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Khushal R, Fatima U. Fuzzy machine learning logic utilization on hormonal imbalance dataset. Comput Biol Med 2024; 174:108429. [PMID: 38631116 DOI: 10.1016/j.compbiomed.2024.108429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
In this research work, a novel fuzzy data transformation technique has been proposed and applied to the hormonal imbalance dataset. Hormonal imbalance is ubiquitously found principally in females of reproductive age which ultimately leads to numerous related medical conditions. Polycystic Ovary Syndrome (PCOS) is one of them. Treatment along with adopting a healthy lifestyle is advised to mitigate its consequences on the quality of life. The biological dataset of hormonal imbalance "PCOS" provides limited results that is whether the syndrome is present or not. Also, there are input variables that contain binary responses only, to deal with this conundrum, a novel fuzzy data transformation technique has been developed and applied to them thus leading to their fuzzy transformation which provides a broader spectrum to diagnose PCOS. Due to this, the output variable has also been transformed. Hence, a novel fuzzy transformation technique has been employed due to the limitation of the dataset leading to the transition of binary classification output into three classes. An adaptive fuzzy machine learning logic model is developed in which the inference of the transformed biological dataset is performed by the machine learning techniques that provide the fuzzy output. Machine learning techniques have also been applied to the untransformed biological dataset. Both implementations have been compared by computation of the relevant metrics. Machine learning employment on untransformed biological dataset provides limited results whether the syndrome is present or absent however machine learning on fuzzy transformed biological dataset provides a broader spectrum of diagnosis consisting of a third class depicting that PCOS might be present which would ultimately alert a patient to take preventive measures to minimize the chances of syndrome development in future.
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Affiliation(s)
- Rabia Khushal
- Department of Mathematics, NED University of Engineering & Technology, Pakistan.
| | - Ubaida Fatima
- Department of Mathematics, NED University of Engineering & Technology, Pakistan.
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Nakamata A, Matsuki M, Otake Y, Himoto Y, Kaneko Y, Nakaya M, Sudo N, Kikuchi T, Watanabe Y, Kobayashi R, Masuoka S, Kunitomo N, Fujii H, Hamamoto K, Mori H. Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome. Abdom Radiol (NY) 2024:10.1007/s00261-024-04282-z. [PMID: 38602521 DOI: 10.1007/s00261-024-04282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS. METHOD This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann-Whitney U and Fisher's exact tests. RESULTS Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values. CONCLUSIONS MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.
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Affiliation(s)
- Akihiro Nakamata
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Mitsuru Matsuki
- Department of Pediatric Radiology, Jichi Children's Medical Center, Tochigi, Japan
| | - Yuko Otake
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuki Himoto
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yo Kaneko
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Sudo
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Tomohiro Kikuchi
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuriko Watanabe
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ryoma Kobayashi
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Sota Masuoka
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naoki Kunitomo
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Da Luz CM, Da Broi MG, Plaça JR, Silva WA, Meola J, Navarro PA. Altered transcriptome in cumulus cells of infertile women with advanced endometriosis with and without endometrioma. Reprod Biomed Online 2021; 42:952-962. [PMID: 33736992 DOI: 10.1016/j.rbmo.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Is the transcriptome of cumulus cells of infertile women with advanced endometriosis (EIII/IV), with and without endometrioma, altered? DESIGN In this prospective case-control study, next-generation RNA sequencing was used to compare the transcript profile of cumulus cells among infertile patients undergoing ovarian stimulation for intracytoplasmic sperm injection with EIII/IV, with (n = 9) and without endometrioma (n = 9), and controls (n = 9). An in-silico enrichment analysis was conducted to establish the possibly altered pathways in cumulus cells of patients with endometriosis. RESULTS Most of the differentially expressed genes (DEG) were found when cumulus cells from women with EIII/IV with endometrioma were compared with controls (DEG, n = 461). In women with EIII/IV without endometrioma, only 66 DEG were verified compared with controls. The enrichment analysis showed that some DEG in cumulus cells of endometriosis are involved in important pathways for the oocyte competence acquisition, such as oxidative phosphorylation, metabolism, mitochondrial function, acetylation and steroid biosynthesis. No DEG were found when cumulus cells from women with EIII/IV with and without endometrioma were compared. CONCLUSION RNA sequencing results suggest that cumulus cells of infertile women with EIII/IV have an altered transcriptome, regardless of endometrioma. The present findings offer a better understanding of the genes and molecular mechanisms that may be involved in endometriosis-related infertility, mostly in the oocyte competence acquisition process.
