1
|
Farland LV, Valenti M, Degnan WJ, Bertone-Johnson ER, Harris HR, DiVasta AD, Rexrode KM, Eliassen AH, Missmer SA. Laparoscopically confirmed endometriosis and anti-Müllerian hormone levels: Findings from the Nurses' Health Study II. Maturitas 2024; 183:107969. [PMID: 38489917 PMCID: PMC11186619 DOI: 10.1016/j.maturitas.2024.107969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Anti-Müllerian hormone is a reliable measure of ovarian reserve associated with menopause timing and fertility. Previous studies have observed that individuals with endometriosis have lower anti-Müllerian hormone levels than those without. However, sample sizes have been small and information is limited regarding the long-term influence of endometriosis on anti-Müllerian hormone levels among the general population, which may have important implications for menopause timing and chronic disease risk. METHODS Among 1961 premenopausal women in the Nurses' Health Study II who provided a blood sample and had not been pregnant in the last 6 months, we used generalized linear models to determine the association between laparoscopically-confirmed endometriosis and log-transformed plasma anti-Müllerian hormone level, adjusted for age (continuous and squared) and other potential confounding variables. RESULTS Participants were on average 40 years old (interquartile range 37-42 years) at blood draw. Women with endometriosis diagnosed prior to blood draw (n = 119) had a lower mean anti-Müllerian hormone level (1.6 ng/mL [SD = 2.3]) than women without known endometriosis (n = 1842) (2.8 ng/mL [SD = 3.0]). In multivariable adjusted models, women with endometriosis had 29.6 % lower anti-Müllerian hormone levels (95 % CI: -45.4, -9.2 %) than women without. This association was greater among women with a body mass index of 25 kg/m2 or more (percent difference: -44.0 % (-63.7, -13.8)), compared to those with a body mass index of under 25 kg/m2 (percent difference: -19.8 % (-41.7, 10.4)), but did not vary by parity or infertility history. CONCLUSIONS Lower anti-Müllerian hormone levels in women with endometriosis may be one mechanism through which endometriosis influences risk of infertility, younger age at menopause, and cardiovascular disease.
Collapse
Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, Department of Obstetrics and Gynecology, College of Medicine -Tucson, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - Michelle Valenti
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - William J Degnan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, Department of Health Promotion and Policy, University of Massachusetts Amherst, 301 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, USA.
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave North, Seattle, WA, 98109, USA.
| | - Amy D DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, 181 Longwood Ave, Boston, MA, 02115, USA.
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA.
| |
Collapse
|
2
|
Lessans N, Gilan A, Dick A, Bibar N, Saar TD, Porat S, Dior UP. Ovarian reserve markers of women with superficial endometriosis. Int J Gynaecol Obstet 2024; 165:696-702. [PMID: 38124348 DOI: 10.1002/ijgo.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Endometriosis affects up to 10% of reproductive age women and is associated with pelvic pain and subfertility. While previous studies have shown an association between deep and ovarian endometriosis to reduced ovarian reserve, there is no data on the effect of superficial endometriosis on ovarian reserve markers. Hence, we aimed to compare ovarian reserve markers of women with superficial endometriosis to that of women without endometriosis. METHODS This was a case control study in a tertiary medical center. The study group included women aged 18-40 with surgically and histopathology-proven superficial endometriosis with no deep lesions or ovarian involvement. The control group included women with no known or suspected endometriosis and was matched to the study group by age, BMI and parity. We excluded women with other known risk factors for ovarian failure and with other gynecological disorders. Participants completed a questionnaire with demographic, medical and gynecological data. Each patient underwent anti-Mullerian hormone (AMH) testing and an ultrasound to assess their antral follicular count (AFC). AMH and AFC were then compared between groups. RESULTS A total of 124 women participated in the study. Of these, 50% (n = 62) had surgically proven superficial endometriosis and 50% (n = 62) were without known or suspected endometriosis. Mean AMH levels of women with and without superficial endometriosis was 3.0 ± 2.8 ng/mL and 2.8 ± 1.9 ng/mL, respectively (P = 0.71). AFC also did not differ between groups (women with superficial endometriosis: 12.0 ± 6.6; women without endometriosis: 10.2 ± 5.0, P = 0.15). CONCLUSIONS In our cohort, superficial endometriosis was not associated with diminished ovarian reserve. While further studies are needed, to date, it does not appear to be justified to assess ovarian reserve for patients with superficial endometriosis.
Collapse
Affiliation(s)
- Naama Lessans
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Gilan
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Dick
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Natalie Bibar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal D Saar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri P Dior
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
3
|
di Clemente N, Racine C, Pierre A, Taieb J. Anti-Müllerian Hormone in Female Reproduction. Endocr Rev 2021; 42:753-782. [PMID: 33851994 DOI: 10.1210/endrev/bnab012] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Anti-Müllerian hormone (AMH), also called Müllerian inhibiting substance, was shown to be synthesized by the ovary in the 1980s. This article reviews the main findings of the past 20 years on the regulation of the expression of AMH and its specific receptor AMHR2 by granulosa cells, the mechanism of action of AMH, the different roles it plays in the reproductive organs, its clinical utility, and its involvement in the principal pathological conditions affecting women. The findings in respect of regulation tell us that AMH and AMHR2 expression is mainly regulated by bone morphogenetic proteins, gonadotropins, and estrogens. It has now been established that AMH regulates the different steps of folliculogenesis and that it has neuroendocrine effects. On the other hand, the importance of serum AMH as a reliable marker of ovarian reserve and as a useful tool in the prediction of the polycystic ovary syndrome (PCOS) and primary ovarian failure has also been acknowledged. Last but not least, a large body of evidence points to the involvement of AMH in the pathogenesis of PCOS.
Collapse
Affiliation(s)
- Nathalie di Clemente
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France
| | - Chrystèle Racine
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France.,Sorbonne Paris Cité, Paris-Diderot Université, Paris, France
| | - Alice Pierre
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
| | - Joëlle Taieb
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
| |
Collapse
|
4
|
Dinsdale NL, Crespi BJ. Endometriosis and polycystic ovary syndrome are diametric disorders. Evol Appl 2021; 14:1693-1715. [PMID: 34295358 PMCID: PMC8288001 DOI: 10.1111/eva.13244] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
Evolutionary and comparative approaches can yield novel insights into human adaptation and disease. Endometriosis and polycystic ovary syndrome (PCOS) each affect up to 10% of women and significantly reduce the health, fertility, and quality of life of those affected. PCOS and endometriosis have yet to be considered as related to one another, although both conditions involve alterations to prenatal testosterone levels and atypical functioning of the hypothalamic-pituitary-gonadal (HPG) axis. Here, we propose and evaluate the novel hypothesis that endometriosis and PCOS represent extreme and diametric (opposite) outcomes of variation in HPG axis development and activity, with endometriosis mediated in notable part by low prenatal and postnatal testosterone, while PCOS is mediated by high prenatal testosterone. This diametric disorder hypothesis predicts that, for characteristics shaped by the HPG axis, including hormonal profiles, reproductive physiology, life-history traits, and body morphology, women with PCOS and women with endometriosis will manifest opposite phenotypes. To evaluate these predictions, we review and synthesize existing evidence from developmental biology, endocrinology, physiology, life history, and epidemiology. The hypothesis of diametric phenotypes between endometriosis and PCOS is strongly supported across these diverse fields of research. Furthermore, the contrasts between endometriosis and PCOS in humans parallel differences among nonhuman animals in effects of low versus high prenatal testosterone on female reproductive traits. These findings suggest that PCOS and endometriosis represent maladaptive extremes of both female life-history variation and expression of sexually dimorphic female reproductive traits. The diametric disorder hypothesis for endometriosis and PCOS provides novel, unifying, proximate, and evolutionary explanations for endometriosis risk, synthesizes diverse lines of research concerning the two most common female reproductive disorders, and generates future avenues of research for improving the quality of life and health of women.
Collapse
Affiliation(s)
| | - Bernard J. Crespi
- Department of Biological SciencesSimon Fraser UniversityBurnabyBCCanada
| |
Collapse
|
5
|
Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and Subfertility. Cells 2021; 10:cells10061381. [PMID: 34205040 PMCID: PMC8226491 DOI: 10.3390/cells10061381] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infertility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions.
