Effects of pulsatile intravenous follicle-stimulating hormone treatment on ovarian function in women with obesity

Objective: To establish conditions for effective hypothalamic suppression in women with normal and high body mass index (BMI) and test the hypothesis that intravenous (IV) administration of pulsatile recombinant follicle-stimulating hormone (rFSH) can overcome the clinically evident dysfunctional pituitary-ovarian axis in women with obesity.Design: Prospective interventional study.Setting: Academic medical center.Patient(s): Twenty-seven normal-weight women and 27 women with obesity, who were eumenorrheic and aged 21-39 years. Intervention(s): Two-day frequent blood sampling study, in early follicular phase, before and after cetrorelix suppression of gonadotropins and exogenous pulsatile IV rFSH administration.Main Outcome Measure(s): Serum inhibin B and estradiol (E2) levels (basal and rFSH stimulated).Result(s): A modified gonadotropin-releasing hormone antagonism protocol effectively suppressed production of endogenous gonadotropins in women with normal and high BMIs, providing a model to address the functional role of FSH in the hypothalamic -pituitary-ovarian axis. The IV rFSH treatment resulted in equivalent serum levels and pharmacodynamics in normal-weight women and those with obesity. However, women with obesity exhibited reduced basal levels of inhibin B and E2 and a significantly decreased response to FSH stimulation. The BMI was inversely correlated with serum inhibin B and E2. In spite of this observed deficit in ovarian function, pulsatile IV rFSH treatment in women with obesity resulted in E2 and inhibin B levels comparable with those in normal-weight women, in the absence of exogenous FSH stimulation.Conclusion(s): Despite normalization of FSH levels and pulsatility by exogenous IV administration, women with obesity demonstrate ovarian dysfunction with respect to E2 and inhibin B secretion. Pulsatile FSH can partially correct the relative hypogonadotropic hypogonadism of obesity, thereby providing a potential treatment strategy to mitigate some of the adverse effects of high BMI on fertility, assisted reproduction, and pregnancy outcomes.Clinical Trial Registration Number: ClinicalTrials.gov #NCT02478775. (Fertil Sterile 2023;120:890-8. (c) 2023 by American Society for Reproductive Medicine.)

Automated summary

The objective of this study was to establish conditions for hypothalamic suppression in women with normal and high BMI and to test the effectiveness of intravenous rFSH administration in overcoming dysfunctional pituitary-ovarian axis in obese women. The results showed that obese women exhibited ovarian dysfunction but pulsatile rFSH treatment partially corrected the hypogonadotropic hypogonadism of obesity.