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Affiliation(s)
- Caroline M Da Luz
- Division of Human Reproduction, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto São Paulo 14049-900, Brazil.
| | - Michele G Da Broi
- Division of Human Reproduction, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto São Paulo 14049-900, Brazil
| | - Jessica R Plaça
- Center for Integrative Systems Biology - CISBi, NAP/USP, Ribeirão Preto São Paulo 14049-900, Brazil
| | - Wilson A Silva
- Center for Integrative Systems Biology - CISBi, NAP/USP, Ribeirão Preto São Paulo 14049-900, Brazil; Center for Medical Genomics, HCFMRP/USP, Ribeirão Preto São Paulo 14049-900, Brazil; Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto São Paulo 14049-900, Brazil
| | - Juliana Meola
- Division of Human Reproduction, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto São Paulo 14049-900, Brazil
| | - Paula A Navarro
- Division of Human Reproduction, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto São Paulo 14049-900, Brazil; National Institute of Hormones and Women's Health, CNPq, Porto Alegre Rio Grande do Sul 90035-003, Brazil
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4
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Xu J, Bian G, Zheng M, Lu G, Chan WY, Li W, Yang K, Chen ZJ, Du Y. Fertility factors affect the vaginal microbiome in women of reproductive age. Am J Reprod Immunol 2020; 83:e13220. [PMID: 31925865 PMCID: PMC7078941 DOI: 10.1111/aji.13220] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/17/2019] [Accepted: 01/04/2020] [Indexed: 12/29/2022] Open
Abstract
Problem For women of reproductive age, achieving a successful pregnancy requires both the normal functioning of reproductive endocrine and the health of the reproductive tract environment. We aimed to study how these fertility factors, such as female age, baseline sexual hormone levels, tubal patency, and vaginal pH, affect the composition of vaginal microbiome. Method of study The 16S rRNA sequencing was carried on vaginal microbiome samples from 85 women of reproductive age without vaginal infections or reproductive endocrine diseases. The detailed correlations between fertility factors and vaginal microbiome were quantified by Spearman's rank tests. A linear discriminant analysis was carried out to explore the effects of fertility factors on the relative abundances of vaginal bacterial species. Results The vaginal pH, levels of basal E2, LH, and FSH all had significant effects on the distribution of vaginal microbiome. The relative abundances of vaginal bacterial species, including Escherichia coli, Streptococcus agalactiae, and Prevotella intermedia, were significantly different due to the host's state of reproductive endocrine and tubal patency. It was worth noting that women with tubal obstruction, or prolonged menstrual cycle, or antral follicle count >15, or vaginal pH > 4.5 all had a higher abundance of Escherichia coli in vagina. Conclusion The fertility factors associated with the reproductive endocrine and the genital tract environment affected vaginal microbiome in women of reproductive age. The species Escherichia coli, Streptococcus agalactiae, Prevotella intermedia, etc could be used as biomarkers to reflect the pathological state of reproductive endocrine and genital tract.
