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Lee J, Hong DG. Serum anti-Müllerian hormone recovery after ovarian cystectomy for endometriosis: A retrospective study among Korean women. Medicine (Baltimore) 2022; 101:e30977. [PMID: 36221377 PMCID: PMC9542760 DOI: 10.1097/md.0000000000030977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Serum anti-Müllerian hormone (sAMH) is a useful marker of ovarian reserve. In many patients, the sAMH levels gradually recover after falling to the lowest level after surgery (nadir phenomenon). This study aimed to analyze the factors related to sAMH recovery from the nadir after an ovarian cystectomy for endometriosis among Korean women. A total of 159 patients with ovarian endometriosis were included in the study. The sAMH levels were measured before surgery and at least twice within 12 months after the surgery. The patients were divided into two groups: those with recovery (nadir group) and those without recovery (reduction group). Postoperative recovery of the sAMH levels from the nadir was not related to the stage and bilaterality of the lesion, surgical methods, such as robot-assisted or laparoscopic surgery, or surgical time. In the nadir group, the level of preoperative cancer antigen 125 was significantly higher, and it decreased significantly after the surgery than in the reduction group (P = .02 and P = .02). Additionally, the postoperative C-reactive protein (CRP) level was significantly higher in the nadir group, and it increased significantly after the surgery than in the reduction group (P = .03 and P = .04). The increasing degree of perioperative CRP level showed a cutoff value on the receiver operating characteristic curve (0.735 mg/dL, area under curve = 0.604; P = .04). Increased serum CRP levels after surgery are significantly related to the recovery of sAMH levels from the nadir. Therefore, postoperative serum CRP level could be used as a marker to predict the sAMH nadir after surgery.
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Affiliation(s)
- Juhun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Therapeutic Effect of Melatonin in Premature Ovarian Insufficiency: Hippo Pathway Is Involved. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3425877. [PMID: 36017238 PMCID: PMC9398856 DOI: 10.1155/2022/3425877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022]
Abstract
Objective Premature ovarian insufficiency (POI) is a female reproductive disorder of unknown etiology with no definite pathogenesis. Melatonin (MT) is an endogenous hormone synthesized mainly by pineal cells and has strong endogenous effects in regulating ovarian function. To systematically explore the pharmacological mechanism of MT on POI therapy, a literature review approach was conducted at the signaling pathways level. Methods Relevant literatures were searched and downloaded from databases, including PubMed and China National Knowledge Infrastructure, using the keywords “premature ovarian insufficiency,” “Hippo signaling pathways,” and “melatonin.” The search criteria were from 2010 to 2022. Text mining was also performed. Results MT is involved in the regulation of Hippo signaling pathway in a variety of modes and has been correlated with ovarian function. Conclusions The purpose of this review is to summarize the research progress of Hippo signaling pathways and significance of MT in POI, the potential crosstalk between MT and Hippo signaling pathways, and the prospective therapy.
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Umarsingh S, Adam JK, Krishna SBN. The relationship between anti-Müllerian hormone (AMH) levels and pregnancy outcomes in patients undergoing assisted reproductive techniques (ART). PeerJ 2021; 8:e10390. [PMID: 33391866 PMCID: PMC7761264 DOI: 10.7717/peerj.10390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Abstract
A variety of predictors are available for ovarian stimulation cycles in assisted reproductive technology (ART) forecasting ovarian response and reproductive outcome in women including biomarkers such as anti- Müllerian hormone (AMH). The aim of our present study was to compare the relationship between AMH levels and pregnancy outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). Overall, fifty patients (n = 50), aged 20-45 years were recruited for the present prospective study. Three AMH levels were presented with high often poly cystic ovarian syndrome (PCOS) amongst 52.4% patients, 40.5% in normal and 7.1% in low to normal, correspondingly. There was statistically significant relationship between AMH and day of embryo transfer (p < 0.05). The Pearson analysis between AMH, age, E2 and FSH displayed no statistically significant relationship between E2 and AMH (p < 0.05) and negative correlation between FSH and age (p > 0.05). The area under the receiver operating characteristic curve for E2 was 0.725 and for AMH levels as predictors of CPR was 0.497 indicating E2 as better predictor than AMH. The number of oocytes, mature oocytes and fertilized oocytes all presented a weak positive relationship to AMH. Our results confirm the clinical significance of AMH to accurately predict ovarian reserve as a marker and its limitations to use as predictor for a positive pregnancy outcome. Additional prospective studies should be conducted to validate the predictive capability of AMH levels for the outcome of clinical pregnancy.
