Disturbed growth and selection of the human ovarian follicle

The first objective of this stody was to review some aspects of current knowledge of ovarian function in normal menstrual cycles. A discussion of the anatomy and physiology of the normal ovary can be found in chapter 2. The second objective was to provide new information about the dynamics of follicular growth in the normal menstrual cycle, and to validate the use of highfrequency transvaginal sonography for this type of investigation. This is presented in chapter 3. The third objective was to provide an overview of present concepts related to the polycystic ovary syndrome pathogenesis. To this end, clinical, pathophysiological, and morphological findings associated with polycystic ovaries are dealt with in chapter 4. Attempts to establish an experimental model of polycystic ovaries have failed in different animal species. The fourth objective was to find a human model for the study of PCOS. To this end, a morphological study performed in female to male transsexuals is presented in chapter 5. The fifth objective was twofold. Firstly, to analyse the data obtained by using transvaginal sonography in the appraisal of ovarian structure in women with irregular cycles. Secondly, to use the same validated method in a attempt to discriminate between normal and polycystic ovaries. These issues are discussed in chapter 6. The sixth objective was also twofold. Firstly, to assess gonadotropin disturbances in serum in women with the polycystic ovary syndrome as compared to a group of women with cycle abnormalities, and a group of regularly cycling women. Secondly, the aim was to appraise these clinical and biochemical findings in the light of our sonographic criteria for polycystic ovaries. The seventh objective was to determine to what extent intra-ovarian steroid perturbations could be present in women with polycystic ovaries. All data concerning these last two objectives can be found in chapter 7. Conclusions which may be drawn from studies performed in this work are presented in the general discussion, in chapter 8.

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