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Meng S, Shi C, Jia Y, Fu M, Zhang T, Wu N, Han H, Shen H. A combined clinical and specific genes' model to predict live birth for in vitro fertilization and embryo transfer patients. BMC Pregnancy Childbirth 2023; 23:702. [PMID: 37777726 PMCID: PMC10541716 DOI: 10.1186/s12884-023-05988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/10/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND We aimed to develop an accurate model to predict live birth for patients receiving in vitro fertilization and embryo transfer (IVF-ET) treatment. METHODS This is a prospective nested case-control study. Women aged between 18 and 38 years, whose body mass index (BMI) were between the range of 18.5-24 kg/m2, who had an endometrium of ≥ 8 mm at the thickest were enrolled from 2018/9 to 2020/8. All patients received IVF-ET treatment and were followed up until Jan. 2022 when they had reproductive outcomes. Endometrial samples during the window of implantation (LH + 6 to 9 days) were subjected to analyze specific endometrial receptivity genes' expression using real-time PCR (RT-PCR). Patients were divided into live birth group and non-live birth group based on IVF-ET outcomes. Clinical signatures relevant to live birth were collected, analyzed, and used to establish a predictive model for live birth by univariate analysis (clinical model). Specific endometrial receptivity genes' expression was analyzed, selected, and used to construct a predictive model for live birth by The Least Absolute Shrinkage and Selection Operator (LASSO) analysis (gene model). Finally, significant clinical factors and genes were used to construct a combined model for predicting live birth using multivariate logistical regression (combined model). Different models' Area Under Curve (AUC) were compared to identify the most predictive model. RESULTS Thirty-nine patients were enrolled in the study, twenty-four patients had live births, fifteen did not. In univariate analysis, the odds of live birth for women with ovulation dysfunction was 4 times higher than that for women with other IVF-ET indications (OR = 4.0, 95% CI: 1.125 - 8.910, P = 0.018). Age, body mass index, duration of infertility, primary infertility, repeated implantation failure, antral follicle counting, ovarian sensitivity index, anti-Mullerian hormone, controlled ovarian hyperstimulation protocol and duration, total dose of FSH/hMG, number of oocytes retrieved, regiment of endometrial preparation, endometrium thickness before embryo transfer, type of embryo transferred were not associated with live birth (P > 0.05). Only ovulation dysfunction was used to construct the clinical model and its AUC was 0.688. In lasso analysis, GAST, GPX3, THBS2 were found to promote the risk of live birth. AUCs for GAST, GPX3, THBS2 reached to 0.736, 0.672, and 0.678, respectively. The gene model was established based on these three genes and its AUC was 0.772. Ovulation dysfunction, GAST, GPX3, and THBS2 were finally used to construct the combined model, reaching the highest AUC (AUC = 0.842). CONCLUSIONS Compared to the single model, the combined model of clinical (Ovulation dysfunction) and specific genes (GAST, GPX3, THBS2) was more accurate to predict live birth for IVF-ET patients.
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Affiliation(s)
- Shihui Meng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Cheng Shi
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Yingying Jia
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Min Fu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Tianzhen Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Na Wu
- Department of Central Laboratory and Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, China
| | - Hongjing Han
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
| | - Huan Shen
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
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Busnelli A, Somigliana E, Cirillo F, Levi-Setti PE. Is diminished ovarian reserve a risk factor for miscarriage? Results of a systematic review and meta-analysis. Hum Reprod Update 2021; 27:973-988. [PMID: 34254138 DOI: 10.1093/humupd/dmab018] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anti-Müllerian hormone (AMH) serum concentration and antral follicle count (AFC), as measured by transvaginal ultrasonography, accurately reflect the antral follicle pool. However, AMH and AFC association with fertility surrogates (i.e. age at menopause, probability of conceiving naturally and ART success rate) is questioned. Miscarriage is often considered an alternative measure of reproductive capacity. Nonetheless, the impact of diminished ovarian reserve (DOR) on miscarriage incidence remains an understudied and unresolved issue. OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis was to elucidate associations between DOR and miscarriage risk, both in women who conceived naturally and in those who achieved pregnancy through ART. SEARCH METHODS Relevant studies were identified by a systematic search in PubMed, MEDLINE, Embase and Scopus, from database inception to 1 March 2021. Studies were included only if all the following conditions were met: DOR was defined using serum AMH concentration or AFC; miscarriage rate was reported separately for different groups of women categorized according to the AMH and/or AFC level; authors reported either the rate of intrauterine pregnancy loss before 22 weeks of gestation or enough data were available to calculate it. OUTCOMES From a total of 347 publications initially identified, 16 studies were included. Pooled results from 13 retrospective studies focusing on ART pregnancies showed a significantly higher rate of miscarriage in women with a low AMH, as compared to women with a medium or high serum AMH concentration (12 042 women, random effects model, odds ratio (OR) 1.35; 95% CI, 1.10-1.66; P = 0.004; I2=50%). The only prospective study on ART pregnancies failed to show any association (61 women, risk ratio (RR) 2.95; 95% CI, 0.66-3.18; P = 0.16). Data from two prospective studies, which included naturally conceived pregnancies, showed a significantly increased miscarriage risk for women with low serum AMH. However, these data could not undergo meta-analysis owing to differing study designs. Using three retrospective studies, we observed an association between low AFC and miscarriage incidence (three retrospective studies on ART pregnancies, random effects model, OR 1.81; 95% CI, 1.02-3.21; P = 0.04; I2=64%). WIDER IMPLICATIONS Our meta-analysis findings suggest that within the DOR patient subgroup, serum AMH and AFC biomarker levels may correlate with both the quantitative and qualitative aspects of ovarian reserve. However, owing to study limitations, the aetiology of this effect remains unclear and we are unable to define a causal relationship between DOR and increased miscarriage or to provide clinical recommendations based on this information. However, if confirmed by future well-designed studies, these findings would be profoundly informative for guiding women in family planning decisions.
