Correlation of inhibin and follicle regulatory protein activities with follicular fluid steroid levels in anovulatory patients

University of Southern California School of Medicine, Livingston Reproductive Biology Laboratory, Department of Obstetrics and Gynecology, Los Angeles, California Follicular fluid was obtained from anovulatory patients (n = 12), stimulated with human menopausal gonadotropin, clomiphene, and human chorionic gonadotropin to evaluate the relative responses of inhibin, follicle regulatory protein, and steroid levels in follicles from ovaries requiring exogenous stimulation for follicular development. Follicular fluid concentrations of estradiol, progesterone, androstenedione, testosterone, dihydrotestosterone, and 3α-androstenediol were determined by radioimmunoassay. Follicular fluid inhibin activity was determined by suppression of rat pituicyte follicle-stimulating hormone, and follicle regulatory protein activity was determined by suppression of porcine granulosa cell aromatase. The mean level of steroids were progesterone (7529 ± 1601 ng/ml), estradiol (1082 ± 158 ng/ml), androstenedione (15.2 ± 3.17 ng/ml), 3α-androstenediol (0.90 ± 0.13 ng/ml), testosterone (2.23 ± 33 ng/ml), and dihydrotestosterone (0.77 ± 0.11 ng/ml). Follicle regulatory protein activity was 16.6% ± 4.3% and mean inhibin level was 62.9 ± 7.52 U. These results are in contrast to reports of follicular fluid steroid levels from normal ovulatory patients treated with exogenous gonadotropin. Although altered levels of hormones were present within these follicles, they clearly were not atretic, as evidenced by elevated estradiol levels and estradiol/androstenedione ratios. Alterations in the normal follicular response to pharmacologic gonadotropin stimulation in the follicles of anovulatory women suggest the presence of granulosa cell dysynchrony.