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Affiliation(s)
- Jieying Xu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Gaorui Bian
- Department of NGS Sequencing, Tianyi Health Sciences Institute, Zhenjiang, China
| | - Min Zheng
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Gang Lu
- The Chinese University of Hong Kong-Shandong University Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wai-Yee Chan
- The Chinese University of Hong Kong-Shandong University Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Weiping Li
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Kaiping Yang
- Department of NGS Sequencing, Tianyi Health Sciences Institute, Zhenjiang, China.,Departments of Obstetrics & Gynaecology and Physiology & Pharmacology, Children's Health Research Institute & Lawson Health Research Institute, Western University, London, ON, Canada
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yanzhi Du
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Spritzer PM, Marchesan LB, Santos BR, Cureau FV, Oppermann K, Reis RMD, Ferriani RA, Weiss R, Meirelles R, Candido AL, Reis FM. Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case-control study. BMJ Open 2019; 9:e029191. [PMID: 31640995 PMCID: PMC6830701 DOI: 10.1136/bmjopen-2019-029191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Brazil is a large country, with a population of mixed ethnic background and broad variation in dietary and physical activity traits across its five main regions. Because data on Brazilian women with polycystic ovary syndrome (PCOS) are still scarce, a nation-wide collaborative study was designed to determine the prevalence of metabolic and reproductive abnormalities and the presence of anxiety and depression in Brazilian women with PCOS. In addition, the study aims at describing how these characteristics are distributed across PCOS phenotypes and at detecting associations with regional demographic and lifestyle aspects, genetic variants, and epigenetic markers. METHODS AND ANALYSIS The Brazilian PCOS study is being conducted in the outpatient clinics of eight university hospitals within the public healthcare network (Unified Health System) across the country. Additional centres will be included following completion of the research ethics approval process. The sample includes women with PCOS according to Rotterdam criteria at inclusion in the study and a control group of healthy women matched by age, socioeconomic status and geographical region. Data will be collected in each centre and incorporated into a unified cloud database. Clinical, demographic, socioeconomic, psychological, metabolic, epigenetic and genotypic variables will be evaluated. The data resulting from this study will be useful to guide specific public strategies for primary and secondary prevention of metabolic and reproductive comorbidities in the PCOS population of Brazil. ETHICS AND DISSEMINATION The study protocol was approved by each local Research Ethics Committee. Written informed consent will be obtained from each participant. During data collection, analysis and publication, care will be taken to ensure confidentiality of participant information. Study results will be published in peer-reviewed journals and disseminated at international conferences. This research protocol was registered with the Research Ethics Committee of HCPA, through Plataforma Brasil. TRIAL REGISTRATION NUMBER CAAE 18082413.9.1001.5327.
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Affiliation(s)
- Poli Mara Spritzer
- Department of Physiology and Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Gynecological Endocrinology Unit, Endocrine Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas B Marchesan
- Department of Physiology and Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Betânia R Santos
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe V Cureau
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Oppermann
- Department of Gynecology and Obstetrics, Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics Ribeirao Preto, Universidade de Sao Paulo Campus de Ribeirao Preto, Ribeirao Preto, Brazil
| | - Rui A Ferriani
- Department of Gynecology and Obstetrics Ribeirao Preto, Universidade de Sao Paulo Campus de Ribeirao Preto, Ribeirao Preto, Brazil
| | - Rita Weiss
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
| | - Ricardo Meirelles
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
| | - Ana Lucia Candido
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Rocha AL, Oliveira FR, Azevedo RC, Silva VA, Peres TM, Candido AL, Gomes KB, Reis FM. Recent advances in the understanding and management of polycystic ovary syndrome. F1000Res 2019; 8. [PMID: 31069057 PMCID: PMC6489978 DOI: 10.12688/f1000research.15318.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 12/17/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multifaceted condition characterized by chronic anovulation and excess ovarian activity, in contrast to other causes of anovulation that involve ovarian dormancy or primary insufficiency. Recent studies indicated that PCOS is associated with low-grade chronic inflammation and that women with PCOS are at increased risk of non-alcoholic fatty liver disease. The inflammatory and metabolic derangements associated with PCOS are explained in part by the coexistence of insulin resistance and obesity but are further fueled by the androgen excess. New insights into the regulation of hormones and cytokines in muscle and fat tissue support the concept that PCOS is a systemic syndrome. The therapeutic plan should be tailored to the patient phenotype, complaints, and reproductive desire. Of note, the aromatase inhibitor letrozole seems to be more effective than the reference drug clomiphene citrate to treat infertility due to PCOS. Integral management by a multidisciplinary team may help the patients to adhere to lifestyle interventions and thereby reduce body adiposity and recover their metabolic and reproductive health.