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Affiliation(s)
- Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Cirillo
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Younis JS, Iskander R, Fauser BCJM, Izhaki I. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update 2021; 26:904-928. [PMID: 32514566 DOI: 10.1093/humupd/dmaa013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population. OBJECTIVE AND RATIONALE The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21-35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes. SEARCH METHODS An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle-Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis. OUTCOMES Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21-27 days) was associated with lower ORT values as compared to normal (28-31 days), long (32-35 days) and all other (28-35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was -1.3 ng/mL (95% CI: -1.75 to -0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was -5.17 (95% CI: -5.96 to -4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72-0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of -1.8 oocytes (95% CI: -2.5 to -1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures. WIDER IMPLICATIONS MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel.,Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Safed, Israel
| | - Rula Iskander
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology, University of Utrecht and University Medical Center Utrecht, 3508 TC, Utrecht, The Netherlands
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa 3498838, Israel
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Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2020; 27:584-618. [PMID: 33302299 DOI: 10.1093/humupd/dmaa051] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women. OBJECTIVE AND RATIONALE The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women. SEARCH METHODS An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis. OUTCOMES Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit. WIDER IMPLICATIONS Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Liao S, Pan W, Dai WQ, Jin L, Huang G, Wang R, Hu C, Pan W, Tu H. Development of a Dynamic Diagnosis Grading System for Infertility Using Machine Learning. JAMA Netw Open 2020; 3:e2023654. [PMID: 33165608 PMCID: PMC7653500 DOI: 10.1001/jamanetworkopen.2020.23654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Many indicators need to be considered when judging the condition of patients with infertility, which makes diagnosis and treatment complicated. OBJECTIVE To construct a dynamic scoring system for infertility to assist clinicians in efficiently and accurately assessing the condition of patients with infertility. DESIGN, SETTING, AND PARTICIPANTS This prognostic study reviewed 95 868 medical records of couples with infertility in which women had undergone in vitro fertilization and embryo transfer at the Reproductive Center of Tongji Medical College, Huazhong University of Science and Technology, in Wuhan, Hubei, China, from January 2006 to May 2019. A dynamic diagnosis and grading system for infertility was constructed. The analysis was conducted between May 20, 2019, and April 15, 2020. MAIN OUTCOMES AND MEASURES Patients were divided into pregnant and nonpregnant groups according to eventual pregnancy results. The evaluation index system was constructed based on the test results of the significant difference between the 2 groups of indicators and the clinician's experience. Random forest machine learning was used to determine the weight of the index, and the entropy-based feature discretization algorithm classified the abnormality of the index and the patient's condition. A 10-fold cross-validation method was used to test the validity of the system. RESULTS A total of 60 648 couples with infertility were enrolled, in which 15 021 women became pregnant, with a mean (SD) age of 30.30 (4.02) years. A total of 45 627 couples were in the nonpregnant group, with a mean (SD) age among women of 32.17 (5.58) years. Seven indicators were selected to build the dynamic grading system for patients with infertility: age, body mass index, follicle-stimulating hormone level, antral follicle count, anti-Mullerian hormone level, number of oocytes, and endometrial thickness. The importance weight of each indicator obtained by the random forest algorithm was 0.1748 for age, 0.0785 for body mass index, 0.0581 for follicle-stimulating hormone level, 0.1214 for antral follicle count, 0.1616 for anti-Mullerian hormone level, 0.2307 for number of oocytes, and 0.1749 for endometrial thickness. The grading system divided the condition of the patient with infertility into 5 grades from A to E. The worst E grade represented a 0.90% pregnancy rate, and the pregnancy rate in the A grade was 53.82%. The cross-validation results showed that the stability of the system was 95.94% (95% CI, 95.14%-96.74%). CONCLUSIONS AND RELEVANCE This machine learning-derived algorithm may assist clinicians in making an efficient and accurate initial judgment on the condition of patients with infertility.
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Affiliation(s)
- ShuJie Liao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Pan
- School of Applied Economics, Renmin University of China, Beijing, China
- School of Economics and Management, Wuhan University, Wuhan, China
| | - Wan-qiang Dai
- School of Economics and Management, Wuhan University, Wuhan, China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ge Huang
- School of Economics and Management, Wuhan University, Wuhan, China
| | - Renjie Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cheng Hu
- School of Economics and Management, Wuhan University, Wuhan, China
| | - Wulin Pan
- School of Economics and Management, Wuhan University, Wuhan, China
| | - Haiting Tu
- School of Economics and Management, Wuhan University, Wuhan, China
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Volodarsky-Perel A, Tulandi T, Son WY, Khojah M, Buckett W. Impact of extent and biochemical parameters of lymphoma on fertility preservation outcome. Fertil Steril 2020; 113:400-407.e1. [PMID: 32106993 DOI: 10.1016/j.fertnstert.2019.09.033] [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: 06/28/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the impact of lymphoma aggressiveness on ovarian response during fertility preservation treatment. DESIGN Retrospective cohort study. SETTING University-affiliated tertiary hospital. PATIENT(S) Women with lymphoma who underwent ovarian stimulation for fertility preservation in the period from 2009 to 2018. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Primary outcome: the number of mature oocytes; secondary outcomes: the number of retrieved oocytes, estradiol level, and number of follicles >14 mm on the day of oocyte maturation trigger. RESULT(S) Patients with stage I-II lymphoid neoplasms (localized disease) were compared with those with stage III-IV lymphomas (advanced disease). Women with favorable levels of biochemical prognostic markers were also compared with those with unfavorable levels. Women with favorable levels of biochemical prognostic markers (n = 74) had a higher number of mature oocytes compared with patients with unfavorable serum levels (n = 67): 11 (7.8-16) versus 9 (5-11), respectively. The number of mature oocytes was similar between patients with localized (n = 75) and advanced (n = 66) lymphomas. Women with unfavorable combination of stage and biochemical factors had lower number of mature oocytes compared to patients with favorable combination: 8 (5-10) versus 11 (7-16), respectively. Multivariate logistic regression showed that favorable levels of biochemical markers as well as a combination of extent and biochemical parameters were statistically significantly associated with the result of over 10 mature oocytes. CONCLUSION(S) Highly-aggressive lymphoid neoplasms have a negative impact on ovarian function and response during fertility preservation treatment.
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Affiliation(s)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohammad Khojah
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
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Hormonal Effects in Reproductive Technology with Focus on Diminished Ovarian Reserve. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32406026 DOI: 10.1007/978-3-030-38474-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Modern use of reproductive technologies has revolutionized the treatment of infertile couples. Strategies to improve ovarian function in cases of diminished ovarian reserve are perhaps the least understood area in this field and will be the chief focus of this chapter.
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Çelebi F, Ordu Ç, Ilgün S, Oztürk A, Erdoğan Iyigün Z, Alço G, Duymaz T, Aktepe F, Soybir G, Baysal B, Özmen V. The Effect of Systemic Chemotherapy on Ovarian Function: A Prospective Clinical Trial. Eur J Breast Health 2020; 16:177-182. [PMID: 32656517 DOI: 10.5152/ejbh.2020.5114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
Objective Premenopausal women with breast cancer are at risk of developing ovarian failure after chemotherapy. The aim of this study was to investigate the negative effects of systemic chemotherapy on ovarian function in premenoupausal women with breast cancer. Materials and Methods Thirty-one premenopausal women with operable breast cancer aged between 26-48 years were enrolled in this prospective cohort study to investigate preliminary results. Additional 69 patients' data will be included after the completion of all five measurements. The change in serum Antimullerian Hormone (AMH) levels, mean ovarian volumes (MOV) and antral follicle counts (AFCs) at 3-month intervals were recorded to evaluate ovarian function. Women who had at least one pretreatment and four post-treatment measurements in one year follow-up period were included in the study. Decision of chemotherapy regimen was taken by the Tumor Board. Results Thirty-one patients had all five AMH, MOV and AFCs results. There was a statistically significant negative correlation between 1st - 5th AMH levels (p=0.006) and 1st - 5th AFCs during the follow-up period (p<0.0001). However pre- and post-chemotherapy measurements of MOVs did not demonstrate any significant correlation (p=0.799). BMI, parity, lactation, histopathology and molecular subtypes of breast cancer, alcohol intake, smoking and type of chemotherapy regimen were not significantly correlated with AMH, AFC and MOV. Conclusion Pretreatment AMH levels and AFC were shown to have a significant role in early prediction of ovarian-reserve after chemotherapy.
