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Liu J, Kumar I, Li T, Ding Y, Tian Q, Tang X, Huang X, Hu W, Liu Y, Wang Z. Simultaneous transfer of one good-quality and one poor-quality cleavage stage embryo does not improve pregnancy outcomes. HUM FERTIL 2023; 26:1142-1148. [PMID: 36380565 DOI: 10.1080/14647273.2022.2144484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
Embryo quality and quantity are key factors that determine the success of IVF-ET. Yet it is still unclear if, for those patients with only one good-quality embryo in an IVF cycle, the inclusion of a poor-quality embryo increases the procedure's success rate. This is a common question for both clinicians and patients in determining their course of treatment. The purpose of this work was to answer this intriguing question in the context of prognosis of patients undergoing fresh cycles with only one good-quality and more than one poor-quality cleavage-stage embryos. To control for confounding effects, we only included patients at similar age, body mass index (BMI), level of basal follicle stimulating hormone (FSH) and endometrial thickness from January 2015 to June 2021. A propensity score-matched analysis was performed to extract the matched pairs. Then we evaluated pregnancy outcome, including the rate of clinical pregnancy, live birth, embryo implantation, early miscarriage, and ectopic pregnancy. We found that the clinical pregnancy rate (34.8 vs. 38.0%, p = 0.553), live birth rate (27.1 vs. 29.9%, p = 0.598), early miscarriage rate (18.1 vs. 9.5%, p = 0.171) and ectopic pregnancy rate (1.3 vs. 1.2%, p = 1.000) did not significantly differ between those two groups, notwithstanding significant difference of the implantation rate (34.8 vs. 21.3%, p <0.001). Our work indicates that, for prognosis patients at approximately 34 years old with only one good-quality embryo, having additional poor-quality embryos does not seem to help to improve ART success rates per intended embryo transfer. In conclusion, we found that simultaneous transfer of one good-quality and one poor-quality cleavage stage embryo does not improve pregnancy outcomes.
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Affiliation(s)
- Jiane Liu
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ishan Kumar
- Institute for Stem Cell Biology and Regenerative Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Teng Li
- The Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Yu Ding
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Quan Tian
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiuming Tang
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoli Huang
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weihong Hu
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yifei Liu
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA
- Greenwich Hospital Fertility Center, Greenwich Hospital, Greenwich, CT, USA
| | - Zheng Wang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Tan Z, Gong X, Li Y, Hung SW, Huang J, Wang CC, Chung JPW. Impacts of endometrioma on ovarian aging from basic science to clinical management. Front Endocrinol (Lausanne) 2023; 13:1073261. [PMID: 36686440 PMCID: PMC9848590 DOI: 10.3389/fendo.2022.1073261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Endometriosis is a common reproductive disorder characterized by the presence of endometrial implants outside of the uterus. It affects ~1 in 10 women of reproductive age. Endometriosis in the ovary, also known as endometrioma (OMA), is the most frequent implantation site and the leading cause of reproductive failure in affected women. Ovarian aging is one of the characteristic features of OMA, however its underlying mechanism yet to be determined. Accumulated evidence has shown that pelvic and local microenvironments in women with OMA are manifested, causing detrimental effects on ovarian development and functions. Whilst clinical associations of OMA with poor ovarian reserve, premature ovarian insufficiency, and early menopause have been reported. Moreover, surgical ablation, fenestration, and cystectomy of OMA can further damage the normal ovarian reservoir, and trigger hyperactivation of primordial follicles, subsequently resulting in the undesired deterioration of ovarian functions. Nevertheless, there is no effective treatment to delay or restore ovarian aging. This review comprehensively summarised the pathogenesis and study hypothesis of ovarian aging caused by OMA in order to propose potential therapeutic targets and interventions for future studies.
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Affiliation(s)
- Zhouyurong Tan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xue Gong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yiran Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sze Wan Hung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jin Huang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Reproduction and Development, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Gong X, Zhang Y, Zhu Y, Wang P, Wang Z, Liu C, Zhang M, La X. Development and validation of a live birth prediction model for expected poor ovarian response patients during IVF/ICSI. Front Endocrinol (Lausanne) 2023; 14:1027805. [PMID: 36798666 PMCID: PMC9927003 DOI: 10.3389/fendo.2023.1027805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A number of live birth predictive model during assisted reproductive technology treatment have been available in recent years, but few targeted evaluating the chances of live birth in poor ovarian response(POR) patients. The aim of this study was to develop a nomogram based on POSEIDON criteria to predict live birth in patients with expected POR. METHODS This retrospective cohort study using clinical data from 657 patients in POSEIDON Groups 3 and 4 (antral follicle count [AFC] ≤5 and AMH <1.2 ng/ml) in the Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, and Construction a nomogram model t. RESULTS Among 657 expected POR patients, 111 (16.89%) had live births, and 546 (83.11%) did not have live births. These were divided into a training set(n=438) and a validation set (n=219). Multivariate logistic regression analysis showed that the age (OR = 0.91, 95% CI: 0.86-0.97), BMI (OR = 1.98, 95% CI: 1.09-3.67), AMH (OR = 3.48, 95% CI: 1.45-8.51), normal fertilized oocytes (OR = 1.40, 95% CI: 1.21-1.63), and the basal FSH (OR = 0.89, 95% CI: 0.80-0.98) of the female were independent factors predicting live birth in patients with expected POR. Then, an individualized nomogram prediction model was built from these five factors. The area under the ROC curve of the live birth prediction model was 0.820 in the training set and 0.879 in the validation set. CONCLUSION We have developed a nomogram combining clinical and laboratory factors to predict the probability of live birth in patients with an expected POR during IVF/ICSI, which can helpful for clinician in decision-making. However, the data comes from the same center, needs a prospective multicenter study for further in-depth evaluation and validation of this prediction model.
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Affiliation(s)
- Xiaoyun Gong
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
| | - Yunian Zhang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Basic Medical College of Xinjiang Medical University, Urumqi, China
| | - Yuejie Zhu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Peng Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhihui Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chen Liu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Manli Zhang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaolin La
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
- *Correspondence: Xiaolin La,
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4
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Jiang R, Cao M, Hao H, Jia R, Chen P, Liu Y, Zhao Z. Effects of follicular output rate on cumulative clinical pregnancy rate and cumulative live birth rate in PCOS patients with different characteristics. Front Endocrinol (Lausanne) 2022; 13:1079502. [PMID: 36601009 PMCID: PMC9806261 DOI: 10.3389/fendo.2022.1079502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Objective We aim to explore the effects of follicular output rate (FORT) on cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR) in polycystic ovary syndrome (PCOS) patients with different characteristics undergoing in vitro fertilization (IVF) treatment. Methods This retrospective study analyzed 454 patients with PCOS undergoing their first IVF cycle at our center from January 2016 to December 2020. FORT was calculated as pre-ovulatory follicle count (PFC) × 100/antral follicle count (AFC). Multivariate regression analyses were conducted to explore the relationships between FORT and CCPR and CLBR. Curve fitting and threshold effect analyses were established to find nonlinear relationships. Effect modification in different subgroups were examined by stratification analyses. Results Based on the FORT values, individuals were classified into the following three groups: low-FORT group, middle-FORT group and high-FORT group. Multivariate regression analyses revealed that FORT was an independent factor affecting the CCPR and CLBR significantly (OR = 1.015, 95% CI: 1.001, 1.030 and OR = 1.010, 95% CI:1.001, 1.020). Curve fitting and threshold effect analyses showed that the CCPR and CLBR had a positive correlation with FORT when the FORT was less than 70% (OR = 1.039, 95% CI: 1.013, 1.065 and OR = 1.024, 95% CI: 1.004, 1.044). Stratification analyses showed that the CLBR increased by 1.3% with each additional unit of FORT for patients with hyperandrogenic manifestations (OR = 1.013, 95% CI: 1.001, 1.025). Compared with the low-FORT group, in the high-FORT group, CCPR increased 1.251 times for patients with polycystic ovarian morphology, while CCPR and CLBR increased 1.891 times and 0.99 times for those with ovulation disorder, respectively (OR = 2.251, 95% CI: 1.008, 5.028 and OR = 2.891, 95% CI: 1.332, 6.323 and OR = 1.990, 95% CI: 1.133, 3.494). Conclusion In patients with PCOS, cumulative IVF outcomes have a positive correlation with FORT when the FORT is less than 70%. For PCOS patients with polycystic ovarian morphology, ovulation disorder or hyperandrogenic manifestations, a high FORT could be conductive to achieving better pregnancy outcomes.
