Abstract
Infertility due to Gonadotropin-Resistant Ovary Syndrome (GROS) is a rare type of hypergonadotropic hypogonadism. Here, we report an original case of GROS, associated with compound heterozygous follicle-stimulating hormone receptor (FSHR) variants, in a woman who achieved a live birth by in vitro maturation (IVM) of her oocytes. This 31-year-old woman consulted our assisted reproduction center for a second opinion after having been advised, because of pervasive high serum follicle-stimulating hormone (FSH) levels, to pursue in vitro fertilization (IVF) with donor oocytes. She presented with primary infertility and progressively prolonged menstrual cycles. Her serum FSH levels were indeed found to be high, but in discordance with a normal anti-Müllerian hormone (AMH) level and antral follicle count. Genetic investigation found the patient to be compound heterozygous for two FSHR variants: I160T, a known pathologic variant, and N558H, which has never been previously reported. As there was no ovarian response to high daily doses of exogenous gonadotropins, IVM was proposed to the patient with success and she finally delivered at term a healthy boy. Effects of the receptor variants were analyzed in heterologous cells. Whereas the I160T mutation blocked FSHR membrane trafficking and FSH-stimulated cAMP-dependent signaling in transfected CHO cells, the novel variant, N558H, functioned equivalently to wild-type FSHR in the assays employed. In conclusion, IVM should always be offered as a first-line therapy to infertile women presenting with GROS. The N558H variant discovered in FSHR is novel, but its functional significance, if any, is unresolved and merits further investigation as it may be associated with a recessive FSHR-related disorder.
References
Dewhurst CJ, de Koos EB, Ferreira HP. The resistant ovary syndrome. Br J Obstet Gynaecol. 1975;82(4):341–5.
Van Campenhout J, Vauclair R, Maraghi K. Gonadotropin-resistant ovaries in primary amenorrhea. Obstet Gynecol. 1972;40(1):6–12.
Jones GS, De Moraes-Ruehsen M. A new syndrome of amenorrhae in association with hypergonadotropism and apparently normal ovarian follicular apparatus. Am J Obstet Gynecol. 1969;104(4):597–600.
Desai SS, Roy BS, Mahale SD. Mutations and polymorphisms in FSH receptor: functional implications in human reproduction. Reprod Camb Engl. 2013;146(6):R235–48.
Huhtaniemi IT, Aittomäki K. Mutations of follicle-stimulating hormone and its receptor: effects on gonadal function. Eur J Endocrinol. 1998;138(5):473–81.
Aittomäki K, et al. Clinical features of primary ovarian failure caused by a point mutation in the follicle-stimulating hormone receptor gene. J Clin Endocrinol Metab. 1996;81(10):3722–6.
Robertson DM, Lee CH, Baerwald A. Interrelationships among reproductive hormones and antral follicle count in human menstrual cycles. Endocr Connect. 2016;5(6):98–107.
Tucker EJ, Grover SR, Bachelot A, Touraine P, Sinclair AH. Premature ovarian insufficiency: new perspectives on genetic cause and phenotypic spectrum. Endocr Rev. 2016;37(6):609–35.
Kotlar TJ, Young RH, Albanese C, Crowley WF, Scully RE, Jameson JL. A mutation in the follicle-stimulating hormone receptor occurs frequently in human ovarian sex cord tumors. J Clin Endocrinol Metab. 1997;82(4):1020–6.
Bonde M, et al. Biased signaling of the angiotensin II type 1 receptor can be mediated through distinct mechanisms. PLoS ONE. 2010.
Ulloa-Aguirre A, Dias JA, Bousfield G, Huhtaniemi I, Reiter E. Trafficking of the follitropin receptor. Methods Enzymol. 2013;521:17–45.
Tran S, Wang Y, Lamba P, Zhou X, Boehm U, Bernard DJ. The CpG island in the murine foxl2 proximal promoter is differentially methylated in primary and immortalized cells. PLoS One. 2013;8(10):e76642.
Lamba P, Santos MM, Philips DP, Bernard DJ. Acute regulation of murine follicle-stimulating hormone beta subunit transcription by activin A. J Mol Endocrinol. 2006;36(1):201–20.
Fan QR, Hendrickson WA. Structure of human follicle-stimulating hormone in complex with its receptor. Nature. 2005;433(7023):269–77.
Jiang X, Liu H, Chen X, Chen P-H, Fischer D, Sriraman V, et al. Structure of follicle-stimulating hormone in complex with the entire ectodomain of its receptor. Proc Natl Acad Sci U S A. 2012;109(31):12491–6.
Ulloa-Aguirre A, Zariñán T. The follitropin receptor: matching structure and function. Mol Pharmacol. 2016;90(5):596–608.
Beau I, et al. A novel phenotype related to partial loss of function mutations of the follicle stimulating hormone receptor. J Clin Invest. 1998;102(7):1352–9.