Collapse
Affiliation(s)
- Teresa Mira Gruber
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Sylvia Mechsner
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Endometriosis Centre Charité, Department of Gynaecology, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence:
| |
Collapse
|
6
|
Suardi D, Permadi W, Djuwantono T, Hidayat YM, Bayuaji H, Edo Gautama GP. Correlation of Serum Anti-Mullerian Hormone (AMH) Level on Ovarian Volume in Women with Endometrioma. Int J Gen Med 2021; 14:1-8. [PMID: 33442285 PMCID: PMC7797296 DOI: 10.2147/ijgm.s272071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Background The correlation between endometrioma and serum Anti-mullerian hormone (AMH) level is a benchmark in determining the prognosis and management of endometrioma. Endometrioma causes a decrease in ovarian reserve due to tissue damage that affects the formation of serum AMH. Serum AMH levels in daily practice are useful as a tool to determine ovarian reserve, markers for diagnosis and prognosis in infertility and reproductive abnormalities. The purpose of this study was to determine the relationship of serum AMH level in women with endometrioma and their correlation to ovarian volume. Methods This research was an analytical observational study with a cross-sectional design in women of reproductive age who were diagnosed with endometrioma within the period of August 2019–March 2020 at Hasan Sadikin Hospital, Bandung. Forty-four women who met the inclusion and exclusion criteria were then divided into endometrioma (n=22) and control (n=22) groups. In both groups, transvaginal ultrasound examination was performed to measure the volume of the ovary, then a laboratory examination of serum AMH level was carried out. Results Serum AMH levels in the endometrioma group were significantly lower than those in the control group (P<0.001). Serum AMH level did not differ significantly based on laterality of the observation group (P=1.000). There was a negative correlation between serum AMH level and the volume of ovarian endometrioma, although not statistically significant (r=−0.332; P=0.066). Conclusion There was a correlation between serum AMH level and endometrioma. Serum AMH levels were significantly lower in the endometrioma group but were not influenced by their laterality. We found a negative correlation between serum AMH level and ovarian volume containing endometrioma, but not statistically significant.
Collapse
Affiliation(s)
- Dodi Suardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Wiryawan Permadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Tono Djuwantono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hartanto Bayuaji
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Gusti Putu Edo Gautama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| |
Collapse
|
7
|
Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med 2020; 47:1-11. [PMID: 32088944 PMCID: PMC7127898 DOI: 10.5653/cerm.2019.02971] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility. Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis. The severity of endometriosis is related to ovarian reserve. With regard to infertility treatment, medical therapy as a neoadjuvant or adjuvant to surgical therapy has no definite beneficial effect. Surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve. To overcome this disadvantage, a multistep technique has been proposed to minimize the reduction of ovarian reserve. When considering surgical treatment of endometriosis in patients experiencing infertility, it should be kept in mind that ovarian reserve can be reduced both due to endometriosis itself and by the process of removing endometriosis. In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy. In cases of severe endometriosis, the characteristics of the patient should be considered in a multidisciplinary manner to determine the prioritization of treatment modalities, including surgical treatment and assisted reproduction methods such as in vitro fertilization. The risk of cancer, complications after pregnancy, and infection during oocyte retrieval should also be considered when making treatment decisions.
Collapse
Affiliation(s)
- Dayong Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - 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
| |
Collapse
|
8
|
Hartono E, Budipramana E, Abdullah N, Tessy T. Ovarian Cystectomy: Stitching or Cauterizing - A Comparison Study of Anti-Mullerian Hormone Level Pre- and Postoperatively. Gynecol Minim Invasive Ther 2019; 8:101-105. [PMID: 31544019 PMCID: PMC6743229 DOI: 10.4103/gmit.gmit_58_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/09/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to analyze the influence of laparoscopic management in an ovarian cyst as measured by serum anti-Mullerian hormone (AMH) levels, by comparing cautery and suturing techniques. Subjects and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, and several private hospitals in Makassar, Indonesia, from January 1, 2016, to January 31, 2018. A total sample of 90 subjects diagnosed with ovarian cysts underwent cystectomy by laparoscopy. Serum AMH level was examined in all participants both preoperatively and 1-month postoperatively. Participants were divided into two groups based on cautery and suturing techniques used in the surgery. Serum AMH levels obtained were statistically analyzed and compared between cautery and suturing groups. P < 0.05 was considered statistically significant. Results: The research result indicated a significant decrease of AMH level in each sample groups using cautery and suturing techniques; however, it was not significantly different if both methods were statistically compared (mean AMH: 1.13 ± 0.34 and 1.02 ± 0.15, with P > 0.05). Both the groups showed a greater decrease with a significant result in endometriotic cyst type and when adhesion was present during laparoscopy (P < 0.05). Other parameters such as unilateral/bilateral cyst and variety of cyst size were not showing significant differences (P > 0.05). Conclusions: This study showed that serum AMH levels clearly decreased after operative laparoscopy for different types of ovarian cysts in female patients; however, there is no significant difference regardless of surgical procedures.
Collapse
Affiliation(s)
- Eddy Hartono
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia.,The International Society for Gynaecologic Endoscopy Board Member 2017-2021
| | - Edwin Budipramana
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Nusratuddin Abdullah
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Telly Tessy
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| |
Collapse
|
9
|
Karadağ C, Yoldemir T, Demircan Karadağ S, Turgut A. The effects of endometrioma size and bilaterality on ovarian reserve. J OBSTET GYNAECOL 2019; 40:531-536. [PMID: 31460808 DOI: 10.1080/01443615.2019.1633518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this study was to investigate the effects of endometrioma (OMAs) size and bilaterality on ovarian reserve. The patients with OMA were determined by ultrasonographic examination. Fifty patients with unilateral OMA (Group A), 30 patients with bilateral OMA (Group B), and 60 women without ovarian cysts (Group C) were included in this study. AMH levels were measured, and antral follicle count (AFC) was determined. The mean serum AMH levels were significantly lower in Group B than Groups C and A, and were significantly lower in Group A than Group C. There was a significant correlation between serum AMH level and OMA size in Group A (R = -.372, p = .008). OMAs per se appear to be associated with damage to the ovarian reserve. Increased OMA size is related to decreased AMH levels in patients with OMA. Bilateral OMAs have a more destructive effect on ovarian reserve.IMPACT STATEMENTWhat is already known on this subject? Previous Studies have demonstrated the effect of surgery on ovarian reserve but there have been contradictory findings reported about the effects of OMAs per se on serum AMH levels and it has not been clear what the relation between OMAs size and AMH levels is, if any.What the results of this study add? In this study, we found decreased AMH levels in patients with OMA. The results showed significant negative correlation between OMA size and AMH levels. The patients with bilateral OMAs had lower AMH levels than the unilateral ones.What the implications are of these findings for clinical practice and/or further research? Increasing OMA size might be harmful to ovarian reserve. Further studies should be done to evaluate whether increasing the size of the OMA is associated with a progressive decline in ovarian reserve and to better clarify the role of the OMAs per se or of laparoscopic surgery in the determination of damage to the ovarian reserve.
Collapse
Affiliation(s)
- Cihan Karadağ
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynecology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sinem Demircan Karadağ
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| |
Collapse
|
10
|
|
11
|
Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Di Donato V, Musella A, Palaia I, Panici PB. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis. Fertil Steril 2019; 110:932-940.e1. [PMID: 30316440 DOI: 10.1016/j.fertnstert.2018.06.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/22/2018] [Accepted: 06/17/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate if the presence of endometriomas impacts on the ovarian reserve as evaluated with antimüllerian hormone (AMH). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Patients with unoperated endometriomas versus controls without endometriomas. INTERVENTION(S) Electronic databases searched up to June 2017 to identify articles evaluating AMH levels in patients with unoperated endometriomas versus controls without endometriomas. MAIN OUTCOME MEASURE(S) The primary analysis was aimed at evaluation of AMH levels (mean and SD) in patients with and without endometriomas. Secondary analyses were aimed at evaluating AMH levels in patients with ovarian endometriomas compared to patients with either non-endometriosis benign ovarian cysts or healthy ovaries. RESULT(S) Of the 39 studies evaluated in detail, 17 were included, for a total of 968 patients with endometriomas and 1874 without endometriomas. AMH was significantly lower in patients with unoperated endometriomas compared to patients with no endometriomas (mean difference -0.84, with 95% confidence interval [CI] -1.16 to -0.52). At secondary analyses, AMH in patients with endometriomas was significantly lower both versus non-endometriosis benign ovarian cysts (mean difference -0.85, 95% CI -1.37 to -0.32, and versus women with healthy ovaries (mean difference -0.61, 95% CI -0.99 to -0.24). CONCLUSION(S) Ovarian reserve evaluated with AMH is reduced in patients with ovarian endometriomas compared both to patients with other benign ovarian cysts, and to patients with healthy ovaries.
Collapse
Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
| | - Chiara Di Tucci
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | | | - Giulia Galati
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Angela Musella
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Innocenza Palaia
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | | |
Collapse
|
12
|
Inal ZO, Engin Ustun Y, Yilmaz N, Aktulay A, Bardakci Y, Gulerman C. Does the anti-Müllerian hormone truly reflect ovarian response in women with endometrioma? J OBSTET GYNAECOL 2019; 39:516-521. [PMID: 30744464 DOI: 10.1080/01443615.2018.1533542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2-4) vs. 3 (2-3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p = .135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p = .125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI. Impact statement What is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response. What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI). What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?
