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Leptin participates in regulation of ovarian folliculogenesis indirectly via control of luteinizing hormone and follicle-stimulating hormone secretion. More recent evidence suggests that leptin also has direct regulatory actions on the developing follicle. The presence of leptin receptors on follicular cells, including oocytes, and early preimplantation embryos suggests that leptin may play a direct physiologic role in follicular maturation, oocyte development, and early cleavage. Because circulating leptin levels are directly related to body adiposity, elevated leptin concentrations associated with obesity may partly explain the negative impact of obesity on fertility. The influence of leptin on follicular development and oocyte maturation has important implications for ovulation induction and assisted reproductive technologies. Moreover, polycystic ovarian syndrome may be associated with altered leptin phsyiology.

Recent evidence has demonstrated that expression of leptin and leptin receptors is expected in the human ovary, and that leptin alters ovarian steroidogenesis in animal models. This study was designed to determine whether leptin modulates basal, gonadotrophin-, and insulin-stimulated progesterone production by human luteinized granulosa cells (GC). GC were recovered from follicular aspirates obtained during transvaginal ultrasound-guided oocyte retrieval for in-vitro fertilization-embryo transfer, and cultured in defined medium with various combinations of chorionic gonadotrophin (HCG; 0 or 100 ng/ml), insulin (0-30 microg/ml), and leptin (0-100 ng/ml). Progesterone concentrations in media were determined at various time points (2 h to 6 days). Leptin time- and dose-dependently inhibited (P < 0.05) HCG-stimulated progesterone production by human luteinized GC, but did not alter basal steroidogenesis. Moreover, the inhibitory effect of leptin on gonadotrophin-stimulated progesterone production was only manifested in the presence of insulin. Leptin suppression of insulin-supported steroidogenesis was also time- and dose-dependent. We conclude that leptin inhibits gonadotrophin-stimulated GC progesterone production apparently by antagonizing insulin action. Leptin suppression of progesterone production by human luteinized GC is consistent with recent data from animal models, and supports the possible role of leptin as a regulator of human ovarian function.

The leptin:BMI ratio appears to be highly predictive of IVF success. Elevated leptin concentrations, particularly relative to BMI, may negatively impact fertility by assisted reproduction, possibly through direct ovarian actions resulting in impaired oocyte quality and/or early embryo development.