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Affiliation(s)
- Rulan Jiang
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingya Cao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haomeng Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Jia
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Peipei Chen
- Department of Gynecology and Obstetrics, Handan First Hospital, Handan, China
| | - Yuanyuan Liu
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiming Zhao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Buratini J, Dellaqua TT, Dal Canto M, La Marca A, Carone D, Mignini Renzini M, Webb R. The putative roles of FSH and AMH in the regulation of oocyte developmental competence: from fertility prognosis to mechanisms underlying age-related subfertility. Hum Reprod Update 2021; 28:232-254. [PMID: 34969065 DOI: 10.1093/humupd/dmab044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/18/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fertility loss during female ageing is associated with increasing basal FSH and decreasing anti-Müllerian hormone (AMH) concentrations, together with compromised oocyte quality, presumably due to increased oxidative stress (OS) and DNA damage, as well as reduced metabolic and meiotic competences. Basal FSH and AMH circulatory concentrations have been broadly utilized as IVF success predictors, regardless of fluctuations in prognostic accuracy; basal FSH and AMH perform better in pre-advanced maternal age (AMA: >35 years) and AMA patients, respectively. The relationships between FSH and AMH intrafollicular levels and IVF outcomes suggest, nevertheless, that both hormones regulate oocyte competence, supporting the hypothesis that changes in FSH/AMH levels cause, at least in part, oocyte quality degradation during ageing. To understand the reasons behind the fluctuations in FSH and AMH prognostic accuracies and to clarify their participation in mechanisms determining oocyte competence and age-related subfertility, a deeper knowledge of the regulation of FSH and AMH intrafollicular signalling during the female reproductive lifespan, and of their effects on the cumulus-oocyte complex, is required. OBJECTIVE AND RATIONALE An extensive body of information on the regulation of FSH and AMH intrafollicular availability and signalling, as well as on the control of folliculogenesis and oocyte metabolism, has been accumulated. However, these datasets have been explored within the relatively narrow boundaries of their specific subjects. Given the aforementioned gaps in knowledge and their clinical relevance, herein we integrate clinical and basic data, within a wide biological perspective, aiming to shed light on (i) the reasons for the variability in the accuracy of serum FSH and AMH as fertility markers, and on (ii) the potential roles of these hormones in mechanisms regulating oocyte quality, particularly those associated with ageing. SEARCH METHODS The PubMed database encompassing the period between 1960 and 2021 was searched. Principal search terms were FSH, FSH receptor, AMH, oocyte, maternal age, cumulus, transzonal projections (TZPs), actin, OS, redox, reactive oxygen species, mitochondria, DNA damage, DNA repair, aneuploidy, spindle, meiosis, gene expression, transcription, translation, oocyte secreted factors (OSFs), cAMP, cyclic guanosine monophosphate, natriuretic peptide C, growth differentiation factor 9, bone morphogenetic protein 15 and fibroblast growth factor. OUTCOMES Our analysis suggests that variations in the accuracy of fertility prognosis reflect a modest association between circulatory AMH levels and oocyte quality as well as increasing basal FSH inter-cycle variability with age. In addition, the basic and clinical data articulated herein support the hypothesis that increased intrafollicular FSH levels, as maternal age advances, may override the physiological protective influences of AMH and OSFs against excessive FSH signalling in cumulus cells. This would result in the disruption of oocyte homeostasis via reduced TZP-mediated transfer of cumulus-derived molecules essential for meiotic competence, gene expression, redox activity and DNA repair. WIDER IMPLICATIONS In-depth data analysis, encompassing a wide biological perspective has revealed potential causative mechanisms of age-related subfertility triggered by alterations in FSH/AMH signalling during the female reproductive life. Insights from new mechanistic models arising from this analysis should contribute to advancing our comprehension of oocyte biology in humans and serve as a valuable reference for novel AMA subfertility treatments aimed at improving oocyte quality through the modulation of AMH/FSH action.
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Affiliation(s)
- Jose Buratini
- Biogenesi Reproductive Medicine Centre-Eugin Group, Istituti Clinici Zucchi, Monza, Italy.,Clinica Eugin Modena, Modena, Italy.,Department of Structural and Functional Biology, Sao Paulo State University, Botucatu, Brazil
| | - Thaisy Tino Dellaqua
- Department of Structural and Functional Biology, Sao Paulo State University, Botucatu, Brazil
| | - Mariabeatrice Dal Canto
- Biogenesi Reproductive Medicine Centre-Eugin Group, Istituti Clinici Zucchi, Monza, Italy.,Clinica Eugin Modena, Modena, Italy
| | - Antonio La Marca
- Clinica Eugin Modena, Modena, Italy.,Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Mario Mignini Renzini
- Biogenesi Reproductive Medicine Centre-Eugin Group, Istituti Clinici Zucchi, Monza, Italy.,Clinica Eugin Modena, Modena, Italy
| | - Robert Webb
- Division of Animal Sciences, School of Biosciences, University of Nottingham, Nottinghamshire, UK
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Buratini J, Dal Canto M, De Ponti E, Brambillasca F, Brigante C, Gippone S, Mignini Renzini M, La Marca A. Maternal age affects the relationship of basal FSH and anti-Müllerian hormone concentrations with post-ICSI/IVF live birth. Reprod Biomed Online 2021; 42:748-756. [PMID: 33653653 DOI: 10.1016/j.rbmo.2020.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
RESEARCH QUESTION Does the association of basal FSH and anti-Müllerian hormone (AMH) concentrations with post-IVF/intracytoplasmic sperm injection (ICSI) live birth change with maternal age? DESIGN A total of 2003 IVF/ICSI patients were stratified according to basal FSH/AMH in concordant favourable (CF; AMH >1 ng/ml and FSH ≤10 IU/l), concordant unfavourable (CU; AMH ≤1 ng/ml and FSH >10 IU/l), discordant with favourable AMH (DFA) and discordant with favourable FSH (DFF) groups, as well as according to age in pre-advanced maternal age (pre-AMA; <35), AMA-1 (≥35, ≤37), AMA-2 (>37, ≤40) and AMA-3 (>40). IVF/ICSI outcomes were compared among CF, CU, DFA and DFF groups, and the association of basal FSH and AMH concentrations with live birth was tested by univariate and multivariate analysis in total, pre-AMA and AMA groups, separately. RESULTS Different outcome patterns were observed in discordant AMH/FSH groups from different age categories; favourable basal FSH concentrations were associated with higher delivery rates in pre-AMA patients, but with lower delivery rates in AMA groups. Within pre-AMA patients, DFF patients presented higher delivery rates but lower oocyte yield compared with DFA patients. In the univariate analysis, favourable AMH (P < 0.02) and oocyte yield (P < 0.002) were positively associated with live birth in all AMA groups. The multivariate analysis revealed that favourable basal FSH, but not AMH or oocyte yield, is associated with live birth in pre-AMA patients independently of other variables (P = 0.012). CONCLUSIONS The relationship of basal FSH and AMH with IVF/ICSI success changes with maternal age; basal FSH better reflects clinical outcomes probably determined by oocyte quality in pre-AMA patients, while AMH better suits AMA patients.
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Affiliation(s)
- Jose Buratini
- Department of Structural and Functional Biology, Institute of Biosciences, Sao Paulo State University, Botucatu, Brazil; Biogenesi, Reproductive Medicine Centre, Monza, Italy.
| | | | | | | | | | | | | | - Antonio La Marca
- Clinica Eugin, Modena, Italy; Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Yang H, Lin J, Jin C, Meng L, Wu S, Chen Y. The Predictive Value of the Follicular Output Rate on Pregnancy Outcome of Patients with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization and Embryo Transfer. Med Sci Monit 2020; 26:e916175. [PMID: 33306667 PMCID: PMC7737407 DOI: 10.12659/msm.916175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This retrospective study aimed to evaluate the predictive value of the follicular output rate (FORT) on the pregnancy outcome of patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). Material/Methods Between January 2012 and June 2016, a total of 1,541 patients with PCOS who underwent IVF-ET at our center were enrolled in the study. FORT was calculated as the pre-ovulatory follicle count (PFC)/antral follicle count (AFC)×100%. Results According to the FORT, patients were divided into low, medium, and high FORT groups. With an increase in the FORT, the PFC and serum estradiol at the day of human chorionic gonadotropin (hCG) injection, the number of retrieved oocytes, metaphase II (MII) oocytes, total number of embryos, and number of high-quality embryos significantly increased (P<0.05 and P<0.001) from the low to high FORT groups, while the AFC, gonadotropin (Gn) stimulation day, and total Gn decreased significantly (P<0.001). The live birth rate from frozen embryo transfer and the cumulative live birth rate was the lowest in middle FORT group but increased significantly in high FORT group (P<0.05). The correlation analysis between FORT and related factors showed that the FORT was negatively correlated with body mass index (BMI), Gn stimulation days, and total Gn (P<0.05). Conclusions FORT is a powerful tool for measuring ovarian reactivity. For patients with PCOS, a high FORT to obtain high-quality embryos and perform frozen embryo transplantation can achieve good pregnancy outcome.
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Affiliation(s)
- Haiyan Yang
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Jia Lin
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Congcong Jin
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Lvhe Meng
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Suichun Wu
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Ya Chen
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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8
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Dogan B, Karaer A, Tuncay G, Tecellioglu N, Mumcu A. High-resolution 1H-NMR spectroscopy indicates variations in metabolomics profile of follicular fluid from women with advanced maternal age. J Assist Reprod Genet 2020; 37:321-330. [PMID: 31942667 DOI: 10.1007/s10815-020-01693-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/10/2020] [Indexed: 12/31/2022] Open
Abstract
AIM To reveal whether there are differences in follicular fluid metabolomics profile of women with advanced maternal age (AMA). METHOD The group with advanced maternal age includes 23 patients above the age of 40, and the control group includes 31 patients aged between 25 and 35 years and AMH values above 1.1 ng/mL with no low ovarian response history. A single follicular fluid sample from a MII oocyte obtained during the oocyte pick-up procedure was analyzed with high-resolution 1H-NMR (nuclear magnetic resonance) spectroscopy. The results were evaluated using advanced bioinformatics analysis methods. RESULTS Statistical analysis of the NMR spectroscopy data from two groups showed that α-glucose and β-glucose levels of follicular fluid were decreased in the patients with AMA, while in contrast, lactate and trimethylamine N-oxide (TMAO) levels were increased in these patients compared with the controls. In addition to these, there was an increase in alanine levels and a decrease in acetoacetate levels in patients with AMA. However, these changes were not statistically significant. CONCLUSION Obtained results suggest that the follicular cell metabolism of patients with AMA is different from controls. These environmental changes could be associated with the low success rates of IVF treatment seen in these patients.