Collapse
Affiliation(s)
- Zeynep Ozturk Inal
- a Department of Reproductive Endocrinology , Konya Education and Research Hospital , Konya , Turkey
| | - Yaprak Engin Ustun
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Nafiye Yilmaz
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Ayla Aktulay
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Yesim Bardakci
- c Department of Embryology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Cavidan Gulerman
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| |
Collapse
|
13
|
Ashrafi M, Arabipoor A, Hemat M, Salman-Yazdi R. The impact of the localisation of endometriosis lesions on ovarian reserve and assisted reproduction techniques outcomes. J OBSTET GYNAECOL 2018; 39:91-97. [PMID: 30257599 DOI: 10.1080/01443615.2018.1465898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This case-control study was designed to evaluate the impact of endometriosis and the presence of endometrioma (OMA) per se on the serum anti-Müllerian hormone (AMH) level and also to compare the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes after therapeutic surgery in endometriosis patients, according to the localisation of endometriosis lesions. One hundred and fifty two infertile women ≤40 years with suspicious symptoms were surgically evaluated to detect the aetiology of infertility at the Royan Institute during this study and, in parallel, 131 patients with a male factor infertility diagnosis were considered as the control group. The serum AMH level and IVF/ICSI outcomes were compared according to the nature and extension degree of endometriosis lesions. The results demonstrated that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in AMH level, antral follicle count and ovarian sensitivity index (OSI) (p < .001 and p = .007, respectively). The multivariable logistic regression analysis adjusted for confounding factors indicated that the OSI and the existence of DIE with and without OMA were a significant predictive variable for clinical pregnancy and for live birth. On the basis of our results, the severity of endometriosis and the location of its lesions could affect an ovarian reserve and the ovarian stimulation outcomes. Impact Statement What is already known on this subject? Previous studies have evaluated the impact of endometrioma (OMA) on ovarian reserve and the assisted reproduction technology (ART) outcomes and controversial results have been reported; therefore, it seems that this topic still needs further research. What the results of this study add? In the present study, the effect of endometriosis lesions' localisation on ovarian reserve and the success rate of the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycle after therapeutic surgery were compared with that of the control group. It was found that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in the anti-Müllerian hormone (AMH) level, antral follicle count, ovarian sensitivity index (OSI), clinical pregnancy and live birth rates. What the implications are of these findings for clinical practice and/or further research? The results of this study has a practical value in the decision making process for the ovarian stimulation protocol in patients with the different severity of endometriosis and the counselling regarding the success rate of IVF or ICSI/embryo transfer cycles.
Collapse
Affiliation(s)
- Mahnaz Ashrafi
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR , Tehran , Iran.,b Department of Obstetrics and Gynecology, School of Medicine , Iran University of Medical Science , Tehran , Iran
| | - Arezoo Arabipoor
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR , Tehran , Iran
| | - Mandana Hemat
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR , Tehran , Iran
| | - Reza Salman-Yazdi
- c Department of Andrology , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR , Tehran , Iran
| |
Collapse
|
14
|
Borges E, Braga DPAF, Setti A, Figueira RDC, Iaconelli A. The predictive value of serum concentrations of anti-Müllerian hormone for oocyte quality, fertilization, and implantation. JBRA Assist Reprod 2017; 21:176-182. [PMID: 28837024 PMCID: PMC5574637 DOI: 10.5935/1518-0557.20170035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to identify a possible correlation between serum levels of
anti-Müllerian hormone (AMH) and oocyte quality, embryo developmental
competence, and implantation potential. Methods 4488 oocytes obtained from 408 patients undergoing ICSI cycles were
evaluated. Oocyte dimorphisms, embryo quality on days two and three,
blastocyst formation competence, fertilization rates, implantation rates,
and pregnancy rates were correlated with serum levels of AMH using Pearson's
correlation coefficient and regression analysis. Results A positive correlation was observed between serum levels of AMH and number of
retrieved oocytes (CC: 0.600, p<0.001), fertilization
rate (CC:0.595, p=0.048), and number of obtained embryos
(CC:0.495, p<0.001). AMH did not affect the quality of
cleavage stage embryos or the chance of blastocyst formation. However, AMH
levels affected oocyte quality (OR:0.75, CI 0.44-0.96,
p<0.001), and implantation (CC:0,116,
p=0.031) and pregnancy (OR:1.22, CI:1.03-1.53,
p<0.001) rates. Conclusion Serum levels of AMH are a useful predictor of ovarian response to COS, oocyte
quality, and fertilization. However, AMH levels may also compromise clinical
outcomes; lower AMH levels did not impair embryo development.
Collapse
Affiliation(s)
- Edson Borges
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| | - Daniela P A F Braga
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil.,Disciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São Paulo, São Paulo, SP - Brazil
| | - Amanda Setti
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| | | | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| |
Collapse
|
15
|
De Conto E, Matte Ú, Bilibio JP, Genro VK, Souza CA, Leão DP, Cunha-Filho JS. Endometriosis-associated infertility: GDF-9, AMH, and AMHR2 genes polymorphisms. J Assist Reprod Genet 2017; 34:1667-1672. [PMID: 28831646 DOI: 10.1007/s10815-017-1026-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this paper is to determine whether there is a correlation between polymorphisms in the growth differentiation factor-9 (GDF-9) gene and anti-Müllerian hormone (AMH) gene and its receptor, AMHR2, and endometriosis-associated infertility. METHODS This is a case-control study to evaluate whether there is a correlation between polymorphisms in the GDF-9 gene (SNPs determined by direct sequencing), AMH gene, AMHR2 (both SNPs determined by genotyping using TaqMan Allelic Discrimination), and endometriosis-associated infertility. The study included 74 infertile women with endometriosis and 70 fertile women (tubal ligation) as a control group. RESULTS Patient age and the mean FSH levels were similar between the infertile with endometriosis and fertile without endometriosis groups. The frequency of genotypes between the groups for GDF-9 gene polymorphisms did not show statistical significance, nor did the AMHR2 gene polymorphism. However, the AMH gene polymorphism did show statistical significance, relating the polymorphic allele with infertility in endometriosis. CONCLUSIONS We demonstrate that an SNP in the AMH gene is associated with infertility in endometriosis, whereas several SNPs in the GDF-9 gene and the - 482A G SNP in the AMHR2 gene were found to be unrelated.
Collapse
Affiliation(s)
- Emily De Conto
- UFRGS - Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama, 110, Porto Alegre, RS, CEP 90.040-060, Brazil. .,HCPA - Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2.350, Porto Alegre, RS, CEP 90.035-903, Brazil.
| | - Úrsula Matte
- HCPA - Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2.350, Porto Alegre, RS, CEP 90.035-903, Brazil
| | - João Paolo Bilibio
- UFRGS - Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama, 110, Porto Alegre, RS, CEP 90.040-060, Brazil
| | - Vanessa Krebs Genro
- HCPA - Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2.350, Porto Alegre, RS, CEP 90.035-903, Brazil
| | - Carlos Augusto Souza
- HCPA - Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2.350, Porto Alegre, RS, CEP 90.035-903, Brazil
| | - Delva Pereira Leão
- UFRGS - Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama, 110, Porto Alegre, RS, CEP 90.040-060, Brazil
| | - João Sabino Cunha-Filho
- UFRGS - Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama, 110, Porto Alegre, RS, CEP 90.040-060, Brazil
| |
Collapse
|
16
|
Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol 2017; 217:129-140. [PMID: 28235465 DOI: 10.1016/j.ajog.2017.02.027] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
Ovarian reserve is a complex clinical phenomenon influenced by age, genetics, and environmental variables. Although it is challenging to predict the rate of an individual's ovarian reserve decline, clinicians are often asked for advice about fertility potential and/or recommendations regarding the pursuit of fertility treatment options. The purpose of this review is to summarize the state-of-the-art of ovarian reserve testing, providing a guide for the obstetrician/gynecologist generalist and reproductive endocrinologist. The ideal ovarian reserve test should be convenient, be reproducible, display little if any intracycle and intercycle variability, and demonstrate high specificity to minimize the risk of wrongly diagnosing women as having diminished ovarian reserve and accurately identify those at greatest risk of developing ovarian hyperstimulation prior to fertility treatment. Evaluation of ovarian reserve can help to identify patients who will have poor response or hyperresponse to ovarian stimulation for assisted reproductive technology. Ovarian reserve testing should allow individualization of treatment protocols to achieve optimal response while minimizing safety risks. Ovarian reserve testing may inform patients regarding their reproductive lifespan and menopausal timing as well as aid in the counselling and selection of treatment for female cancer patients of reproductive age who receive gonadotoxic therapy. In addition, it may aid in establishing the diagnosis of polycystic ovary syndrome and provide insight into its severity. While there is currently no perfect ovarian reserve test, both antral follicular count and antimüllerian hormone have good predictive value and are superior to day-3 follicle-stimulating hormone. The convenience of untimed sampling, age-specific values, availability of an automated platform, and potential standardization of antimüllerian hormone assay make this test the preferred biomarker for the evaluation of ovarian reserve in women.
