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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Setti AS, Braga DPDAF, Guilherme P, Iaconelli A, Borges E. Serum anti-Müllerian hormone concentrations are related to embryo development: lessons from time-lapse imaging. ZYGOTE 2023; 31:570-576. [PMID: 37743564 DOI: 10.1017/s0967199423000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Our objective was to study whether serum anti-Müllerian hormone (AMH) concentrations were associated with embryo morphokinetic events. This retrospective cohort study was performed in a private university-affiliated in vitro fertilization centre between March 2019 and December 2020 and included 902 oocytes cultured in a time-lapse imaging incubator, obtained from 114 intracytoplasmic sperm injection cycles performed. The relationship between AMH concentrations and morphokinetic events was investigated by considering the clustering of data (multiple embryos/patient). Evaluated kinetic markers were time to pronuclei appearance (tPNa) and fading (tPNf), time to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), (tSB) and time to the start of blastulation (tSB) and to blastulation (tB). Significant inverse relationships were observed between serum AMH concentrations and tPNf, t3, t4, t5, t6, t7, t8, and tB. The AMH was positively correlated with the KIDScore and implantation rate. Increased serum AMH concentrations correlated with faster embryo development. The clinical implications of this effect on embryo development warrant further investigation.
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Affiliation(s)
- Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Patricia Guilherme
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
| | - Assumpto Iaconelli
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
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Ferrand T, Boulant J, He C, Chambost J, Jacques C, Pena CA, Hickman C, Reignier A, Fréour T. Predicting the number of oocytes retrieved from controlled ovarian hyperstimulation with machine learning. Hum Reprod 2023; 38:1918-1926. [PMID: 37581894 PMCID: PMC10546073 DOI: 10.1093/humrep/dead163] [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: 04/14/2022] [Revised: 07/05/2023] [Indexed: 08/16/2023] Open
Abstract
STUDY QUESTION Can machine learning predict the number of oocytes retrieved from controlled ovarian hyperstimulation (COH)? SUMMARY ANSWER Three machine-learning models were successfully trained to predict the number of oocytes retrieved from COH. WHAT IS KNOWN ALREADY A number of previous studies have identified and built predictive models on factors that influence the number of oocytes retrieved during COH. Many of these studies are, however, limited in the fact that they only consider a small number of variables in isolation. STUDY DESIGN, SIZE, DURATION This study was a retrospective analysis of a dataset of 11,286 cycles performed at a single centre in France between 2009 and 2020 with the aim of building a predictive model for the number of oocytes retrieved from ovarian stimulation. The analysis was carried out by a data analysis team external to the centre using the Substra framework. The Substra framework enabled the data analysis team to send computer code to run securely on the centre's on-premises server. In this way, a high level of data security was achieved as the data analysis team did not have direct access to the data, nor did the data leave the centre at any point during the study. PARTICIPANTS/MATERIALS, SETTING, METHODS The Light Gradient Boosting Machine algorithm was used to produce three predictive models: one that directly predicted the number of oocytes retrieved and two that predicted which of a set of bins provided by two clinicians the number of oocytes retrieved fell into. The resulting models were evaluated on a held-out test set and compared to linear and logistic regression baselines. In addition, the models themselves were analysed to identify the parameters that had the biggest impact on their predictions. MAIN RESULTS AND THE ROLE OF CHANCE On average, the model that directly predicted the number of oocytes retrieved deviated from the ground truth by 4.21 oocytes. The model that predicted the first clinician's bins deviated by 0.73 bins whereas the model for the second clinician deviated by 0.62 bins. For all models, performance was best within the first and third quartiles of the target variable, with the model underpredicting extreme values of the target variable (no oocytes and large numbers of oocytes retrieved). Nevertheless, the erroneous predictions made for these extreme cases were still within the vicinity of the true value. Overall, all three models agreed on the importance of each feature which was estimated using Shapley Additive Explanation (SHAP) values. The feature with the highest mean absolute SHAP value (and thus the highest importance) was the antral follicle count, followed by basal AMH and FSH. Of the other hormonal features, basal TSH, LH, and testosterone levels were similarly important and baseline LH