rFSH in medically assisted procreation: Evidence for ovarian follicular hyperplasia and interest of mass spectrometry to measure 17-hydroxyprogesterone and Δ4-androstenedione in serum.

Publication date: Available online 28 April 2017
Source:Molecular and Cellular Endocrinology
Author(s): M.C. Menet, M.L. Hebert-Schuster, N. Lahlou, L. Marcellin, M.C. Leguy, V. Gayet, E. Guibourdenche
Ovarian monitoring requires the determination of serum estradiol and progesterone levels. We investigated whole follicular steroidogenesis under rFSH in medically assisted procreation (MAP: 26 IVF, 24 ICSI) compared to 11 controls (IUI). Estrone, estradiol, Δ4-androstenedione, testosterone, progesterone and 17-hydroxyprogesterone were measured by immunoassay and mass spectrometry except for estrogens.At the start of a spontaneous or induced cycle, steroids levels fluctuated within normal ranges: estradiol (314–585 pmol/L), estrone (165–379 pmol/L) testosterone (1.3–1.6 nmol/L), Δ4-androstenedione (4.5–5.6 nmol/L), 17-hydroxyprogesterone (2.1–2.2 nmol/L) and progesterone (1.8–1.9 nmol/L). 17-hydroxyprogesterone, Δ 4-androstenedione and estradiol predominated. Then estradiol and oestrone levels rise, but less markedly for oestrone in IUI. In MAP, rFSH injections induce a sharp increase in estrogens associated with a rise in 17-hydroxyprogesterone and Δ4-androstenedione levels, disrupting oestrogen/androgen ratios. rFSH stimulation induces an ovarian hyperplasia and Δ4pathway which could become abnormal. Determining 17-hydroxyprogesterone and Δ4-androstenedione levels with LC-MS/MS may therefore be useful in managing recurrent MAP failures.

Graphical abstract

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