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Affiliation(s)
- Shalini Umarsingh
- Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Jamila Khatoon Adam
- Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Suresh Babu Naidu Krishna
- Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical Practice Guidelines on Menopause: *An Executive Summary and Recommendations: Indian Menopause Society 2019-2020. J Midlife Health 2020; 11:55-95. [PMID: 33281418 PMCID: PMC7688016 DOI: 10.4103/jmh.jmh_137_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Meeta Meeta
- Gynecologist, Co-Director and Chief Consultant, Tanvir Hospital, Hyderabad, Telangana, India
| | - Leela Digumarti
- Gynecologist, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Neelam Agarwal
- Obs Gynae, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nirmala Vaze
- Consultant Obstetrician/Gynaecologist, Counselar Breast, Gynae Cancer & Menopause, Nagpur, India
| | - Rashmi Shah
- Gynecologist, Ex Senior Deputy Director, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Sonia Malik
- Gynecologist, Director and HOD, Southend Fertility & IVF Centre, New Delhi, India
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Yunus S, Rasheed S, Amanullah A, Aman S, Ullah U, Wazir FU. OVARIAN VOLUME BETWEEN FERTILE AND INFERTILE MARRIED WOMEN WITH TRANSVAGINAL SONOGRAPHY. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/16.04.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Infertility is a social problem and a big stigma. The objectives of the study were to determine the age wise distribution of ovarian volume and the difference in ovarian volume between married fertile and infertile women with transvaginal sonography. Materials & Methods: This comparative, cross-sectional study was conducted in the Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from March 2013 to December 2013. Sample Size was 100 women selected by consecutive non probability sampling technique. Sample size was calculated using online calculator Raosoft. Inclusion criteria were women aged 18-50 years, married, fertile and infertile. Color Doppler sonoscape with multi frequency transvaginal probes were used in measurements on any day in the start of menstrual cycle by the same observer. The volume was calculated by applying formula for ellipsoid called Prolate ellipsoid formula. The total volume was represented by sum of volume of two ovaries. Data collection site was out patient department of Radiology DHQ Teaching Hospital, D.I.Khan. Demographic variable were age groups and presence of fertility. Research variable was ovarian volume. Mean and standard deviation were calculated for ovarian volume whereas frequency and percentages were calculated for age groups and presence of fertility. Descriptive statistics along with estimation of parameter was done at 95% confidence interval for proportion and mean. Student- t test was used for significance of difference in ovarian volume between fertile and infertile women with p value
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Siddiqui QUA, Anjum S, Zahra F, Yousuf SM. Ovarian reserve parameters and response to controlled ovarian stimulation in infertile patients. Pak J Med Sci 2019; 35:958-962. [PMID: 31372124 PMCID: PMC6659047 DOI: 10.12669/pjms.35.4.753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: To determine the ovarian reserve parameters in patients presenting for IVF and intracytoplasmic sperm injection (ICSI) treatment and its association with the number of follicles retrieved and number of oocyte retrieved and fertilized. Methods: A retrospective cross sectional study was conducted at Australian Concept Infertility Medical Centre from January 2017 to August 2017. Around 120 couples presenting to infertility clinics selected for IVF and ICSI with Females (25-45) had their FSH, AMH and AFC done. After ovulation induction, its response was determined by number of follicles retrieved, quality of oocytes retrieved or fertilized and inseminated. SPSS version 20 was used for the purpose of data analysis. Results: The median age of the patients was 34 (29-38) years. A moderate negative correlation of age and FSH levels was observed with quality of oocytes, Number of oocyte inseminated, number of oocyte fertilized and number of follicle restored. However, a positive correlation of AMH and AFC levels were found with quality of oocytes, Number of oocyte inseminated, number of oocyte fertilized and number of follicle restored. The correlation of AMH levels with number of oocyte inseminated (rho 0.729, p-value <0.001), number of oocyte fertilized (rho 0.721, <0.001) and number of follicle restored (rho 0.723, p-value <0.001) were found strongly correlated. Conclusion: Our study concluded that AMH and AFC have a strong correlation with number of follicles restored and number of oocytes retrieved whereas FSH and age has a weak correlation with the number of follicles restored and number of oocytes retrieved.