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Affiliation(s)
- B Dogan
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Biomedical Engineering, School of Engineering, Inonu University, Malatya, Turkey
| | - A Karaer
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey. .,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey.
| | - G Tuncay
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey
| | - N Tecellioglu
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey
| | - A Mumcu
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Laboratory of NMR, Scientific and Technological Research Center, Inonu University, Malatya, Turkey
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9
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Tan X, Wen Y, Chen H, Zhang L, Wang B, Wen H, Zhang F, Wu Q, Du J. Follicular output rate tends to improve clinical pregnancy outcomes in patients with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer treatment. J Int Med Res 2019; 47:5146-5154. [PMID: 31379237 PMCID: PMC6833430 DOI: 10.1177/0300060519860680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to examine the relationship between the follicular output rate (FORT) and clinical outcomes in patients with polycystic ovarian syndrome (PCOS). Methods A total of 841 patients with PCOS undergoing in vitro fertilization-embryo transfer (IVF-ET) were divided into three groups according to their FORT (low, middle, and high). Controlled ovarian hyperstimulation and clinical outcomes were compared retrospectively. Results Serum estradiol levels on the day of human chorionic gonadotropin (3780.5, 3599.9, and 3375.7 pg/mL) and the number of retrieved oocytes (17.5, 16.1, and 14.8) decreased from the high to low FORT groups. Pre-ovulatory follicle counts were significantly higher in the high FORT group than in the middle and low FORT groups. The number of retrieved oocytes, high-quality embryo rate, and clinical pregnancy rate decreased from the high to low FORT groups. The incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) in the middle FORT group was significantly lower than that in the high and low FORT groups. Conclusions FORT may be used to predict clinical outcomes of IVF/intracytoplasmic sperm injection-embryo transfer in patients with PCOS. Efforts should be made to prevent OHSS in patients with PCOS and a high or low FORT in controlled ovarian hyperstimulation cycles.
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Affiliation(s)
- Xiaoqing Tan
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Yu Wen
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Huixiao Chen
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China.,Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ling Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Bin Wang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hongwei Wen
- Department of Reproductive Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Fengli Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Qin Wu
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Jing Du
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Deng J, Jia M, Cheng X, Yan Z, Fan D, Tian X. ABO blood group and ovarian reserve: a meta-analysis and systematic review. Oncotarget 2018; 8:25628-25636. [PMID: 28445964 PMCID: PMC5421956 DOI: 10.18632/oncotarget.15759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/10/2017] [Indexed: 01/09/2023] Open
Abstract
Ovarian reserve reflects a woman's fertility potential. The ABO blood group system is a very stable genetic marker. Although many recent studies have explored the relationship between ABO blood group and ovarian reserve, a consensus has not yet been reached. This paper is the first meta-analysis and systematic review of the relationship between ABO blood type and ovarian reserve. We analyzed seven cross-sectional studies evaluating follicle stimulating hormone (FSH) or anti-Mullerian hormone (AMH) levels in 55,113 participants to determine ovarian reserve. This study found no relationship between ABO blood type and ovarian reserve when FSH was used as an indicator of ovarian reserve (A vs non-A:OR=1.03, 95% CI:0.96-1.11; B vs non-B: OR=0.98, 95% CI:0.75-1.29; AB vs non-AB:OR=0.96, 95% CI:0.71-1.30; O vs non-O:OR=1.03, 95%CI:0.74-1.43).There was also no relationship between ABO blood type and ovarian reserve when AMH was used as an indicator (A vs non-A:OR=0.89, 95% CI:0.76-1.03; B vs non-B:OR=1.02, 95% CI:0.80-1.30; AB vs non-AB:OR=1.14, 95% CI:0.80-1.64, O vs non-O:OR=1.07, 95% CI:0.86-1.34). Overall, the current study found no relationship between ABO blood group and ovarian reserve. However, additional rigorous, high-quality and multi-indicator studies with large sample sizes are required for further verification.
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Affiliation(s)
- Jie Deng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Mengmeng Jia
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaolin Cheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Zhen Yan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Dongmei Fan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaoyu Tian
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Lee Y, Kim TH, Park JK, Eum JH, Lee HJ, Kim J, Lyu SW, Kim YS, Lee WS, Yoon TK. Predictive value of antral follicle count and serum anti-Müllerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment? Eur J Obstet Gynecol Reprod Biol 2018; 221:151-155. [DOI: 10.1016/j.ejogrb.2017.12.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/15/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
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12
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Sun Z, Wu H, Lian F, Zhang X, Pang C, Guo Y, Song J, Wang A, Shi L, Han L. Human Follicular Fluid Metabolomics Study of Follicular Development and Oocyte Quality. Chromatographia 2017. [DOI: 10.1007/s10337-017-3290-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Begum K, Muttukrishna S, Sievert LL, Sharmeen T, Murphy L, Chowdhury O, Kasim A, Gunu R, Bentley GR. Ethnicity or environment: effects of migration on ovarian reserve among Bangladeshi women in the United Kingdom. Fertil Steril 2015; 105:744-754.e1. [PMID: 26706133 DOI: 10.1016/j.fertnstert.2015.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/24/2015] [Accepted: 11/16/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess whether the quality of early childhood environments among different groups of Bangladeshi women, including migrants to the United Kingdom (UK), contributes to variation in ovarian reserve and the rate of reproductive aging in later life. DESIGN Cross-sectional study. SETTING Not applicable. PATIENT(S) A total of 179 healthy women volunteers aged 35-59 years were divided into four groups: [1] 36 Bangladeshis living in Sylhet, Bangladesh; [2] 53 Bangladeshis who migrated to the UK as adults; [3] 40 Bangladeshis who migrated to the UK as children aged 0-16 years; and [4] a reference group of 50 women of European origin living in London. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Levels of serum antimüllerian hormone, inhibin B, FSH, and E2, and anthropometrics derived from biomarkers; reproductive, demographic, and health variables from structured questionnaires. RESULT(S) Bangladeshi migrants who moved to the UK as children and European women had a highly significantly larger, age-related ovarian reserve compared with migrant Bangladeshis who had moved to the UK as adults or Bangladeshi women still living in Bangladesh. There were no other significant covariates in the model aside from age and menopausal status. CONCLUSION(S) The study points to the importance of childhood development in considering variation in ovarian reserve across different ethnic groups. Clinical studies and research in assisted reproductive technology have emphasized the role of genes or race in determining inter-population variation in ovarian reserve. Early life developmental factors should be given due consideration when evaluating inter-group differences in response to assisted reproductive technology.
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Affiliation(s)
- Khurshida Begum
- Department of Anthropology, University College London, London, United Kingdom
| | - Shanthi Muttukrishna
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Republic of Ireland
| | | | - Taniya Sharmeen
- Department of Anthropology, University College London, London, United Kingdom
| | - Lorna Murphy
- School of Public Health, University of Massachusetts, Amherst, Massachusetts
| | | | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, United Kingdom
| | - Richard Gunu
- Institute for Women's Health, University College London, London, United Kingdom
| | - Gillian R Bentley
- Department of Anthropology and Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, United Kingdom.
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14
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Usability and utility of the CONSORT calculator for FSH starting doses: a prospective observational study. Reprod Biomed Online 2015. [DOI: 10.1016/j.rbmo.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Fang T, Su Z, Wang L, Yuan P, Li R, Ouyang N, Zheng L, Wang W. Predictive value of age-specific FSH levels for IVF-ET outcome in women with normal ovarian function. Reprod Biol Endocrinol 2015; 13:63. [PMID: 26082101 PMCID: PMC4470037 DOI: 10.1186/s12958-015-0056-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/30/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most of infertile women with normal follicle stimulating hormone (FSH) levels and antral follicle count (AFC) at day 2-3 of the period, but poor IVF outcomes may occur when use of routine controlled ovarian stimulation. This paper is to evaluate the predictive value of age-specific FSH levels for IVF-ET outcomes in women with normal ovarian function. METHODS A total of 1287 women undergoing their first IVF cycles were enrolled in this retrospective study. The FSH levels and AFC of all of the women were within normal ranges (FSH ≤ 12 IU/L;AFC ≥ 5). The patients were grouped by age (younger: < 33 years, medium-aged:33-37years and older:38-41years), and within each age group, the patients were subdivided by the upper limit of the 95 % confidence interval (CI) for mean FSH levels. Patients with FSH levels equal to or greater than the upper 95 % CI of FSH in each age group were included into a premature ovarian aging (POA) subgroup (younger:FSH ≥ 7.84, medium-aged: ≥8.12 and older: FSH ≥ 8.47),the remaining patients in each age group were included into a control subgroup. The outcomes of IVF-ET were compared between the POA subgroup and the control subgroup in each age group. RESULTS In each age group, the total dose of gonadotropin(Gn) in the POA subgroups were significantly higher than those of the corresponding control subgroups. In the younger and medium-aged groups, women in the POA subgroups had significantly lower oocyte yields, frozen embryos, and higher rates of poor ovarian response(POR) than those in the corresponding control subgroups. When controlling for age, BMI and AFC, the multiple logistic regression analysis indicated the following: In each age group, the total dose of Gn was significantly correlated with POA; the oocyte yield was significantly related to POA only in the younger group; and in the whole age groups, the incidence of POR in the POA group was 2.719 times greater than in the control group (OR = 2.719, 95 % CI [1.598-4.625], P < 0.001). CONCLUSION Basal FSH levels combined with age (age-specific FSH levels) can be used as a more accurate marker for the ovarian response in women with normal ovarian reserves undergoing IVF-ET, particularly in women ≤37 years old.