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Affiliation(s)
- Ana L Rocha
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávia R Oliveira
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosana C Azevedo
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Virginia A Silva
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thais M Peres
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana L Candido
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karina B Gomes
- Department of Clinical and Toxicological Analysis, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved. J Assist Reprod Genet 2018; 36:569-578. [PMID: 30478807 DOI: 10.1007/s10815-018-1377-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the capacity of random antral follicle count (AFC), i.e., AFC recorded at any time during the menstrual cycle, to predict the number of retrieved mature oocytes in women with malignancies undergoing random start ovarian hyperstimulation METHODS: A consecutive series of 72 women with malignancies who underwent ovarian hyperstimulation aimed at egg freezing between July 2014 and December 2016 was retrospectively reviewed. A standardized random start protocol was used for all women. AFC and serum AMH were systematically assessed prior to initiating ovarian hyperstimulation. The main outcome was the retrieval of ≥ 10 mature oocytes. The accuracy of random AFC was tested with the c-statistics (area under the ROC curve). RESULTS For the whole cohort, the c-statistics for the prediction of ≥ 10 mature oocytes using AFC and serum AMH were similar. Specifically, the areas under the curve were 0.76 (95%CI 0.66-0.87) and 0.82 (95%CI 0.72-0.92), respectively (p = ns). Moreover, when considering the subgroup of women recruited after day 5 of the cycle (proper random start, n = 52), the areas under the curve did not also differ. Specifically, they resulted in 0.77 (95%CI 0.64-0.89) and 0.83 (95%CI 0.72-0.95), respectively (p = ns). CONCLUSIONS AFC collected at any time during the menstrual cycle can provide valuable information for the counseling of women with malignancies scheduled for oocyte cryopreservation. Its reliability appears to be non-inferior to that of serum AMH.
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Skiba MA, Islam RM, Bell RJ, Davis SR. Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2018; 24:694-709. [DOI: 10.1093/humupd/dmy022] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marina A Skiba
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Robin J Bell
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Susan R Davis
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
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Affiliation(s)
- Maria-Elisabeth Smet
- Sydney Ultrasound for Women; Level 1, 56 Neridah Street Chatswood New South Wales 2067 Australia
| | - Andrew McLennan
- Sydney Ultrasound for Women; Level 1, 56 Neridah Street Chatswood New South Wales 2067 Australia
- Discipline of Obstetrics Gynaecology and Neonatology; Faculty of Medicine; University of Sydney; Sydney New South Wales 2067 Australia
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Coelho Neto MA, Ludwin A, Borrell A, Benacerraf B, Dewailly D, da Silva Costa F, Condous G, Alcazar JL, Jokubkiene L, Guerriero S, Van den Bosch T, Martins WP. Counting ovarian antral follicles by ultrasound: a practical guide. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:10-20. [PMID: 29080259 DOI: 10.1002/uog.18945] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/23/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
This Consensus Opinion summarizes the main aspects of several techniques for performing ovarian antral follicle count (AFC), proposes a standardized report and provides recommendations for future research. AFC should be performed using a transvaginal ultrasound (US) probe with frequency ≥ 7 MHz. For training, we suggest a minimum of 20-40 supervised examinations. The operator should be able to adjust the machine settings in order to achieve the best contrast between follicular fluid and ovarian stroma. AFC may be evaluated using real-time two-dimensional (2D) US, stored 2D-US cine-loops and stored three-dimensional (3D) US datasets. Real-time 2D-US has the advantage of permitting additional maneuvers to determine whether an anechoic structure is a follicle, but may require a longer scanning time, particularly when there is a large number of follicles, resulting in more discomfort to the patient. 2D-US cine-loops have the advantages of reduced scanning time and the possibility for other observers to perform the count. The 3D-US technique requires US machines with 3D capability and the operators to receive additional training for acquisition/analysis, but has the same advantages as cine-loop and also allows application of different imaging techniques, such as volume contrast imaging, inversion mode and semi-automated techniques such as sonography-based automated volume calculation. In this Consensus Opinion, we make certain recommendations based on the available evidence. However, there is no strong evidence that any one method is better than another; the operator should choose the best method for counting ovarian follicles based on availability of resources and on their own preference and skill. More studies evaluating how to improve the reliability of AFC should be encouraged. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - A Borrell
