[...]... of the polycystic ovary, can by the same common intracellular mechanism, add to the effects of LH and insulin on follicle maturation There is direct evidence for premature responsiveness to LH in antral follicles of anovulatory women with polycystic ovaries Granulosa cells from follicles of normal 250 14 0 lactate (% basal) progesterone (% basal) 15 0 13 0 12 0 11 0 10 0 200 15 0 ** 10 0 50 90 0 .1 1 10 insulin... 90 0 .1 1 10 insulin ng/ml 10 0 10 00 0 .1 1 10 10 0 10 00 insulin ng/ml Fig 1 Production of progesterone and lactate (expressed a percentage of baseline values) by cultured granulosa-lutein cells after 48 h of incubation in response to insulin (1 10 00 ng/ml) or luteinizing hormone (LH) (1 5 ng/ml) in seven women with normal ovaries (open squares), six with ovulatory polycystic ovary (PCO) (open diamonds),... complete caption on p 16 5.) Fig 4, Chapter 11 : Change in ( ) hormone levels (30-min value minus 0-min value) in response to ACTH stimulation pre- and post-metformin treatment in adolescents with PCOS (See complete caption on p 17 3.) xv 1 Folliculogenesis in Polycystic Ovaries Stephen Franks, MD, FMEDSCI, and Kate Hardy, PHD CONTENTS 1 Introduction 2 Antral Follicle Function in Polycystic Ovaries 3 Mechanisms... earliest, gonadotropin-independent stages The underlying molecular basis of this fundamental ovarian abnormality remains to be determined Key Words: Polycystic ovary syndrome; anovulation; luteinizing hormone; insulin; granulosa cells; preantral follicles; anti-Müllerian hormone 1 INTRODUCTION Polycystic ovary syndrome (PCOS) is the commonest cause of anovulatory infertility (1, 2), but the mechanism... steroids in theca-conditioned medium, we observed that concentrations of androstenedione (20-fold), 1 7- -hydroxyprogesterone (10 -fold) and progesterone (fivefold) were significantly greater in cultures from polycystic ovaries compared with control cultures, regardless of menstrual cycle history (10 ) Similar results have been recorded in studies of passaged theca cell cultures from normal and polycystic ovaries,... hyperandrogenic or with normoandrogenic phenotype Fig 1, Chapter 11 : Upper panel: insulin-stimulated glucose disposal during a hyperinsulinemic euglycemic clamp in obese PCOS girls vs matched obese control girls Lower panel: insulin sensitivity in PCOS versus obese control girls (See complete caption on p 16 3.) Fig 3, Chapter 11 : First-phase and second-phase insulin secretion during a hyperglycemic clamp... changes in ovarian steroids in normal early pubertal girls (Tanner stages I-III) Fig 1, Chapter 8: Distribution of body weight in US and Italian women with the classic polycystic ovary syndrome (PCOS) phenotype Fig 2, Chapter 8: Prevalence of the metabolic syndrome in Italian normal woman aged 20–39 years and in Italian polycystic ovary syndrome (PCOS) patients with the classic or ovulatory hyperandrogenic... insulin-mediated glucose uptake (19 ) and lactate production (19 , 21, 22) but without significant impairment of progesterone production (19 ) (Fig 1) , suggesting a post-receptor defect affecting metabolic, but not steroidogenic, signaling pathways It is conceivable that androgens may also contribute to the disordered folliculogenesis of PCOS In granulosa cell cultures, androgens augment gonadotropin-induced... steroidogenesis between normal and polycystic ovaries (15 ,19 ) Furthermore, insulin appears to exert its action by binding to its own receptor rather than by “cross-talk” with the type-I IGF receptor (20) Why then does the ovary retain apparently normal steroidogenesis in response to insulin in the face of peripheral insulin resistance? Data from studies in cultured granulosa-lutein cells may provide the... Chang, md, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, and Department of Obstetrics and Gynecology, The David Geffen School of Medicine, UCLA, Los Angeles, CA Eva Dahlgren, md, phd, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden Didier Dewailly, md, Department of Endocrine . of anovulatory women with polycystic ovaries. Granulosa cells from follicles of normal 0 5 0 01 0 51 0 02 052 00 010 010 111 .0 09 0 01 011 02 1 0 31 04 1 0 51 00 010 01 01 1 1. 0 progesterone (% basal) lactate. of Polycystic Ovary Syndrome R. Jeffrey Chang 14 7 11 Insulin Action and Secretion in Polycystic Ovary Syndrome Julia Warren-Ulanch and Silva A. Arslanian 15 9 ix x Contents 12 Polycystic Ovary Syndrome. Science University, Beaverton, OR ISBN: 97 8 -1 -5 882 9-8 3 1- 7 e-ISBN: 97 8 -1 -5 974 5 -1 0 8-6 Library of Congress Control Number: 2007933472 ©2008 Humana Press, a part of Springer Science+Business Media,