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Affiliation(s)
- Qurat Ul Aman Siddiqui
- Dr. Qurat ul Aman Siddiqui, FCPS. Associate Professor, Department of Obstetrics and Gynaecology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Australian Concept Infertility Medical Centre
| | - Sagheera Anjum
- Dr. Sagheera Anjum, FCPS Assistant Professor, Department of Obstetrics and Gynaecology, Liaquat College of Medicine and Dentistry and Darul Sehat Hospital, Karachi Pakistan
| | - Fatima Zahra
- Dr. Fatima Zahra, FCPS Assistant Professor, Department of General Medicine, Liaquat College of Medicine and Dentistry and Darul Sehat Hospital, Karachi Pakistan
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Yang Y, Lei L, Wang S, Sheng X, Yan G, Xu L, Liu J, Liu M, Zhen X, Ding L, Sun H. Transplantation of umbilical cord-derived mesenchymal stem cells on a collagen scaffold improves ovarian function in a premature ovarian failure model of mice. In Vitro Cell Dev Biol Anim 2019; 55:302-311. [PMID: 30820812 DOI: 10.1007/s11626-019-00337-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/12/2019] [Indexed: 12/21/2022]
Abstract
Premature ovarian failure (POF) is a refractory disease; one of the most important goals of treatment is to improve fertility. In the study, collagen scaffold loaded with human umbilical cord-derived mesenchymal stem cells (collagen/UC-MSCs) transplantation in POF mice preserved ovarian function, as supported by increased estrogen (E2) and anti-Mullerian hormone (AMH) levels, increased ovarian volume, and an increased number of antral follicles. Immunohistochemistry results of Ki67 indicated transplantation of collagen/UC-MSCs promoted granulosa cell proliferation, which is crucial to oocyte maturation and follicular development. Additionally, transplantation of collagen/UC-MSCs significantly promoted ovarian angiogenesis with the increased expression of CD31. In general, collagen/UC-MSCs transplantation probably is an effective therapeutic strategy of POF.
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Affiliation(s)
- Yanjun Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Lei Lei
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.,Department of Obstetrics and Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Shanshan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Xiaoqiang Sheng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Guijun Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Lu Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Jingyu Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Mengyuan Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Xin Zhen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Lijun Ding
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China. .,Clinical Center for Stem Cell Research, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Haixiang Sun
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
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8
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Chang Y, Li J, Li X, Liu H, Liang X. Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve. Med Sci Monit 2018; 24:7279-7284. [PMID: 30310048 PMCID: PMC6195787 DOI: 10.12659/msm.910410] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background This study investigated the quality and quantity of eggs and embryos as well as the clinical pregnancy outcome in young infertile women with diminished ovarian reserve (DOR) after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Material/Methods We retrospectively reviewed records of 4285 infertile women and divided them into 3 groups according to age and ovarian reserve: young women with normal ovarian reserve (n=1695), young women with DOR (n=1121), and older women with DOR (n=1469). Results In young women with DOR, the proportion of high-quality embryos was significantly higher than in older women with DOR and lower than in young women with normal ovarian reserve (P<0.01). The proportions of ovulation cancellation, ovulation without egg acquisition, and ovulation without available embryos in young women with DOR were significantly higher than in young women with normal ovarian reserve. The rates of biochemical pregnancy, clinical pregnancy, and embryo implantation in young women with DOR were significantly higher than in older women with DOR, and lower than in young women with normal ovarian reserve. The miscarriage rate was 19.17% in young women with DOR, significantly lower than in older women with DOR (33.90%), and higher than in young women with normal ovarian reserve. Conclusions Young women with DOR have ovarian hypo-response and low numbers of acquired eggs and embryos, but the possibilities of high-quality embryo and good clinical pregnancy are higher once eggs are acquired. The indications to IVF/ICSI can be widened and active treatments should be administered for these women.
