Recombinant FSH and pregnancy-associated plasma protein

Objectives: To evaluate the effect of rec-FSH on the ovarian follicular environment in controlled ovarian hyperstimulation (COH) cycle, we compared the expression of the markers that have been reported to reflect the follicle health. Study design: A total of 31 women (<35 years) with normal ovarian function were allocated to three different COH protocols (urinary FSH (u-FSH)+hMG, rec-FSH only, or u-FSH only). E ₂ , P4, leptin and IGF-I levels in serum or follicular fluid (FF) were measured with radioimmunoassay; cyclin D2, EGF receptor (EGF-R), and inhibin-α mRNA levels in luteinized granulosa cells were measured with RT-PCR; and IGFBP-4 and PAPP-A levels in FF were measured with Western blot analysis. Results: There were no significant differences in serum E ₂ , P4 and leptin levels and follicular leptin and IGF-I levels. Cyclin D2, EGF-R, and inhibin-α mRNA expression in luteinized granulosa cells were not different among three groups. However, follicular IGFBP-4 and PAPP-A levels in rec-FSH group were significantly higher than other groups (P<0.05). Conclusions: The use of rec-FSH increases the expression of follicular PAPP-A reflecting IGFBP-4 proteolytic activity and it may influence positively the follicular environment.