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Affiliation(s)
- Tingfeng Fang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Zheng Su
- Comprehensive Department, SunYat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Liangan Wang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Ping Yuan
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Ruiqi Li
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Nengyong Ouyang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Lingyan Zheng
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
| | - Wenjun Wang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou, 510120, P. R. China.
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Devine K, Mumford SL, Wu M, DeCherney AH, Hill MJ, Propst A. Diminished ovarian reserve in the United States assisted reproductive technology population: diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertil Steril 2015; 104:612-19.e3. [PMID: 26049057 DOI: 10.1016/j.fertnstert.2015.05.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate trends in diminished ovarian reserve (DOR) assignment in the Society for Assisted Reproductive Technology (SART) Clinic Outcomes Reporting System database and to evaluate its accuracy in predicting poor ovarian response (POR) as defined in European Society of Human Reproduction and Embryology's Bologna criteria (2011). DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) A total of 181,536 fresh, autologous ART cycles reported to SART by U.S. clinics in 2004 and 2011 (earliest and most recent available reporting years). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) DOR assignment was the primary exposure. POR, defined as cycle cancellation for poor response or less than 4 oocytes retrieved after conventional gonadotropin stimulation (>149 IU FSH daily), was the primary outcome. Secondary outcomes were live birth and number of oocytes retrieved. DOR prevalence, power of DOR and FSH (</≥12 mIU/mL) to predict POR, and live birth in POR cycles were also calculated. RESULT(S) DOR prevalence increased from 19% to 26% from 2004 to 2011. Among cycles clinically assigned as DOR, incidence of POR decreased from 32% to 30%, and live birth improved from 15% to 17%. Comparing basal FSH ≥12 versus clinical assignment of DOR, basal FSH had a higher specificity (92.2% vs. 81.6%) and positive predictive value (38.3% vs. 30.9%) for predicting POR. Live birth among POR cycles was 4%. CONCLUSION(S) DOR diagnosis is increasing, and accuracy remains poor, despite the availability of additional diagnostic parameters such as antral follicle count and antimüllerian hormone. POR entailed poor outcomes, but the majority of patients clinically assigned as DOR did not experience POR. Development and use of more accurate predictors of POR are needed to minimize patient distress resulting from overdiagnosis.
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Affiliation(s)
- Kate Devine
- National Institutes of Health, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
| | - Sunni L Mumford
- National Institutes of Health, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Mae Wu
- National Institutes of Health, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Alan H DeCherney
- National Institutes of Health, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Micah J Hill
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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In Vitro Fertilization Is Successful in Women With Ulcerative Colitis and Ileal Pouch Anal Anastomosis. Am J Gastroenterol 2015; 110:792-7. [PMID: 25512339 DOI: 10.1038/ajg.2014.400] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women with ulcerative colitis (UC), who require ileal pouch anal anastomosis (IPAA), have up to a threefold increased incidence of infertility. To better counsel patients who require colectomy, we examined the success rates of in vitro fertilization (IVF) among women who have undergone IPAA. METHODS This was a retrospective cohort study conducted at the Brigham and Women's Hospital and Beth Israel Deaconess Medical Center. Female patients with UC were identified via ICD-9 codes and cross-referenced with those presenting for IVF from 1998 through 2011. UC patients with IPAA were compared with the following two unexposed groups that underwent IVF: (1) patients with UC, who had not undergone IPAA, and (2) patients without inflammatory bowel disease (IBD). The primary outcome was the cumulative live birth rate. Secondary outcomes included number of oocytes retrieved, proportion of patients who underwent embryo transfer, pregnancy rate, and live birth rate at first cycle. RESULTS There were 22 patients with UC and IPAA, 49 patients with UC and without IPAA, and 470 patients without IBD. The cumulative live birth rate after six cycles in the UC and IPAA groups was 64% (95% confidence interval (CI): 44-83%). This rate did not differ from the cumulative live birth rate in the UC without IPAA group (71%, 95% CI: 59-83%; P=0.63) or the group without IBD (53%, 95% CI: 48-57%; P=0.57). CONCLUSIONS This study demonstrates that in our cohort, women who undergo IPAA achieve live births following IVF at comparable rates to women with UC without IPAA and to women without IBD.
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Naether OG, Tandler-Schneider A, Bilger W. Individualized recombinant human follicle-stimulating hormone dosing using the CONSORT calculator in assisted reproductive technology: a large, multicenter, observational study of routine clinical practice. Drug Healthc Patient Saf 2015; 7:69-76. [PMID: 25926756 PMCID: PMC4403744 DOI: 10.2147/dhps.s77320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose This postmarketing surveillance survey was conducted to investigate the utility of the CONsistency in r-FSH Starting dOses for individualized tReatmenT (CONSORT) calculator for individualizing recombinant human follicle-stimulating hormone (r-hFSH) starting doses for controlled ovarian stimulation (COS) in routine clinical practice. Methods This was a 3-year, open-label, observational study evaluating data from women undergoing COS for assisted reproductive technology at 31 German fertility centers. Physicians stated their recommended r-hFSH starting dose, then generated a CONSORT-recommended r-hFSH starting dose. Physicians could prescribe any r-hFSH starting dose. The primary objective was to compare the r-hFSH starting dose recommended by the physician with the CONSORT-calculated dose and that prescribed. Statistical analyses were conducted post hoc. Results Data were collected from 2,579 patients; the mean (standard deviation [SD]) age was 30.5 (2.93) years (range: 19–40 years). The mean (SD) CONSORT-calculated r-hFSH starting dose was significantly lower than the physician-recommended dose (134.5 [38.0] IU versus 164.6 [47.1] IU; P<0.0001); the mean (SD) starting dose prescribed was 162.2 (48.4) IU. CONSORT-calculated doses were prescribed for 27.3% (number [n] =677) of patients, and non-CONSORT-calculated doses prescribed for 72.7% (n=1,800). The mean (SD) number of oocytes retrieved per patient was 10.6 (6.15) and 11.4 (6.66) in the CONSORT and non-CONSORT groups, respectively; the mean (SD) number of embryos transferred per patient was 1.98 (0.41) and 2.03 (0.45), respectively. Clinical pregnancy rates per COS cycle were 38.8% (CONSORT) and 34.8% (non-CONSORT) (P=0.142); clinical pregnancy rates per embryos transferred were 45.0% and 39.5%, respectively (P=0.049). Miscarriage occurred in 14.8% of all clinical pregnancies (CONSORT: 12.5%; non-CONSORT: 15.3%). The rate of grade 3 ovarian hyperstimulation syndrome (OHSS) was 0.3% (n=2) in the CONSORT group and 0.6% (n=11) in the non-CONSORT group. OHSS led to hospitalization in 0.81% (n=21) of cases (CONSORT group: 0.74% [n=5]; non-CONSORT group: 0.83% [n=15]). Conclusion Physician-recommended r-hFSH starting doses were generally higher than those calculated by CONSORT; most patients were prescribed a higher starting dose than that recommended by CONSORT.