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Affiliation(s)
- Yajie Chang
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jingjie Li
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaolan Li
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hong'e Liu
- Department of Obstetrics and Gynecology, Guangzhou Development District Hospital, Guangzhou, Guangdong, China (mainland)
| | - Xiaoyan Liang
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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9
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Current approaches for the treatment of premature ovarian failure with stem cell therapy. Biomed Pharmacother 2018; 102:254-262. [PMID: 29567538 DOI: 10.1016/j.biopha.2018.03.056] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 02/08/2023] Open
Abstract
One of the common disorders found in women is premature ovarian failure (POF). Recently some studies have explained premature ovarian insufficiency (POI). The causes of it are unknown although various types of study have been done. The most common causes such as genetic and autoimmune conditions can have a role in POF and can lead to infertility. Some characterization of POF are hypo-oestrogenism (estrogen deficiency), increased gonadotropin level and most importantly amenorrhea. The main purpose of this review is to describe the cause and treatment of POF, especially stem cell therapy proposed in previous studies. Stem cells have self-renewal and regeneration potential, hence they can be very effective in the treatment of ovarian failure and consequently infertility. There are several kinds of stem cells such as, mesenchymal stem cells (MSCs), stem cells from extra-embryonic tissues, induced pluripotent stem cells (iPSCs), and ovarian stem cells that are used in POF stem cell therapy as observed in previous studies. This article reviews the latest studies on POF to summarize current understanding and future directions.
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10
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Zhang D, Xia L, Xu H, Chen Q, Jin B, Zhang A, Xu B. Flexible Low-Dose GnRH Antagonist Protocol Is Effective in Patients With Sufficient Ovarian Reserve in IVF. Front Endocrinol (Lausanne) 2018; 9:767. [PMID: 30619095 PMCID: PMC6305714 DOI: 10.3389/fendo.2018.00767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/06/2018] [Indexed: 01/20/2023] Open
Abstract
Gonadotropin-releasing hormone antagonist (GnRH-ant) has been shown to negatively influence endometrial receptivity. Reducing the GnRH-ant dose during controlled ovarian stimulation (COS) when using a GnRH-ant protocol may be beneficial to embryo implantation. However, whether or not the minimum daily GnRH-ant dose should be individualized remains uncertain. In this retrospective study, we aimed to elucidate the feasibility and effectiveness of moderately reducing the daily GnRH-ant dose to 0.125 mg, and then adjusting the dose to 0.25 mg based on subsequent luteinizing hormone (LH) levels. Of the 434 patients analyzed in this study, 209 received our new flexible low-dose GnRH-ant protocol (Group 1) and 225 received a conventional GnRH-ant protocol with a fixed daily dose of 0.25 mg (Group 2). Furthermore, 105 and 114 cycles from groups 1 and 2 received fresh embryo transfer. In Group 1, 30 patients whose dose of 0.125 mg GnRH-ant was adjusted according to their LH levels and 179 patients who received consistently low doses were further divided into subgroups 1 and 2, respectively. Neither the number of retrieved oocytes and available embryos nor the implantation rate, clinical pregnancy rate, and ongoing pregnancy rate significantly differed between the two groups. However, GnRH-ant dose and stimulation duration were much lower and shorter in Group 1 than in Group 2 (p < 0.05). Subgroup 1 exhibited higher basal follicle-stimulating hormone (FSH) and lower antral follicle count (AFC) than subgroup 2 significantly. The number of retrieved oocytes and available embryos were lower in subgroup 1 than in subgroup 2 (6.83 ± 3.28 vs. 11.83 ± 4.82, 2.93 ± 1.86 vs. 4.99 ± 3.46, respectively, p < 0.05), while more canceled cycles for pre-ovulation occurred in subgroup 1 than in subgroup 2 (3/30 vs. 1/179, p < 0.05). The results showed that the flexible low-dose GnRH-ant protocol was as effective as the conventional fixed-dose GnRH-ant protocol with 0.25 mg per day for most patients with normal ovarian reserve. This retrospective analysis and the small sample size are the main limitations of this study, and a large sample RCT will be carried out in the future.
