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Chapter 2 32 Table 2.1 Clinical, endocrine and menstrual cycle characteristics (median and range) in 40 normoovulatory volunteers receiving exogenous FSH (75 IU/d) starting on cycle day (CD) 3, 5 or 7. CD 3 CD 5 CD 7 n 13 13 14 Age (yrs) 29 (21-35) 29 (22-34) 28 (20-35) BMI (kg/m2 ) 22 (19-27) 23 (19-27) 22 (19-27) Cycle length (d) 28 (26-31) 28 (25-31) 28 (26-30) Cycle day 3 FSH (IU/l) 6.5 (2.8-13.5) 6.3 (3.3-9.8) 7.7 (5.4-13.1) E (pmol/l) 2 127 (64-220) 175 (91-404) 137 (109-264) Inhibin B (ng/l) 87 (21-192) 130 (12-213) 114 (57-179) Day of hCG FSH (IU/l) 5.8 (4.5-9.6) 6.1 (5.5-10.9) 6.9 (4.7-20.4) LH (IU/l) 6.8 (1.5-19.1) 4.6 (1.0-21.1) 7.9 (0.3-57.2) E (pmol/l) 2 945 (660-2840) 1106 (470-2302) 985 (682-1610) P (nmol/l) 4.3 (2.5-5.4) 3.6 (1.4-27.3) 4.1 (2.4-8.7) Inhibin A (ng/l) 51 (28-224) 69 (27-143) 73 (38-195) Follicle number (≥10 mm) 2.5 (1-6) 2 (1-7) 1 (1-5) Follicle number (≥12 mm) 1.5 (1-6) 2 (1-5) 1 (1-4) Follicle number (≥15 mm) 1.5 (1-4) 1 (1-3) 1 (1-3) Number of subjects with multiple DFa* 9 (69%) 10 (77%) 5 (36%) Number of subjects with multiple PFb 7 (54%) 6 (46%) 4 (29%) Total amount recFSH (IU) ** 750 (600-1125) 525 (375-825) 450 (75-900) Follicular phase length (d) 13 (12-19) 13 (11-17) 14 (9-20) Luteal phase length (d) 12 (9-15) 12 (8-16) 13 (11-17) P (nmol/l) c 53 (23-287) 44 (18-109) 61 (17-96) a DF = dominant follicle (diameter ≥ 10 mm) b PF = pre-ovulatory follicle (diameter ≥ 15 mm) * P = 0.07 (Chi-square test) ** P = 0.001 (Kruskal-Wallis H test) c midluteal A daily dose of 75 IU of recFSH was able to interfere with single dominant follicle selection in 24 subjects (60%) in all 3 groups. There was no difference in multifollicular growth (defined as at least 2 follicles ≥ 10 mm) or the development of multiple pre-ovulatory follicles (defined as a follicle ≥ 15 mm) between the 3 groups, although a tendency was seen towards less multifollicular growth in group CD 7 (P = 0.07) (Table 2.1). Group CD 7 versus all other subjects (groups CD 3 and CD 5) did show a statistical difference in the development of multiple dominant follicles (36% vs. 73%; P = 0.02). Figure 2.1 shows the mean follicle number in both ovaries during the
Multiple dominant follicle development Mean number of follicles 6 4 2 0 6 4 2 0 6 4 2 0 3 recFSH (n=9) (n=10) (n=5) 5 recFSH 7 recFSH 8-10 mm 10-12 mm 12-15 mm >15 mm Intervention in the normal menstrual cycle 33 follicular phase in subjects presenting with multiple dominant follicle development, in each group. Table 2.2 shows the comparison of women presenting with single (n=16) or multiple (n=24) dominant follicle development following the administration of recFSH. With regard to age, BMI, cycle length and initial (CD 3) hormone levels, no differences were found between the two groups. There was no difference in parity between the groups with mono- or multifollicular growth (nullipara vs. multipara: 62% vs. 38% and 50% vs. 50%, respectively). The lower the BMI, the more follicles developed (Figure 2.2: r = −0.44, P = 0.007). None of the subjects with a BMI ≥ 24 kg/m 2 (n=10) 9 cycle days hCG hCG-1/2 Figure 2.1 Number of follicles (≥ 8 mm) during the follicular phase in 24 normo-ovulatory women receiving fixed low daily doses (75 IU) of exogenous FSH (starting on either cycle day 3, 5 or 7), who developed multiple dominant follicles (≥ 10 mm) on the day of hCG administration. Areas represent the mean number of follicles in both ovaries on a given day in all subjects, with shaded areas representing different size classes. The time scale on the x-axis is divided into cycle days (day of onset menses = cycle day 1) and days prior to administration of hCG.
Page 1 and 2: Aspects of Mono- and Multiple Domin
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Page 8 and 9: 4.2.1. Introduction 69 4.2.2. Mater
Page 10 and 11: SRY sex-determining region of the Y
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Page 21 and 22: Introduction and objectives 21 WHO
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Alternative approaches to disturbed
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FSH treatment duration (days) FSH r
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Alternative approaches to disturbed
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General discussion General discussi
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General discussion 93 the developin
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General discussion 95 study in term
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General discussion 97 ian response
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References
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References 102 Beckers NG, Macklon
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References 104 Dunaif A, Graf M, Ma
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References 106 Gerris J, De Neubour
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References 108 Hughes EG, Collins J
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References 110 Mannaerts B, de Leeu
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References 112 Olivennes F and Fryd
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References 114 Sullivan MW, Stewart
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References 116 Whiteford LM and Gon
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Summary Chapter 1 Summary 119 The i
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Summary 121 resulted in pregnancy r
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Samenvatting Hoofdstuk 1 Samenvatti
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Samenvatting 125 op cyclusdag 2 of
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Publications and presentations
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Publications and presentations 130
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Dankwoord Dankwoord 133 Mijn promot
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Dankwoord 135 Dank je voor het bijb
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Dankwoord 137 Zonder ondersteuning
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Dankwoord 139 Lieve Elly en Joost,
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Curriculum vitae auctoris Curriculu
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