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Chen Z, Wang Z, Du M, Liu Z. Artificial Intelligence in the Assessment of Female Reproductive Function Using Ultrasound: A Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1343-1353. [PMID: 34524706 PMCID: PMC9292970 DOI: 10.1002/jum.15827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 05/27/2023]
Abstract
The incidence of infertility is continuously increasing nearly all over the world in recent years, and novel methods for accurate assessment are of great need. Artificial Intelligence (AI) has gradually become an effective supplementary method for the assessment of female reproductive function. It has been used in clinical follicular monitoring, optimum timing for transplantation, and prediction of pregnancy outcome. Some literatures summarize the use of AI in this field, but few of them focus on the assessment of female reproductive function by AI-aided ultrasound. In this review, we mainly discussed the applicability, feasibility, and value of clinical application of AI in ultrasound to monitor follicles, assess endometrial receptivity, and predict the pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET). The limitations, challenges, and future trends of ultrasound combined with AI in providing efficient and individualized evaluation of female reproductive function had also been mentioned.
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Affiliation(s)
- Zhiyi Chen
- The First Affiliated Hospital, Medical Imaging Center, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
- Institute of Medical ImagingUniversity of South ChinaHengyangChina
| | - Ziyao Wang
- The First Affiliated Hospital, Medical Imaging Center, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Meng Du
- Institute of Medical ImagingUniversity of South ChinaHengyangChina
| | - Zhenyu Liu
- The First Affiliated Hospital, Medical Imaging Center, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
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Tamauchi S, Kajiyama H, Osuka S, Moriyama Y, Yoshihara M, Kikkawa F. Reduced response to controlled ovarian stimulation after radical trachelectomy: A pitfall of fertility-sparing surgery for cervical cancer. Int J Gynaecol Obstet 2021; 154:162-168. [PMID: 33438209 DOI: 10.1002/ijgo.13529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/02/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To clarify the decrease in response to controlled ovarian stimulation in patients who receive in vitro fertilization treatment after radical trachelectomy. METHODS The outcomes of ovarian stimulation were retrospectively evaluated and compared between patients who have undergone radical trachelectomy and control patients who had male factor infertility or unexplained infertility. RESULTS A total of 30 ovarian stimulation cycles in 14 radical trachelectomy patients and 54 cycles in 30 control patients were reviewed. The median age at ovarian stimulation was 34.8 years in the radical trachelectomy group and 36.5 years in the control group. Compared with the control group, the radical trachelectomy group had significantly lower mean estradiol concentration (1461.7 pg/ml, SD 775.0 vs. 1950.9 pg/ml, SD 1057.3, P = 0.029) during controlled ovarian stimulation cycle and smaller median number of retrieved oocytes (5, range 1-14 vs. 8, range 1-19, P = 0.007), despite the higher use of gonadotropin (3527.5 IU, SD 1313.4 vs. 2670.8 IU, SD 905.1, P = 0.001). CONCLUSION The response to controlled ovarian stimulation decreased after radical trachelectomy.
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Affiliation(s)
- Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abushama M, Rawhani R, Abdellatif A. Antenatal Diagnosis of Fetal Skeletal Malformation. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10009-1561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Panchal S, Kurjak A, Nagori C. 3D and 4D studies from human reproduction to perinatal medicine. J Perinat Med 2017; 45:759-772. [PMID: 28284038 DOI: 10.1515/jpm-2016-0374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/10/2017] [Indexed: 11/15/2022]
Abstract
Three-dimensional ultrasound (3D US) is a modality of choice for prenatal diagnosis of congenital malformations. But 3D-four-dimensional US(4D US) is of utmost importance also to achieve pregnancy. 3D US plays an important role for diagnosis of PCO, to assess ovarian reserve and response and thus to decide optimum stimulation protocols. It adds to the information on follicular maturity and endometrial receptivity, thus improving the chances to achieve pregnancy for patients under treatment for fertility. 3D hystero-contrast-salpingography (HyCoSy) has also proved itself to be one of the best modalities for assessment of tubal patency. In this article, the role of 3D and 4D US is discussed for the following. I. Pretreatment assessment of the females desiring fertility which includes assessment of uterus and fallopian tubes. II. Monitoring of infertile females undergoing treatment. III. Assessment of very early pregnancy - especially in abnormal locations.