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Affiliation(s)
- Dan Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Xia
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huihui Xu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Chen
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bailing Jin
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Aijun Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Reproductive Medicine, Department of Histo-Embryology, Genetics and Developmental Biology, Shanghai Jiaotong University, School of Medicine, Shanghai, China
- *Correspondence: Aijun Zhang
| | - Bufang Xu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Bufang Xu
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Abstract
Premature ovarian failure (POF) is the term usually used to describe women aged younger than 40 years, who present with amenorrhoea, hypergonadotropic hypogonadism, and infertility. POF is a devastating diagnosis for reproductive-aged women. The clinical presentation is diverse, and several different disorders can lead to premature ovarian failure. POF has serious health consequences, including psychological distress, infertility, osteoporosis, autoimmune disorders, ischaemic heart disease, and increased risk of mortality. Hashimoto's disease is the most frequent autoimmune disorder associated with premature ovarian failure. Management should be initiated immediately to prevent long-term consequences. Oestrogen therapy is the mainstay of management. Hormone therapy should be provided to eliminate symptoms of oestrogen deficiency.
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Chen Y, Ye B, Yang X, Zheng J, Lin J, Zhao J. Predicting the outcome of different protocols of in vitro fertilization with anti-Muüllerian hormone levels in patients with polycystic ovary syndrome. J Int Med Res 2017; 45:1138-1147. [PMID: 28449632 PMCID: PMC5536432 DOI: 10.1177/0300060517704140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This study evaluated associations of basal serum and follicular fluid (FF) anti-Muüllerian hormone (AMH) levels with in vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) patients. Methods This prospective study included 179 consecutive women undergoing IVF, including 59 with PCOS and non-PCOS controls. Thirty PCOS cases had long gona-dotrophin-releasing hormone agonist (GnRH-a) and 29 had antagonist (GnRH-ant) protocols. Controls underwent conventional GnRH-a. Associations of basal serum and FF AMH levels with IVF outcomes were assessed. Results Median serum and FF AMH levels, antral follicle count (AFC), oestradiol human chorionic gonadotropin injection day (peak E2), and retrieved oocyte numbers were higher in PCOS patients than in controls (all P < 0.01). Oocyte maturation and high-quality embryo rates were lower in PCOS patients than in controls (P < 0.01), but both groups had similar fertilization, implantation, clinical pregnancy, and newborn rates. Peak E2 was higher in GnRH-ant than in GnRH-a protocols (16.5 nmol/L vs. 12.1 nmol/L, P < 0.05). AMH levels were correlated with AFC in PCOS patients (P < 0.01). Peak E2 and FF AMH levels were independent predictors of oocyte number. Peak E2 predicted the fertilization rate. Conclusion Serum basal AMH levels are predictive of oocyte quantity, but not oocyte quality or IVF outcomes. Serum AMH, FF AMH, and outcomes are similar among protocols.