was the least important. The treatment characteristic with the highest SHAP value was the initial dose of gonadotropins. LIMITATIONS, REASONS FOR CAUTION The models produced in this study were trained on a cohort from a single centre. They should thus not be used in clinical practice until trained and evaluated on a larger cohort more representative of the general population. WIDER IMPLICATIONS OF FINDINGS These predictive models for the number of oocytes retrieved from COH may be useful in clinical practice, assisting clinicians in optimizing COH protocols for individual patients. Our work also demonstrates the promise of using the Substra framework for allowing external researchers to provide clinically relevant insights on sensitive fertility data in a fully secure, trustworthy manner and opens a number of exciting avenues for accelerating future research. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the French Public Bank of Investment as part of the Healthchain Consortium. T.Fe., C.He., J.C., C.J., C.-A.P., and C.Hi. are employed by Apricity. C.Hi. has received consulting fees and honoraria from Vitrolife, Merck Serono, Ferring, Cooper Surgical, Dibimed, Apricity, and Fairtility and travel support from Fairtility and Vitrolife, participates on an advisory board for Merck Serono, was the founder and organizer of the AI Fertility conference, has stock in Aria Fertility, TMRW, Fairtility, Apricity, and IVF Professionals, and received free equipment from Planar in exchange for first user feedback. C.J. has received a grant from BPI. J.C. has also received a grant from BPI, is a member of the Merck AI advisory board, and is a board member of Labelia Labs. C.He has a contract for medical writing of this manuscript by CHU Nantes and has received travel support from Apricity. A.R. haș received honoraria from Ferring and Organon. T.Fe. has received a grant from BPI. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | | | - Chloe He
- AI Team, Apricity, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | | | | | | | - Cristina Hickman
- AI Team, Apricity, London, UK
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | - Thomas Fréour
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
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Peigné M, Bernard V, Dijols L, Creux H, Robin G, Hocké C, Grynberg M, Dewailly D, Sonigo C. Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis. Hum Reprod 2023; 38:1789-1806. [PMID: 37475164 DOI: 10.1093/humrep/dead147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/02/2023] [Indexed: 07/22/2023] Open
Abstract
STUDY QUESTION Is serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after ART or in women trying to conceive naturally? SUMMARY ANSWER Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after IUI or in women trying to conceive without ART. WHAT IS KNOWN ALREADY Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian stimulation. It is unclear whether AMH measurement can predict CLB in spontaneous or assisted conception. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally. PARTICIPANTS/MATERIALS, SETTING, METHODS A systematic review and meta-analysis was performed using the following keywords: 'AMH', 'anti-mullerian hormone', 'live-birth', 'cumulative live birth'. Searches were conducted from January 2004 to April 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality, and risk of bias assessment as well as data extraction. Odds ratios were estimated using a random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB. MAIN RESULTS AND THE ROLE OF CHANCE A total of 32 studies were included in the meta-analysis. Overall, 27 articles were included in the meta-analysis of the relation between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relation was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown, especially no serum AMH level threshold below which live birth could not be achieved after IVF/ICSI. After IVF-ICSI, only four studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels were shown between patients with and without CLB, but with a high heterogeneity. After exclusion of two studies with high risks of bias, there was no more heterogeneity [I2 = 0%] and the mean AMH level was statistically significantly higher in women with CLB. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART. LIMITATIONS, REASONS FOR CAUTION The systematic review and meta-analysis had some limitations owing to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level thresholds used and the use of various assays for serum AMH. This could explain, in part, the absence of a discriminating AMH threshold found in this analysis. WIDER IMPLICATIONS OF THE FINDINGS Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established, therefore low serum AMH level should not be used as the sole criterion for rejecting IVF treatment, especially in young patients. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI. STUDY FUNDING/COMPETING INTERESTS No external funding was obtained for this study. There are no conflicts of interest. REGISTRATION NUMBER PROSPERO CRD42021269332.