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Ultrasound in Assisted Reproductive Technologies and the First Trimester: Is There a Risk? Clin Obstet Gynecol 2017; 60:121-132. [DOI: 10.1097/grf.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takahashi N, Harada M, Hirota Y, Zhao L, Yoshino O, Urata Y, Izumi G, Takamura M, Hirata T, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. A potential role of endoplasmic reticulum stress in development of ovarian hyperstimulation syndrome. Mol Cell Endocrinol 2016; 428:161-9. [PMID: 27032713 DOI: 10.1016/j.mce.2016.03.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/12/2016] [Accepted: 03/25/2016] [Indexed: 02/06/2023]
Abstract
Vascular endothelial growth factor A (VEGFA) is crucial for ovarian angiogenesis, but its excess production induces ovarian hyperstimulation syndrome (OHSS). The aim of this study was to determine whether endoplasmic reticulum (ER) stress regulates VEGFA expression in granulosa cells, and whether its activation is involved in OHSS development. The expression of the spliced form of X-box-binding protein 1 [XBP1(S)], induced by ER stress, in cumulus cells from OHSS patients was higher than that in cumulus cells from non-OHSS patients. The ER stress inducer tunicamycin increased human chorionic gonadotropin-induced VEGFA production in human granulosa cells through the induction of XBP1(S), and pretreatment with the ER stress inhibitor tauroursodeoxycholic acid (TUDCA) abrogated the effect of tunicamycin. In OHSS model rats, TUDCA administration prevented the OHSS development, reducing ovarian VEGFA production. Our findings suggest ER stress upregulates hCG-induced VEGFA production in granulosa cells, indicating that ER stress might be involved in OHSS development.
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Affiliation(s)
- Nozomi Takahashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Lin Zhao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116044, PR China
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yoko Urata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Gentaro Izumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
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Nuñez-Calonge R, Cortés S, Gutierrez Gonzalez LM, Kireev R, Vara E, Ortega L, Caballero P, Rancan L, Tresguerres J. Oxidative stress in follicular fluid of young women with low response compared with fertile oocyte donors. Reprod Biomed Online 2016; 32:446-56. [PMID: 26805046 DOI: 10.1016/j.rbmo.2015.12.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 12/31/2022]
Abstract
The aim of this study was to determine the concentrations of oxidative stress markers, antioxidant enzymes and cytokines in the follicular fluid of young women with low response in ovarian stimulation cycles compared with high responders and fertile oocyte donors of the same age, to assess the impact of oxidative stress on ovarian reserve. The activity of follicular fluid antioxidant enzymes glutathione transferase, glutathione reductase and glutathione peroxidase was significantly lower in young women with reduced ovarian reserve compared with that in high responders and oocyte donors. Follicular fluid concentrations of oxidative stress marker malondialdehyde combined with 4-hydroxyalkenals and nitric oxide were higher in low responders than in high responders and oocyte donors. Significant differences between low responders and donors in concentrations of IL-2, IL-6, IL-8 and vascular endothelial growth factor were observed, with higher concentrations in low responders. However, IL-10 concentration was lower in low responders than in high responders and donors. No significant differences were found in follicular fluid concentrations of tumour necrosis factor alpha between the three groups. These results demonstrate that different concentrations of oxidative stress markers, oxidant enzymes and cytokines in low responders compared with high responders and oocyte donors may negatively impact ovarian response.