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Affiliation(s)
- Filiz Çelebi
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Department of Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan Ilgün
- Department of General Surgery, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Alper Oztürk
- Department of General Surgery, Biruni University Hospital, İstanbul, Turkey
| | - Zeynep Erdoğan Iyigün
- Department of Physical Therapy and Rehabilitation, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, Bilgi University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Etiler Hospital, İstanbul, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
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Liao S, Xiong J, Tu H, Hu C, Pan W, Geng Y, Pan W, Lu T, Jin L. Prediction of in vitro fertilization outcome at different antral follicle count thresholds combined with female age, female cause of infertility, and ovarian response in a prospective cohort of 8269 women. Medicine (Baltimore) 2019; 98:e17470. [PMID: 31593108 PMCID: PMC6799863 DOI: 10.1097/md.0000000000017470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Antral follicle count (AFC) has been widely investigated for the prediction of clinical pregnancy or live birth. This study discussed the effects of AFC quartile levels on pregnancy outcomes combined with female age, female cause of infertility, and ovarian response undergoing in vitro fertilization (IVF) treatment. At present, many research about AFC mainly discuss its impact on clinical practice at different thresholds, or the analyses of AFC with respect to assisted reproductive technology outcomes under using different ovarian stimulation protocols. Factors that include ovarian sensitivity index, female age, and infertility cause are all independent predictors of live birth undergoing IVF/intracytoplasmic sperm injection, while few researchers discussed influence of female-related factors for clinical outcomes in different AFC fields.A total of 8269 infertile women who were stimulated with a long protocol with normal menstrual cycles were enrolled in the study, and patients were categorized into 4 groups based on AFC quartiles (1-8, 9-12, 13-17, and ≥18 antral follicles).The clinical pregnancy rates increased in the 4 AFC groups (28.25% vs 35.38% vs 37.38% vs 40.13%), and there was a negative association between age and the 4 AFC groups. In addition, female cause of infertility like polycystic ovary syndrome, Tubal factor, and other causes had great significance on clinical outcome, and ovarian response in medium (9-16 oocytes retrieved) had the highest clinical pregnancy rate at AFC quartiles of 1 to 8, 9 to 12, 13 to 17, and ≥18 antral follicles.This study concludes that the female-related parameters (female cause of infertility, female age, and ovarian response) combined with AFC can be useful to estimate the probability of clinical pregnancy.
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Affiliation(s)
- ShuJie Liao
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jianwu Xiong
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Haiting Tu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Cheng Hu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Wulin Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Yudi Geng
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Tingjuan Lu
- 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Lei Jin
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Pan W, Tu H, Jin L, Hu C, Xiong J, Pan W, Yu D, Wang R, Li Y, Huang W, Liao S. Comparison of recombinant and urinary follicle-stimulating hormones over 2000 gonadotropin-releasing hormone antagonist cycles: a retrospective study. Sci Rep 2019; 9:5329. [PMID: 30926887 PMCID: PMC6441040 DOI: 10.1038/s41598-019-41846-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 03/08/2019] [Indexed: 01/12/2023] Open
Abstract
The objective of this paper was to compare the effect of recombinant follicle-stimulating hormone (rFSH) and urinary follicle-stimulating hormone (uFSH) on pregnancy rates and live birth rates with the gonadotropin-releasing hormone (GnRH) antagonist protocol in China. This retrospective study was conducted from January 2014 through August 2017. Patients treated with uFSH had significantly higher levels of luteinizing hormone (3.79 mIU/ml vs. 3.09 mIU/ml) and progesterone (0.93 ng/ml vs. 1.16 ng/ml) on the day of human chorionic gonadotropin (HCG) administration, and they also had higher pregnancy rates (24.19% vs. 22.86%). There was no significant difference in the rate of live births. In the logistic regression results of the rFSH group, the pregnancy rate was positively correlated with the level of luteinizing hormone, with an odds ratio (OR) of 1.09 (95% confidence interval [CI]: 1.00-1.18; P = 0.048). In the uFSH group, the pregnancy rate was negatively correlated with the progesterone level on the day of HCG administration, with an OR of 0.47 (95% CI: 0.27-0.77; P = 0.004). Our research concluded that uFSH performed better than rFSH in terms of pregnancy rates when it was associated with the GnRH antagonist protocol. Meanwhile, no significant differences in the rate of live births were observed between the two groups.
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Affiliation(s)
- Wei Pan
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Haiting Tu
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Lei Jin
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - Cheng Hu
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Jianwu Xiong
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Wulin Pan
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Dongyang Yu
- Economics and Management School, Wuhan University, Wuhan, 430072, China
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan, 430072, China
| | - Renjie Wang
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - Yuehan Li
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - Weiming Huang
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - ShuJie Liao
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China.
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López Martín MJ, García D, Vassena R, Rodríguez A. Oocyte developmental competence is independent of ovarian reserve in women younger than 35 years. Reprod Biomed Online 2018; 37:677-684. [PMID: 30366842 DOI: 10.1016/j.rbmo.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION Is higher antral follicle count (AFC) in healthy young women associated with higher oocyte developmental competence? DESIGN Retrospective study of 1985 first oocyte donation cycles, corresponding to 3210 fresh embryo transfers in oocyte recipients, conducted between January 2010 and May 2014. RESULTS Donors with higher AFC who underwent ovarian stimulation, produced both more cumulus-oocyte complexes (COC) (B coefficient = 0.47, 95% CI 0.41 to 0.53;P ≤ 0.001) and MII oocytes (B coefficient = 0.36, 95% CI 0.32 to 0.41;P ≤ 0.001) at linear regression analysis. Donors with low AFC had a higher risk of cancellation (OR 4.79, 95% CI 2.99 to 7.69;P < 0.001) or obtaining fewer than four metaphase II (MII) at ovum retrieval (OR 3.87, 95% CI 2.38 to 6.27;P < 0.001). No association was found between AFC and biochemical (OR 1.13, 95% CI 0.93 to 1.36), clinical (OR 1.05, 95% CI 0.87 to 1.28), ongoing pregnancy (OR 1.00, 95%, CI 0.82 to 1.21) or live birth rates (OR 0.97, 95% CI 0.8 to 1.19), when at least four MII were obtained at ovum retrieval. CONCLUSIONS AFC does not relate to the developmental competence of oocytes in women younger than 35 years.
