by aspiration of human Graafian follicles in cycles stimulated by clomiphene and hMG + hCG, was analyzed for estrogen content. Carefully controlled extraction and efficient preliminary chromatographic separations were set up. Deuterium labelled analogues were used as internal standards for the quantitative determination by gas chromatography-mass spectrometry and some new derivatives were included in the identification procedure. The identified estrogens and their mean concentrations (ng/ml) are: 2-hydroxy-estrone (0.14), 4-hydroxy-estrone (0.12), 2-hydroxy-estradiol (0.36), 4-hydroxy-estradiol (0.34), 6 alpha-hydroxy-estradiol (13.2), 6 beta-hydroxy-estradiol (6.40), 2-methoxy-estrone (0.83), 2-methoxy-estradiol (10.5), 16-oxo-estradiol (0.41), estriol (10.2), estradiol-17 beta (1365), estradiol-17 alpha (1.91), estrone (211). Metabolism of estradiol by 6-hydroxylation seems to be predominant in the human ovary. The other data suggest that 2-hydroxylation, with subsequent O-methylation, and 16-hydroxylation may be by equivalent pathways, since the sum of the 2-methoxy-estrone and 2-methoxy estradiol concentrations is rather similar to the estriol concentration. Hence, the latter three compounds and the 6-hydroxy-estradiols may be end-products of follicular estrogen metabolism. Catechol estrogen formation by 2-hydroxylation and 4-hydroxylation is shown to be of equal importance in the ovary. These results confirm the presence in the human follicle of various competing estrogen hydroxylases and catechol-O-methyltransferase.

On some useful statistical techniques in the analysis of hormone data

Three multivariate statistical techniques, which have been found very useful in the analysis of hormone data, are demonstrated. The value of these techniques as a means of compressing the information contained in a complex array of experimental units and variates into a few "dimensions" is emphasised.

Steroids in porcine follicular fluid: analysis by HPLC, capillary CG and capillary CG/MS after purification on SEP-PAK C18 and ion exchange chromatography

Steroids in porcine follicular fluid have been concentrated by reverse phase chromatography in SEP-PAK C18 and purified further on the cation exchanger SP-Sephadex C-25. Fractionation into unconjugated neutral and phenolic steroids, glucuronides and sulfates was carried out on triethylaminohydroxypropyl Sephadex LH-20 (TEAP-LH-20). The unconjugated neutral fraction was analysed by high pressure liquid chromatography (HPLC) on a C18 radial cartridge 5 mm I.D.; 10 mu, or on a C18 5 mu RESOLVE column, and by capillary gas chromatography (GC) on a 12 M OV-1 cross linked fused silica column. Testosterone, progesterone and androstenedione were the major steroids detected by HPLC monitored at 254 nm, although 17- hydroxy-, 20 alpha-dihydro- and 20 beta-dihydroprogesterone were also present. Pregnenolone, pregnanediol, dehydroepiandrosterone, 17-hydroxypregnenolone and androsterone were detected by capillary CG as their 0-methyloxime trimethylsilyether derivatives. Further confirmation of structure was provided by complete mass spectral data or by selective ion monitoring (SIM).

Human luteal phase function following oocyte aspiration from the immediately preovular graafian follicle of spontaneous ovular cycles

Human luteal phase function as evaluated by peripheral venous blood steroid levels does not appear to be impaired following the aspiration of follicular fluid together with a cumulus enclosed oocyte and a number of granulosal cells from the immediate preovular follicle in women having otherwise spontaneous ovular cycles. The day to day levels of luteinising hormone, oestradiol-17 beta, 17 alpha-hydroxy-progesterone, progesterone and basal temperatures in 14 women who had their preovular follicle aspirated were compared with a control group of 28 spontaneously ovulating women. It was concluded that a carefully performed single aspiration of the contents of a preovular follicle, for the purpose of extra-corporeal fertilisation of the mature oocyte, did not lead to impaired steroid function of the subsequent corpus luteum, although the prolactin levels were increased due to the effects of the relaxant anaesthetic and/or the laparoscopic procedure. A safe and simple laparoscopic procedure is also described, which is particularly suitable for women with a likelihood of extensive pelvic adhesions.

The binding of oestradiol-17beta to human spermatozoa - an electron microscope autoradiographic study

The location of steroid binding sites with specificity for oestradiol-17beta at an ultrastructural level has been examined on human spermatozoa by electron microscope autoradiography. About 75% of the 438 gains produced by 3H-oestradiol-17beta, and counted on electron microscope autoradiographs, were found over the plasma membrane or within 1000 A of it. This study provides evidence suggesting that the plasma membrane is a site of action of oestradiol-17beta in human spermatozoa.

Morphological and functional relations of Graafian follicle growth to ovulation in women using ultrasonic, laparoscopic and biochemical measurements

The daily growth rates of ovarian follicles were recorded ultrasonically for five days until ovulation in 56 spontaneously ovulating women and related to endocrine and clinical parameters. Over the 5-day period, the average diameter of the follicle destined to ovulate increased from 12 to 23 mm, the second largest follicle from 6 to 12 mm, the third largest follicle from 5 to 9 mm and the fourth largest follicle from 4 to 8 mm. Similar but lesser growth rates occurred in the follicles in the contralateral ovary. Ovulation occurred within 24 hours of the luteinizing hormone (LH) peak, and the mean peak diameter of the ovulating follicle was 23.2 +/- 0.3 (SEM) mm, (range 18-29 mm) before ovulation, and subsequent luteal function was judged to be normal. Follicular growth was most closely correlated with increasing peripheral blood oestrogen levels. In 16 women who had a laparoscopy within 12 hours of the last ultrasound and following the LH peak, the mean diameter of the largest follicle as measured by ultrasound (23.6 +/- 0.4 mm) was similar to that measured at laparoscopy (22.8 +/- 0.04 mm) and estimated from the volume of follicular fluid aspirated (average 5.8 +/- 0.2 ml), 22.5 mm. The follicular fluid levels of progesterone were high on the day of the LH peak and blood progesterone levels had risen significantly indicating that luteinization of the dominant Graafian follicles had already occurred prior to ovulation. This study confirms that ultrasonic monitoring provides a reliable measure of follicular growth and allows studies correlating morphological changes with both normal and abnormal endocrine function of the human ovary.

Observations on preovulatory human ovarian follicles and their aspirates

During laparoscopy for the collection of preovulatory oocytes the ovaries were inspected and the numbers of Graafian follicles were counted. Most patients had one large preovulatory follicle but three patients had two and might have had twin ovulations. The large follicle was in the left ovary in 9 patients and in the right ovary in 11. It could be aspirated easily in most patients, viscous follicular fluid, presumably rich in hyaluronic acid, appeared to accumulate in preovulatory follicles between 18 and 27 hours after the luteinizing hormone surge. The content of steroids in follicular fluids indicated that the largest follicle was preovulatory in most patients, the smaller follicles being non-ovulatory. Granulosa cells aspirated from the large preovulatory follicles were active on the delta 4 pathway and able to aromatise androgens to oestrogens, but did not undertake conversions on the delta 5 pathway.

Oestradiol production by human graafian follicles cultured in vitro

Intact human Graafian follicles recovered during the preovulatory phase of the menstrual cycle and cultured in vitro, gave a mean oestradiol production of 33 ng/hour over periods of 4 to 92 hours. Treatment of follicles with human pituitary gonadotrophin or human chorionic gonadotrophin resulted in an increased production of oestradiol.