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By A. Altchek, et al.,

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Chun, S. , Eisenhauer, K. , and Hsueh, A. J. W. (1996). Hormonal regulation of apoptosis in early antral follicles: follicle-stimulating hormone as a major survival factor. Endocrinology 137, 1447–1456. 18. J. , Chun, S. , Hsu, S. , and Billig, H. (1996). Gonadal cell apoptosis. Recent Prog. Horm. Res. 51, 433–455. 19. Chun, S. , Tilly, J. , and Hsueh, A. J. W. (1994). Gonadotropin suppression of apoptosis in cultured preovulatory follicles: mediatory role of endogenous insulin-like growth factor.

2. The Importance of Gonadotropins Although negative feedback of serum estradiol and progesterone leads to suppression of FSH and LH during the luteal phase, continued availability of LH even at low levels is essential (Figs. [72] This LH dependence is graphically demonstrated in ovulation induction practices in hypophysectomized women. Either the longer acting HCG or daily administration of LH is necessary to sustain corpus luteum function. [73] LH plays the critical role in progesterone biosynthesis and secretion by its classic induction of cholesterol side chain cleavage and upregulation of a variety of steroidogenic enzymes which insures continued high-level progesterone secretion.

91] Combining these properties with the ability of this fat to aromatize androgen to estrogen it is clear why morbidly obese women are prone to dyslipidemia, cardiovascular disease, anovulation, hirsutism, and breast and endometrial cancer. Progesterone on the other hand circulates bound to corticosteroid-binding globulin (CBG). The binding distributions are 18% bound to CBG, 80% to albumin, and a minor quantity to SHBG. C. Metabolism and Clearance of Ovarian Steroid Secretions Before describing the specific metabolic and clearance mechanisms governing each class of ovarian steroid secretion, certain important generalities are worthy of mention.

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