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Affiliation(s)
| | - Désirée García
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - Rita Vassena
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain.
| | - Amelia Rodríguez
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
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Selcuk S, Bilgic BE, Kilicci C, Kucukbas M, Cam C, Kutlu HT, Karateke A. Comparison of ovarian responsiveness tests with outcome of assisted reproductive technology - a retrospective analysis. Arch Med Sci 2018; 14:851-859. [PMID: 30002704 PMCID: PMC6040134 DOI: 10.5114/aoms.2016.62447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aims to compare the association between the most commonly used ovarian responsiveness markers - age, anti-Müllerian hormone levels (AMH), antral follicle count (AFC), ovarian sensitivity index (OSI), and ovarian response prediction index (ORPI) - and ovarian responsiveness to gonadotropin stimulation in assisted reproductive technology (ART) cycles. MATERIAL AND METHODS Patients who underwent intracytoplasmic sperm injection treatment using either a gonadotropin releasing hormone (GnRH) antagonist or agonist protocol were enrolled in the study. Data of the patients were abstracted from the hospital's database. Tests were compared for total number of retrieved oocytes, metaphase II (MII) oocytes, embryos, good quality embryos on day 1 and day 3, and ongoing pregnancies per cycle. RESULTS The OSI was the ovarian response test that had the strongest relationship with the ART outcomes. The level of association between the ovarian response tests and poor ovarian response data was (in descending order): OSI, ORPI, AFC, AMH, and age (AUCOSI = 0.976, AUCORPI = 0.905, AUCAFC = 0.899, AUCAMH = 0.864, AUCage = 0.617). The overall association between OSI and poor ovarian response was significantly higher than the other parameters (p1 = 0.0023, p2 = 0.0014, p3 = 0.0001, p4 ≤ 0.0001). In patients with high ovarian response data, OSI had the highest association, followed by AFC and ORPI age (AUCOSI = 0.984, AUCAFC = 0.907, AUCORPI = 0.887). There was no statistically significant difference among the tests for the data of patients with ongoing pregnancies. CONCLUSIONS In this study, which is the first study comparing the five most frequently used ovarian responsiveness markers and the second study signifying the role of OSI in an antagonist protocol, OSI was found to be more convenient to calculate, and it could be superior to other ovarian responsiveness markers for poor and high ovarian responses on cycles with agonist or antagonist protocols.
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Affiliation(s)
- Selcuk Selcuk
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Bulent Emre Bilgic
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Kucukbas
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Cam
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Tayfun Kutlu
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Ates Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
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Palomba S, Daolio J, La Sala GB. Oocyte Competence in Women with Polycystic Ovary Syndrome. Trends Endocrinol Metab 2017; 28:186-198. [PMID: 27988256 DOI: 10.1016/j.tem.2016.11.008] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and affects fertility and pregnancy in cases of oligoanovulation. Ovulation induction is often used to treat anovulatory patients with PCOS, but many of these women fail to conceive and resort to assisted reproductive technologies. Alterations in oocyte competence (OC) are considered potential causative factors for subfertility in women with PCOS. In this review we present and critically assess all recent clinical and experimental data regarding OC in women with PCOS. Our analysis demonstrates that the contribution of OC to reproductive potential in women with PCOS varies and largely depends on the PCOS phenotype and comorbidities associated with PCOS.
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Affiliation(s)
- Stefano Palomba
- Unit of Gynecology and Obstetrics, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia 42123, Italy.
| | - Jessica Daolio
- Unit of Gynecology and Obstetrics, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia 42123, Italy
| | - Giovanni Battista La Sala
- Unit of Gynecology and Obstetrics, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia 42123, Italy; University of Modena and Reggio Emilia, Via Università 4, Modena 41100, Italy
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Vaegter KK, Lakic TG, Olovsson M, Berglund L, Brodin T, Holte J. Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments? Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers. Fertil Steril 2017; 107:641-648.e2. [DOI: 10.1016/j.fertnstert.2016.12.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/09/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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Torres-Rovira L, Succu S, Pasciu V, Manca ME, Gonzalez-Bulnes A, Leoni GG, Pennino MG, Spezzigu A, Gallus M, Dattena M, Monniaux D, Naitana S, Berlinguer F. Postnatal pituitary and follicular activation: a revisited hypothesis in a sheep model. Reproduction 2015; 151:215-25. [PMID: 26621920 DOI: 10.1530/rep-15-0316] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
The importance of postnatal pituitary activation as regards female reproductive development is not yet understood. By taking advantage of the experimental model developed in a previous study, i.e. ewe lambs expressing markedly different ovarian phenotypes at 50 days of age, we designed this study to determine whether differences found in ovarian status during the early prepubertal period are due to different patterns of postnatal pituitary activation, and to assess whether these differences have long lasting effects on subsequent reproductive performance. Results showed that ewe lambs with high antral follicle count (AFC) at 50 days of age had significantly lower plasma FSH concentrations and higher anti-Mullerian hormone (AMH) concentrations during the first 9 weeks of age compared with low AFC ewe lambs (P<0.0001). With a longitudinal experiment we showed that a high AFC in the early prepubertal period is associated with consistently higher AMH concentrations and numbers of antral follicles up to the postpubertal period, and with higher pregnancy rates in the first breeding season. In addition, the effect of age in decreasing AMH concentrations was more marked in the low AFC group. Results of the present study demonstrate that ewe lambs undergo different patterns of postnatal pituitary activation. A high AFC at 50 days of age indicates an advanced phase of ovarian maturation, which was accompanied by constantly higher AMH concentrations up to the postpubertal period, a greater ovarian response to FSH stimulation and by higher pregnancy rates at first mating, as compared with the low AFC group.
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Affiliation(s)
| | | | | | | | - Antonio Gonzalez-Bulnes
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France
| | | | - Maria Grazia Pennino
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France
| | - Antonio Spezzigu
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France
| | - Marilia Gallus
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France
| | - Maria Dattena
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France
| | - Danielle Monniaux
- Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertility, Perfugas, Sassari, ItalyAGRIS SardegnaDepartment of Animal Production, Loc. Bonassai, 07100 Sassari, ItalyINRAUMR85 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceCNRSUMR7247 Physiologie de la Reproduction et des Comportements, F-37380 Nouzilly, FranceUniversité François Rabelais de ToursF-37041 Tours, FranceIFCEF-37380 Nouzilly, France Department of Veterinary MedicineUniversity of Sassari, Via Vienna 2, 07100 Sassari, ItalyDepartment of Animal ReproductionINIA, Avenida Puerta de Hierro s/n, 28040 Madrid, SpainDepto. de BotânicaEcologia e Zoologia - DBEZ, Universidade Federal do Rio Grande do Norte - UFRN, Campus Universitário s/n, Lagoa Nova. Cx postal 1524. CEP 59.098-970 Natal (RN), BrazilEmbryo SardegnaTechnology, Reproduction, and Fertil
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The Bologna criteria for poor ovarian response: a contemporary critical appraisal. J Ovarian Res 2015; 8:76. [PMID: 26577149 PMCID: PMC4650906 DOI: 10.1186/s13048-015-0204-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/05/2015] [Indexed: 01/24/2023] Open
Abstract
Postponement of child bearing and maternal age at first pregnancy are on the rise, contributing considerably to an increase in age-related infertility and the demand for assisted reproductive technologies (ART) treatment. This brings to the infertility clinics many women with low ovarian reserve and poor ovarian response (POR) to conventional stimulation. The Bologna criteria were released to standardize the definition of POR and pave the way for the formulation of evidence-based, efficient modalities of treatment for women undergoing IVF-ET. More than four years have passed since the introduction of these criteria and the debate is still ongoing whether a revision is due. Women with POR comprise several sub-groups with diverse baseline distinctiveness, a major issue that has fueled the discussion. Although antral follicle count (AFC) and anti-Müllerian hormone (AMH), are considered good predictors of ovarian reserve, their threshold values are still not universally standardized. Different definitions for sonographic AFC and diverse assays for AMH are held responsible for this delay in standardization. Adding established risk factors to the criteria will lead to more reliable and reproducible definition of a POR, especially in young women. The original criteria did not address the issue of oocyte quality, and the addition of risk factors may yield specific associations with quality vs. quantity. Patient’s age is the best available criterion, although limited, to predict live-birth and presumably oocyte quality. High scale studies to validate these criteria are still missing while recent evidence raises concern regarding over diagnosis.