- BCNatal, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain
| | - B Benacerraf
- Department of Radiology and Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Dewailly
- CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, Lille, France
| | - F da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University and Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, University of Sydney, Sydney; and Nepean Hospital, Penrith, Australia
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmo, Sweden
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - T Van den Bosch
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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Ludwin A, Ludwin I, Martins WP. Venous intravasation during evaluation of tubal patency by ultrasound contrast imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:143-145. [PMID: 28078761 DOI: 10.1002/uog.17405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 12/28/2016] [Accepted: 01/08/2017] [Indexed: 06/06/2023]
Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - I Ludwin
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Elmahdy M, Abdelsalam EA, Maghraby HA. Combining several interventions to reduce the incidence of OHSS: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2017; 212:110-114. [PMID: 28351814 DOI: 10.1016/j.ejogrb.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the outcome of using low-dose aspirin, dopamine agonist and triggering ovulation by low dose of HCG in combination with GnRH agonist in fixed GnRH antagonist protocol in patients at risk of OHSS. STUDY DESIGN This prospective cohort study was conducted on 50 infertile women who were at high risk of OHSS. They received low dose aspirin from first day of stimulation, cabergoline 0.5mg daily from the day of HCG for 8days and low dose of HCG (2500 IU) in combination with GnRH agonist for final oocyte maturation in fixed GnRH antagonist protocol. RESULTS The study was conducted on 50 cases and all of them completed the study protocol. The clinical pregnancy rate was 40% (20 cases of 50) and no cases developed severe or critical OHSS. Only 8% (4 cases) developed moderate OHSS. CONCLUSION Combining aspirin, cabergoline, and triggering with low dose of HCG in combination with GnRH agonist produced excellent clinical pregnancy rate, and decreased hospital admissions with severe or critical OHSS.
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Affiliation(s)
- Mohamed Elmahdy
- Obstetrics and Gynecology department, Faculty of Medicine, Alexandria University, Egypt.
| | - Eman A Abdelsalam
- Obstetrics and Gynecology department, Faculty of Medicine, Alexandria University, Egypt
| | - Hassan A Maghraby
- Obstetrics and Gynecology department, Faculty of Medicine, Alexandria University, Egypt
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Christopoulos G, Vlismas A, Salim R, Islam R, Trew G, Lavery S. Fibroids that do not distort the uterine cavity and IVF success rates: an observational study using extensive matching criteria. BJOG 2016; 124:615-621. [PMID: 27921379 DOI: 10.1111/1471-0528.14362] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of non-cavity-distorting fibroids on in vitro fertilisation (IVF) pregnancy outcomes. DESIGN A retrospective, matched, single-centre, cohort study was performed. SETTING The IVF unit of a tertiary, university hospital. POPULATION We analysed all women with non-cavity-distorting uterine fibroids undergoing IVF/intracytoplasmic sperm injection (ICSI) cycles from 1 January 2011 to 1 May 2015. METHODS Each woman was matched with two separate controls of the same age (±6 months), stimulation protocol (gonadotropin-releasing hormone agonist or antagonist), starting dose of follicle-stimulating hormone (FSH), number of embryos transferred (one or two), day of transfer (day 3 or day 5), and no uterine fibroids identified by transvaginal ultrasound. MAIN OUTCOME MEASURES Clinical pregnancy and live birth rates. RESULTS Our study demonstrates that the presence of non-cavity-distorting fibroids appears to negatively affect clinical pregnancy (odds ratio, OR 0.62; 95% confidence interval, 95% CI 0.41-0.94) and live birth rates (OR 0.58; 95% CI 0.48-0.78) in patients undergoing their first IVF/ICSI cycle, when matched with controls of the same age, starting dose of FSH, stimulation protocol, number of embryos, and day of embryo transfer. The deleterious effect of fibroids on live birth rates was significant in women with two or more fibroids (OR 0.47; 95% CI 0.26-0.83) and in women with fibroids of ≥30 mm in diameter (OR 0.41; 95% CI 0.19-0.89). The negative impact of non-cavity-distorting fibroids was also present in women with an embryo transfer on day 5 (OR 0.58; 95% CI 0.35-0.94). Conversely, in women with single fibroids of <30 mm in diameter, no difference in pregnancy outcomes was identified. CONCLUSIONS A well-designed, adequately powered, randomised controlled trial is required to address the role of medical or surgical interventions in patients with intramural and subserosal fibroids before undergoing fertility treatment. TWEETABLE ABSTRACT Non-cavity-distorting fibroids negatively affect pregnancy rates after IVF.