Collapse
|
17
|
Hosseini E, Nikmard F, Aflatoonian B, Vesali S, Alenabi T, Aflatoonian A, Mehraein F, Aflatoonian R. CONTROLLED OVARIAN STIMULATION IN ENDOMETRIOSIS PATIENTS CAN BE INDIVIDUALIZED BY ANTI-MÜLLERIAN HORMONE LEVELS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2017; 13:195-202. [PMID: 31149173 PMCID: PMC6516439 DOI: 10.4183/aeb.2017.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis. OBJECTIVE This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRH-antagonist(GnRH-ant) protocols in endometriosis patients. DESIGN This is a cross-sectional study between March 2012 and November 2015. SUBJECTS AND METHODS Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated. RESULTS The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL. CONCLUSIONS This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.
Collapse
Affiliation(s)
- E. Hosseini
- Iran University of Medical Sciences, School of Medicine, Dept. of Anatomy, Tehran, Iran
| | - F. Nikmard
- Iran University of Medical Sciences, School of Medicine, Dept. of Anatomy, Tehran, Iran
| | - B. Aflatoonian
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Tehran, Iran
| | - S. Vesali
- Dept. of Epidemiology and Reproductive Health at Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - T. Alenabi
- Assisted Conception Unit, Laleh Hospital, Tehran, Iran
| | - A. Aflatoonian
- Assisted Conception Centre, Yazd Reproductive Sciences Institute, Yazd Shahid Sadoughi University For Medical Sciences, Yazd, Tehran, Iran
| | - F. Mehraein
- Iran University of Medical Sciences, School of Medicine, Dept. of Anatomy, Tehran, Iran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - R. Aflatoonian
- Iran University of Medical Sciences, School of Medicine, Dept. of Anatomy, Tehran, Iran
| |
Collapse
|
18
|
Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol 2016; 215:589.e1-589.e6. [PMID: 27242204 DOI: 10.1016/j.ajog.2016.05.029] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many women who experience endometriosis and endometriomas also encounter problems with fertility. OBJECTIVE The purpose of this study was to determine the impact of surgical excision of endometriosis and endometriomas compared with control subjects on ovarian reserve. STUDY DESIGN This was a prospective cohort study of 116 women aged 18-43 years with pelvic pain and/or infertility who underwent surgical treatment of suspected endometriosis (n=58) or endometriomas (n=58). Based on surgical findings, the suspected endometriosis group was further separated into those with evidence of peritoneal disease (n=29) and those with no evidence of endometriosis (n=29). Ovarian reserve was measured by anti-Müllerian hormone and compared before surgery and at 1 month and 6 months after surgery. RESULTS Baseline anti-Müllerian hormone values were significantly lower in the endometrioma vs negative laparoscopy group (1.8 ng/mL [95% confidence interval, 1.2-2.4 ng/mL] vs 3.2 ng/mL [95% confidence interval, 2.0-4.4 ng/mL]; P<.02), but the peritoneal endometriosis group was not significantly different than either of these groups. Only patients with endometriomas had a significant decline in ovarian reserve at 1 month (-48%; 95% confidence interval, -54 to -18%; P<.01; mean anti-Müllerian hormone baseline value, 1.77-1.12 ng/mL at 1 month). Six months after surgery, anti-Müllerian hormone values continued to be depressed from baseline but were no longer significantly different. The rate of anti-Müllerian hormone decline was correlated positively with baseline preoperative anti-Müllerian hormone values and the size of endometrioma that was removed. Those with bilateral endometriomas (n=19) had a significantly greater rate of decline (53.0% [95% confidence interval, 35.4-70.5%] vs 17.5% [95% confidence interval, 3.2-31.8%]; P=.002). CONCLUSION At baseline, patients with endometriomas had significantly lower anti-Müllerian hormone values compared with women without endometriosis. Surgical excision of endometriomas appears to have temporary detrimental effects on ovarian reserve.
Collapse
|
19
|
Chun S, Cho HJ, Ji YI. Comparison of early postoperative decline of serum antiMüllerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis. Taiwan J Obstet Gynecol 2016; 55:641-645. [DOI: 10.1016/j.tjog.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 10/20/2022] Open
|
20
|
Shebl O, Sifferlinger I, Habelsberger A, Oppelt P, Mayer RB, Petek E, Ebner T. Oocyte competence in in vitro fertilization and intracytoplasmic sperm injection patients suffering from endometriosis and its possible association with subsequent treatment outcome: a matched case-control study. Acta Obstet Gynecol Scand 2016; 96:736-744. [PMID: 27317364 DOI: 10.1111/aogs.12941] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Endometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome. MATERIAL AND METHODS Oocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997. RESULTS Patients with endometriosis had a significantly lower rate of mature oocytes (p < 0.03) and morphologically normal oocytes (p < 0.001). In particular, brownish oocytes (p < 0.009; stage I-IV) and the presence of refractile bodies (p < 0.001; stage IV) were found to be increased. Endometriosis stage IV was associated with significantly worse-quality oocytes than stages I-III (p < 0.01). Fertilization was significantly reduced in conventional in vitro fertilization but not in intracytoplasmic sperm injection (p < 0.03). This was due to lower fertilization rates in stage III-IV endometriosis compared with stage I-II (p < 0.04). No difference was observed with respect to rates of implantation, clinical pregnancy, miscarriage, live birth, and malformation. CONCLUSIONS Endometriosis patients, in particular those with severe endometriosis, present lower-quality oocytes. Once fertilized, no impairment of further preimplantation embryo development and pregnancy outcome right up to healthy live birth rate has to be expected.
Collapse
Affiliation(s)
- Omar Shebl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | | | - Alwin Habelsberger
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Richard B Mayer
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Erwin Petek
- Institute of Human Genetics, Medical University, Graz, Austria
| | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| |
Collapse
|
21
|
Salihoğlu KN, Dilbaz B, Cırık DA, Ozelci R, Ozkaya E, Mollamahmutoğlu L. Short-Term Impact of Laparoscopic Cystectomy on Ovarian Reserve Tests in Bilateral and Unilateral Endometriotic and Nonendometriotic Cysts. J Minim Invasive Gynecol 2016; 23:719-25. [DOI: 10.1016/j.jmig.2016.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 01/07/2023]
|
22
|
Kinderwunsch und Schwangerschaft bei Endometriose. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-015-0052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
23
|
The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet 2016; 33:317-323. [PMID: 26768141 DOI: 10.1007/s10815-016-0646-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/03/2016] [Indexed: 12/29/2022] Open
Abstract
Patients affected with severe endometriosis are at significant risk for ovarian tissue damage, which may lead to infertility, reduced response to ovarian stimulation, and occasionally, premature ovarian failure. The risk for a compromised ovarian reserve in young patients is especially high following repeated surgical intervention and in the presence of bilateral endometriomas. In many cases, enhanced loss of ovarian reserve may also result from the damaging effect of the pathologic process on follicle reservoir even without surgical interventions. Women diagnosed with severe endometriosis and those designated for extensive ovarian surgical intervention are frequently not planning to conceive. In light of recent advances in fertility preservation techniques (FPT), such as oocytes and ovarian tissue freezing, as well as their increasing success rates, we critically evaluate the options for FPT in patients suffering from endometriosis. Personalized counseling should be offered to all patients with endometriosis taking into account age, extent of ovarian involvement, current ovarian reserve, previous and impending surgeries for endometriosis, along with current success rates and possible risks associated with FPT.
Collapse
|
24
|
Jeon JH, Park SY, Lee SR, Jeong K, Chung HW. Serum Anti-Müllerian Hormone Levels before Surgery in Patients with Ovarian Endometriomas Compared to Other Benign Ovarian Cysts. J Menopausal Med 2015; 21:142-8. [PMID: 26793679 PMCID: PMC4719088 DOI: 10.6118/jmm.2015.21.3.142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate preoperative anti-Müllerian hormone (AMH) levels in women with endometrioma or other benign ovarian cysts and differences of AMH changes according to various characteristics. METHODS Ninety-seven patients aged 20 to 39 years who underwent surgery for benign ovarian cyst were enrolled retrospectively. Of these, 65 patients were diagnosed as endometriomas, and 32 had other benign cysts. Serum AMH, mean, maximum, and total diameter of ovarian cysts were measured. The AMH levels were compared according to pathology (endometrioma vs. other benign cyst), size of ovarian cyst, age-matched AMH quartile percentile and characteristics of endometrioma. RESULTS Preoperative serum AMH level was significantly lower in endometrioma group than other benign cyst group (4.12 ± 2.42 ng/mL vs. 6.02 ± 2.29 ng/mL, P < 0.001). Serum AMH level was significantly lower in endometrioma group, especially in patients aged 30 to 39 years. Dividing to age-matched AMH quartile percentile, there were significantly fewer patients with AMH level ≥ 75 percentile in endometrioma group (24.6% vs. 50.0%, P = 0.035). Among 4 subgroups of endometrioma, patients with AMH level ≥ 75 percentile were significantly decreased in multiple bilateral endometrioma group. Mean and total diameter of cysts were negatively correlated with preoperative serum AMH level in other benign cyst group. CONCLUSION We suggest that preoperative AMH level measurement might be considered in women with endometrioma, especially in 30 to 39 years old, multiple bilateral type, or big-sized other benign ovarian cyst to assess the diminished ovarian reserve.