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Affiliation(s)
| | | | | | - Roman Kireev
- Department Physiology, Medical School, University Complutense of Madrid, Madrid, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Xerencia de Xestión Integrada de Vigo, SERGAS, Vigo, Spain
| | - Elena Vara
- Department of Biochemistry and Mollecular Biology Medical School, University Complutense of Madrid, Madrid, Spain
| | | | | | - Lisa Rancan
- Department Physiology, Medical School, University Complutense of Madrid, Madrid, Spain
| | - Jesús Tresguerres
- Department Physiology, Medical School, University Complutense of Madrid, Madrid, Spain
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2015; 103:e9-e17. [DOI: 10.1016/j.fertnstert.2014.12.093] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/21/2022]
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Giugliano E, Cagnazzo E, Giugliano B, Vesce F, Caserta D, Moscarini M, Marci R. Can Doppler study of the ovarian artery predict the fertility outcome of intrauterine insemination? JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:331-335. [PMID: 24526273 DOI: 10.1002/jcu.22140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 10/10/2013] [Accepted: 01/16/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To test the velocimetric pattern of the ovarian artery as a routine ovarian reserve test. METHODS We enrolled 317 consecutive patients from January 2011 to June 2012. At the second day of the menstrual cycle, a transvaginal ultrasound was performed to evaluate the antral follicle count and ovarian volume, and Doppler of both ovarian arteries was also performed. Controlled ovarian stimulation was performed and the patients were divided in two groups according to the result of the intrauterine insemination: group A (nonpregnant women) and group B (pregnant women). RESULTS Ovarian velocimetric pattern was similar between the two groups. Follicle stimulating hormone value had a significant correlation with the ultrasound markers; however, the multiple regression linear analysis showed that the only independent variables were the antral follicle count (t = -2.74, p = 0.008) and the systolic/diastolic ratio (t = 3.95, p = 0.0005). The best parameters in predicting the pregnancy were the mean ovarian volume, total and partial antral follicle count between 7 and 10 mm, and the mean resistance index (area under the curve: 0.744, 0.671, 0.667, 0.573, respectively). CONCLUSIONS The Doppler study of the ovarian arteries did not add significant information about the ovarian reserve status. Only the mean resistance index had a significant diagnostic accuracy, but its specificity (53%) is too low to consider it a screening test.
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Affiliation(s)
- Emilio Giugliano
- Department of Morphology, Surgery, and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
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Shaban MM, Abdel Moety GAF. Role of ultrasonographic markers of ovarian reserve in prediction of IVF and ICSI outcome. Gynecol Endocrinol 2014; 30:290-3. [PMID: 24456542 DOI: 10.3109/09513590.2013.875996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to assess correlation of ultrasonographic markers of ovarian reserve and IVF/ICSI outcome. Two-hundred twelve IVF/ICSI patients were included. Upon pituitary suppression confirmation, antral follicle count (AFC), ovarian volume (OV), and ovarian stromal indices [vascularization index (VI), flow index (FI), and vascularization flow index (VFI)] were assessed by three-dimensional (3D) and power Doppler (PD) ultrasound and correlated with the number of mature oocytes retrieved. The number of mature oocytes retrieved correlated strongly with AFC (r = 0.832, p ≤ 0.001) and OV (r = 0.835, p ≤ 0.001), but weakly with VI (r = 0.166, p = 0.016), FI (r = 0.151, p = 0.028), and VFI (r = 0.14, p = 0.041). AFC and OV correlate strongly with the number of mature oocytes retrieved in IVF/ICSI cycles, whereas 3D PD indices of the ovarian stromal vascularity have a weak correlation.
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Affiliation(s)
- Mona Mohamed Shaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University , Cairo , Egypt
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Broer SL, Dólleman M, van Disseldorp J, Broeze KA, Opmeer BC, Bossuyt PMM, Eijkemans MJC, Mol BW, Broekmans FJM. Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis. Fertil Steril 2013; 100:420-9.e7. [PMID: 23721718 DOI: 10.1016/j.fertnstert.2013.04.024] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/12/2013] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. DESIGN Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. SETTING In vitro fertilization clinics. PATIENT(S) A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Excessive response prediction. RESULT(S) We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. CONCLUSION(S) We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.
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Affiliation(s)
- Simone L Broer
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands
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Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BWJ, Broekmans FJ, Broer S, van Disseldorp J, Broeze K, Dolleman M, Opmeer B, Anderson R, Ashrafi M, Bancsi L, Caroppo LE, Copperman A, Ebner T, Eldar Geva M, Erdem M, Greenblatt E, Jayaprakasan K, Fenning R, Klinkert E, Kwee J, Lambalk C, La Marca A, McIlveen M, Merce L, Muttukrishna S, Nelson S, Ng H, Popovic-Todorovic B, Smeenk J, Tomás C, Van der Linden P, van Rooij I, Vladimirov I, Bossuyt P, Eijkemans M, Mol B, Frank B. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update 2013. [DOI: 10.1093/humupd/dms041] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone L. Broer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Disseldorp
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Kimiko A. Broeze
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Madeleine Dolleman
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Brent C. Opmeer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Patrick Bossuyt
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Marinus J.C. Eijkemans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Ben-Willem J. Mol
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Frank J.M. Broekmans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2012; 98:1407-15. [PMID: 23095141 DOI: 10.1016/j.fertnstert.2012.09.036] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/21/2012] [Indexed: 11/18/2022]
Abstract
Currently, there is no uniformly accepted definition of decreased ovarian reserve (DOR), as the term may refer to three related but distinctly different outcomes: oocyte quality, oocyte quantity, or reproductive potential. Available evidence concerning the performance of ovarian reserve tests is limited by small sample sizes, heterogeneity among study design, analyses and outcomes, and the lack of validated outcome measures.