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Affiliation(s)
- Ya Chen
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Ya Chen, Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.
| | - Bilv Ye
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojing Yang
- Gynaecology and Obstetrics Department, The First People’s Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Jiujia Zheng
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinju Lin
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junzhao Zhao
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Amanvermez R, Tosun M. An Update on Ovarian Aging and Ovarian Reserve Tests. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:411-5. [PMID: 26985328 PMCID: PMC4793161 DOI: 10.22074/ijfs.2015.4591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 06/15/2014] [Indexed: 11/04/2022]
Abstract
Ovaries are the female organs that age more quickly than other tissues such as the
uterus, the pituitary gland or pancreas. Different from males, an interesting question
is why and how the females lose fertility so rapidly. During the aging process, both
the number and quality of the oocytes in the ovaries decrease and reach to a point
beyond that no more viable offspring may be produced and the associated cyclic
endocrinological activities cease, entering the menopause in females at an average
age of 50 years. Females who delayed childbearing with or without their willing
until their 30 years or 40 years constitute the largest portion of the total infertility
population. Ovarian reserve tests (ORTs) provide an indirect estimate of a female’s
diminishing ovarian reserve or remaining follicular pool. This article briefly reviews recent progresses in relation to ovarian aging and ORTs.
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Affiliation(s)
- Ramazan Amanvermez
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Migraci Tosun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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14
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Stern JE, Brown MB, Wantman E, Kalra SK, Luke B. Live birth rates and birth outcomes by diagnosis using linked cycles from the SART CORS database. J Assist Reprod Genet 2013; 30:1445-50. [PMID: 24014215 DOI: 10.1007/s10815-013-0092-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study uses linked cycles of assisted reproductive technology (ART) to examine cumulative live birth rates, birthweight, and length of gestation by diagnostic category. METHODS We studied 145,660 women with 235,985 ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System during 2004-2010. ART cycles were linked to individual women by name, date of birth, social security number, partner's name, and sequence of ART treatments. The study population included the first four autologous oocyte cycles for women with a single diagnosis of male factor, endometriosis, ovulation disorders, diminished ovarian reserve, or unexplained infertility. Live birth rates were calculated per cycle, per cycle number (1-4), and cumulatively. Birthweight and length of gestation were calculated for singleton births. RESULTS Within each diagnosis, live birth rates were highest in the first cycle and declined with successive cycles. Women with diminished ovarian reserve had the lowest live birth rate (cumulative rate of 28.3 %); the live birth rate for the other diagnoses were very similar (cumulative rates from 62.1 % to 65.7 %). Singleton birthweights and lengths of gestation did not differ substantially across diagnoses, ranging from 3,112 to 3,286 g and 265 to 270 days, respectively. These outcomes were comparable with national averages for singleton births in the United States (3,296 g and 271 days). CONCLUSION Women with the diagnosis of diminished ovarian reserve had substantially lower live birth rates. However, singleton birthweights and lengths of gestation outcomes were similar across all other diagnoses.
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Affiliation(s)
- Judy E Stern
- Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA,
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Abstract
ABSTRACT
Diminished ovarian reserve predicts diminished ovarian response to stimulation but does not predict cycle fecundity. It has been recently defined by ESHRE, the Bologna's criteria, according to which at least two of the following three features should be present: (1) Age >40 years/any other risk factor for DOR, (2) abnormal ovarian reserve test, i.e. antral follicle count, AMH, (3) poor ovarian response in a previous stimulated cycle, i.e. less than three follicles after standard gonadotropin stimulation. Poor response to maximal stimulation on two previous occasions also defines DOR.
The treatment options are limited. Avoiding the GnRH agonist long protocol and stimulation with microdose flare or antagonist protocol yields better results. Adjuvant therapy with LH, DHEAS and growth hormone shows some benefit in improving the oocyte yield. It is advisable to perform ICSI for all obtained oocytes and some advocate assisted hatching. Pregnancy rates are, however, poor and often these patients require ovum donation. Developing tests that will diagnose DOR in a low-risk population will allow women to plan their reproductive careers early.
How to cite this article
Kaur M, Arora M. Diminished Ovarian Reserve, Causes, Assessment and Management. Int J Infertility Fetal Med 2013;4(2):45-55.
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