Collapse
Affiliation(s)
- Ji Hyun Jeon
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - So Yun Park
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Won Chung
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Korea
| |
Collapse
|
25
|
Mostaejeran F, Hamoush Z, Rouholamin S. Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis. Adv Biomed Res 2015; 4:182. [PMID: 26605221 PMCID: PMC4617155 DOI: 10.4103/2277-9175.164006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/15/2013] [Indexed: 11/20/2022] Open
Abstract
Background: Serum antimullerian hormone (AMH) proposed to be a reliable marker of ovarian reserve; the aim of this study was to evaluate the influence and value of laparoscopic management in endometriosis as measured by serum AMH levels. Materials and Methods: In this cross-sectional study, 33 infertile patients who referred to fertility - Infertility Center of Isfahan - with different stages of endometriosis managed by diagnostic operative laparoscopy and serum AMH levels were measured pre and one month postoperative laparoscopy. Main outcome measures were serum AMH levels in correlation with the type of infertility, stage of endometriosis, and type of surgery in infertile patients. Results: 33 infertile patients enrolled in the study with mean age 28.9 ± 5 years, and thus did not show a significant difference. Mean serum AMH levels was 4.23 ± 3.75 ng/ml and 2.2 ± 2.47 ng/ml, respectively, in primary and secondary infertility groups before and one month after laparoscopy, which shows a significant difference (P < 0.001). Median AMH level changes in Cauterization (0.67 ± 0.76 ng/ml), endometrioma excision 2 ± 0.6 ng/ml, both 2.18 ± 0.81 ng/ml and shows no significant differences. Mean serum AMH levels were definitely decreased in minimal/mild and severe stage endometriosis before and 1 month after laparoscopy, (1.84 ± 2.06 ng/ml and 2.18 ± 3.45 ng/ml), respectively. Also serum AMH according to ovarian appearance and evolvement showed no significant differences after laparoscopy: (5.5 ± 1.4 ng/ml and 2.76 ± 0.96 ng/ml) and (3.37 ± 2.2 ng/ml and 1.84 ± 1.5 ng/ml). Conclusion: Serum AMH levels clearly decreased 1 month after operative laparoscopy.
Collapse
Affiliation(s)
- Fatemeh Mostaejeran
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Hamoush
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
26
|
Nieweglowska D, Hajdyla-Banas I, Pitynski K, Banas T, Grabowska O, Juszczyk G, Ludwin A, Jach R. Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery. Reprod Biol Endocrinol 2015; 13:128. [PMID: 26596960 PMCID: PMC4657379 DOI: 10.1186/s12958-015-0125-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/17/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. The present study was a prospective analysis of age-dependent AMH serum concentration in women with bilateral and unilateral ovarian endometriomas before therapy onset compared with healthy controls. METHODS This prospective cross-sectional study included 384 women aged 18-48 years. AMH serum concentration was assessed between days 3 and 6 of the menstrual cycle in 78 patients with bilateral and 157 patients with unilateral ovarian endometriomas and compared with 149 healthy controls. Ovarian endometriosis was confirmed histopathologically, and data were presented as medians with interquartile range (IQR). RESULTS Stage III endometriosis was diagnosed in 53.2 %, stage IV in 18.3 %, stage V in 23.4 % and stage VI in 5.4 % of the patients. Patients with bilateral ovarian endometriomas showed the lowest median AMH levels compared with patients suffering from unilateral ovarian endometriosis (0.55; IQR: 0.59 vs. 2.00; IQR: 2.80; p < 0.001) and the control group (0.55; IQR: 0.59 vs. 2.84; IQR: 3.2; p < 0.001). Median AMH concentration values were not significantly different between patients with unilateral ovarian endometriosis and the healthy controls (2.00; IQR: 2.80 vs. 2.84; IQR: 3.2; p = 0.182). A strongly negative correlation between AMH levels and age was confirmed in healthy individuals (R = -0.834; p < 0.001) and women with unilateral ovarian endometriomas (R = -0.774; p < 0.001). Patients with bilateral ovarian endometriosis showed a significantly negative but only moderate correlation between AMH levels and age (R = -0.633; p < 0.001), which was significantly lower than in the healthy controls (R = -0.633 vs. R = -0.834; p = 0.006) but not in the patients with unilateral ovarian endometriosis (R = -0.663 vs. R-0.774; p = 0.093). Based on a multivariate regression analysis, only bilateral localization of ovarian endometrial cysts (p = 0.003) and patient age (p < 0.001), but not left/right localization of unilateral cyst or cyst volume, were negatively associated with AMH serum concentration. CONCLUSION According to our data, unilateral ovarian endometriosis had a moderately negative and nonsignificant effect on AMH-based ovarian reserve evaluated prior to surgery, irrespective of age. In contrast, the ovarian reserve was significantly reduced in women with bilateral ovarian endometriomas.
Collapse
Affiliation(s)
- Dorota Nieweglowska
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Iwona Hajdyla-Banas
- Center of Rheumatology, Immunology and Rehabilitation, Dietl Specialistic Hospital, Krakow, Poland
| | - Kazimierz Pitynski
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland.
| | - Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Oliwia Grabowska
- Nuffield Division of Clinical Laboratory Science, University of Oxford, Level 4, John Radcliffe Hospital, Headington, OX3 9DU, Oxford, UK
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Robert Jach
- Department of Gynecological Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
27
|
Chiang HJ, Lin PY, Huang FJ, Kung FT, Lin YJ, Sung PH, Lan KC. The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. BMC WOMENS HEALTH 2015; 15:74. [PMID: 26359251 PMCID: PMC4566490 DOI: 10.1186/s12905-015-0230-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 08/25/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. METHODS A total of 829 female patients were recruited. Their medical records were reviewed retrospectively. Patients who had diagnoses of endometriosis or endometrioma were defined as the endometriosis group, and those without endometriosis were as the control group. We further divided these patients into four groups according to whether they had received ovarian surgeries before. Group 1: control group without previous surgery; Group 2: control group with previous surgery; Group 3: endometriosis group without previous surgery; Group 4: endometriosis group with previous surgery. The subgroups with endometrioma or not and different operative procedures were also analyzed. The parameters for comparison included age, body mass index, serum estradiol, follicle-stimulating hormone, luteinizing hormone, cancer antigen 125, and anti-Müllerian hormone (AMH) level. RESULTS The level of serum AMH was highest in group 1 and lowest in group 4. The decline was significant between group 1 and group 4 (p < 0.05). The serum AMH level was lower in group 4 than in group 3 but no significant difference. Serum estradiol level was significantly higher in group 3 than in group 2 (p < 0.05). Cancer antigen 125 levels were both significantly higher in group 3 and group 4 as compared with group 1 and group 2 (p < 0.05). CONCLUSIONS Performing repeated ovarian surgery in patients with recurrent endometriosis needs careful consideration and adequate patient counselling because of the predictable deteriorating ovarian reserve.
Collapse
Affiliation(s)
- Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Pin-Yao Lin
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| |
Collapse
|
28
|
Abstract
Endometriosis is characterized by development of the endometrial tissue outside the uterus like ovary, pelvic peritoneum, pelvic organs, and affects 6-10% of reproductive-aged women. The prevalence of endometrioma is 17-44% of women with endometriosis. Since endometriosis is mainly a disease for the women at their reproductive ages, it is important to consider ovarian reserve when managing the cases with ovarian endometriosis. There has been a long debate whether the endometrioma per se decreases the ovarian reserve and/or surgery for endometrioma - either by laparoscopy or by laparotomy - decreases it. Although the dispute for these questions is not totally settled down, in this article, we would like to give some clues for the answers in view of the literature.
Collapse
|
29
|
Abstract
Endometrioma surgery should be planned and executed very carefully as it is associated with risks that may hamper future reproductive potential. Symptoms, age, risk of malignancy, bilaterality, ovarian reserve, and desire to have children should all be taken into account prior to surgical intervention. Cyclic and noncyclic severe pain may be an indicator or deep infiltrating diseases. Laparoscopic surgery is the gold standard, however, the issue of resection versus ablation should be further studied.
Collapse
Affiliation(s)
- Bulent Urman
- Obstetrics & Gynecology & Assisted Reproduction Unit, American Hospital, Istanbul, Department of Obstetrics & Gynecology, Koc University, Faculty of Medicine, Guzelbahce sokak No:20, Nisantasi, Istanbul, Turkey
| |
Collapse
|
30
|
Hipp H, Loucks TL, Nezhat C, Sidell N, Session DR. Anti-Müllerian Hormone in Peritoneal Fluid and Plasma From Women With and Without Endometriosis. Reprod Sci 2015; 22:1129-33. [PMID: 25824010 DOI: 10.1177/1933719115578927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anti-Müllerian hormone (AMH) has potential local effects on ovarian function and endometrial tissue, including endometriosis, but its presence in peritoneal fluid is not fully understood. This is a cross-sectional study evaluating AMH in peritoneal fluid and plasma from women with endometriosis (N = 61) and from control women without endometriosis (N = 36). There was a significant correlation between AMH in plasma and peritoneal fluid from both patients with endometriosis (r(2) = .767 [P < .001]) and control participants (r(2) = .647 [P < .001]) less than 45 years of age. Anti-Müllerian hormone declined with women's increasing age in both plasma and peritoneal fluid in women with and without endometriosis. There were no differences in the plasma or peritoneal fluid AMH in women with endometriosis versus control women. The strong relationship between plasma and peritoneal fluid may allow plasma AMH to be a marker for peritoneal AMH in studies evaluating the local effects of AMH.