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A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril 2010; 93:855-64. [DOI: 10.1016/j.fertnstert.2008.10.042] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 10/16/2008] [Accepted: 10/17/2008] [Indexed: 11/20/2022]
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Jayaprakasan K, Al-Hasie H, Jayaprakasan R, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. The three-dimensional ultrasonographic ovarian vascularity of women developing poor ovarian response during assisted reproduction treatment and its predictive value. Fertil Steril 2009; 92:1862-9. [DOI: 10.1016/j.fertnstert.2008.09.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 11/16/2022]
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Jayaprakasan K, Jayaprakasan R, Al-Hasie HA, Clewes JS, Campbell BK, Johnson IR, Raine-Fenning NJ. Can quantitative three-dimensional power Doppler angiography be used to predict ovarian hyperstimulation syndrome? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:583-591. [PMID: 19402100 DOI: 10.1002/uog.6373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To test the hypothesis that ovarian vascularity is increased in women developing ovarian hyperstimulation syndrome (OHSS) and to assess its value as a predictor of OHSS during in-vitro fertilization (IVF). METHODS 118 subjects undergoing their first cycle of IVF had a three-dimensional (3D) transvaginal ultrasound scan in the early follicular phase of the menstrual cycle preceding IVF treatment. 18 of them developed moderate or severe OHSS and 100 subjects had normal ovarian response. Antral follicle count, ovarian volume, and ovarian vascularity (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were compared between OHSS and control groups. Multiple regression analysis was used to assess the predictive value of these variables against age, body mass index and basal follicle-stimulating hormone level for the development of OHSS. RESULTS The ovarian blood flow indices VI (11.1 +/- 11.6 vs. 8.6 +/- 7.3%; P = 0.23), FI (38.0 +/- 4.8 vs. 38.0 +/- 5.5; P = 0.95) and VFI (4.2 +/- 3.3 vs. 3.5 +/- 3.1; P = 0.40) were similar in the OHSS group and the normal responders. While antral follicle count was significantly higher in women developing OHSS (33.0 +/- 15.1) than in the control group (19.2 +/- 9.9, P < 0.001), ovarian volume did not differ between the two groups (10.6 +/- 3.8 vs. 8.9 +/- 4.8 cm(3), respectively, P = 0.11). On multiple regression analysis, antral follicle count was the only significant predictor of OHSS (P < 0.01). CONCLUSIONS Women developing OHSS during IVF do not demonstrate an increased ovarian blood flow as measured by 3D ultrasound but do have a significantly higher antral follicle count, which is the only significant predictor of OHSS.
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Affiliation(s)
- K Jayaprakasan
- Nottingham University Research and Treatment Unit in Reproduction (NURTURE), Division of Human Development, School of Clinical Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
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Abstract
Various predictors of fertility have been described, suggesting that none are ideal. The literature on tests of ovarian reserve is largely limited to women undergoing in vitro fertilization, and is reliant on the use of surrogate markers, such as cycle cancellation and number of oocytes retrieved, as reference standards. Currently available prediction models are far from ideal; most are applicable only to subfertile women seeking assisted reproduction, and lack external validation. Systematic reviews and meta-analyses of predictors of fertility are limited by their heterogeneity in terms of the population sampled, predictors tested and reference standards used. There is an urgent need for consensus in the design of these studies, definition of abnormal tests, and, above all, a need to use robust outcomes such as live birth as the reference standard. There are no reliable predictors of fertility that can guide women as to how long childbearing can be deferred.
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Affiliation(s)
- Abha Maheshwari
- Assisted Conception Unit, Department of Obstetrics & Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, UK
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