« gnomAD browsewr beta - Gene: FSHR », 03-oct-2018. Online: Available on http://gnomad.broadinstitute.org/gene/ENSG00000170820. [Consulted: 03-oct-2018].
Li Y, Pan P, Yuan P, Qiu Q, Yang D. Successful live birth in a woman with resistant ovary syndrome following in vitro maturation of oocytes. J Ovarian Res. 2016;9(1):54.
Dewailly D, et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014;20(3):370–85.
Greene AD, Patounakis G, Segars JH. Genetic associations with diminished ovarian reserve: a systematic review of the literature. J Assist Reprod Genet. 2014;31(8):935–46.
Grynberg M, Peltoketo H, Christin-Maître S, Poulain M, Bouchard P, Fanchin R. First birth achieved after in vitro maturation of oocytes from a woman endowed with multiple antral follicles unresponsive to follicle-stimulating hormone. J Clin Endocrinol Metab. 2013;98(11):4493–8.
Binder H, et al. Association of FSH receptor and CYP19A1 gene variations with sterility and ovarian hyperstimulation syndrome. Reprod Camb Engl. 2008;135(1):107–16.
Binder H, et al. Assessment of FSHR variants and antimüllerian hormone in infertility patients with a reduced ovarian response to gonadotropin stimulation. Fertil Steril. 2012;97(5):1169–1175.e1.
Schulz A, Schöneberg T, Paschke R, Schultz G, Gudermann T. Role of the third intracellular loop for the activation of gonadotropin receptors. Mol Endocrinol Baltim Md. 1999;13(2):181–90.
Cohen BD, Bariteau JT, Magenis LM, Dias JA. Regulation of follitropin receptor cell surface residency by the ubiquitin-proteasome pathway. Endocrinology. 2003;144(10):4393–402.
Kluetzman KS, Thomas RM, Nechamen CA, Dias JA. Decreased degradation of internalized follicle-stimulating hormone caused by mutation of aspartic acid 6.30(550) in a protein kinase-CK2 consensus sequence in the third intracellular loop of human follicle-stimulating hormone receptor. Biol Reprod. 2011;84(6):1154–63.
Gromoll J, Simoni M, Nieschlag E. An activating mutation of the follicle-stimulating hormone receptor autonomously sustains spermatogenesis in a hypophysectomized man. J Clin Endocrinol Metab. 1996;81(4):1367–70.
Yang Z-Y, Chian R-C. Development of in vitro maturation techniques for clinical applications. Fertil Steril. 2017;108(4):577–84.
Ali A, Benkhalifa M, Miron P. In-vitro maturation of oocytes: biological aspects. Reprod BioMed Online. 2006;13(3):437–46.
Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. In vitro maturation: a committee opinion. Fertil Steril. 2013;99(3):663–6.
ESHRE Capri Workshop Group. Health and fertility in World Health Organization group 2 anovulatory women. Hum Reprod Update. 2012;18(5):586–99.
Lunenfeld B, Insler V. Classification of amenorrhoeic states and their treatment by ovulation induction. Clin Endocrinol. 1974;3(2):223–37.
Insler V, Melmed H, Mashiah S, Monselise M, Lunenfeld B, Rabau E. Functional classification of patients selected for gonadotropic therapy. Obstet Gynecol. 1968;32(5):620–6.
Anovulatory infertility. The ESHRE Capri Workshop Group. Hum Reprod Oxf Engl. 1995;10(6):1549–53.
Acknowledgments
We would like to thank the personnel of FERTILYS, the Division of Medical Genetics, Centre hospitalier universitaire de Sherbrooke, and the McGill Centre for Research in Reproduction and Development. We also thank Cook Medical and its representative, Benoît Quezel, who kindly provided the IVM follicle aspiration needle. We finally want to thank Dr. Étienne Audet-Walsh for his help and his critical reading of the manuscript.
Funding
DJB was supported by operating grants from Canadian Institutes of Health Research (CIHR) (MOP-133557 and -123447) and Natural Sciences and Engineering Research Council of Canada NSERC (2015-05178).
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CF was responsible for the laboratory procedures, literature review, writing, and coordinating the submission of the manuscript. VB developed the IVM procedure and participated in the laboratory procedures. SC provided genetic consultation, interpretation of genetic testing, and contributed to manuscript writing. SA participated in the reflection and writing of the manuscript. MB supervised the IVM procedures. CT and DJB studied the in vitro effects of the identified mutations on FSHR function and wrote parts of the manuscript. PM was responsible for the diagnostic evaluation and clinical management of the couple, wrote parts of the manuscript, and coordinated its preparation.
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Flageole, C., Toufaily, C., Bernard, D.J. et al. Successful in vitro maturation of oocytes in a woman with gonadotropin-resistant ovary syndrome associated with a novel combination of FSH receptor gene variants: a case report. J Assist Reprod Genet 36, 425–432 (2019). https://doi.org/10.1007/s10815-018-1394-z
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DOI: https://doi.org/10.1007/s10815-018-1394-z