Our previous demonstrated that macrophage colonyâstimulating factor (MâCSF) stimulated the production of estradiol (E2) and progesterone (P) in luteinized granulosa cells (GCs), and that its secretion may be regulated by follicleâstimulating hormone (FSH). The present study aimed to examine the effect of MâCSF alone or with Letrozole treatment on the function of nonâluteinizing granulosa cells, using the COV434 cell line, and its interaction with FSH. Human luteinized granulosa cells (LGC) were isolated from the follicular fluid of superovulated infertile patients (average age, 30.8±2.1 years) undergoing an intracytoplasmic sperm injection. The LGC were cultured with various concentrations of recombinant human macrophage colony stimulating factor (rhMâCSF; 0, 10, 25, 50 or 100 ng/ml), rhMâCSF+Letrozole (10â6 mol/l), rhFSH (0, 10, 25, 50 or 100 IU/ml), or rhFSH+Letrozole (10â6 mol/l). E2 concentrations in the media were measured using ELISA. The expression levels of the FSH receptor and the MâCSF receptor were detected via reverse transcriptionâquantitative polymerase chain reaction. Following COV434 cell treatment with MâCSF, cell proliferation was quantified using the MTS assay and protein expression was detected by western blotting. It was demonstrated that MâCSF and FSH stimulated the production of E2. The production of FSH receptors was enhanced by rhMâCSF or rhMâCSF+Letrozole in vitro in a doseâdependent manner. It was observed that rhFSH promoted the expression of the MâCSF receptor, at a certain concentration. Proliferation of COV434 cells increased in a doseâdependent manner following treatment with RhMâCSF. Furthermore, MâCSF induced the phosphorylation of câJun Nâterminal kinase (JNK) and p38; however, the level of E2 in the medium was not altered when the cells were pretreated with the JNK inhibitor SP600125 or the p38 inhibitor SB203580. The present study suggested that MâCSF may be important in regulating the response of GCs to gonadotropin and may have a promotive effect in the early phase of follicular development. The biological effects of MâCSF may partially be attributed to activation of the JNK and p38 signaling pathways. MâCSF may represent a novel follicular development regulator agent in the future.