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  • Print publication year: 2021
  • Online publication date: March 2021

Chapter 6 - Hormonal Ovarian Treatment

from Section 2 - Assisted Reproductive Procedures


At the beginning of the menstrual cycle, there is an increase in bioactive follicle-stimulating hormone (FSH) levels, a stimulus for the growth and differentiation of follicular granulosa cells (GCs). GC steroidogenic enzymes are also inducible by FSH and are necessary for the production of estradiol (E2) and progesterone (P4), as well as expression of luteinizing hormone (LH) receptors on theca cells (TCs). LH then stimulates theca cells to produce androgens, which are metabolized to E2 by GCs under the influence of FSH. Elevated levels of E2 then inhibit FSH secretion, providing a negative feedback effect. Growth of the leading follicle continues owing to elevated levels of FSH receptors, whereas secondary follicles with fewer FSH receptors undergo atresia. Taken together, FSH and LH work in concert, as depicted by the classic two-cell (TC and GC), two-gonadotropin (FSH and LH) theory.

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