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Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Comparing four ovarian reserve markers--associations with ovarian response and live births after assisted reproduction. Acta Obstet Gynecol Scand 2015; 94:1056-63. [PMID: 26184379 DOI: 10.1111/aogs.12710] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/09/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We compared the ability of four different ovarian reserve tests (ORTs) to predict live births per started in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycle, and poor and excessive response to controlled ovarian hyperstimulation. MATERIAL AND METHODS This was a cohort study in a private infertility center in collaboration with Uppsala University, comprising 1230 IVF-ICSI cycles in 892 consecutive women between April 2008 and June 2011. Anti-Müllerian hormone (AMH) levels, antral follicle counts (AFC), combinations of basal levels of follicle-stimulating hormone and luteinizing hormone, and menstrual cycle lengths were analyzed for correlation and treatment outcome prediction in age-adjusted statistical models. Stepwise multivariable generalized estimating equation analyses were carried out in a sub-group with complete data on all four ORTs (620 cycles in 443 women). Odds ratios and c-statistics were calculated in the largest available set of data for each significant variable. Primary outcomes were live birth rate per started cycle and poor and excessive ovarian response to controlled ovarian hyper-stimulation (defined by the ovarian sensitivity index). RESULTS All ORTs correlated significantly with each other, with the strongest correlation between AFC and AMH (r = 0.71, p < 0.0001). Univariately, AMH and age equivalently predicted live birth (c-statistic 0.61), and together they provided a significantly better model (c-statistic 0.64). For prediction of poor and excessive response the best model included AMH, AFC and age (c-statistic 0.89). CONCLUSIONS AMH improves the ability to estimate live birth rates after assisted reproduction compared with female age alone. AMH, AFC and age together constituted the best model for prediction of ovarian response.
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Affiliation(s)
- Thomas Brodin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Carl von Linné Clinic, Uppsala, Sweden
| | | | | | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jan Holte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Carl von Linné Clinic, Uppsala, Sweden.,Centre for Reproductive Biology in Uppsala (CRU), Uppsala, Sweden
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18
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Torres-Rovira L, Gonzalez-Bulnes A, Succu S, Spezzigu A, Manca ME, Leoni GG, Sanna M, Pirino S, Gallus M, Naitana S, Berlinguer F. Predictive value of antral follicle count and anti-Müllerian hormone for follicle and oocyte developmental competence during the early prepubertal period in a sheep model. Reprod Fertil Dev 2015; 26:1094-106. [PMID: 24008140 DOI: 10.1071/rd13190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/02/2013] [Indexed: 11/23/2022] Open
Abstract
Circulating anti-Müllerian hormone (AMH) and antral follicle count (AFC) are addressed as suitable markers of oocyte quantity and quality during adulthood. To investigate whether AFC and circulating AMH could predict follicle development and oocyte quality during the prepubertal period we used 40-day-old ewe lambs with high, intermediate and low AFC (≥30, 16-29 and≤15 follicles respectively). The analysis of the response to the exogenous FSH ovarian reserve test showed a positive correlation between AFC, AMH plasma levels, total follicle number and the number of large follicles (≥3mm) grown after exogenous FSH administration. The incorporation of abattoir-derived oocytes collected from ovaries with different AFC in an in vitro embryo production system showed that a high AFC can predict oocyte quality in prepubertal ovaries, reflecting an ovarian status suitable for follicular development. The histological quantification of the ovarian reserve evidenced that AFC was not predictive of differences in either the number of healthy follicles or the size of the primordial follicle pool in prepubertal ovaries. Further studies are needed to investigate the implication on the reproductive performance of the significant inter-individual differences found in the present study in AFC and circulating AMH in the early prepubertal period.
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Affiliation(s)
- Laura Torres-Rovira
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | | | - Sara Succu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Antonio Spezzigu
- Embryo Sardegna, Technology, Reproduction and Fertility, 07034 Perfugas, Località Suiles (SS), Italy
| | - Maria E Manca
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni G Leoni
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Marina Sanna
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Salvatore Pirino
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Marilia Gallus
- Department of Animal Production, AGRIS Sardegna, Loc. Bonassai S.S. 291 Sassari-Fertilia -Km. 18,600, 07100 Sassari, Italy
| | - Salvatore Naitana
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Fiammetta Berlinguer
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
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Tarín JJ, García-Pérez MA, Cano A. Deficiencies in reporting results of lesbians and gays after donor intrauterine insemination and assisted reproductive technology treatments: a review of the first emerging studies. Reprod Biol Endocrinol 2015; 13:52. [PMID: 26022418 PMCID: PMC4450473 DOI: 10.1186/s12958-015-0053-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
At a time when increasing numbers of lesbians and gays consider parenthood using reproductive assistance in infertility centers, the present review aims to summarize the results obtained so far by lesbians after intrauterine insemination (IUI) and in-vitro fertilization (IVF) using donor spermatozoa (D-IUI and D-IVF, respectively) and gays entering into gestational-surrogacy programs. Data show that gays display normal semen parameters and lesbians exhibit no specific causes of female infertility except perhaps for polycystic ovary syndrome (PCOS) and some PCOS-related factors. Pair-bonded lesbians entering into D-IUI programs, tend to have higher pregnancy and delivery percentages following spontaneous or induced ovulation than single or pair-bound heterosexual women. The only single study reporting success percentages of lesbians after D-IVF provides, however, puzzling results. In particular, pair-bonded lesbians have lower pregnancy and live-birth percentages than pair-bonded heterosexual women in fresh D-IVF cycles but percentages are similar in frozen/thawed D-IVF cycles. Like in lesbians after D-IUI, surrogate women recruited by pair-bonded gays/single men tend to have higher pregnancy percentages and lower miscarriage percentages than surrogate women recruited by heterosexual couples. Notably, all the reports reviewed in the present study are methodologically flawed because of sampling bias, small sample sizes and inadequate use of statistical methods to control for the effects of influential covariates including age, smoking habits, previous gynecological problems, hormonal stimulation type and protocol, and number of prior treatment types and pregnancies/deliveries. Clinicians, reproductive biologists and editors of fertility/infertility journals should make efforts to prevent these deficiencies in future data reporting.
