Manipulation of Human Ovarian Function: Physiological Concepts and Clinical Consequences*

I. Introduction II. Dynamics of Normal Human Follicle Growth and Selection A. Gonadotropin-independent and -dependent follicle growth B. Intrafollicular endocrine changes C. Are estrogens needed for follicle development? D. In vivo regulation of follicle maturation in the monkey E. The FSH threshold and window concept for in vivo follicle growth 1. FSH threshold and follicle recruitment 2. FSH window and single dominant follicle selection 3. Dominant follicle development F. Modulation of FSH action 1. Heterogeneity of FSH 2. Direct interference with FSH action 3. Intraovarian interference with FSH action by growth factors III. Gonadotropin Induction of Ovulation A. The concept of monofollicle growth in anovulatory patients B. Conditions affecting treatment outcome 1. Patient-related factors 2. Hormone preparation-related factors 3. Other factors involved C. Commonly used step-up dose regimens 1. Conventional step-up protocol 2. Low-dose, step-up protocol D. Potential for a step-down dose regimen IV. Stero...