We are interested in understanding and improving the treatment of 2 very common disorders of reproduction that may result in failure to ovulate (release an egg) and consequently impaired fertility, namely polycystic ovary syndrome (PCOS) (which is also associated with an increased risk of developing diabetes in later life) and premature menopause.

A woman is born with all the eggs she will ever have. Of the half a million or so eggs she has when she starts her periods, only about 400 will be ovulated (released) during the monthly cycle over her reproductive lifetime. The rest will degenerate and die, mostly long before they reach maturity. The eggs are stored in the cortex (outer layer) of the ovary, each one in a very small “follicle” comprising the egg itself surrounded by a single thin layer of supporting cells. They may stay in this “resting” state for up to 50 years before starting to grow but, surprisingly, very little is known about what triggers the growth of these early follicles or how a steady supply of growing eggs is maintained throughout reproductive life. We do know that when this process is disturbed the ovary may have too many follicles (as in polycystic ovary syndrome) or too few (resulting in an early menopause).

Our research has focused on studying these very early stages of development of the egg and its follicle, and the molecules that might be involved in this process. We have been fortunate in being able to obtain tiny pieces of ovarian cortex from small biopsies taken from women at the time of routine laparoscopy, usually as part of infertility investigations in women between 21 and 40 years of age (with, of course, local Ethical Committee approval and with the informed, written consent of the patients). We have already been able to show that these crucial early stages of follicle development are abnormal in PCOS (and have published our findings in the Lancet) but much more needs to be done to find out why these abnormalities occur.

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