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Affiliation(s)
- Juan J Tarín
- Department of Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
| | - Miguel A García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
- Research Unit-INCLIVA, Hospital Clínico de Valencia, Valencia, 46010, Spain.
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, 46010, Spain.
- Service of Obstetrics and Gynecology, University Clinic Hospital, Valencia, 46010, Spain.
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Nelson SM, Fleming R, Gaudoin M, Choi B, Santo-Domingo K, Yao M. Antimüllerian hormone levels and antral follicle count as prognostic indicators in a personalized prediction model of live birth. Fertil Steril 2015; 104:325-32. [PMID: 26003269 DOI: 10.1016/j.fertnstert.2015.04.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare antimüllerian hormone (AMH) and antral follicle count (AFC) separately and in combination with clinical characteristics for the prediction of live birth after controlled ovarian stimulation. DESIGN Retrospective development and temporal external validation of prediction model. SETTING Outpatient IVF clinic. PATIENT(S) We applied the boosted tree method to develop three prediction models incorporating clinical characteristics plus AMH or AFC or the combination on 2,124 linked IVF cycles from 2006 to 2010 and temporally externally validated predicted live-birth probabilities with an independent data set comprising 1,121 cycles from 2011 to 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Predictive power (posterior log of odds ratio compared to age, or PLORA), reclassification, receiver operator characteristic analysis, calibration, dynamic range. RESULT(S) Predictive power, was highest for the AMH model (PLORA = 29.1), followed by the AMH-AFC model (PLORA = 28.3) and AFC model (PLORA = 22.5). The prediction errors were 1% to <5% in each prognostic tier for all three models, except for the predicted live-birth probabilities of <10% in the AFC model, where the prediction error was 8%. The improvement in predictive power was highest for the AMH model: 76.2% improvement over age alone relative to 59% improvement for AFC and 73.3% for the combined model. Receiver operating characteristic analysis demonstrated that the AMH and the combined model had comparable discrimination (area under the curve = 0.716) and similar prediction error for high and low strata of live-birth prediction, with an improvement of 6.3% over age alone. CONCLUSION(S) The validated prediction model confirmed that AMH when combined with clinical characteristics can accurately identify the likelihood of live birth with a low prediction error. AFC provided no added predictive value beyond AMH.
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Affiliation(s)
- Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom.
| | - Richard Fleming
- School of Medicine, University of Glasgow, Glasgow, United Kingdom; Glasgow Centre for Reproductive Medicine, Glasgow, United Kingdom
| | - Marco Gaudoin
- Glasgow Centre for Reproductive Medicine, Glasgow, United Kingdom
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La Marca A, Grisendi V, Giulini S, Sighinolfi G, Tirelli A, Argento C, Re C, Tagliasacchi D, Marsella T, Sunkara SK. Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study. J Assist Reprod Genet 2015; 32:931-7. [PMID: 25925345 DOI: 10.1007/s10815-015-0476-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 04/06/2015] [Indexed: 01/22/2023] Open
Abstract
PURPOSE to compare the baseline characteristics and chance of live birth in the different categories of poor responders identified by the combinations of the Bologna criteria and establish whether these groups comprise a homogenous population. METHODS database containing clinical and laboratory information on IVF treatment cycles carried out at the Mother-Infant Department of the University Hospital of Modena between year 2007 and 2011 was analysed. This data was collected prospectively and recorded in the registered database of the fertility centre. Eight hundred and thirty women fulfilled the inclusion/ exclusion criteria of the study and 210 women fulfilled the Bologna criteria definition for poor ovarian response (POR). Five categories of poor responders were identified by different combinations of the Bologna criteria. RESULTS There were no significant differences in female age, AFC, AMH, cycle cancellation rate and number of retrieved oocytes between the five groups. The live birth rate ranged between 5.5 and 7.4 % and was not statistically different in the five different categories of women defined as poor responders according to the Bologna criteria. CONCLUSION The study demonstrates that the different groups of poor responders based on the Bologna criteria have similar IVF outcomes. This information validates the Bologna criteria definition as women having a uniform poor prognosis and also demonstrates that the Bologna criteria poor responders in the various subgroups represent a homogenous population with similar pre-clinical and clinical outcomes.
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Affiliation(s)
- Antonio La Marca
- Mother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Policlinico di Modena Largo del Pozzo, 41100, Modena, Italy,
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22
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Does ovarian reserve predict egg quality in unstimulated therapeutic donor insemination cycles? Fertil Steril 2015; 103:1170-5.e2. [DOI: 10.1016/j.fertnstert.2015.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 11/21/2022]
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Rhenman A, Berglund L, Brodin T, Olovsson M, Milton K, Hadziosmanovic N, Holte J. Which set of embryo variables is most predictive for live birth? A prospective study in 6252 single embryo transfers to construct an embryo score for the ranking and selection of embryos. Hum Reprod 2014; 30:28-36. [DOI: 10.1093/humrep/deu295] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tremellen K, Savulescu J. Ovarian reserve screening: a scientific and ethical analysis. Hum Reprod 2014; 29:2606-14. [DOI: 10.1093/humrep/deu265] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Nordqvist S, Kårehed K, Skoog Svanberg A, Menezes J, Åkerud H. Ovarian response is affected by a specific histidine-rich glycoprotein polymorphism: a preliminary study. Reprod Biomed Online 2014; 30:74-81. [PMID: 25456162 DOI: 10.1016/j.rbmo.2014.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 12/13/2022]
Abstract
Genetic polymorphisms involved in angiogenesis, apoptosis and chemokine signalling are associated with varying ovarian response and oocyte quality. The protein, histidine-rich glycoprotein (HRG), is involved in these processes, but its effect on ovarian response in IVF has not been previously studied. A single nucleotide polymorphism (SNP) in the HRG gene (C633T) seems to affect pregnancy results in IVF. Women with the C/C genotype had higher pregnancy rates, C/T had moderate rates and none of those in the T/T group conceived. The aim of this study was to investigate if the HRG C633T SNP affects ovarian response. The HRG C633T SNP genotype of 67 women with unexplained infertility undergoing IVF was analysed and related to medical data. The T/T genotype obtained fewer oocytes, including mature oocytes, despite higher dosages of FSH administered. Additionally, the highest proportion of women who had exclusively poor-quality embryos was in the T/T group. No differences in demographic factors known to affect these parameters were found. The results suggest that the HRG C633T SNP influences ovarian response. Further studies of this SNP may increase knowledge about the biological processes involved in oocyte development and, furthermore, improve predicted ovarian response and fertilization.