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Affiliation(s)
- Olaf Gj Naether
- Reproductive Endocrinology, MVZ Fertility Center Hamburg, Hamburg, Germany
| | | | - Wilma Bilger
- Medical Affairs, Fertility, Endocrinology and General Medicine, Merck Serono GmbH, a subsidiary of Merck KGaA, Darmstadt, Germany
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Venturella R, Lico D, Sarica A, Falbo MP, Gulletta E, Morelli M, Zupi E, Cevenini G, Cannataro M, Zullo F. OvAge: a new methodology to quantify ovarian reserve combining clinical, biochemical and 3D-ultrasonographic parameters. J Ovarian Res 2015; 8:21. [PMID: 25881987 PMCID: PMC4392473 DOI: 10.1186/s13048-015-0149-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background In the last decade, both endocrine and ultrasound data have been tested to verify their usefulness for assessing ovarian reserve, but the ideal marker does not yet exist. The purpose of this study was to find, if any, a statistical advanced model able to identify a simple, easy to understand and intuitive modality for defining ovarian age by combining clinical, biochemical and 3D-ultrasonographic data. Methods This is a population-based observational study. From January 2012 to March 2014, we enrolled 652 healthy fertile women, 29 patients with clinical suspect of premature ovarian insufficiency (POI) and 29 patients with Polycystic Ovary syndrome (PCOS) at the Unit of Obstetrics & Gynecology of Magna Graecia University of Catanzaro (Italy). In all women we measured Anti Müllerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Estradiol (E2), 3D Antral Follicle Count (AFC), ovarian volume, Vascular Index (VI) and Flow Index (FI) between days 1 and 4 of menstrual cycle. We applied the Generalized Linear Models (GzLM) for producing an equation combining these data to provide a ready to use information about women ovarian reserve, here called OvAge. To introduce this new variable, expression of ovarian reserve, we assumed that in healthy fertile women ovarian age is identical to chronological age. Results GzLM applied on the healthy fertile controls dataset produced the following equation OvAge = 48.05 - 3.14*AHM + 0.07*FSH - 0.77*AFC - 0.11*FI + 0.25*VI + 0.1*AMH*AFC + 0.02*FSH*AFC. This model showed a high statistical significance for each marker included in the equation. We applied the final equation on POI and PCOS datasets to test its ability of discovering significant deviation from normality and we obtained a mean of predicted ovarian age significantly different from the mean of chronological age in both groups. Conclusions OvAge is one of the first reliable attempt to create a new method able to identify a simple, easy to understand and intuitive modality for defining ovarian reserve by combining clinical, biochemical and 3D-ultrasonographic data. Although design data prove a statistical high accuracy of the model, we are going to plan a clinical validation of model reliability in predicting reproductive prognosis and distance to menopause. Electronic supplementary material The online version of this article (doi:10.1186/s13048-015-0149-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberta Venturella
- Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Daniela Lico
- Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Alessia Sarica
- School of Informatics and Biomedical Engineering-Bioinformatics Laboratory, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Maria Pia Falbo
- Chair of Clinical Pathology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Elio Gulletta
- Chair of Clinical Pathology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Michele Morelli
- Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | - Mario Cannataro
- School of Informatics and Biomedical Engineering-Bioinformatics Laboratory, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
| | - Fulvio Zullo
- Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Viale Europa - Localitá Germaneto, 88100, Catanzaro, Italy.
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20
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2015; 103:e9-e17. [DOI: 10.1016/j.fertnstert.2014.12.093] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/21/2022]
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Abstract
PURPOSE This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). MATERIALS AND METHODS A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. RESULTS The 25th percentile of the distribution corresponded to total oocytes ≤2 and mature oocyte ≤1. The cut-off values for the prediction of IVF outcomes were total oocytes >5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes ≤2 or mature oocyte ≤1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was ≤0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes ≤2 or mature oocyte ≤1 in a previous cycle or a serum AMH level of ≤0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. CONCLUSION We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.
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Affiliation(s)
- Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Levin D, Jun SH, Dahan MH. Predicting pregnancy in women undergoing in-vitro fertilization with basal serum follicle stimulating hormone levels between 10.0 and 11.9 IU/L. J Turk Ger Gynecol Assoc 2015; 16:5-10. [PMID: 25788842 DOI: 10.5152/jtgga.2015.15218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/10/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the results of the in vitro fertilization (IVF) cycle outcomes in women whose borderline basal follicle stimulating hormone (FSH) levels were between 10.0 and 11.9 IU/L and to analyze the predictors of pregnancy in this population. MATERIAL AND METHODS A prospective cohort study was performed at an academic teaching hospital; participants were infertile couples in which the women were undergoing IVF treatment and had borderline basal highest FSH levels between 10.0 and 11.9 IU/L. Statistical modeling was performed to determine risk factors for pregnancy and clinical pregnancy. RESULTS A clinical pregnancy rate of 26.5% per cycle and 35% per patient was found in the study population. Among all subjects and non-intracytoplasmic sperm injection (ICSI) subjects, younger age, higher gravidity, higher number of mature follicles on day of Human Chorionic gonadotrophin (hCG) triggering, higher number of oocytes retrieved, and number of embryos produced were significant discriminators between individuals who conceived and those who did not. However, only the number of embryos predicted those who had a clinical pregnancy when compared with those who did not. Higher gravidity, and basal estradiol (E2) levels, and lower maximum basal FSH levels predicted clinical pregnancy in non-ICSI patients. Among ICSI patients, the only predictor of pregnancy was a thicker endometrium. A trend towards higher pregnancy rates was noted in ICSI patients. CONCLUSION We showed that pregnancy rates per cycle and per patient in this population were not significantly different than those in patients with a basal FSH level below 10.0 IU/L. Preliminary evidence suggests that ICSI is the fertilization method of choice in these patients.
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Affiliation(s)
- Dan Levin
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University Health Center, Montreal, Quebec, Canada
| | - Sunny H Jun
- Department of Obstetrics and Gynecology, Palo Alto Medical Foundation, Fremont, California, USA
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University Health Center, Montreal, Quebec, Canada
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Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 8:393-8. [PMID: 25780521 PMCID: PMC4355926 DOI: 10.22074/ijfs.2015.4179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/06/2013] [Indexed: 11/22/2022]
Abstract
Background The objective of our study was to identify the correlations between the
tests currently used in ovarian reserve assessment: anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH) and antral follicle count (AFC) and to distinguish the
most reliable markers for ovarian reserve in order to select an adequate strategy for the
initial stages of infertility treatment. Materials and Methods In this prospective study, 112 infertile women were assessed.
Subjects were divided into three age groups: group I <35 years (n=39), group II 35-40
years (n=31), and group III 41-46 years (n=42). AMH, FSH and AFC were determined
on days 2-3 of the patients’ menstrual cycles. Results There was a significantly elevated negative correlation between age and
AMH level (rs=-0.67, p<0.0001) and AFC (rs=-0.55, p<0.0001). We observed a
significantly positive correlation between age and FSH (rs=0.38, p<0.0001). AMH
negatively correlated with FSH (rs=-0.48, p<0.0001) and positively with AFC (r=-0.71, p=0.0001). There was a moderate negative relation between FSH and AFC
(r=-0.41, p=0.0001) and moderate positive relation between age and FSH (rs=0.38,
p<0.0001). The correlation analysis performed in separate groups showed that AMH
and AFC showed a statistically significant positive correlation for group I (r=0.57,
p<0.0001), group II (r=0.69, p<0.0001) and group III (r=0.47, p<0.002). A statistically significant correlation between FSH and AMH was detected only in groups I
(r=-0.41, p<0.02) and II (r=-0.55, p<0.0001). A statistically significant correlation
existed between FSH and AFC only in group III (r=-0.42, p<0.006), as well as between age and AFC only in group I (r=-0.35, p<0.03). Conclusion Currently, AMH should be considered as the more reliable of the ovarian
reserve assessments tests compared to FSH. There is a strong positive correlation between
serum AMH level and AFC. The use of AMH combined with AFC may improve ovarian
reserve evaluation.
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Affiliation(s)
- Ludmila Barbakadze
- Department of Reproductology, Obstetrics and Gynecology, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Jenara Kristesashvili
- Department of Reproductology, Obstetrics and Gynecology, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive. J Int AIDS Soc 2015; 18:19447. [PMID: 25579801 PMCID: PMC4289674 DOI: 10.7448/ias.18.1.19447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/12/2014] [Accepted: 11/28/2014] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Increased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfillment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive. METHODS Original English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved. RESULTS AND DISCUSSION Calendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected. CONCLUSIONS FAMs provide effective, economical and accessible options for HIV serodiscordant couples to conceive while minimizing unnecessary viral exposure. It is important for health care providers to initiate conversations about fertility desires in HIV-positive couples and to educate identified couples on safer conception strategies.
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Kato N, Iwase A, Sugita A, Goto M, Nakahara T, Nakamura T, Kondo M, Osuka S, Mori M, Saito A, Kikkawa F. Anti-Müllerian hormone as a possible predictor of fecundability in subfertile women over 38 years: a retrospective cohort study. Gynecol Endocrinol 2015; 31:22-5. [PMID: 25030844 DOI: 10.3109/09513590.2014.943720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is a relatively novel method for examining the ovarian reserve that reflects female reproductive function. In the era in which the number of women delaying attempts to conceive has increased, a good predictor for long-term fecundability has been explored. We performed the retrospective cohort study to investigate whether initial serum AMH levels are useful for predicting long-term fertility during infertility treatments. We recruited 149 women in the retrospective cohort, and 52 women were gravid during the follow-up period. According to the multiple logistic analyses, only age was found to have a significant correlation with pregnancy success in all women. In women ≥38 years, significantly higher serum AMH levels were detected in the pregnant group (median = 2.83 ng/mL, range = 1.11-6.29 ng/mL) than the non-pregnant group (median = 1.22 ng/mL, range = 0-9.46 ng/mL; p = 0.015). None of the women with serum AMH levels <0.7 ng/mL were pregnant during treatment. AMH may be used to identify poor pregnancy prospects in women who are above 38 years.