Collapse
Affiliation(s)
- Heather Hipp
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Tammy L Loucks
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Neil Sidell
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donna R Session
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
31
|
Signorile PG, Baldi A. A Tissue Specific Magnetic Resonance Contrast Agent, Gd-AMH, for Diagnosis of Stromal Endometriosis Lesions: A Phase I Study. J Cell Physiol 2015; 230:1270-5. [DOI: 10.1002/jcp.24862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/30/2014] [Indexed: 11/10/2022]
|
32
|
Wahd SA, Alalaf SK, Al-Shawaf T, Al-Tawil NG. Ovarian reserve markers and assisted reproductive technique (ART) outcomes in women with advanced endometriosis. Reprod Biol Endocrinol 2014; 12:120. [PMID: 25442239 PMCID: PMC4266956 DOI: 10.1186/1477-7827-12-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/26/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The role of ovarian reserve markers as predictors of the controlled ovarian stimulation (COS) response in intracytoplasmic sperm injection (ICSI) cycles in women with endometriosis has been much debated. The aim of the present study is to assess the predictability of ovarian reserve markers for the number of mature oocytes (MII) retrieved and to assess the pregnancy rate and live birth rate in women with advanced endometriosis. METHODS Two hundred eighty-five infertile women who had laparoscopy followed by a first ICSI cycle were recruited in this prospective study. One hundred ten patients were diagnosed with endometriosis stage III-IV (group 1), and 175 patients had no endometriosis (group II). Sixty-three patients in group 1 had no history of previous endometrioma surgery (group Ia), and 47 patients had a history of previous endometrioma surgery (group Ib). RESULTS The number of mature oocytes retrieved was significantly lower in women with advanced endometriosis than in women with no endometriosis. The number of mature oocytes retrieved in women with and without endometriosis was best predicted by antral follicle count (AFC) and age, whereas only AFC was a predictor in women with previous endometrioma surgery (odds ratio: 0.49; 95% confidence interval: 0.13-0.60). Women with endometriosis had a lower rate of live births than the control group, but this difference was not statistically significant; the number of live births was significantly lower in those with previous endometrioma surgery. CONCLUSIONS The best predictor of the COS response in ICSI was AFC, followed by age. Women receiving ICSI following surgery for ovarian endometrioma had a poorer clinical outcome and lower rate of live births compared with those with endometriosis but no previous surgery and the control group.
Collapse
Affiliation(s)
- Safiya A Wahd
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Talha Al-Shawaf
- Barts and The London Medical College, Women’s Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University, London, UK
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Namir G Al-Tawil
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| |
Collapse
|
33
|
AMH: An ovarian reserve biomarker in assisted reproduction. Clin Chim Acta 2014; 437:175-82. [DOI: 10.1016/j.cca.2014.07.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/18/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022]
|
34
|
Ebner T, Shebl O, Holzer S, Oppelt P, Petek E, Schappacher-Tilp G, Mayer RB. Viability of cumulus cells is associated with basal AMH levels in assisted reproduction. Eur J Obstet Gynecol Reprod Biol 2014; 183:59-63. [PMID: 25461354 DOI: 10.1016/j.ejogrb.2014.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/30/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE(S) An interesting non-invasive approach to select embryos for transfer is analyzing the health state of somatic granulosa cells surrounding the oocyte addressing their mutual dependence. This prospective study was set up to analyse whether the DNA integrity of cumulus cells correlates with preimplantation development and basal AMH levels. STUDY DESIGN Therefore, 56 patients who gave written consent were enrolled. Sequential denudation of the cumulus-oocyte-complexes was performed in order to separate corona radiata from outer cumulus cells. DNA integrity of both cell types was analysed using a modified chromatin dispersion test. RESULTS The percentage of viable corona radiata cells per patient showed a linear correlation to blastulation (P<0.05). These innermost cells showed significantly lower rates of strand breaks (P<0.01) as compared to outer cumulus cells. Age-corrected AMH was significantly associated with the DNA integrity of outer cumulus cells (P<0.05). CONCLUSION(S) For the first time it could be shown that in fact clinical embryologists deal with two different entities of cumulus cells, inner and outer ones. It seems that any protective mechanism of the female gamete follows an outward gradient, so that negative effects, e.g. apoptosis, may impair outer cumulus cells first. Age-corrected AMH reflects quality of these outer cumulus cells. KEYWORDS AMH; Corona radiata cells; DNA fragmentation; Outer cumulus cells; SCD test.
Collapse
Affiliation(s)
- Thomas Ebner
- Landes- Frauen- und Kinderklinik, Departement of Gynecological Endocrinology and Kinderwunsch Zentrum Linz, Krankenhausstr. 26-30, Linz, Upper Austria, Austria; Johannes Kepler University, Faculty of Medicine, Altenberger Straße 69, Linz, Upper Austria, Austria; Karl-Franzens-University Graz, Department for Mathematics and Scientific Computing, Heinrichstraße 36, Graz, Styria, Austria.
| | - Omar Shebl
- Landes- Frauen- und Kinderklinik, Departement of Gynecological Endocrinology and Kinderwunsch Zentrum Linz, Krankenhausstr. 26-30, Linz, Upper Austria, Austria; Johannes Kepler University, Faculty of Medicine, Altenberger Straße 69, Linz, Upper Austria, Austria
| | - Sandra Holzer
- Technical University of Graz, Institute of Biochemistry, Petersgasse 12, Graz, Styria, Austria
| | - Peter Oppelt
- Landes- Frauen- und Kinderklinik, Departement of Gynecological Endocrinology and Kinderwunsch Zentrum Linz, Krankenhausstr. 26-30, Linz, Upper Austria, Austria; Johannes Kepler University, Faculty of Medicine, Altenberger Straße 69, Linz, Upper Austria, Austria
| | - Erwin Petek
- Medical University of Graz, Institute of Human Genetics, Harrachgasse 21, Graz, Styria, Austria
| | - Gudrun Schappacher-Tilp
- Karl-Franzens-University Graz, Department for Mathematics and Scientific Computing, Heinrichstraße 36, Graz, Styria, Austria
| | - Richard B Mayer
- Landes- Frauen- und Kinderklinik, Departement of Gynecological Endocrinology and Kinderwunsch Zentrum Linz, Krankenhausstr. 26-30, Linz, Upper Austria, Austria; Johannes Kepler University, Faculty of Medicine, Altenberger Straße 69, Linz, Upper Austria, Austria
| |
Collapse
|
35
|
Unlü C, Yıldırım G. Ovarian cystectomy in endometriomas: Combined approach. J Turk Ger Gynecol Assoc 2014; 15:177-89. [PMID: 25317047 DOI: 10.5152/jtgga.2014.1111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
Endometrioma is one of the most frequent adnexal masses in the premenopausal population, but the recommended treatment is still a subject of debate. Medical therapy is inefficient and can not be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence. To the best of our knowledge, the modified combined technique seems to be more efficient in the treatment of endometriomas.
Collapse
Affiliation(s)
- Cihat Unlü
- Department of Obstetrics and Gynecology, Acıbadem University, Bakırköy Acıbadem Hospital, İstanbul, Turkey
| | - Gazi Yıldırım
- Department of Obstetrics and Gynecology, Yeditepe University Hospital, İstanbul, Turkey
| |
Collapse
|
36
|
Shaw ND, Srouji SS, Welt CK, Cox KH, Fox JH, Adams JM, Sluss PM, Hall JE. Evidence that increased ovarian aromatase activity and expression account for higher estradiol levels in African American compared with Caucasian women. J Clin Endocrinol Metab 2014; 99:1384-92. [PMID: 24285681 PMCID: PMC3973772 DOI: 10.1210/jc.2013-2398] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Serum estradiol levels are significantly higher across the menstrual cycle in African American (AAW) compared with Caucasian women (CW) in the presence of similar FSH levels, yet the mechanism underlying this disparity is unknown. OBJECTIVE The objective of the study was to determine whether higher estradiol levels in AAW are due to increased granulosa cell aromatase mRNA expression and activity. DESIGN The design of the study included daily blood sampling and dominant follicle aspirations at an academic medical center during a natural menstrual cycle. SUBJECTS Healthy, normal cycling AAW (n = 15) and CW (n = 14) aged 19-34 years participated in the study. MAIN OUTCOME MEASURES Hormone levels in peripheral blood and follicular fluid (FF) aspirates and aromatase and FSH receptor mRNA expression in granulosa cells were measured. RESULTS AAW had higher FF estradiol [1713.0 (1144.5-2032.5) vs 994.5 (647.3-1426.5) ng/mL; median (interquartile range); P < .001] and estrone [76.9 (36.6-173.4) vs 28.8 (22.5-42.1) ng/mL; P < .001] levels than CW, independent of follicle size. AAW also had lower FF androstenedione to estrone (7 ± 1.8 vs 15.8 ± 4.1; mean ± SE; P = .04) and T to estradiol (0.01 ± 0.002 vs 0.02 ± 0.005; P = .03) ratios, indicating enhanced ovarian aromatase activity. There was a 5-fold increase in granulosa cell aromatase mRNA expression in AAW compared with CW (P < .001) with no difference in expression of FSH receptor. FSH, inhibin A, inhibin B, and AMH levels were not different in AAW and CW. CONCLUSIONS Increased ovarian aromatase mRNA expression, higher FF estradiol levels, and decreased FF androgen to estrogen ratios in AAW compared with CW provide compelling evidence that racial differences in ovarian aromatase activity contribute to higher levels of estradiol in AAW across the menstrual cycle. The absence of differences in FSH, FSH receptor expression, and AMH suggest that population-specific genetic variation in CYP19, the gene encoding aromatase, or in factors affecting its expression should be sought.
