Human Reproduction, Vol 13, 9-14, Copyright © 1998 by Oxford University Press
T Eldar-Geva, EJ Margalioth, B Brooks, N Algur, E Zylber-Haran and YZ Diamant
The study was designed to investigate the source of progesterone secretion
during pituitary suppression and ovarian stimulation. It involved 416 women
undergoing in-vitro fertilization (IVF) who were treated with
gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal
gonadotrophin (HMG) (group I), 139 women undergoing ovulation induction
with HMG only (group II) and nine women who were diagnosed previously as
late-onset adrenal hyperplasia and treated continuously with dexamethasone,
in addition to ovulation induction (group III). During HMG treatment, serum
oestradiol and progesterone were measured every 1-2 days. If progesterone
concentration exceeded 3.0 nmol/l, at least 36 h before human chorionic
gonadotrophin (HCG) administration, the patients were prospectively
randomized to treatment with dexamethasone or not and the hormones
concentrations were measured again 12 h later. Mean age and pretreatment
serum concentrations of dehydroepiandrosterone sulphate, androstenedione,
testosterone and luteinizing hormone/follicle stimulating hormone (LH/FSH)
ratio, were not significantly different in the patients with and without
progesterone elevation. Pituitary down-regulation did not reduce the
incidence of progesterone elevation (13.9 and 12.2% in groups I and II
respectively), while in group III, progesterone concentrations did not
increase. After dexamethasone administration a significant decrease in
serum progesterone concentration was demonstrated (mean +/- SD, -2.1 +/-
1.4 and -1.6 +/- 1.2 in groups I and II respectively, while in the
untreated patients it increased (+1.9 +/- 1.9 and +4.2 +/- 4.8). The
increase in serum progesterone concentrations was not accompanied by an
increase in cortisol and 11-deoxycortisol but by an increase in LH. After
dexamethasone administration the concentrations of cortisol, 11-
deoxycortisol and LH significantly decreased. Progesterone concentration
was positively correlated with both oestradiol concentration (r = 0.290; P
< 0.05) and the number of oocytes retrieved (r = 0.207; P < 0.05). We
conclude that at least a part of serum follicular-phase progesterone
appears to be of adrenal origin. High oestrogen concentrations (or other
ovarian factors) may cause changes in the hypothalamic-pituitary-adrenal
axis and in adrenal enzyme activity as a part of the complex 'cross-talk'
between the hypothalamic- pituitary-ovarian and the
hypothalamic-pituitary-adrenal axes.
ARTICLES
The origin of serum progesterone during the follicular phase of menotropin-stimulated cycles
Department of Obstetrics and Gynaecology, Shaare-Zedek Medical Centre, Jerusalem, Israel.
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