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Affiliation(s)
- Nao Kato
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine , Nagoya , Japan and
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Iwase A, Nakamura T, Nakahara T, Goto M, Kikkawa F. Assessment of ovarian reserve using anti-Müllerian hormone levels in benign gynecologic conditions and surgical interventions: a systematic narrative review. Reprod Biol Endocrinol 2014; 12:125. [PMID: 25510324 PMCID: PMC4274680 DOI: 10.1186/1477-7827-12-125] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/14/2014] [Indexed: 11/10/2022] Open
Abstract
The usefulness of anti-Müllerian hormone (AMH) for the quantitative evaluation of ovarian reserve has been established. Therefore, serum AMH has been recently applied to the assessment of ovarian reserve outside infertility treatment. We conducted a computer-based search, using keywords, through the PubMed database from inception until May 2014 and summarized available studies evaluating ovarian damage caused by gynecologic diseases, such as endometriosis and ovarian tumor, as well as surgical interventions, such as cystectomy and uterine artery embolization (UAE), to discuss the usefulness of serum AMH. Most of the studies demonstrated a decline of serum AMH levels after cystectomy for endometriomas. It is not conclusive whether electrocoagulation or suturing is preferable. The effects of other gynecologic diseases and interventions, such as hysterectomy and UAE, on ovarian reserve are controversial. Serum AMH levels should be considered in determining the indication and selection of operative methods for benign gynecologic conditions.
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Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Using individual patient data to adjust for indirectness did not successfully remove the bias in this case of comparative test accuracy. J Clin Epidemiol 2014; 68:290-8. [PMID: 25475365 DOI: 10.1016/j.jclinepi.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 09/29/2014] [Accepted: 10/17/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In comparative systematic reviews of diagnostic accuracy, inconsistencies between direct and indirect comparisons may lead to bias. We investigated whether using individual patient data (IPD) can adjust for this form of bias. STUDY DESIGN AND SETTING We included IPD of 3 ovarian reserve tests from 32 studies. Inconsistency was defined as a statistically significant difference in relative accuracy or different comparative results between the direct and indirect evidence. We adjusted for the effect of threshold and reference standard, as well as for patient-specific variables. RESULTS Anti-Müllerian hormone (AMH) and follicle stimulation hormone (FSH) differed significantly in sensitivity (-0.1563, P = 0.04). AMH and antral follicle count (AFC) differed significantly in sensitivity (0.1465, P < 0.01). AMH and AFC differed significantly in specificity (-0.0607, P = 0.02). The area under the curve (AUC) differed significantly between AFC and FSH (0.0948, P < 0.01) in the direct comparison but not (0.0678, P = 0.09) in the indirect comparison. The AUCs of AFC and AMH differed significantly (-0.0830, P < 0.01) in the indirect comparison but not (-0.0176, P = 0.29) in the direct comparison. These differences remained after adjusting for indirectness. CONCLUSION Estimates of comparative accuracy obtained through indirect comparisons are not always consistent with those obtained through direct comparisons. Using IPD to adjust for indirectness did not successfully remove the bias in this case study.
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28
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Hashemitabar M, Bahmanzadeh M, Mostafaie A, Orazizadeh M, Farimani M, Nikbakht R. A proteomic analysis of human follicular fluid: comparison between younger and older women with normal FSH levels. Int J Mol Sci 2014; 15:17518-40. [PMID: 25268621 PMCID: PMC4227176 DOI: 10.3390/ijms151017518] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 01/10/2023] Open
Abstract
The follicular fluid (FF) is produced during folliculogenesis and contains a variety of proteins that play important roles in follicle development and oocyte maturation. Age-related infertility is usually considered as a problem that can be solved by assisted reproduction technology. Therefore, the identification of novel biomarkers that are linked to reproductive aging is the subject of this study. FF was obtained from healthy younger (20–32 years old) and older (38–42 years old) women undergoing intracytoplasmic sperm injection (ICSI) due to male factor infertility. The FF was analyzed by two-dimensional gel electrophoresis (2-DE). The power of two-dimensional gel electrophoresis and the identification of proteins were exploited using matrix-assisted laser desorption-ionization time-of-flight/time-of-flight (MALDI-TOF-TOF) mass spectrometry. Twenty three protein spots showed reproducible and significant changes in the aged compared to the young group. Of these, 19 protein spots could be identified using MALDI-TOF-TOF-MS. As a result of MASCOT search, five unique downregulated proteins were identified in the older group. These were identified as serotransferrin, hemopexin precursor, complement C3, C4 and kininogen. A number of protein markers were found that may help develop diagnostic methods of infertility.
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Affiliation(s)
- Mahmoud Hashemitabar
- Cellular and Molecular Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 1579461357, Iran.
| | - Maryam Bahmanzadeh
- Cellular and Molecular Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 1579461357, Iran.
| | - Ali Mostafaie
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah 6714415185, Iran.
| | - Mahmoud Orazizadeh
- Cellular and Molecular Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 1579461357, Iran.
| | - Marzieh Farimani
- Endometr and Endometriosis Research Center, Hamedan University of Medical Sciences, Hamedan 6517789971, Iran.
| | - Roshan Nikbakht
- Fertility and Infertility & Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6193673166, Iran.
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Iwase A, Nakamura T, Nakahara T, Goto M, Kikkawa F. Anti-Müllerian hormone and assessment of ovarian reserve after ovarian toxic treatment: a systematic narrative review. Reprod Sci 2014; 22:519-26. [PMID: 25228631 DOI: 10.1177/1933719114549856] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since serum anti-Müllerian hormone (AMH) levels enable quantitative evaluation of ovarian damage, we conducted a computer-based search, using key words, of all articles published in English through the PubMed database from inception until September 2013 to summarize available studies evaluating ovarian reserve after ovarian toxic interventions to discuss the usefulness of serum AMH levels. We found that most of the studies demonstrated a decline in serum AMH levels when compared to control or pretreatment levels, with levels dependent on the type of treatment modality. Measurement of serum AMH levels enables quantitative evaluation of ovarian damage caused by ovarian toxic interventions, such as chemotherapy and radiotherapy, instead of qualitative evaluation using menstrual condition or basal follicle-stimulating hormone levels. Serum AMH levels are becoming indispensable to assess the ovarian reserve of patients who desire preservation of ovarian function for fertility and endogenous sex steroid hormones.
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Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
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30
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Sun B, Wang F, Sun J, Yu W, Sun Y. Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF. J Assist Reprod Genet 2014; 31:829-35. [PMID: 24849376 DOI: 10.1007/s10815-014-0246-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/05/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) cycles and examine the association between basal T levels and ovarian response or IVF pregnancy outcome. METHODS We retrospectively analyzed 1413 infertile Chinese women undergoing their first IVF treatment at our institution's reproductive center from March 2011 to May 2013. The basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) and the relationship between basal T levels and ovarian response or IVF pregnancy outcome were determined. These patients did not have polycystic ovary syndrome (PCOS) or endometriosis, and were treated with a long luteal down-regulation protocol. Subjects were divided into 2 groups according to basal testosterone (T) levels: Group 1, basal T values <20 ng/dl (n = 473), and Group 2, basal T values >20 ng/dl (n = 940). We evaluated the association of basal T levels with ovarian response and IVF outcome in the two groups. RESULTS In this study, BMI, basal follicle-stimulating hormone (FSH) levels, basal luteinizing hormone (LH) levels, antral follicle count (AFC), days of stimulation, total gonadotrophin dose, basal FSH/LH ratio, and the number of follicles >14 mm were significantly different (P < 0.05) between the two groups. Basal T level positively correlated with ovarian reserve function, number of follicles >14 mm on human chorionic gonadotrophin (HCG) day, and total gonadotropin dose. However, basal T levels play no role in predicting IVF pregnancy outcome. CONCLUSION Basal T level can be used as a good predictor for ovarian response and the number of large follicles on HCG day. Additionally, we may use basal T level as a marker to predict FSH dosage. In general women, lower level of T might relate with potential poor ovarian response. However, based on our data, basal T levels do not predict pregnancy outcome.
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Affiliation(s)
- Bo Sun
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Henan, China
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31
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Karakaya C, Guzeloglu-Kayisli O, Hobbs RJ, Gerasimova T, Uyar A, Erdem M, Oktem M, Erdem A, Gumuslu S, Ercan D, Sakkas D, Comizzoli P, Seli E, Lalioti MD. Follicle-stimulating hormone receptor (FSHR) alternative skipping of exon 2 or 3 affects ovarian response to FSH. Mol Hum Reprod 2014; 20:630-43. [PMID: 24670307 DOI: 10.1093/molehr/gau024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Genes critical for fertility are highly conserved in mammals. Interspecies DNA sequence variation, resulting in amino acid substitutions and post-transcriptional modifications, including alternative splicing, are a result of evolution and speciation. The mammalian follicle-stimulating hormone receptor (FSHR) gene encodes distinct species-specific forms by alternative splicing. Skipping of exon 2 of the human FSHR was reported in women of North American origin and correlated with low response to ovarian stimulation with exogenous follicle-stimulating hormone (FSH). To determine whether this variant correlated with low response in women of different genetic backgrounds, we performed a blinded retrospective observational study in a Turkish cohort. Ovarian response was determined as low, intermediate or high according to retrieved oocyte numbers after classifying patients in four age groups (<35, 35-37, 38-40, >40). Cumulus cells collected from 96 women undergoing IVF/ICSI following controlled ovarian hyperstimulation revealed four alternatively spliced FSHR products in seven patients (8%): exon 2 deletion in four patients; exon 3 and exons 2 + 3 deletion in one patient each, and a retention of an intron 1 fragment in one patient. In all others (92%) splicing was intact. Alternative skipping of exons 2, 3 or 2 + 3 were exclusive to low responders and was independent of the use of agonist or antagonist. Interestingly, skipping of exon 3 occurs naturally in the ovaries of domestic cats--a good comparative model for human fertility. We tested the signaling potential of human and cat variants after transfection in HEK293 cells and FSH stimulation. None of the splicing variants initiated cAMP signaling despite high FSH doses, unlike full-length proteins. These data substantiate the occurrence of FSHR exon skipping in a subgroup of low responders and suggest that species-specific regulation of FSHR splicing plays diverse roles in mammalian ovarian function.