Collapse
Affiliation(s)
- N D Shaw
- Reproductive Endocrine Unit (N.D.S., S.S.S., C.K.W., K.H.C., J.M.A., P.M.S., J.E.H.), Department of Medicine, Massachusetts General Hospital, Boston Massachusetts 02114; and Division of Endocrinology (N.D.S.), Children's Hospital Boston, and Center for Infertility and Reproductive Surgery (S.S.S., J.H.F.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Evaluation of serum anti-Mullerian hormone levels to assess the ovarian reserve in women with severe endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 172:62-4. [DOI: 10.1016/j.ejogrb.2013.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/01/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
|
38
|
Abstract
PURPOSE OF REVIEW Endometriosis is a complex disease, one aspect being the existence of multiple staging systems. The recent Endometriosis Fertility Index (EFI) is compared with other endometriosis infertility staging systems and three new studies assessing the EFI are reported. RECENT FINDINGS The revised American Fertility Society classification system has historically been most widely used but does not predict pregnancy rates. The ENZIAN classification system is designed to describe more severe disease as an adjunct to the ASRM system, but does not predict pregnancy rates. The American Association of Gynecological Laparoscopists (now named AAGL) is developing a categorization system more focused on pain. Novel research in imaging, biomarkers, histology and the human genome may provide useful information to develop future classification systems. The EFI has recently been published as a validated prospective staging system that predicts non-assisted reproductive technology pregnancy rates in infertility patients following surgical diagnosis. Three other investigators have now validated the EFI. SUMMARY The only validated endometriosis classification system that predicts a clinical outcome is the EFI. The EFI has now been validated by three additional investigators. Renewed interest in the importance and utility of classification systems will hopefully result in novel classification systems that are useful for other clinical presentations of endometriosis.
Collapse
|
39
|
Probability of live birth in women with extremely low anti-Müllerian hormone concentrations. Reprod Biomed Online 2013; 28:64-9. [PMID: 24268729 DOI: 10.1016/j.rbmo.2013.09.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 08/23/2013] [Accepted: 09/04/2013] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to investigate the clinical pregnancy and live birth rates in women with extremely low (≤ 0.4 ng/ml) anti-Müllerian hormone (AMH) concentrations. The study included 101 women (188 cycles) with extremely low AMH concentrations undergoing IVF cycles and compared the number of live births in women with low AMH. Moreover, the study compared the number of live births in women with or without endometriosis stage III/IV. Fourteen clinical pregnancies and 14 live births (including one pair of twins) were recorded; one woman miscarried. Significantly higher clinical pregnancy (P = 0.046) and live birth rates (P = 0.018) were found in women aged < 35 years compared with older women. AMH concentration did not differ significantly between women with or without endometriosis and there were six live births in women with endometriosis. This was not significantly different from the rate in healthy women. It is concluded that live births are possible in women with extremely low AMH concentrations. The presence of endometriosis stage III/IV did not affect live birth rates in women with extremely low AMH concentrations although an important limitation of the study is the small number of women included who were affected by that disease.
Collapse
|
40
|
Kim JY, Jee BC, Suh CS, Kim SH. Preoperative serum anti-mullerian hormone level in women with ovarian endometrioma and mature cystic teratoma. Yonsei Med J 2013; 54:921-6. [PMID: 23709427 PMCID: PMC3663244 DOI: 10.3349/ymj.2013.54.4.921] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. MATERIALS AND METHODS In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. RESULTS Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean±SEM, 2.9±0.3 ng/mL vs. 3.3±0.3 ng/mL, p=0.28 and 1.3±0.1 vs. 1.6±0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1±0.3 vs. 3.1±0.4 ng/mL, p=0.02 and 1.1±0.1 vs. 1.7±0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7±0.5 vs. 3.4±0.5 ng/mL and 1.6±0.2 vs. 1.5±0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0±0.5 ng/mL vs. 4.0±0.5 ng/mL and 1.6±0.2 vs. 1.6±0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r²=0.13, p<0.01). CONCLUSION In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma.
Collapse
Affiliation(s)
- Ju Yeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, 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
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, 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
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
41
|
Cook AS, Adamson GD. The Role of the Endometriosis Fertility Index (EFI) and Endometriosis Scoring Systems in Predicting Infertility Outcomes. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0051-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Borahay MA, Lu F, Ozpolat B, Tekedereli I, Gurates B, Karipcin S, Kilic GS. Mullerian inhibiting substance suppresses proliferation and induces apoptosis and autophagy in endometriosis cells in vitro. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:361489. [PMID: 23853725 PMCID: PMC3703732 DOI: 10.1155/2013/361489] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/06/2013] [Indexed: 11/21/2022]
Abstract
Objective. To determine the effects of Mullerian inhibiting substance (MIS) treatment on endometriosis cells through study of apoptosis and autophagy. Design. Experimental in vitro study. Setting. University research laboratory. Cell Line. CRL-7566 endometriosis cell line. This line was established from a benign ovarian cyst taken from a patient with endometriosis. Interventions. In vitro treatment with MIS. Main Outcome Measures. The main outcome measures were cellular viability, proliferation, cell-cycle arrest, and induction of apoptosis and autophagy in endometriotic cells. Results. MIS treatment inhibited proliferation of endometriosis cells and induced apoptosis, as indicated by Annexin V staining, and induced caspase-9 cleavage and cell-cycle arrest, as evidenced by increased expression of p27 CDK-inhibitor. MIS treatment also induced autophagy in endometriosis cells as demonstrated by a significant increase in LC3-II induction, a hallmark of autophagy. Conclusions. MIS inhibits cell growth and induces autophagy, as well as apoptosis, in ectopic endometrial cell lines. Our results suggest that MIS may have a potential as a novel approach for medical treatment of endometriosis. Further studies may be needed to test the efficacy of MIS treatment in animal models and to develop MIS treatment specifically targeted to the endometriosis.
Collapse
Affiliation(s)
- Mostafa A. Borahay
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA
| | - Fangxian Lu
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA
| | - Bulent Ozpolat
- Division of Cancer Medicine, Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ibrahim Tekedereli
- Division of Cancer Medicine, Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bilgin Gurates
- Department of Obstetrics & Gynecology, Firat University, 23119 Elazig, Turkey
| | - Sinem Karipcin
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA
| | - Gokhan S. Kilic
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA
| |
Collapse
|
43
|
Dolmans MM, Jadoul P, Gilliaux S, Amorim CA, Luyckx V, Squifflet J, Donnez J, Van Langendonckt A. A review of 15 years of ovarian tissue bank activities. J Assist Reprod Genet 2013; 30:305-14. [PMID: 23417329 DOI: 10.1007/s10815-013-9952-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/28/2013] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To review 15 years of activities in ovarian tissue cryobanking from medical database files, including patient indications, histological evaluation and clinical characteristics. METHODS Retrospective longitudinal analysis of data from an ovarian tissue bank in an academic hospital. Five hundred and eighty-two patients had their ovarian tissue cryobanked between April 1997 and January 2012. Analysis of cryobanking database: precryopreservation patient characteristics, indications and safety issues, laboratory files and postcryopreservation clinical data. RESULTS Of the 582 patients who had their ovarian tissue cryopreserved, 106 patients donated for research purposes and 476 patients for fertility preservation and long-term cryopreservation. Clinical data analysis of the 476 patients revealed a mean age at the time of cryopreservation of 23 ± 8.5 years (range: 9 months - 39 years), with 96.2 % of subjects aged ≤35 years (n = 458). Among 391 cases of malignant disease, hematological malignancies (39.9 %, n = 156) and breast cancer (21.7 %, n = 85) were the two main indications. At histology, malignant cells were found in ovarian tissue from leukemia patients (n = 3) and non-Hodgkin's lymphoma patients (n = 2). Eleven patients underwent autotransplantation, resulting in 5 live births and 1 ongoing pregnancy. CONCLUSION This is the largest and most comprehensive study to describe and analyze indications and clinical patient characteristics before and after ovarian tissue cryopreservation. The procedure is safe, easy and promising. The database concept is a useful tool in patient selection for autotransplantation.
