Characterization of follicle stimulating hormone profiles in normal ovulating women

René Ecochard; Agnes Guillerm; René Leiva; Thomas Bouchard; Ana Direito; Hans Boehringer

doi:10.1016/j.fertnstert.2014.03.034

Reproductive Endocrinology Ovarian Hormones

Characterization of follicle stimulating hormone profiles in normal ovulating women

Ecochard R, Guillerm A, Leiva R, Bouchard T, Direito A, Boehringer H

Published July 2014 Fertility and sterility

DOI 10.1016/j.fertnstert.2014.03.034 PMID 24746737

RRM Academy Synopsis

FSH declines before ovulation in only 42% of normal cycles

In this study of 107 women with normal cycles, researchers tracked 271 ovulatory cycles. Follicle-stimulating hormone (FSH) fell before ovulation in only 42% of those cycles. They used daily urine tests and ultrasound. FSH held steady in 39% of cycles and rose in 18%.

Key Findings

Across 271 ovulatory cycles, FSH decreased before ovulation in 114 (42%), stayed unchanged in 107 (39%), and increased in 50 (18%).
Cycles without a late-follicular FSH decline had slightly delayed ovulation, a shorter luteal phase, and higher PDG, FSH and LH at ovulation (all P < .01).
Marked day-to-day FSH variability appeared in 96 of 283 cycles (34%). It went with higher BMI (P = .01), more physical activity (P = .02), and lower overall FSH (P = .01).
The FSH peak fell on the day before ovulation, the day of ovulation, or the day after in 66% of cycles. In 116 of 283 cycles (41%), the peak came after ovulation.

Interpretation

This cohort study followed 107 women with regular cycles through 271 ovulatory cycles. Researchers recruited them from eight natural family planning clinics in 1996 and 1997. Ultrasound confirmed each ovulation. Most cycles showed no FSH drop before ovulation. Ovulation still occurred in those cycles, but a bit later, with a shorter luteal phase. The authors suggest that each woman's own FSH pattern may reveal cycle changes that an averaged curve would miss. The findings support larger studies of individual FSH patterns across the cycle.

RRM Context

An average curve describes a group. The paper's introduction notes that most individual LH curves also differ from the classic mean. Restorative reproductive medicine examines each woman's own cycle. The authors say average FSH curves may miss day-to-day hormone changes.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To describe FSH profile variants.

Design

Observational study.

Setting

Multicenter collaborative study.

Patients

A total of 107 women.

Interventions

Women collected daily first morning urine and underwent serial ovarian ultrasound.

Main Outcome Measures

FSH

Results

The individual FSH cyclic profiles demonstrated a significant departure from the currently accepted model. A decline in FSH levels at the end of the follicular phase was observed in only 42% of cycles. The absence of this decline was significantly associated with a shorter luteal phase and higher pregnanediol-3α-glucuronide, FSH, and LH levels at the time of ovulation. In 34% of the cycles, significant FSH variability was observed throughout the follicular phase; this variability was associated with higher body mass index and lower overall FSH and LH levels throughout the cycle. The FSH peak occurs on average 2 hours before ovulation. The FSH peak duration was shorter than the LH peak.

Conclusions

These results suggest that average FSH profiles may not reflect the more complex dynamics of daily hormonal variations in the menstrual cycle. It is possible that discrepancies between the average normal FSH profile and the individual day-to-day variants can be used to detect abnormalities.

Topics

Reproductive Endocrinology › Ovarian Hormones › Progesterone · Menstrual Cycle › Cycle Physiology › Hormonal Regulation · Diagnostics › Hormone Testing › Urinary Metabolites

René Ecochard, Agnes Guillerm, René Leiva, Thomas Bouchard, Ana Direito, Hans Boehringer

R Ecochard, A Guillerm, R Leiva, Tom Bouchard, T Bouchard, A Direito, H Boehringer

PMID 24746737 24746737 DOI 10.1016/j.fertnstert.2014.03.034 10.1016/j.fertnstert.2014.03.034 Ecochard et al. 2014, Ecochard 2014

Characterization of follicle stimulating hormone profiles in normal ovulating women

FSH declines before ovulation in only 42% of normal cycles

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research