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Hum. Reprod. Advance Access published online on January 26, 2006
Human Reproduction, doi:10.1093/humrep/dei499
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received October 5, 2005
Revised December 12, 2005
Accepted December 22, 2005

Article

Dynamics of FSH-induced follicular growth in subfertile women: relationship with age, insulin resistance, oocyte yield and anti-Mullerian hormone

R. Fleming 1 *, N. Deshpande 1, I. Traynor 1, and R.W.S. Yates 1

1 Assisted Conception Unit, Royal Infirmary, Glasgow, UK

* To whom correspondence should be addressed.
R. Fleming, E-mail: r.fleming{at}udcf.gla.ac.uk


  Abstract

BACKGROUND: During excess FSH treatment, different categories of follicles can be discerned: those responding and appearing to grow immediately (FolsS8) and those appearing subsequently during the follicular phase (Fols/d). These follicular categories were explored in cycles of assisted reproduction in the context of follicular biology, including primordial follicle pool (PFP) depletion, age, insulin resistance and potential markers. METHODS: Follicular cohorts were examined in 365 conventional ART cycles and related to patient insulin sensitivity, plasma FSH and anti-Mullerian hormone (AMH). RESULTS: Age had no influence upon the FolsS8 category but was associated with a significant (P < 0.005) decline in the Fols/d. In contrast, insulin-resistant polycystic ovary syndrome (IR-PCOS) showed a significant (P = 0.005) increase in FolsS8. Circulating AMH correlated strongly with oocyte yield and Fols/d. CONCLUSION: Age showed little impact on the initial follicular cohort, but a significant impact upon the secondary cohort, while insulin resistance appeared to promote the former category alone. The disturbance to follicular dynamics and AMH in IR-PCOS reflected a larger stockpile of FSH-sensitive follicles. Circulating AMH appears to represent all categories of antral follicles observed.

Keywords: AMH/follicle cohort/FSH/oocyte yield/PCOS.
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