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Affiliation(s)
- Cengiz Karakaya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Ozlem Guzeloglu-Kayisli
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA Present address: Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Rebecca J Hobbs
- Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC 20008, USA Present address: Taronga Conservation Society Australia, Taronga Western Plains Zoo, Duboo, NSW 2830, Australia
| | - Tsilya Gerasimova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - Asli Uyar
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - Mehmet Erdem
- Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Mesut Oktem
- Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Ahmet Erdem
- Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Seyhan Gumuslu
- Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Deniz Ercan
- Division of Reproductive Endocrinology and Infertility, IVF Center, Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara 06500 Turkey
| | - Denny Sakkas
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA Present address: Boston IVF, Waltham, MA 02451, USA
| | - Pierre Comizzoli
- Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC 20008, USA
| | - Emre Seli
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - Maria D Lalioti
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
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Arthur R, Kachura J, Liu G, Chan C, Shapiro H. Laparoscopic Myomectomy Versus Uterine Artery Embolization: Long-Term Impact on Markers of Ovarian Reserve. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:240-247. [DOI: 10.1016/s1701-2163(15)30632-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Comparison of serum anti-Mullerian hormone levels following hysterectomy and myomectomy for benign gynaecological conditions. Eur J Obstet Gynecol Reprod Biol 2013; 171:368-71. [DOI: 10.1016/j.ejogrb.2013.09.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/16/2013] [Accepted: 09/27/2013] [Indexed: 11/24/2022]
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35
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Prediction of IVF/ICSI outcome based on the follicular output rate. Reprod Biomed Online 2013; 27:147-53. [DOI: 10.1016/j.rbmo.2013.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/07/2013] [Accepted: 04/09/2013] [Indexed: 11/23/2022]
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Affiliation(s)
- Menelaos L Batrinos
- Professor Emeritus of Endocrinology, Athens University Medical School, Athens, Greece
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37
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Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro
fertilization. J Obstet Gynaecol Res 2013; 39:1246-52. [DOI: 10.1111/jog.12056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/18/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Akiko Takashima
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Kiwamu Otaka
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Toshihiko Kinoshita
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
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Antimüllerian hormone as predictor of reproductive outcome in subfertile women with elevated basal follicle-stimulating hormone levels: a follow-up study. Fertil Steril 2013; 100:831-8. [PMID: 23755952 DOI: 10.1016/j.fertnstert.2013.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the role of serum antimüllerian hormone (AMH) as a predictor of live birth and reproductive stage in subfertile women with elevated basal FSH levels. DESIGN A prospective observational cohort study conducted between February 2005 and June 2009. SETTING Tertiary fertility center. PATIENT(S) Subfertile women with [1] a regular menstrual cycle (mean cycle length 25-35 days); [2] basal FSH concentrations ≥12.3 IU/L; and [3] younger than 40 years (n = 96). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth and reproductive stage according to the Stages of Reproductive Aging Workshop. RESULT(S) A cumulative live birth rate of 63.5% was observed during a median follow-up of 3.3 years (n = 85). The AMH level was significantly associated with live birth. There was evidence of a nonlinear prediction pattern, with an increase in chances of live birth until an AMH level of 1 μg/L. Other ovarian reserve tests and chronological age appeared of limited value in predicting live birth. In addition, AMH was significantly associated with the timing of reproductive stages (n = 68) (i.e., the occurrence of menopausal transition or menopause during follow-up). CONCLUSION(S) The present findings suggest applicability of AMH determination as a marker for actual fertility in subfertile women with elevated basal FSH levels.
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El-Shalakany AH, Ali MS, Abdelmaksoud AA, Abd El-Ghany S, Hasan EA. Ovarian function in female survivors of childhood malignancies. Pediatr Hematol Oncol 2013; 30:328-35. [PMID: 23574301 DOI: 10.3109/08880018.2013.778927] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chemotherapy-induced infertility is a common side effect observed in women of fertile age after treatment for malignant disease. OBJECTIVES to study gonadal function and fertility in female survivors of childhood malignancies. PATIENTS AND METHODS Study included 30 female cancer survivors and 30 age-matched healthy females as a control group. Data collected regarding; type of malignancy, age at diagnosis, duration on and off treatment, treatment received (radiation or chemotherapeutic regimens), sexual, menstrual, pregnancy, and fertility histories were also recorded. Laboratory investigations included; T4, thyroid stimulating hormone (TSH), leutinizing hormone (LH), follicular stimulating hormone (FSH), and anti-Mullerian hormone (AMH). Pelviabdominal ultrasound was done to estimate the mean ovarian volume. RESULTS Among patients; 80% had normal menarche and 6 (20%) had delayed menarche (P > .05). There was higher LH and FSH levels and lower AMH levels in patients (P < .05) with no significant difference in thyroid function tests (P > .05). Lower mean ovarian volume was observed among female survivors (6.32 ± 2.31 cm(3)) (P = .041). There was a higher FSH and LH levels among female survivors of solid tumors compared to those with hematological tumors (P = .05 and .04 respectively). There was a significant positive correlation between FSH level and patients' age at start of malignancy (r = 0.65, P = .014), age of menarche (r = 0.74, P = .036), and duration of treatment (r = 0.54, P = .025).There was a significant negative correlation between age of menarche and AMH level (r = -0.61, P = .03). CONCLUSION Female survivors of childhood malignancies had reduced ovarian reserve and reduced mean ovarian volume, especially those with older age, older age of menarche, and longer treatment duration.
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Affiliation(s)
- Amr H El-Shalakany
- Department of Obstetrics & Gynecology, Ain Shams University, Cairo, Egypt
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Association of Abnormal Ovarian Reserve Parameters With a Higher Incidence of Aneuploid Blastocysts. Obstet Gynecol 2013; 121:71-7. [DOI: 10.1097/aog.0b013e318278eeda] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Satwik R, Kochhar M, Gupta SM, Majumdar A. Anti-mullerian hormone cut-off values for predicting poor ovarian response to exogenous ovarian stimulation in in-vitro fertilization. J Hum Reprod Sci 2012; 5:206-12. [PMID: 23162361 PMCID: PMC3493837 DOI: 10.4103/0974-1208.101023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/20/2012] [Accepted: 06/23/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES: (a) To establish the cut-off levels for anti-Mullerian hormone (AMH) in a population of Indian women that would determine poor response. (b) To determine which among the three ie.,: age, follicle stimulating hormone (FSH), or AMH, is the better determinant of ovarian reserve. STUDY DESIGN: Prospective observational study. SETTING: In vitro fertilization (IVF) unit of a tertiary hospital. MATERIALS AND METHODS: The inclusion criterion was all women who presented to the center for in-vitro fertilization/Intracytoplasmic sperm injection (IVF/ICSI). The exclusion criteria were age >45 years, major medical illnesses precluding IVF or pregnancy, FSH more than 20 IU/L, and failure to obtain consent. The interventions including baseline pelvic scan, day 2/3 FSH, luteinizing hormone (LH), estradiol estimations, and AMH measurement on any random day of cycle were done. Subjects underwent IVF according to long agonist or antagonist protocol regimen. Oocyte recovery was correlated with studied variables. The primary outcome measure was the number of oocytes aspirated (OCR). Three categories of ovarian response were defined: poor response, OCR ≤ 3; average response, OCR between 4 and 15; hyperresponse, OCR > 15. RESULTS: Of the 198 patients enrolled, poor, average, and hyperresponse were observed in 23%, 63%, and 14% respectively. Correlation coefficient for AMH with ovarian response was r = 0.591. Area under the curve (AUCs) for poor response for AMH, subject's age, and FSH were 0.768, 0.624, and 0.635, respectively. The discriminatory level of AMH for prediction of absolute poor response was 2 pmoL/l, with 98% specificity and 20% sensitivity. CONCLUSIONS: AMH fares better than age and FSH in predicting the overall ovarian response and poor response, though it cannot be the absolute predictor of non-responder status. A level of 2 pmol/l is discriminatory for poor response.
