Effects of pulsatile intravenous follicle-stimulating hormone treatment on ovarian function in women with obesity.

Autor:	Luu TH; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Kuhn K; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: katherine.kuhn@cuanschutz.edu., Bradford AP; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Wempe MF; Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Wittenburg L; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California., Johnson RL; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Carlson NE; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Kumar TR; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado., Polotsky AJ; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Shady Grove Fertility, Greenwood Village, Colorado.
Jazyk:	angličtina
Zdroj:	Fertility and sterility [Fertil Steril] 2023 Oct; Vol. 120 (4), pp. 890-898. Date of Electronic Publication: 2023 Jun 03.
DOI:	10.1016/j.fertnstert.2023.05.170
Abstrakt:	Objective: To establish conditions for effective hypothalamic suppression in women with normal and high body mass index (BMI) and test the hypothesis that intravenous (IV) administration of pulsatile recombinant follicle-stimulating hormone (rFSH) can overcome the clinically evident dysfunctional pituitary-ovarian axis in women with obesity. Design: Prospective interventional study. Setting: Academic medical center. Patient(s): Twenty-seven normal-weight women and 27 women with obesity, who were eumenorrheic and aged 21-39 years. Intervention(s): Two-day frequent blood sampling study, in early follicular phase, before and after cetrorelix suppression of gonadotropins and exogenous pulsatile IV rFSH administration. Main Outcome Measure(s): Serum inhibin B and estradiol (E2) levels (basal and rFSH stimulated). Result(s): A modified gonadotropin-releasing hormone antagonism protocol effectively suppressed production of endogenous gonadotropins in women with normal and high BMIs, providing a model to address the functional role of FSH in the hypothalamic-pituitary-ovarian axis. The IV rFSH treatment resulted in equivalent serum levels and pharmacodynamics in normal-weight women and those with obesity. However, women with obesity exhibited reduced basal levels of inhibin B and E2 and a significantly decreased response to FSH stimulation. The BMI was inversely correlated with serum inhibin B and E2. In spite of this observed deficit in ovarian function, pulsatile IV rFSH treatment in women with obesity resulted in E2 and inhibin B levels comparable with those in normal-weight women, in the absence of exogenous FSH stimulation. Conclusion(s): Despite normalization of FSH levels and pulsatility by exogenous IV administration, women with obesity demonstrate ovarian dysfunction with respect to E2 and inhibin B secretion. Pulsatile FSH can partially correct the relative hypogonadotropic hypogonadism of obesity, thereby providing a potential treatment strategy to mitigate some of the adverse effects of high BMI on fertility, assisted reproduction, and pregnancy outcomes. Clinical Trial Registration Number: ClinicalTrials.gov #NCT02478775. (Copyright © 2023 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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