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Successful Pregnancy Reported with Immature Oocytes. Center for Applied Reproductive Science. Dr. Samuel Thatcher.


The LH Surge
Title:Initiation of periovulatory events in gonadotropin stimulated macaques with varying doses of recombinant human chorionic gonadotropin
Address: Beaverton, Oregon
Source: Human Reproduction 12, 1877-1885 (September) 1997
Summary: A large and certainly supraphysiologic dose of hCG is given to IVF patients undergoing controlled ovarian stimulation to invoke the final maturation of the preovulatory follicle. This study assessed the efficacy of lower doses of HCG. Nineteen rhesus monkeys were used to evaluate injections of 100, 300, 1000 IU recombinant HCG or 1000 IU urinary HCG. Bioactive HCG rose to peak concentration within 2 hours proportionate to dose administration (100<300<1000 IU= recombinant HCG=urinary HCG ). Duration of surge values was also proportionate to dosage (0 h,100 IU; 24 h, 300 IU; >48 h,1000 IU, recombinant or urinary HCG). The proportion of oocytes resuming meiosis and undergoing IVF was similar in all groups. Fertilized oocytes were fewer in the 100 IU and 300 IU HCG group with only 5 out of 9 oocytes fertilizing compared with 9 out of 10 oocytes fertilizing in the 1000 IU recombinantor urinary HCG group. Progesterone peak values were similar in all groups but declined 2 days earlier in the 100 and 300 IU HCG group when compared with the 1000 IU recombinant or urinary HCG group. The authors concluded that 3-10 fold lower doses of HCG elicit low amplitude surges of short duration and suggest that oocyte fertilization and luteal function may require surges of higher amplitude and longer duration similar to those produced with 1000 IU recombinant or urinary HCG for optimal results.
Comment: The mid-cycle luteinizing hormone (LH) surge is an important modulator of preovulatory events. The LH surge is intimately involved in 3 separate, but interrelated events: 1) resumption of oocyte meiosis; 2) ovulation; and 3) luteinization of the follicle wall and the early development of the corpus luteum. Human chorionic gonadotropin (hCG) binds to the same receptor as LH is substituted for LH to induce the above necessary cascade. The threshold of LH for the each preovulatory event is probably different. That is, the amount of LH necessary for luteinization may differ from that necessary ovulation. Clinically, the Œspasticı LH surge may be related to two elusive phenomenon; development preovulatory follicles without ovulation-the luteinized unruptured follicle and the luteal phase defect. With the increased availability of recombinant LH, we now have a tool to better investigate the precise action of LH.

>PCOS: More Keys to the Puzzle
Title: Heterogeneity in beta activity, hepatic insulin clearance and peripheral insulin sensitivity in women with polycystic ovary syndrome
Author: M. Ciampelli.
Address: Rome, Italy
Source: Human Reproduction 12, 1897-1901 (September) 1997
Summary: This study evaluated the impact of reduced peripheral insulin sensitivity, beta cell hypersecretion and reduced hepatic insulin clearance in (PCOS) patients. Study population was comprised of 35 women, aged 17-31 with PCOS. PCOS was diagnosed by the following criteria: presence of amenorrhea or oligomenorrhea; hirsuitism; elevated plasma androstenedione or testosterone; and bilaterally normal or enlarged ovaries with the 7 or more microcysts less than 5mm diameter. LH/FSH ration was not considered as part of the exclusion criteria. PCOS patients were divided into 4 groups based on their body mass index (BMI) and insulin secretion. Ten lean ovulatory women were used as controls. The groups were classified as: normoinsulinemic-lean; normoinsulinemic-obese; hyperinsulinemic lean; hyperinsulinemic-obese. Obesity was defined as a (BMI) over 25 (normal range 19-25). All PCOS groups showed significantly higher insulin secretion. Glucose load elicited no differences in insulin response in any of the groups. Secretion of c-peptide was greater in PCOS groups and all hyper-insulinemic PCOS patients had lower values of hepatic insulin clearance independent of BMI when compared with the controls P less than 0.0001 or with the PCOS normo-insulinemic patients Pless than 0.01. Lean PCOS subjects and controls had higher body glucose utilization rates than the normo and hyperinsulinemic obese subjects. The authors suggest that insulin resistance and hyper-insulinemia may represent 2 distinct features of the insulin disorder in PCOS: the former appears to reflect the presence of obesity, while the latter may be a primary feature of PCOS.
Comment:Possibly another piece of the PCOS puzzle. It is still hard to know whether to be a lumper of splitter when considering the manifestation of the the PCO spectrum.

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