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Affiliation(s)
- Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, AP-HP- Hôpital Jean Verdier -Université Sorbonne Paris Nord, Bondy, France
| | - Valérie Bernard
- Department of Gynecology and Reproductive Medicine, Centre Aliénor d'Aquitaine, Bordeaux University Hospital, Bordeaux, France
| | - Laura Dijols
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Bretonneau, CHU de Tours, Tours, France
| | - Hélène Creux
- Department of Gynecology-Obstetric and Reproductive Medicine, Clinique Saint Roch, Montpellier, France
| | - Geoffroy Robin
- CHU Lille, Assistance Médicale à la Procréation et Préservation de la Fertilité and UF de Gynécologie Endocrinienne-Service de Gynécologie Médicale, Orthogénie et Sexologie, Hôpital Jeanne de Flandre, Lille, France
- Faculty of Medicine Henri Warembourg, University of Lille, Lille, France
| | - Claude Hocké
- Department of Gynecology and Reproductive Medicine, Centre Aliénor d'Aquitaine, Bordeaux University Hospital, Bordeaux, France
| | - Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, AP-HP- Hôpital Jean Verdier -Université Sorbonne Paris Nord, Bondy, France
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclère Hospital, Clamart, France
| | - Didier Dewailly
- Faculty of Medicine Henri Warembourg, University of Lille, Lille, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclère Hospital, Clamart, France
- Université Paris Saclay, Inserm, Physiologie et Physiopathologie Endocrinienne, Le Kremlin-Bicêtre, France
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Xu W, Li R, Qiao J. ART outcomes of patients in women with Isolated Hypogonadotropic Hypogonadism: a retrospective study in China. BMC Pregnancy Childbirth 2023; 23:255. [PMID: 37059970 PMCID: PMC10103367 DOI: 10.1186/s12884-023-05579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Isolated Hypogonadotropic Hypogonadism (IHH) is a rare reproductive disorder caused by the dysfunction of the gonadotropin-releasing hormone axis. Patients with IHH typically fail to enter or develop through puberty and retain infertile without an exogenous hormone supplement. This study aimed to investigate the population characteristics and reproductive outcomes in IHH patients undergoing assisted reproductive technology (ART) treatment, and evaluate the best-performed predictor for ovarian response and clinical pregnancy in patients with IHH. METHODS This retrospective cohort study included 83 women with IHH who underwent fresh ART cycles and non-diagnosed controls (n = 676). The receiver operating characteristic curves were generated to assess the predictor for the ovarian response. Logistic regression analyses were performed to investigate the independent factors for clinical pregnancy in IHH. RESULTS The basal hormone levels were significantly lower in the IHH group compared to the control group. The fertilization rate and 2PN rate were significantly higher in IHH groups, as was the number of transferable embryos. The study identified that AMH was the best predictor of high ovarian response in IHH, with an AUC of 0.767 (0.573, 0.961). Conversely, the follicle-to-oocyte index (FOI) exhibited the highest AUC of 0.814 (0.642, 0.985) for predicting low ovarian response. Based on FOI values, the IHH patients were divided into two groups, and the study found a significant increase in clinical pregnancy rate (43.8%, 58%; P < 0.001) and live birth rate (37.5%, 58%; P < 0.001) from the low FOI to the normal FOI groups. Moreover, the number of oocytes retrieved, fertilized embryos/rate, 2PN embryos/rate, and number of excellent quality embryos were significantly higher in the normal FOI group (P < 0.001 or P = 0.005) than in the low FOI group. Logistic regression analyses revealed FOI to be the independent factor affecting clinical pregnancy in IHH patients. CONCLUSIONS The study findings suggest that patients with IHH were good responders to IVF treatment. Although AMH was the best-performed predictor for the high ovarian response, FOI had the best capability in predicting the low ovarian response. FOI was an independent factor affecting clinical pregnancy in IHH undergoing IVF/ICSI.
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Affiliation(s)
- Wanxue Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China.