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Affiliation(s)
- G Christopoulos
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Vlismas
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R Salim
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R Islam
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G Trew
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Lavery
- IVF Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Van Schoubroeck D, Raine-Fenning N, Installé AJF, De Neubourg D, De Moor B, Bourne T, Van den Bosch T, Timmerman D. Interobserver agreement in assessment of polycystic ovarian morphology using pattern recognition. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:652-653. [PMID: 26415824 DOI: 10.1002/uog.15768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/29/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - D De Neubourg
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Kollmann M, Klaritsch P, Martins WP, Craciunas L, Raine-Fenning N. Reply: Maternal and neonatal outcomes in women diagnosed with PCOS by different definitions. Hum Reprod 2015; 31:225. [PMID: 26561544 DOI: 10.1093/humrep/dev285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz 8036, Austria
| | - P Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz 8036, Austria
| | - W P Martins
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14048-900, Brazil
| | - L Craciunas
- Clinical Academic Office, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Kollmann M, Klaritsch P, Martins WP, Guenther F, Schneider V, Herzog SA, Craciunas L, Lang U, Obermayer-Pietsch B, Lerchbaum E, Raine-Fenning N. Maternal and neonatal outcomes in pregnant women with PCOS: comparison of different diagnostic definitions. Hum Reprod 2015. [PMID: 26223675 DOI: 10.1093/humrep/dev187] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Does the prevalence of adverse maternal and neonatal outcomes vary in women diagnosed with polycystic ovary syndrome (PCOS) according to different definitions? SUMMARY ANSWER A comparison of different criteria revealed that there is a substantial risk for perinatal complications in PCOS women, regardless of the used definition. WHAT IS KNOWN ALREADY Pregnant women with PCOS are susceptible to perinatal complications. At present, there are three main definitions for PCOS. So far, we are aware of only one study, which found that the elevated risk for complications varied widely depending on the different phenotypes and features but only considered a relatively small sample size for some of the phenotypes. STUDY DESIGN, SIZE, DURATION Retrospective matched cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS Data of primiparous women with PCOS according to ESHRE/ASRM 2003 criteria and healthy controls giving birth to neonates ≥500 g were included. A total of 885 women were analysed: out of 177 women with PCOS, 85 (48.0%) met the National Institutes of Health (NIH) 1990 criteria, another 14 (7.9%) featured the additional phenotypes defined by The Androgen Excess and PCOS Society (AE-PCOS) 2006 criteria, 78 (44.1%) were classified as PCOS exclusively by the ESHRE/ASRM 2003 definition, and 708 represented the control group. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of adverse maternal (49.4 versus 64.3 versus 60.3%, P = 0.313) and neonatal (27.1 versus 35.7 versus 23.1%, P = 0.615) outcomes did not differ within the three PCOS groups (ESHRE/ASRM, NIH, AE-PCOS, respectively). Compared with healthy controls, the risk for maternal complications was increased in PCOS patients [odds ratio (OR) 2.57; 95% confidence interval (CI) 1.82-3.64; P < 0.001] while there was no difference in neonatal complications (OR 0.83; 95% CI 0.56-1.21; P = 0.343). LIMITATIONS, REASONS FOR CAUTION A limitation of our study is its retrospective design and the relatively small sample size, particularly in the AE-PCOS subgroup. WIDER IMPLICATIONS OF THE FINDINGS Since women with PCOS have, regardless of the used definition, a high risk of maternal and neonatal complications they should be informed and advised to follow regular checks in units where problems can be detected early to allow specialized care. STUDY FUNDING/COMPETING INTERESTS Marietta Blau Grant (Austrian Agency for International Cooperation in Education and Research; OeAD-GmbH) and mobility scholarship (Medical University of Graz).
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Affiliation(s)
- M Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - P Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - W P Martins
- Department of Obstetrics and Gynaecology, Medical School of Ribeirao Preto, University of Sao Paulo, 14048-900 Ribeirao Preto, Brazil
| | - F Guenther
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - V Schneider
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - S A Herzog
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria
| | - L Craciunas
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
| | - U Lang
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - B Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - E Lerchbaum
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
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