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Human Reproduction, Vol. 9, No. 5, pp. 806-811, 1994
© 1994 European Society of Human Reproduction and Embryology

research-article

Aetiological factors involved in the low response to gonadotrophins in infertile women with normal basal serum follicle stimulating hormone levels

Antonio Pellicer1,2,5, María J. Ballester2, María D. Serrano4, Amparo Mir3, Vicente Serra-Serra2, José Remohi1 and Fernando Bonilla-Musoles1,2

1Instituto Valenciano de Infertilidad, Departments of Valencia Spain 2Departments of Obststrics and Gynaecology and Valencia Spain 3Departments of Microbilogy, Valencia University School of Valencia Spain 4General Laboratory, Hospital Clinico Universitario, Valencia Spain

Correspondence: 5To whom correspondence should be addressed at: Instituto Valenciano de Infertilidad, Guardia Civil, 23, Valencia-46020, Spain

This study was designed to Investigate possible aetiological factors involved in the low response to gonadotrophins in women with normal basal serum follicle stimulating hormone (FSH) concentrations, stimulated for assisted reproduction. Nine of these patients with normal basal serum FSH and 22 normal controls (five of whom had had a normal response to previous gonadotrophln stimulation) were prospectively subjected to: (i) transvaginal pulsed colour Doppler ultrasound evaluation of the vessels surrounding the dominant follicle for blood flow impedance analysis, (ii) the clonidine test to explore the ability of the pituitary to release growth hormone, and (iii) detection of anti-granulosa cell auto-antibodies in blood using an enzyme-linked immunosorbent assay (ELISA). The pulsatility and resistance Indices (PI, RI) were significantly (P < 0.01) higher in the women with low responses as compared to the controls on days –1 and 0 (day 0=ovulation). Seven out of the nine low responders were out of the range calculated for normal values after evaluation of the controls. A significant (P < 0.05) decrease in the secretion of growth hormone 60–90 min after clonidine ingestion was observed in the low responders as compared to five controls with previous normal response to ovarian stimulation. Six out of the nine low responders showed a negative cloiildlne test. No increase in anti-granulosa cell auto-antibodies was observed in the low responders as compared to the controls, Including normal responders. In conclusion, an abnormal follicular blood flow impedance in the natural cycle may be related to low responses to gonadotrophins in patients with normal serum FSH concentrations. Simultaneously, a decreased growth hormone pituitary reserve has been identified in most of these patients, suggesting that the insulin-like growth factors system might be related to the vascularization of the ovarian follicle.

Key words: anti-ovarian antibodies/Doppler ultrasound/insulin-like growth factors/low responders/ovarian stimulation


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