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Affiliation(s)
- Sarah Nordqvist
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Karin Kårehed
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Judith Menezes
- Fertilitetscentrum Stockholm, Storängsvägen 10, SE-115 42 Stockholm, Sweden
| | - Helena Åkerud
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
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Huber M, Hadziosmanovic N, Berglund L, Holte J. Using the ovarian sensitivity index to define poor, normal, and high response after controlled ovarian hyperstimulation in the long gonadotropin-releasing hormone-agonist protocol: suggestions for a new principle to solve an old problem. Fertil Steril 2013; 100:1270-6. [DOI: 10.1016/j.fertnstert.2013.06.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update 2013; 20:124-40. [PMID: 24077980 DOI: 10.1093/humupd/dmt037] [Citation(s) in RCA: 339] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main objective of individualization of treatment in IVF is to offer every single woman the best treatment tailored to her own unique characteristics, thus maximizing the chances of pregnancy and eliminating the iatrogenic and avoidable risks resulting from ovarian stimulation. Personalization of treatment in IVF should be based on the prediction of ovarian response for every individual. The starting point is to identify if a woman is likely to have a normal, poor or a hyper response and choose the ideal treatment protocol tailored to this prediction. The objective of this review is to summarize the predictive ability of ovarian reserve markers, such as antral follicle count (AFC) and anti-Mullerian hormone (AMH), and the therapeutic strategies that have been proposed in IVF after this prediction. METHODS A systematic review of the existing literature was performed by searching Medline, EMBASE, Cochrane library and Web of Science for publications in the English language related to AFC, AMH and their incorporation into controlled ovarian stimulation (COS) protocols in IVF. Literature available to May 2013 was included. RESULTS The search generated 305 citations of which 41 and 25 studies, respectively, reporting the ability of AMH and AFC to predict response to COS were included in this review. The literature review demonstrated that AFC and AMH, the most sensitive markers of ovarian reserve identified to date, are ideal in planning personalized COS protocols. These sensitive markers permit prediction of the whole spectrum of ovarian response with reliable accuracy and clinicians may use either of the two markers as they can be considered interchangeable. Following the categorization of expected ovarian response to stimulation clinicians can adopt tailored therapeutic strategies for each patient. Current scientific trend suggests the elective use of the GnRH antagonist based regimen for hyper-responders, and probably also poor responders, as likely to be beneficial. The selection of the appropriate and individualized gonadotrophin dose is also of paramount importance for effective COS and subsequent IVF outcomes. CONCLUSION Personalized IVF offers several benefits; it enables clinicians to give women more accurate information on their prognosis thus facilitating counselling especially in cases of extremes of ovarian response. The deployment of therapeutic strategies based on selective use of GnRH analogues and the fine tuning of the gonadotrophin dose on the basis of potential ovarian response in every single woman can allow for a safer and more effective IVF practice.
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Affiliation(s)
- Antonio La Marca
- Mother-Infant Department, Institute of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, 41100 Modena, Italy
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Abstract
Although it is widely appreciated that age is the primary determinant of the number of primordial follicles remaining within the ovary, it is now also recognized that for any given age two women can have a 100-fold difference in their ovarian reserve. Consequently, age alone has relatively poor accuracy in determining the reproductive potential for young women, and this has led to the development of additional biomarkers that more accurately reflect the ovarian reserve. In this review we discuss the strengths and limitations of the classical and novel biomarkers and provide a rationale for the adoption of biomarkers to facilitate the individualization of reproductive health.
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Affiliation(s)
- Stamatina Iliodromiti
- Maternal & Reproductive Medicine, School of Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
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Holte J, Brodin T. High levels of anti-Müllerian hormone: what does this mean for IVF treatment? Expert Rev Endocrinol Metab 2013; 8:209-211. [PMID: 30780814 DOI: 10.1586/eem.13.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jan Holte
- a Carl von Linné Clinic, Uppsala Science Park, Uppsala S-751 83, Sweden and Department of Women's and Children's Health, Uppsala University, Akademiskasjukhuset, Uppsala S-751 85, Sweden and Centre for Reproductive Biology in Uppsala (CRU), PO Box 7054, Uppsala S-750 07, Sweden.
| | - Thomas Brodin
- b Carl von Linné Clinic, Uppsala Science Park, Uppsala S-751 83, Sweden and Department of Women's and Children's Health, Uppsala University, Akademiskasjukhuset, Uppsala S-751 85, Sweden and Centre for Reproductive Biology in Uppsala (CRU), PO Box 7054, Uppsala S-750 07, Sweden
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Mossa F, Carter F, Walsh SW, Kenny DA, Smith GW, Ireland JLH, Hildebrandt TB, Lonergan P, Ireland JJ, Evans ACO. Maternal undernutrition in cows impairs ovarian and cardiovascular systems in their offspring. Biol Reprod 2013; 88:92. [PMID: 23426432 DOI: 10.1095/biolreprod.112.107235] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Severe prenatal undernutrition is usually associated with low birth weights in offspring and disorders including hypertension, obesity, and diabetes. Whether alterations in maternal nutrition insufficient to impair birth weight or prenatal growth impact the cardiovascular, stress, or metabolic systems is unknown. In addition, little is known about the effects of maternal dietary restriction on development of the reproductive system in mammals. Here, we use the bovine model, which has a gestational length and birth rate similar to humans, to show that offspring from nutritionally restricted dams (during the first trimester) were born with identical birth weights and had similar postnatal growth rates (to 95 wk of age), puberty, glucose metabolism, and responses to stress compared to offspring from control mothers. However, an increase in maternal testosterone concentrations was detected during dietary restriction, and these dams had offspring with a diminished ovarian reserve (as assessed by a reduction in antral follicle count, reduced concentrations of anti-Müllerian hormone, and increased follicle-stimulating hormone concentrations), enlarged aorta, and increased arterial blood pressure compared with controls. Our study links transient maternal undernutrition and enhanced maternal androgen production with a diminished ovarian reserve as well as potential suboptimal fertility, enlarged aortic trunk size, and enhanced blood pressure independent of alterations in birth weight, postnatal growth, or stress response and glucose tolerance. The implications are that relatively mild transient reductions in maternal nutrition during the first trimester of pregnancy (even those that do not affect gross development) should be avoided to ensure healthy development of reproductive and cardiovascular systems in offspring.