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Li HJ, Seifer DB, Tal R. AMH independently predicts aneuploidy but not live birth per transfer in IVF PGT-A cycles. Reprod Biol Endocrinol 2023; 21:19. [PMID: 36739415 PMCID: PMC9898926 DOI: 10.1186/s12958-023-01066-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/21/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While anti-Müllerian hormone (AMH) predicts quantitative IVF outcomes such as oocyte yield, it is not certain whether AMH predicts markers of oocyte quality such as aneuploidy. METHODS Retrospective case-control analysis of the SART-CORS database, 2014-2016, to determine whether anti-Müllerian hormone (AMH) predicts aneuploidy and live birth in IVF cycles utilizing preimplantation genetic testing for aneuploidy (PGT-A). RESULTS Of 51,273 cycles utilizing PGT-A for all embryos, 10,878 cycles were included in the final analysis; of these, 2,100 cycles resulted in canceled transfer due to lack of normal embryos and 8,778 cycles resulted in primary FET. AMH levels of cycles with ≥ 1 euploid embryo were greater than those of cycles with no normal embryos, stratifying by number of embryos biopsied (1-2, 3-4, 5-6, and ≥ 7), P < 0.017 for each stratum. Adjusting for age and number of embryos biopsied, AMH was a significant independent predictor of ≥ 1 euploid embryo for all age groups: < 35 yrs (aOR 1.074; 95%CI 1.005-1.163), 35-37 years (aOR 1.085; 95%CI 1.018-1.165) and ≥ 38 years (aOR 1.055; 95%CI 1.020-1.093). In comparative model analysis, AMH was superior to age as a predictor of ≥ 1 euploid embryo for age groups < 35 years and 35-37 years, but not ≥ 38 years. Across all cycles, age (aOR 0.945, 95% CI 0.935-0.956) and number of embryos (aOR 1.144, 95%CI 1.127-1.162) were associated with live birth per transfer, but AMH was not (aOR 0.995, 95%CI 0.983-1.008). In the subset of cycles resulting in ≥ 1 euploid embryo for transfer, neither age nor AMH were associated with live birth. CONCLUSIONS Adjusting for age and number of embryos biopsied, AMH independently predicted likelihood of obtaining ≥ 1 euploid embryo for transfer in IVF PGT-A cycles. However, neither age nor AMH were predictive of live birth once a euploid embryo was identified by PGT-A for transfer. This analysis suggests a predictive role of AMH for oocyte quality (aneuploidy risk), but not live birth per transfer once a euploid embryo is identified following PGT-A.
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Affiliation(s)
- Howard J Li
- Dept. of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, U.S.A..
| | - David B Seifer
- Dept. of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, U.S.A
| | - Reshef Tal
- Dept. of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, U.S.A
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The Polymorphism Asn680Ser on the FSH Receptor and Abnormal Ovarian Response in Patients with Normal Values of AMH and AFC. Int J Mol Sci 2023; 24:ijms24021080. [PMID: 36674596 PMCID: PMC9865618 DOI: 10.3390/ijms24021080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023] Open
Abstract
After the controlled ovarian stimulation (COS), the number of cumulus oocyte complexes collected is lower than predicted. The aim of this study is to understand if there is a possible reason for that deficient ovarian response. It was hypothesized that this is associated with the SNP (single-nucleotide polymorphism) of the FSH receptor (FSHr), specifically c.2039A > G, resulting in Asn680Ser. Two groups of patients were enrolled for this purpose: the normal (n = 36) and abnormal responses (n = 31). To predict the number of retrievable oocytes, according to the anti-Mũllerian hormone (AMH) and the antral follicle count (AFC), the following formula was applied in a log scale: the number of oocytes retrieved = 2.584 − 0.015 × (age) − 0.035 × (FSH) + 0.038 × (AMH) + 0.026 × (AFC). Then, when the number of oocytes collected was less than 50% of the calculated value, it was proposed that the patients result in an abnormal response. DNA sample blood was collected from the women, and then the genetic assessment for the Asn680Ser of the FSHr was evaluated in both groups. The differences between the two categories were statistically analyzed with an independent samples t test, a Mann−Whitney U test and a Chi-squared test. In a patient with an abnormal response, a significant prevalence of the amino acid serine at position 680 of the FSHr compared to the counterpart group (p < 0.05) was detected. In conclusion, according to the results, the genetic evaluation of the FSHr could represent an accurate and predictive feature for patients undergoing assisted reproductive technology treatment.
