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Contents
Chapter 1: Introduction and objectives
1.1 General introduction 13
1.2 Ovarian physiology 18
1.1.1. Ovarian development 18
1.1.2. Early follicle development 18
1.1.3. Advanced follicle development: the “threshold/window” concept 19
1.3 Disturbed folliculogenesis 20
1.4 Assisted reproduction 22
1.4.1. Management of subfertility 22
1.4.2. Ovulation induction 22
1.4.3. Ovarian (hyper)stimulation 23
1.5 Study objectives 24
Chapter 2: Follicle dynamics and endocrine aspects after intervention in the
normal menstrual cycle
2.1 Low-dose exogenous FSH initiated during the early, mid or late follicular
phase can induce multiple dominant follicle development
2.1.1. Introduction 29
2.1.2. Materials and methods 30
2.1.3. Results 31
2.1.4. Discussion 39
2.2 Relationship between inhibin A and B, oestradiol and follicle growth
dynamics during ovarian stimulation in normo-ovulatory women
42
2.2.1. Introduction 42
2.2.2. Materials and methods 43
2.2.3. Results 45
2.2.4. Discussion 49
Chapter 3: Mild ovarian stimulation for assisted reproduction
3.1 Introduction 53
3.2 A randomized comparison of two stimulation protocols with GnRH
antagonist co-treatment for in vitro fertilization commencing recombinant
FSH on cycle day 2 or 5 with the standard long GnRH agonist protocol
54
3.2.1. Introduction 54
3.2.2. Materials and methods 55
3.2.3. Results 58
3.2.4. Discussion 63
Chapter 4: Alternative approaches to disturbed follicle growth
4.1 Introduction 69
4.2 LH suppression following different doses of the GnRH antagonist
ganirelix (Orgalutran ® 69
) in polycystic ovary syndrome