Use of Pulsatile Intravenous FSH to Mitigate Reprometabolic Syndrome

Inclusion Criteria (obseity):

* • BMI between 30 kg/m2 and 40 kg/m

  * Weight stability, i.e. no continued weight loss of \>1lb per week for a minimum of 4 weeks prior to enrollment
  * Normal thyroid stimulating hormone (TSH) and prolactin
  * Anti-Mullerian Hormone (AMH) \> 1 ng/ml or \< 8 ng/mL
  * Willingness to postpone conception for the first study cycle
  * Involuntary inability to conceive for at least 6 months
  * No clinical diagnosis of polycystic ovarian syndrome (PCOS)
  * Documentation of ovulation with luteal progesterone \>6 ng/ml or positive ovulation predictor home testing
  * Regular menstrual cycles 25-40 days in length
  * Male partner (or sperm donor) with adequate sperm (\>14 million sperm per ml)
  * Hysterosalpingogram or saline infusion sonography demonstrating at least one patent Fallopian tube and a normal uterine cavity
  * Serum total and free testosterone within the 95% CIearance for women with obesity previously studied in our laboratory.
  * Acceptance of the indwelling catheter and willingness to take part in the study

Inclusion criteria (DOR):

* BMI less than 30 kg/m2
* Normal TSH and prolactin
* Regular menstrual cycles 25-40 days in length
* Male partner (or sperm donor) with adequate sperm (\>14M sperm per ml)
* Hysterosalpingogram or saline infusion sonography demonstrating at least one patent Fallopian tube and a normal uterine cavity
* Anti-Mullerian Hormone (AMH) \< 1.0 ng/ml
* Antral follicle count 8 or less
* Willingness to postpone conception for the first study cycle
* at least 2 prior canceled cycles for lack of response at maximum dose
* Involuntary inability to conceive for at least 6 months
* Acceptance of the indwelling catheter and willingness to take part in the study