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Affiliation(s)
- Francesca Mossa
- School of Agriculture & Food Science, University College Dublin, Belfield, Dublin, Ireland
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Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Antimüllerian hormone levels are strongly associated with live-birth rates after assisted reproduction. J Clin Endocrinol Metab 2013; 98:1107-14. [PMID: 23408576 DOI: 10.1210/jc.2012-3676] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Previous studies have suggested that antimüllerian hormone (AMH) levels are positively associated with in vitro fertilization (IVF) outcome through their relationship with oocyte yield and not by reflecting oocyte or embryo quality. OBJECTIVE The aim was to investigate whether AMH levels are associated with pregnancy and live-birth rates and whether the results may also reflect qualitative aspects of oocytes and embryos. DESIGN The study was a prospective cohort study between April 2008 and June 2011. SETTING The study was done at a university-affiliated private infertility center. PATIENTS The study cohort consisted of 892 consecutive women undergoing 1230 IVF-intracytoplasmic sperm injection cycles. INTERVENTION(S) AMH levels, analyzed using the DSL ELISA kit, were statistically adjusted for repeated treatments and age and analyzed for associations with treatment outcome. MAIN OUTCOME MEASURES Pregnancy rates, live-birth rates, and stimulation outcome parameters were measured. RESULTS AMH was log-normally distributed with a mean (SD) of 2.3 (2.5) ng/mL. Live-birth rates per started cycle (mean [95% confidence interval]) increased log-linearly from 10.7% [7.2-14.1] for AMH < 0.84 ng/mL (25th percentile) to 30.8% [25.7-36.0] for AMH > 2.94 ng/mL (75th percentile), Ptrend < .0001, being superior in women with polycystic ovaries. These findings were significant also after adjustments were made for age and oocyte yield. AMH was also associated with ovarian response variables and embryo scores. CONCLUSIONS AMH is strongly associated with live-birth rates after IVF-intracytoplasmic sperm injection. AMH may therefore serve as a prognostic factor for the chance of a pregnancy and live birth. Treatment outcome was superior in patients with polycystic ovaries. The findings also indicate that AMH may partially comprise information about oocyte quality.
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Affiliation(s)
- Thomas Brodin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Meldrum DR, Chang RJ, Giudice LC, Balasch J, Barbieri RL. Role of decreased androgens in the ovarian response to stimulation in older women. Fertil Steril 2013; 99:5-11. [DOI: 10.1016/j.fertnstert.2012.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 11/16/2022]
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Abstract
The oocyte is at the center of the equation that results in female fertility. Many factors influence oocyte quality, including external factors such as maternal nutrition, stress, and environmental exposures, as well as ovarian factors such as steroids, intercellular communication, antral follicle count, and follicular fluid composition. These influences are interconnected; changes in the external environment of the female translate into ovarian changes that affect the oocyte. The lengthy period during which the oocyte remains arrested in the ovary provides ample time and opportunity for environmental factors to take their toll. An appropriate environment for growth and maturation of the oocyte, in vivo and in vitro, is critical to ensure optimal oocyte quality, which determines the success of fertilization and preimplantation embryo development, and has long-term implications for implantation, fetal growth, and offspring health.
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Affiliation(s)
- Rebecca L Krisher
- National Foundation for Fertility Research, Lone Tree, Colorado 80124;
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Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, Raine-Fenning N. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril 2012; 98:657-63. [DOI: 10.1016/j.fertnstert.2012.05.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/15/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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de Ziegler D, Streuli I, Gayet V, Frydman N, Bajouh O, Chapron C. Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era. Fertil Steril 2012; 98:290-3. [DOI: 10.1016/j.fertnstert.2012.06.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/18/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
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Follicle stimulating hormone and anti-Müllerian hormone per oocyte in predicting in vitro fertilization pregnancy in high responders: a cohort study. PLoS One 2012; 7:e34290. [PMID: 22545082 PMCID: PMC3335835 DOI: 10.1371/journal.pone.0034290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/25/2012] [Indexed: 11/19/2022] Open
Abstract
Background Follicle stimulating hormone (FSH) and Anti-Müllerian hormone (AMH) are utilized to differentiate between good and poor response to controlled ovarian hyperstimulation. Their respective roles in defining functional ovarian reserve remain, however, to be elucidated. To better understand those we investigated AMH and FSH per oocyte retrieved (AMHo and FSHo). Methodology/Principal Findings Three-hundred and ninety-six women, undergoing first in vitro fertilization cycles, were retrospectively evaluated. Women with oocyte yields >75th percentile for their age group were identified as high responders. In a series of logistic regression analyses, AMHo and FSHo levels were then evaluated as predictive factors for pregnancy potential in high responders. Patients presented with a mean age of 38.0±5.0 years, mean baseline FSH of 11.8±8.7 mIU/mL and mean AMH of 1.6±2.1 ng/mL. Those 88 women, who qualified as high responders, showed mean FSH of 9.7±6.5 mIU/mL, AMH of 3.1±3.1 ng/mL and oocyte yields of 15.8±7.1. Baseline FSH and AMH did not predict pregnancy in high responders. However, a statistically significant association between FSHo and pregnancy was observed in high responders, both after univariate regression (p = 0.02) and when adjusted for age, percentage of usable embryos, and number of embryos transferred (p = 0.03). Rate of useable embryos also significantly affected pregnancy outcome independently of FSHo (p = 0.01). AMHo was also associated with clinical pregnancy chances in high responders (p = 0.03) and remained significant when adjusted for usable embryos and number of embryos transferred (p = 0.04). Conclusions AMHo and FSHo are predictive of pregnancy potential in high responders, but likely reflect different responsibilities in recruitment and maturation of growing follicle cohorts.
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Gleicher N, Weghofer A, Kim A, Barad DH. The impact in older women of ovarian FMR1 genotypes and sub-genotypes on ovarian reserve. PLoS One 2012; 7:e33638. [PMID: 22438971 PMCID: PMC3306274 DOI: 10.1371/journal.pone.0033638] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/14/2012] [Indexed: 11/18/2022] Open
Abstract
We recently associated ovarian FMR1genotypes and sub-genotypes with distinct ovarian aging patterns. How they impact older females is, however, unknown. We, therefore, investigated 217 consecutive first in vitro fertilization (IVF) cycles in women >40 assessing oocyte yields, stratified for better (anti-Müllerian hormone, AMH >1.05 ng/mL) or poorer (AMH≤1.05 ng/mL) functional reserve (FOR)). Mean age was 42.4±2.0 years, mean AMH 0.76±0.92 ng/mL and mean oocyte yield 5.3±5.4. Overall, and in women with better FOR, FMR1 did not affect oocyte yields. With poorer FOR (AMH≤1.05 ng/mL) women with het-norm/high, however, demonstrated higher oocyte yields (5.0±3.8) than those with het-norm/low sub-genotype 3.1±2.5; P = 0.03), confirmed after log conversion. Known associated with low FOR at young age, het-norm/high, thus, appears to preserve FOR into older age, and both het sub-genotypes appear to expand female reproductive lifespan into opposite directions.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- * E-mail: (NG); (DHB)
| | - Andrea Weghofer
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Vienna, Vienna, Austria
| | - Ann Kim
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
| | - David H. Barad
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Epidemiology and Social Medicine and Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail: (NG); (DHB)
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Nelson SM, Anderson RA, Broekmans FJ, Raine-Fenning N, Fleming R, La Marca A. Anti-Mullerian hormone: clairvoyance or crystal clear? Hum Reprod 2012; 27:631-6. [DOI: 10.1093/humrep/der446] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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