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Abstract. Anovulatory infertility in 134 women was treated with gonadotropins for a total of 318 cycles. The patients were classified into WHO group I, hypothalamic-pituitary failure (72 patients), and WHO group II, hypothalamic-pituitary dysfunction (62 patients). All patients in this group had failed to achieve pregnancy with clomiphene citrate therapy in repeated cycles. The pregnancy rate in group I was 72.2% vs 17.7% in group II. The 'take home' baby rate was 57.1% in group I vs 13.1% in group II. The rate of miscarriages was 14.3% without any significant difference between the groups. Multiple pregnancies occurred only in group I patients (19.2%). The conception rate was highest in the first four cycles, whereas no patient became pregnant after the sixth treatment cycle. Ovarian hyperstimulation syndrome occurred most frequently in group II patients, however, overall only 2.2% of the patients needed hospitalization because of hyperstimulation. Gonadotropin therapy must be considered an efficient and successful treatment of infertility in patients with hypothalamic-pituitary failure, whereas the success rate is rather poor in patients with hypothalamic-pituitary dysfunction.

There are three possible sources of cholesterol for immediate use in progesterone production by preovulatory human granulosa cells: follicular fluid high-density lipoprotein, de novo synthesis of cholesterol, and preformed intracellular cholesteryl ester stores. In the present study these three alternatives were investigated. First, an in vitro model was established that mimics the preovulatory environment, including short-term cultures and use of autologous follicular fluid in the culture medium, instead of serum. Using this model it was found that the presence of high-density lipoprotein from follicular fluid in the culture medium did not affect the synthesis of progesterone by the granulosa cells. Next, addition of inhibitors of de novo sterol synthesis, like low-density lipoprotein, 25-OH cholesterol and compactin to the culture medium, did not reduce [14C]acetate incorporation into sterols and steroids by the cells. The sterol synthesis was accordingly interpreted to be at a low and therefore uninhibitable level. Finally, the content of free and esterified cholesterol in freshly isolated granulosa cells was found to be 50±7 and 52±13 pmol/mg cell protein, respectively. We suggest that neither follicular high-density lipoprotein nor endogenous synthesis is the imim- cholesterol source for the progesterone production in preovulatory human granulosa cells. However, granulosa cells have a large store of cholesteryl esters that may provide free cholesterol for the preovulatory progesterone production.