A prospective evaluation of antral follicle function in women with 46,XX spontaneous primary ovarian insufficiency

ObjectiveTo assess ovarian follicle function in women with 46,XX spontaneous primary ovarian insufficiency.DesignCase–control with nested prospective cohort.SettingClinical Research Center, National Institutes of Health.Patient(s)Women with primary ovarian insufficiency without estrogen replacement for 2 weeks (N = 97) and regularly menstruating control women (N = 42).Intervention(s)Single injection of 300 IU hrFSH.Main Outcome Measure(s)Change in serum estradiol at 24 hours.Result(s)Antral follicles ≥3 mm were detected in 73% (69/95) of patients; both serum estradiol and progesterone levels correlated significantly with maximum follicle diameter in these women. Patients with a maximum follicle diameter ≥8 mm had significantly higher serum estradiol and progesterone levels and significantly lower FSH and LH levels compared with patients without such follicles. In controls estradiol levels increased significantly after FSH administration, but in patients this was not the case despite the presence of an antral follicle ≥8 mm.Conclusion(s)Most women with 46,XX spontaneous primary ovarian insufficiency have antral follicles detectable by ultrasound, suggesting that down-regulation of FSH receptors is not the predominant mechanism of follicle dysfunction. Evidence of progesterone secretion by antral follicles ≥8 mm in these patients is consistent with prior histologic evidence that follicle luteinization is the predominant mechanism of follicle dysfunction in this condition. Prospective controlled investigation designed to improve ovulatory function and fertility in these women is indicated.