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Kasaven LS, Jones BP, Heath C, Odia R, Green J, Petrie A, Saso S, Serhal P, Nagi JB. Reproductive outcomes from ten years of elective oocyte cryopreservation. Arch Gynecol Obstet 2022; 306:1753-1760. [PMID: 35988095 PMCID: PMC9519701 DOI: 10.1007/s00404-022-06711-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/17/2022] [Indexed: 11/24/2022]
Abstract
RESEARCH QUESTION To assess the relationship between the number of oocytes retrieved during elective oocyte cryopreservation (EOC) cycles with various clinical, biochemical, and radiological markers, including age, body mass index (BMI), baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥ 12 mm on the day of trigger. To also report the reproductive outcomes from women who underwent EOC. METHODS A retrospective cohort of 373 women embarking on EOC and autologous oocyte thaw cycles between 2008 and 2018 from a single London clinic in the United Kingdom. RESULTS 483 stimulation cycles were undertaken amongst 373 women. The median (range) age at cryopreservation was 38 (26-47) years old. The median numbers of oocytes retrieved per cycle was 8 (0-37) and the median total oocytes cryopreserved per woman was 8 (0-45). BMI, E2 level and number of follicles ≥ 12 mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed there was no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. Thirty six women returned to use their cryopreserved oocytes, of which there were 41 autologous oocyte thaw cycles undertaken. There were 12 successful livebirths achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths were achieved in women who underwent EOC ≥ 40 years old, and 82% of all livebirths were achieved in women who had done so between 36 and 39 years old. CONCLUSION Clinical, biochemical and radiological markers can predict oocyte yield in EOC cycles. Reproductive outcomes are more favourable when cryopreservation is performed before the age of 36, with lower success rates of livebirth observed in women aged 40 years and above.
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Affiliation(s)
- Lorraine S Kasaven
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK.
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK.
- Department of Cutrale Perioperative and Ageing Group, Imperial College London, London, W12 0NN, UK.
| | - Benjamin P Jones
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK
| | - Carleen Heath
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Joycelia Green
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London, WC1X 8LD, UK
| | - Srdjan Saso
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
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Piquette T, Rydze RT, Pan A, Bosler J, Granlund A, Schoyer KD. The effect of maternal body mass index on embryo division timings in women undergoing in vitro fertilization. F S Rep 2022; 3:324-331. [PMID: 36568924 PMCID: PMC9783148 DOI: 10.1016/j.xfre.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To measure the impact of maternal body mass index (BMI) on the morphokinetics of embryo development as monitored by a time-lapse system. Design A retrospective chart review of in vitro fertilization (IVF) cycles from September 2016 to January 2019. Setting Academic IVF practice. Patients Patients <age 38 years undergoing IVF with their own gametes. Interventions Not applicable. Main outcome measures The primary outcome was to compare embryo division timings between morbidly obese, obese, overweight, and normal-weight patients. A multilevel mixed effects model was performed to investigate the relationships between BMI categories and embryo division timings. Log or square transformation were used to improve fit. Results A total of 366 patients met inclusion criteria, yielding 4,475 embryos: 1,948 embryos from 162 normal-weight women (BMI 18.5-24.9), 1,242 embryos from 96 overweight women (BMI 25.0-29.9), 1,119 embryos from 91 obese women (BMI 30.0-39.9), and 166 embryos from 17 morbidly obese women (BMI ≥40). There were no differences in age, Antimüllerian hormone, or IVF cycle outcomes among the different BMI categories. When comparing embryo division timings based on BMI, controlling for covariates, embryos from obese patients had a shorter time to division to 2 cell embryo (T2) than normal-weight patients. When analyzing BMI as a continuous variable, there was no significant relationship between BMI and embryo division timing. Conclusions Early embryo divisions were accelerated in only certain categories of obesity. This suggests a more complex mechanism for the effect of obesity on embryo development that may not be perceptible through the assessment of cell division timing events.
