Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women.

Women experience a decline in fertility that precedes the menopause by several years. Previous studies have demonstrated a monotropic rise in FSH associated with reproductive aging: however, the mechanism of this rise and its role in the aging process are poorly understood. The purpose of this study was to characterize ovarian follicular development and ovarian hormone secretion in older reproductive age women. Sixteen women, aged 40-45 yr, with regular ovulatory cycles were studied. The control group consisted of 12 ovulatory women, aged 20-25 yr. Serum obtained by daily blood sampling was analyzed for FSH, LH, estradiol (E), progesterone, and inhibin (Monash polyclonal assay). Follicle growth and ovulation were documented by transvaginal ultrasound. Older women had significantly higher levels of FSH throughout the menstrual cycle. E, progesterone, LH, and inhibin levels did not differ between the two age groups when compared relative to the day of the LH surge. Ultrasound revealed normal growth, size, and collapse of a dominant follicle in all subjects. Older women had significantly shorter follicular phase length associated with an early acute rise in follicular phase E, reflecting accelerated development of a dominant follicle. We conclude that older reproductive age women have accelerated development of a dominant follicle in the presence of the monotropic FSH rise. This is manifested as a shortened follicular phase and elevated follicular phase E. The fact that ovarian steroid and inhibin secretion were similar to those in the younger women suggests that elevated FSH in women of advanced reproductive age may represent a primary neuroendocrine change associated with reproductive aging.

[1]  N. Klein,et al.  The Gonadotropin Secretion Pattern in Normal Women of Advanced Reproductive Age in Relation to the Monotropic FSH Rise , 1996, The Journal of the Society for Gynecologic Investigation: JSGI.

[2]  Klein.  The ovarian follicular fluid environment in reproductive aging: changes in hormones and growth factors , 1995 .

[3]  S. Killick,et al.  Age related changes in the female reproductive cycle , 1994 .

[4]  R. Écochard,et al.  Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. , 1994, Biology of reproduction.

[5]  I. Cooke,et al.  The significance of elevated basal follicle stimulating hormone in regularly menstruating infertile women , 1994 .

[6]  H. Burger,et al.  Perimenopausal patterns of gonadotrophins, immunoreactive inhibin, oestradiol and progesterone. , 1993, Maturitas.

[7]  Fivnat.  French National IVF Registry: analysis of 1986 to 1990 data. FIVNAT (French In Vitro National). , 1993, Fertility and sterility.

[8]  M. Faddy,et al.  Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. , 1992, Human reproduction.

[9]  N. Groome,et al.  Evidence that most of the radioimmunoassayable inhibin secreted by the corpus luteum of the common marmoset monkey is of a non-dimeric form. , 1992, Biology of reproduction.

[10]  H. Burger,et al.  Age related changes in follicle stimulating hormone, luteinizing hormone, oestradiol and immunoreactive inhibin in women of reproductive age , 1992, Clinical endocrinology.

[11]  D. Baird,et al.  The source of inhibin secretion during the human menstrual cycle. , 1991, The Journal of clinical endocrinology and metabolism.

[12]  W. Dodson,et al.  Effect of age on response to human menopausal gonadotropin stimulation. , 1990, The Journal of clinical endocrinology and metabolism.

[13]  David Handelsman,et al.  Inhibin and estradiol responses to ovarian hyperstimulation: effects of age and predictive value for in vitro fertilization outcome. , 1990, The Journal of clinical endocrinology and metabolism.

[14]  David Handelsman,et al.  Comparison of inhibin immunological and in vitro biological activities in human serum. , 1988, The Journal of clinical endocrinology and metabolism.

[15]  Sylvia Richardson,et al.  Follicular Depletion During the Menopausal Transition: Evidence for Accelerated Loss and Ultimate Exhaustion* , 1987 .

[16]  D. Collins,et al.  Age-related changes in the female hormonal environment during reproductive life. , 1987, American journal of obstetrics and gynecology.

[17]  J. Menken,et al.  Age and infertility. , 1986, Science.

[18]  M. Metcalf,et al.  Gonadotrophin excretion in fertile women: effect of age and the onset of the menopausal transition. , 1985, The Journal of endocrinology.

[19]  E. Lenton,et al.  Normal variation in the length of the follicular phase of the menstrual cycle: effect of chronological age , 1984, British journal of obstetrics and gynaecology.

[20]  D. Schwartz,et al.  Female Fecundity as a Function of Age: Results of Artificial Insemination in 2193 Nulliparous Women with Azoospermic Husbands , 1982 .

[21]  J. Winter,et al.  Pituitary-ovarian relationships preceding the menopause , 1977 .

[22]  S. Korenman,et al.  The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. , 1976, The Journal of clinical endocrinology and metabolism.

[23]  S. Korenman,et al.  Hormonal characteristics of the human menstrual cycle throughout reproductive life. , 1975, The Journal of clinical investigation.

[24]  J. Loraine,et al.  ENDOCRINOLOGICAL STUDIES IN WOMEN APPROACHING THE MENOPAUSE , 1971, The Journal of obstetrics and gynaecology of the British Commonwealth.

[25]  Y. Wan,et al.  Inhibin subunit gene expression and distribution in the ovaries of immature, young adult, middle-aged, and old female rats. , 1993, Endocrinology.

[26]  D. Meldrum.  Female reproductive aging--ovarian and uterine factors , 1993 .