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Affiliation(s)
- Ruma Satwik
- Consultant Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi 110060, India
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Steiner AZ, Long DL, Herring AH, Kesner JS, Meadows JW, Baird DD. Urinary follicle-stimulating hormone as a measure of natural fertility in a community cohort. Reprod Sci 2012; 20:549-56. [PMID: 23171685 DOI: 10.1177/1933719112459226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High serum follicle-stimulating hormone (FSH) levels have been associated with diminished ovarian reserve; however, the association between high urinary FSH and reduced natural fertility has yet to be established. We sought to characterize the relationship between a single or multiple measurements of early follicular phase urinary FSH and fertility. Women (n = 209), 30 to 44 years old with no history of infertility, who had been trying to conceive for less than 3 months, provided early follicular phase urine. Participants subsequently kept a diary to record bleeding and intercourse and conducted standardized pregnancy testing for up to 6 months. A subset of women (N = 95) collected urine on cycle day 3 for up to 6 cycles. Urine was analyzed for FSH and creatinine (cr) corrected. Proportional hazard models were used to calculate fecundability ratios (FRs). Urinary FSH levels across cycles from the same woman were highly correlated (adjusted intraclass correlation = .77); within-woman variance was 3-fold lower than variance among women. Women with an initial urinary FSH level <7 mIU/mg cr exhibited a nonsignificant reduction in the probability of pregnancy (adjusted FR 0.71, 95% confidence interval [CI]: 0.45-1.13), as did women with elevated urinary FSH (≥12 mIU/mg cr; adjusted FR 0.78, 95% CI: 0.46-1.32). Using the most recent or maximum urinary FSH value did not strengthen the association. In the general population, urinary FSH levels appear to be nonlinearly associated with fertility; however, broad CIs indicate a lack of statistical significance. Repetitive testing appears to be of little benefit.
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Affiliation(s)
- Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2012; 98:1407-15. [PMID: 23095141 DOI: 10.1016/j.fertnstert.2012.09.036] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/21/2012] [Indexed: 11/18/2022]
Abstract
Currently, there is no uniformly accepted definition of decreased ovarian reserve (DOR), as the term may refer to three related but distinctly different outcomes: oocyte quality, oocyte quantity, or reproductive potential. Available evidence concerning the performance of ovarian reserve tests is limited by small sample sizes, heterogeneity among study design, analyses and outcomes, and the lack of validated outcome measures.
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van Tilborg TC, Eijkemans MJC, Laven JSE, Koks CAM, de Bruin JP, Scheffer GJ, van Golde RJT, Fleischer K, Hoek A, Nap AW, Kuchenbecker WKH, Manger PA, Brinkhuis EA, van Heusden AM, Sluijmer AV, Verhoeff A, van Hooff MHA, Friederich J, Smeenk JMJ, Kwee J, Verhoeve HR, Lambalk CB, Helmerhorst FM, van der Veen F, Mol BWJ, Torrance HL, Broekmans FJM. The OPTIMIST study: optimisation of cost effectiveness through individualised FSH stimulation dosages for IVF treatment. A randomised controlled trial. BMC WOMENS HEALTH 2012; 12:29. [PMID: 22989359 PMCID: PMC3460731 DOI: 10.1186/1472-6874-12-29] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022]
Abstract
Background Costs of in vitro fertilisation (IVF) are high, which is partly due to the use of follicle stimulating hormone (FSH). FSH is usually administered in a standard dose. However, due to differences in ovarian reserve between women, ovarian response also differs with potential negative consequences on pregnancy rates. A Markov decision-analytic model showed that FSH dose individualisation according to ovarian reserve is likely to be cost-effective in women who are eligible for IVF. However, this has never been confirmed in a large randomised controlled trial (RCT). The aim of the present study is to assess whether an individualised FSH dose regime based on an ovarian reserve test (ORT) is more cost-effective than a standard dose regime. Methods/Design Multicentre RCT in subfertile women indicated for a first IVF or intracytoplasmic sperm injection cycle, who are aged < 44 years, have a regular menstrual cycle and no major abnormalities at transvaginal sonography. Women with polycystic ovary syndrome, endocrine or metabolic abnormalities and women undergoing IVF with oocyte donation, will not be included. Ovarian reserve will be assessed by measuring the antral follicle count. Women with a predicted poor response or hyperresponse will be randomised for a standard versus an individualised FSH regime (150 IU/day, 225-450 IU/day and 100 IU/day, respectively). Participants will undergo a maximum of three stimulation cycles during maximally 18 months. The primary study outcome is the cumulative ongoing pregnancy rate resulting in live birth achieved within 18 months after randomisation. Secondary outcomes are parameters for ovarian response, multiple pregnancies, number of cycles needed per live birth, total IU of FSH per stimulation cycle, and costs. All data will be analysed according to the intention-to-treat principle. Cost-effectiveness analysis will be performed to assess whether the health and associated economic benefits of individualised treatment of subfertile women outweigh the additional costs of an ORT. Discussion The results of this study will be integrated into a decision model that compares cost-effectiveness of the three dose-adjustment strategies to a standard dose strategy. The study outcomes will provide scientific foundation for national and international guidelines. Trial registration NTR2657
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Affiliation(s)
- Theodora C van Tilborg
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Mutlu MF, Erdem A. Evaluation of ovarian reserve in infertile patients. J Turk Ger Gynecol Assoc 2012; 13:196-203. [PMID: 24592038 DOI: 10.5152/jtgga.2012.28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/13/2012] [Indexed: 11/22/2022] Open
Abstract
Diminished ovarian reserve is a more common occurrence as more women postpone childbearing in modern societies due to social and demographic trends. Diminished ovarian reserve is one of the primary reasons for poor ART outcome. Due to high costs, side effects and heavy burden on patients on ART treatments, patient selection and counseling for prognosis is an important aspect before starting ART. Proper prediction of ovarian reserve before initiation of the treatment can decrease cycle cancellations, help clinicians to establish alternative treatment options (i.e.oocyte donation) for poor prognosis patients. However, indicators of ovarian reserve are not fully successful in predicting the outcome of the treatment. In this review, our aim was to discuss the efficacy of ovarian reserve tests on predicting poor ovarian response and treatment outcome in ART patients.
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Affiliation(s)
- Mehmet Fırat Mutlu
- Department of Gynecology and Obstetrics, HRS Ankara Women Hospital, Ankara, Turkey
| | - Ahmet Erdem
- Department of Gynecology and Obstetrics, Faculty of Medicine, Gazi University, Ankara, Turkey
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Jirge PR. Ovarian reserve tests. J Hum Reprod Sci 2012; 4:108-13. [PMID: 22346076 PMCID: PMC3276943 DOI: 10.4103/0974-1208.92283] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/02/2011] [Accepted: 11/17/2011] [Indexed: 11/04/2022] Open
Abstract
Ovarian reserve plays a crucial role in achieving pregnancy following any treatment in subfertile women. The estimation of ovarian reserve is routinely performed through various ovarian reserve tests (ORTs) in an effort to predict the response and outcome in couples prior to In Vitro Fertilization and counsel them. Most widely used tests are basal follicle stimulating hormone and anti-Mullerian hormone and antral follicle count. The role of ORTs in our routine practice is discussed in this article. A MEDLINE search was done to identify suitable articles for review.
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Affiliation(s)
- Padma Rekah Jirge
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic, Kolhapur, India
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Kahapola Arachchige KM, Wardrop R, Lim EM, Stuckey B, Hadlow N. Waiting for an elevated FSH - Too late a marker of reduced ovarian reserve? Aust N Z J Obstet Gynaecol 2012; 52:460-4. [DOI: 10.1111/j.1479-828x.2012.01464.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 05/30/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Robert Wardrop
- PathWest Laboratory Medicine, Department of Biochemistry, Sir Charles Gairdner Hospital; Nedlands; WA; Australia
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[Low circulating anti-Müllerian hormone and normal follicle stimulating hormone levels: which prognosis in an IVF program?]. ACTA ACUST UNITED AC 2012; 40:411-8. [PMID: 22521986 DOI: 10.1016/j.gyobfe.2012.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/27/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL). PATIENTS AND METHODS A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve). RESULTS IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. DISCUSSION AND CONCLUSIONS This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.
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Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online 2012; 24:424-32. [DOI: 10.1016/j.rbmo.2011.12.012] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/15/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022]
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Enhanced hypothalamic-pituitary sensitivity to estrogen in premenopausal women with diminished ovarian reserve compared with older perimenopausal controls. Menopause 2011; 18:880-5. [PMID: 21712737 DOI: 10.1097/gme.0b013e31820cc564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We have previously characterized the reproductive hormone profile in infertile women with diminished ovarian reserve (DOR) as being distinct from that seen in age-comparable healthy controls. Hypothesizing that DOR reflects accelerated reproductive aging, we herein compare urinary reproductive hormone dynamics between young women with DOR and a population of chronologically older perimenopausal controls. METHODS In this prospective observational study, urinary levels of pituitary gonadotropins (follicle-stimulating hormone and luteinizing hormone) and metabolites of estrogen (estrone conjugate) and progesterone were assessed in daily morning urine samples collected in a spontaneous menstrual cycle in 8 infertile premenopausal women with DOR and in 11 perimenopausal controls. Areas under the curves were calculated for the respective measured hormones, and comparisons were made using the Mann-Whitney U test. RESULTS Urinary estrone conjugate levels were significantly attenuated in premenopausal women with DOR compared with the older perimenopausal cohort. Despite the relatively lower estrogen, a significantly more pronounced luteinizing hormone surge was evident in the younger population. Early follicle-stimulating hormone was lower in women with DOR, but luteal urinary progesterone excretion was comparable in the two groups. CONCLUSIONS Our data suggest distinctions in functioning of the central (hypothalamic-pituitary) and peripheral (ovarian) components of the hypothalamic-pituitary-ovarian axis in premenopausal women with DOR compared with chronologically older perimenopausal controls. Increased hypothalamic-pituitary sensitivity to estrogen positive feedback is suggested in premenopausal women with DOR. Our observations identify DOR as a distinct entity in the paradigm of reproductive senescence.
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