This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Klein, N. A. Articles by Soules, M. R. Search for Related Content PubMed PubMed Citation Articles by Klein, N. A. Articles by Soules, M. R.

Is the Short Follicular Phase in Older Women Secondary to Advanced or Accelerated Dominant Follicle Development?

Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington 98105; and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital (P.M.S.), Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Nancy A. Klein, M.D., Division of Reproductive Endocrinology, 4225 Roosevelt Way NE, Suite 305, Seattle, Washington 98105. E-mail: nklein{at}u.washington.edu.

Abstract

This study sought to determine whether the shortened follicular phase in ovulatory older women is secondary to advanced (i.e. earlier) or accelerated (i.e. more rapid) folliculogenesis. Normal ovulatory women, aged 40–45 yr (n = 15) and 20–25 yr (n = 13), underwent daily venipuncture and transvaginal ultrasonography throughout the follicular phase of a spontaneous menstrual cycle (control cycle) and after pituitary down-regulation with a GnRH agonist (study cycle). As expected, the older subjects in the control cycles demonstrated an elevated d 3 FSH and a shortened follicular phase compared with the younger subjects. After release from hypothalamic-pituitary-ovarian axis suppression, the early follicular phase FSH peak occurred earlier (6.8 vs. 9.8 d; P < 0.01) and was of a greater magnitude (12.1 vs. 6.5 mIU/ml; P < 0.01) in the older subjects. The time from release of suppression until the subsequent LH surge was also shorter (17.5 vs. 20.8 d; P < 0.01) in the older group. However, the time from FSH peak to LH surge was similar in the older and younger groups (10.7 vs. 11.0 d; P = 0.74). Compared with younger women, older subjects had normal follicular phase levels of estradiol and inhibin A and lower levels of inhibin B in both control and study cycles. We conclude that the shortened follicular phase observed in older ovulatory women is due to earlier dominant follicle selection, independent of hormonal influences from the preceding luteal phase.

This article has been cited by other articles:

				C.H. de Koning, J. McDonnell, A.P.N. Themmen, F.H. de Jong, R. Homburg, and C.B. Lambalk The endocrine and follicular growth dynamics throughout the menstrual cycle in women with consistently or variably elevated early follicular phase FSH compared with controls Hum. Reprod., June 1, 2008; 23(6): 1416 - 1423. [Abstract] [Full Text] [PDF]

				M. Sonmezer, H. Bang, and K. Oktay In Reply: Can GnRH Analogues Preserve Gonadal Function Without Preserving Fertility? Oncologist, May 1, 2008; 13(5): 615 - 617. [Full Text] [PDF]

				K. R. Hansen, N. S. Knowlton, A. C. Thyer, J. S. Charleston, M. R. Soules, and N. A. Klein A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to menopause Hum. Reprod., March 1, 2008; 23(3): 699 - 708. [Abstract] [Full Text] [PDF]

				G. E. Hale, X. Zhao, C. L. Hughes, H. G. Burger, D. M. Robertson, and I. S. Fraser Endocrine Features of Menstrual Cycles in Middle and Late Reproductive Age and the Menopausal Transition Classified According to the Staging of Reproductive Aging Workshop (STRAW) Staging System J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3060 - 3067. [Abstract] [Full Text] [PDF]

				M.F.G. Verberg, M.J.C. Eijkemans, N.S. Macklon, E.M.E.W. Heijnen, B.C.J.M. Fauser, and F.J. Broekmans Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF Hum. Reprod., July 1, 2007; 22(7): 1919 - 1924. [Abstract] [Full Text] [PDF]

				R. Fanchin, D. H. Mendez Lozano, N. Frydman, A. Gougeon, N. di Clemente, R. Frydman, and J. Taieb Anti-Mullerian Hormone Concentrations in the Follicular Fluid of the Preovulatory Follicle Are Predictive of the Implantation Potential of the Ensuing Embryo Obtained by in Vitro Fertilization J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1796 - 1802. [Abstract] [Full Text] [PDF]

				N. S. Macklon, R. L. Stouffer, L. C. Giudice, and B. C. J. M. Fauser The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization Endocr. Rev., April 1, 2006; 27(2): 170 - 207. [Abstract] [Full Text] [PDF]

				P. S. Malhi, G. P. Adams, and J. Singh Bovine Model for the Study of Reproductive Aging in Women: Follicular, Luteal, and Endocrine Characteristics Biol Reprod, July 1, 2005; 73(1): 45 - 53. [Abstract] [Full Text] [PDF]

				F. Miro and L.J. Aspinall The onset of the initial rise in follicle-stimulating hormone during the human menstrual cycle Hum. Reprod., January 1, 2005; 20(1): 96 - 100. [Abstract] [Full Text] [PDF]

				K. R. Hansen, A. C. Thyer, P. M. Sluss, W. J. Bremner, M. R. Soules, and N. A. Klein Reproductive ageing and ovarian function: is the early follicular phase FSH rise necessary to maintain adequate secretory function in older ovulatory women? Hum. Reprod., January 1, 2005; 20(1): 89 - 95. [Abstract] [Full Text] [PDF]

				F. Miro, S. W. Parker, L. J. Aspinall, J. Coley, P. W. Perry, and J. E. Ellis Relationship between Follicle-Stimulating Hormone Levels at the Beginning of the Human Menstrual Cycle, Length of the Follicular Phase and Excreted Estrogens: The FREEDOM Study J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3270 - 3275. [Abstract] [Full Text] [PDF]

				J. Kline, A. Kinney, M.L. Reuss, A. Kelly, B. Levin, M. Ferin, and D. Warburton Trisomic pregnancy and the oocyte pool Hum. Reprod., July 1, 2004; 19(7): 1633 - 1643. [Abstract] [Full Text] [PDF]

				F. J. Broekmans, S. M. Weima, and E. R. te Velde A Randomized Comparison of Two Ovarian Stimulation Protocols with Gonadotropin-Releasing Hormone (GnRH) Antagonist Cotreatment for in Vitro Fertilization Commencing Recombinant Follicle-Stimulating Hormone on Cycle Day 2 or 5 with the Standard Long GnRH Agonist Protocol J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4510 - 4510. [Full Text]

				M. S. Golub, C. E. Hogrefe, S. L. Germann, B. L. Lasley, K. Natarajan, and A. F. Tarantal Effects of Exogenous Estrogenic Agents on Pubertal Growth and Reproductive System Maturation in Female Rhesus Monkeys Toxicol. Sci., July 1, 2003; 74(1): 103 - 113. [Abstract] [Full Text] [PDF]