Menopausal women requesting egg/embryo donation: examining health screening guidelines for assisted reproductive technology

Risk Prediction Models of Natural Menopause Onset: A Systematic Review

CONTEXT

Predicting the onset of menopause is important for family planning and to ensure prompt intervention in women at risk of developing menopause-related diseases.

OBJECTIVE

We aimed to summarize risk prediction models of natural menopause onset and their performance.

METHODS

Five bibliographic databases were searched up to March 2022. We included prospective studies on perimenopausal women or women in menopausal transition that reported either a univariable or multivariable model for risk prediction of natural menopause onset. Two authors independently extracted data according to the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist. Risk of bias was assessed using a prediction model risk of bias assessment tool (PROBAST).

RESULTS

Of 8132 references identified, we included 14 articles based on 8 unique studies comprising 9588 women (mainly Caucasian) and 3289 natural menopause events. All included studies used onset of natural menopause (ONM) as outcome, while 4 studies also predicted early ONM. Overall, there were 180 risk prediction models investigated, with age, anti-Müllerian hormone, and follicle-stimulating hormone being the most investigated predictors. Estimated C-statistic for the prediction models ranged from 0.62 to 0.95. Although all studies were rated at high risk of bias mainly due to the methodological concerns related to the statistical analysis, their applicability was satisfactory.

CONCLUSION

Predictive performance and generalizability of current prediction models on ONM is limited given that these models were generated from studies at high risk of bias and from specific populations/ethnicities. Although in certain settings such models may be useful, efforts to improve their performance are needed as use becomes more widespread.

Embryo donation among Latin-Americans who have attended assisted reproduction techniques: a first empirical approach

Objective:

To determine whether Latin Americans who have undergone assisted reproduction techniques would donate embryos.

Methods:

This is a multinational cross-sectional study, involving 602 patients. We invited the Latin American Network of Assisted Reproduction centers. Those who accepted received the instrument distributed among the patients who agreed by signing the informed consent form. In total, 261 men and 341 women participated from seven countries.

Results:

Patients would donate their embryos as follows: treatment with embryonic stem cells (73.6%), heterosexual couples (63.8%), Assisted Reproduction Techniques (ART) research (57%), scientific or basic research (55.3%), research with embryonic stem cells (55.2%), premenopausal women (53.8%), single women (45.1%), people with disabilities (25.4%), lesbians (25.3%), menopausal women (25.2%), lesbian couples (24.6%), gay couples (19.6%), senile women (15.1%).

Conclusions:

The results favor embryos donation for research purposes, and a little less for clinical purposes, contrary to what was thought in qualitative studies conducted among Latin American populations.

Anti-Müllerian hormone, follicle stimulating hormone, antral follicle count, and risk of menopause within 5 years

OBJECTIVE

To evaluate the ability of concentration of anti-Müllerian hormone (AMH), antral follicle count (AFC), and concentration of follicle stimulating hormone (FSH) to predict the onset of menopause.

STUDY DESIGN

The Coronary Artery Risk Development in Young Adults Study (CARDIA) Women's Study was an ancillary study to CARDIA, a population-based study of adults aged 18-30 years followed for 3 decades. For this report, participants were women (n=426) who had attended the CARDIA year 15-16 (2000-2001) examination, had at least one ovary, were not pregnant, and underwent serum AMH and FSH measurement and transvaginal ultrasonography in 2002-2003.

MAIN OUTCOME MEASURES

The probability of menopause in 5 years based upon AMH, FSH, and AFC.

RESULTS

The mean age of the women at the time of AMH, FSH, and AFC assessment was 43 years. The cumulative incidence of menopause at 25 years (or follow-up) was 27% (n=426), and the incidence within 5 years was 13% (n=55). Among women aged 45-49 years, undetectable AMH concentrations were associated with a greater than 60% probability of menopause within 5 years, whereas approximately 1/3 of women with no or just one antral follicle experienced menopause within 5 years. Both low and high concentrations of FSH were associated with greater odds of menopause than intermediate concentrations. Models with multiple markers did not improve the prediction of menopause over that afforded by models with single markers.

CONCLUSION

The ability to predict onset of menopause was improved with any of the three menopausal markers in addition to age. AMH concentrations were more closely associated with menopause than AFC or FSH.