The classical view of ovarian follicle development is that it is regulated by the hypothalamic-pituitary-ovarian axis, in which gonadotropin-releasing hormone (GnRH) controls the release of the gonadotropic hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and that ovarian steroids exert both negative and positive regulatory effects on GnRH secretion. More recent studies in mice and humans indicate that many other intra-ovarian signaling cascades affect follicular development and gonadotropin action in a stage-and context-specific manner. As we discuss here, mutant mouse models and clinical evidence indicate that some of the most powerful intraovarian regulators of follicular development include the TGF-β/SMAD, WNT/FZD/β-catenin, and RAS/ERK1/2 signaling pathways and the FOXO/FOXL2 transcription factors.
IntroductionThe ovary is a highly organized composite of germ cells (oocytes or eggs) and somatic cells (granulosa cells, thecal cells, and stromal cells) whose interactions dictate formation of oocyte-containing follicles, development of both oocytes and somatic cells as follicles, ovulation, and formation of the corpus luteum (the endocrine structure that forms from the ovarian follicle after ovulation and is required for establishing and maintaining pregnancy) (Figure 1). Many events in the adult ovary are controlled by two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), secreted from the anterior pituitary gland under the control of pulses of gonadotropin-releasing hormone (GnRH) from the hypothalamus (Figure 1). Low-frequency GnRH pulses stimulate a slight increase in FSH levels early in a woman's menstrual cycle, enhancing follicle growth, while high-frequency GnRH pulses lead to a sharp rise in levels of LH just before mid-cycle (an event known as the "LH surge"), triggering ovulation and formation of the corpus luteum (Figure 1). The ovary also has a key role in these processes, ensuring the timely release of fertilizable oocytes and the maintenance of luteal cell function, a necessity for pregnancy, by directing feedback mechanisms to the hypothalamus and pituitary. For example, estrogen produced by the cells of the developing follicle both inhibits GnRH production in the hypothalamus and elicits elevated GnRH pulses, which trigger the mid-cycle LH surge that initiates ovulation. Thus, fertility depends on highly orchestrated endocrine events involving multiple organ systems.Disruption of this finely controlled network can lead to many clinical syndromes including premature ovarian failure (POF), polycystic ovarian syndrome (PCOS), ovarian hyperstimulation syndrome, ovulation defects, poor oocyte quality, and cancer. The goal of this Review is to cover some of the advances in our understanding of the basic biology of the mammalian ovary that may shed light on specific ovarian dysfunctions that lead to infertility. We primarily focus on recent developments using mouse genetic models to study follicle growth and ovarian function because of the inherent di...