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Rising Follicle-Stimulating Hormone Levels with Age Accelerate Female Reproductive Failure

ANZAC Research Institute (C.M.A., K.J.M., M.J., K.A.W., J.S., D.J.H.), University of Sydney, Concord Hospital, New South Wales 2139, Australia; School of Biomolecular Sciences (N.P.G.), Oxford Brookes University, Oxford OX3 0BP, United Kingdom; and Department of Internal Medicine (J.A.V., A.P.T.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Dr. Charles M. Allan, ANZAC Research Institute Research Institute, University of Sydney, Concord Hospital, New South Wales, 2139 Australia. E-mail: charles{at}anzac.edu.au.

Rising serum FSH levels is one of the earliest signs of human female reproductive aging. Whether or not elevated FSH remains a passive reflection of a diminishing ovarian follicle pool or actively contributes to declining female fertility with age has not been established. We therefore investigated female reproduction in mice expressing progressively rising serum levels of transgenic human FSH (Tg-FSH, 2.5–10 IU/liter) independently of follicle depletion. We show that serum LH and estradiol levels and uterine size remained normal in Tg-FSH females, whereas ovarian weight and corpora lutea number were significantly increased up to 1.3- and 5-fold, respectively. Furthermore, the monotrophic FSH rise produced a striking biphasic effect on female fertility. Tg-FSH females less than 22 wk old delivered increased litter sizes, then beyond 23 wk, litter sizes decreased rapidly culminating in premature infertility despite continued ovary follicle development, and increased ovulation and uterine embryo implantation sites as well as normal serum levels of anti-Mullerian hormone, a marker of ovarian follicle reserve. We found that rising circulating Tg-FSH produced premature infertility by increasing embryo-fetal resorption and parturition failure with age. Thus, our Tg-FSH mice present a novel paradigm to investigate selective contributions of elevated FSH to age-related female infertility, which revealed that rising FSH levels, despite no exhaustion of ovarian reserve, actively accelerates female reproductive aging primarily by postimplantation reduction of embryo-fetal survival.

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