Collapse
Affiliation(s)
- Marie-Madeleine Dolmans
- Department of Gynecology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, Brussels, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97:3146-54. [PMID: 22723324 DOI: 10.1210/jc.2012-1558] [Citation(s) in RCA: 312] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Endometriomas are mainly treated surgically. However, there has been concern over the potential damaging effect of this surgery on ovarian reserve. OBJECTIVE The aim of this meta-analysis was to investigate the impact of surgery for endometriomas on ovarian reserve as determined by serum anti-müllerian hormone (AMH). DATA SOURCES MEDLINE, PubMed, and Embase were searched electronically. STUDY SELECTION All prospective cohort studies that analyzed changes of serum AMH concentrations after surgical treatment of endometriomas were eligible. Twenty-one studies were identified, of which eight were selected for meta-analysis. DATA EXTRACTION Two reviewers performed the data extraction independently. DATA SYNTHESIS Pooled analysis of 237 patients showed a statistically significant decrease in serum AMH concentration after ovarian cystectomy (weighted mean difference -1.13 ng/ml; 95% confidence interval -0.37 to -1.88), although heterogeneity was high. Sensitivity analysis for studies with a preoperative serum AMH level of 3.1 ng/ml or greater improved heterogeneity but also still showed a significant postoperative fall in serum AMH (weighted mean difference -1.52 ng/ml, 95% confidence interval -1.04 to -2). CONCLUSION The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH.
Collapse
Affiliation(s)
- Francesca Raffi
- University of Nottingham, Medical School, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom.
| | | | | |
Collapse
|
45
|
Streuli I, de Ziegler D, Gayet V, Santulli P, Bijaoui G, de Mouzon J, Chapron C. In women with endometriosis anti-Mullerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod 2012; 27:3294-303. [DOI: 10.1093/humrep/des274] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
LEE JOONGYEUP, JEE BYUNGCHUL, LEE JUNGRYEOL, KIM CHUNGHYON, PARK TAESUNG, YEON BORA, SEO SOYEON, LEE WONDON, SUH CHANGSUK, KIM SEOKHYUN. Age-related distributions of anti-Müllerian hormone level and anti-Müllerian hormone models. Acta Obstet Gynecol Scand 2012; 91:970-5. [DOI: 10.1111/j.1600-0412.2012.01448.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Ballester M, d'Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E. Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod 2012; 27:1043-9. [DOI: 10.1093/humrep/des012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
48
|
Abstract
PURPOSE OF REVIEW Endometriosis remains an enigmatic disease for many reasons, not the least being a continued inability to stage its clinical presentation so that prognosis and treatment for both pain and infertility patients can be facilitated. This article reviews issues with current staging systems. RECENT FINDINGS The revised American Fertility Society (rAFS) classification system has historically been the only classification system. Recently, the ENZIAN classification system, developed as an adjunct to the rAFS to describe more severe disease, has been introduced but is rarely used. More recently, the Endometriosis Fertility Index (EFI) that has been validated to predict pregnancy rates in infertility patients following surgical diagnosis and treatment of endometriosis was published. Currently, the AAGL is developing a categorization system that will be more focused on pain. Novel research in imaging, biomarkers, histology, and the human genome may provide useful information to develop future classification systems. SUMMARY The only validated endometriosis classification system that predicts a clinical outcome is the EFI. It is to be hoped that renewed interest in the importance and utility of classification systems will result in novel classification systems that are clinically useful.
Collapse
|
49
|
Sills ES, Collins GS, Brady AC, Walsh DJ, Marron KD, Peck AC, Walsh APH, Salem RD. Bivariate analysis of basal serum anti-Müllerian hormone measurements and human blastocyst development after IVF. Reprod Biol Endocrinol 2011; 9:153. [PMID: 22136508 PMCID: PMC3241207 DOI: 10.1186/1477-7827-9-153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report on relationships among baseline serum anti-Müllerian hormone (AMH) measurements, blastocyst development and other selected embryology parameters observed in non-donor oocyte IVF cycles. METHODS Pre-treatment AMH was measured in patients undergoing IVF (n = 79) and retrospectively correlated to in vitro embryo development noted during culture. RESULTS Mean (+/- SD) age for study patients in this study group was 36.3 ± 4.0 (range = 28-45) yrs, and mean (+/- SD) terminal serum estradiol during IVF was 5929 +/- 4056 pmol/l. A moderate positive correlation (0.49; 95% CI 0.31 to 0.65) was noted between basal serum AMH and number of MII oocytes retrieved. Similarly, a moderate positive correlation (0.44) was observed between serum AMH and number of early cleavage-stage embryos (95% CI 0.24 to 0.61), suggesting a relationship between serum AMH and embryo development in IVF. Of note, serum AMH levels at baseline were significantly different for patients who did and did not undergo blastocyst transfer (15.6 vs. 10.9 pmol/l; p = 0.029). CONCLUSIONS While serum AMH has found increasing application as a predictor of ovarian reserve for patients prior to IVF, its roles to estimate in vitro embryo morphology and potential to advance to blastocyst stage have not been extensively investigated. These data suggest that baseline serum AMH determinations can help forecast blastocyst developmental during IVF. Serum AMH measured before treatment may assist patients, clinicians and embryologists as scheduling of embryo transfer is outlined. Additional studies are needed to confirm these correlations and to better define the role of baseline serum AMH level in the prediction of blastocyst formation.
Collapse
Affiliation(s)
- E Scott Sills
- Division of Reproductive Endocrinology, Pacific Reproductive Center; Irvine, California, USA
- Division of Reproductive Endocrinology, The Sims Institute/Department of Obstetrics & Gynaecology, School of Medicine, Royal College of Surgeons in Ireland; Dublin, Ireland
| | - Gary S Collins
- Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford; Oxford, UK
| | - Adam C Brady
- Department of Medicine, University of Massachusetts School of Medicine; Worcester, Massachusetts, USA
| | - David J Walsh
- Division of Reproductive Endocrinology, The Sims Institute/Department of Obstetrics & Gynaecology, School of Medicine, Royal College of Surgeons in Ireland; Dublin, Ireland
| | - Kevin D Marron
- Division of Reproductive Endocrinology, The Sims Institute/Department of Obstetrics & Gynaecology, School of Medicine, Royal College of Surgeons in Ireland; Dublin, Ireland
| | - Alison C Peck
- Division of Reproductive Endocrinology, Pacific Reproductive Center; Irvine, California, USA
| | - Anthony PH Walsh
- Division of Reproductive Endocrinology, The Sims Institute/Department of Obstetrics & Gynaecology, School of Medicine, Royal College of Surgeons in Ireland; Dublin, Ireland
| | - Rifaat D Salem
- Division of Reproductive Endocrinology, Pacific Reproductive Center; Irvine, California, USA
| |
Collapse
|
50
|
Ballester M, Oppenheimer A, d'Argent EM, Touboul C, Antoine JM, Coutant C, Daraï E. Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod 2011; 27:451-6. [PMID: 22114107 DOI: 10.1093/humrep/der392] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several scoring systems have been published to evaluate the pregnancy rate after ICSI-IVF in infertile patients, none of them are applicable for patients with deep infiltrating endometriosis (DIE) nor can they evaluate the chances of pregnancy for individual patients. The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the clinical pregnancy rate in patients with endometriosis. METHODS This prospective longitudinal study was conducted from January 2007 to June 2010. The nomogram was built from a training cohort of 94 consecutive patients (141 ICSI-IVF cycles) and tested on an independent validation cohort of 48 patients (83 ICSI-IVF cycles). DIE was confirmed in all participants. RESULTS The pregnancy rate (per patient) in women with and without DIE was 58 and 83%, respectively (P = 0.03). Increased patient age (P = 0.04), serum anti-Mullerian hormone (AMH) level ≤ 1 ng/ml (P = 0.03) and increased number of ICSI-IVF cycles (P = 0.03) were associated with a decreased clinical pregnancy rate. The presence of DIE was the strongest determinant factor of the clinical pregnancy rate in our model [odds ratio = 0.26, 95% confidence interval (CI): 0.07-0.9 (P = 0.006)], which also included patient age, serum AMH level and number of attempts at ICSI-IVF. The nomogram showed an area under the curve (AUC) of 0.76 for the training cohort (95% CI: 0.7-0.8) and was well calibrated. The AUC for the validation cohort was 0.68 (95% CI: 0.6-0.75) and calibration was good. CONCLUSIONS Our nomogram provides realistic and precise information about ICSI-IVF success and can be used to guide couples and practitioners.
Collapse
Affiliation(s)
- Marcos Ballester
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, 4 rue de la Chine, 75020 Paris, France.
| | | | | | | | | | | | | |
Collapse
|