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Affiliation(s)
- Theresa Piquette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert T. Rydze
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jayme Bosler
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Granlund
- Reproductive Medicine Center, Froedtert Hospital, North Hills Health Center, Menomonee Falls, Wisconsin
| | - Kate D. Schoyer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin,Reprint requests: Kate D. Schoyer, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, Wisconsin; 53226.
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10
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Gözükara İ, Yılmaz N, Ceran MU, Atalay E, Kahyaoğlu İ, Gülerman HC, Engin-Üstün Y. The role of FSH to AMH ratio in poor prognosis patients undergoing ICSI cycle. J Turk Ger Gynecol Assoc 2022; 23:184-189. [PMID: 35263958 PMCID: PMC9450925 DOI: 10.4274/jtgga.galenos.2022.2021-9-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The objective of this study was to estimate the number of oocyte retrieval and cycle cancellation using follicle stimulating hormone (FSH) to anti-Mullerian hormone (AMH) ratio in poor prognosis patients undergoing intracytoplasmic sperm injection treatment. Material and Methods: This retrospective study including fresh cycles was conducted in Zekai Tahir Burak Women’s Health Training and Research Hospital, between January 2015 and October 2018. Women aged between 24 and 44 years were recruited and the baseline serum hormone levels, FSH/AMH ratio, and the antral follicle count were recorded. Number of retrieved oocytes, metaphase-II oocytes, fertilised oocytes, and the number and grade of the embryos were also recorded. Results: A total of 108 cycles, corresponding to 92 women with poor prognosis were eligible for analysis. The use of FSH/AMH ratio performed well in predicting retrieved oocyte count <5 with an area under the curve (AUC) of 0.82 [95% confidence interval (CI): 0.71-0.92]. A FSH/AMH ratio cut-off of 11.36 was set for the retrieval of <5 oocyte at oocyte pick-up (OPU) with 80% sensitivity and 87% specificity. The FSH/AMH cut-off value was 14.22 to differentiate cycle cancellation and no oocyte retrieval at OPU, with a sensitivity of 91% and a specificity of 44% (AUC of 0.71; 95% CI: 0.59-0.83). There was no correlation between FSH/AMH ratio and clinical pregnancy. Conclusion: The assessment of this simple ratio at the beginning of the cycle may help clinicians better anticipate gonadotropin stimulation treatment and better counsel patients about cycle cancellation and the expected oocyte yield.
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Affiliation(s)
- İlay Gözükara
- Department of Obstetrics and Gynecology, Prof. Dr. Turan Çetin Women’s Health and IVF Center, Adana, Turkey
| | - Nafiye Yılmaz
- Clinic of Infertility and Reproductive Medicine, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ufuk Ceran
- Department of Obstetrics and Gynecology, Başkent University, Konya Application and Research Center, Konya, Turkey
| | - Ece Atalay
- Clinic of Infertility and Reproductive Medicine, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - İnci Kahyaoğlu
- Clinic of Infertility and Reproductive Medicine, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Hacer Cavidan Gülerman
- Clinic of Infertility and Reproductive Medicine, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Yaprak Engin-Üstün
- Clinic of Obstetric and Gynecology, University of Health Sciences Turkey, Ankara Etlik Zübeyde Hanım Women’s Health Research Center, Ankara, Turkey
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Sun H, Jiao J, Tian F, Liu Q, Bian J, Xu R, Li D, Wang X, Shu H. Ovarian reserve and IVF outcomes in patients with inflammatory bowel disease: A systematic review and meta-analysis. EClinicalMedicine 2022; 50:101517. [PMID: 35812999 PMCID: PMC9257324 DOI: 10.1016/j.eclinm.2022.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) mainly affects people during reproductive age. However, it is unclear whether IBD might be associated with impaired ovarian reserve in female patients or with in vitro fertilization (IVF) outcomes. METHODS This systematic review and meta-analysis included articles from inception to May, 2022. Random-effect model was applied to calculate the standardized mean differences (SMDs) and odds ratios (ORs) and their 95% confidence intervals (95%CIs). Studies comparing the ovarian reserve or IVF outcomes of patients with IBD with the population were considered. To be included in this study, necessary measurements such as OR, relative risk (RR), SMD or hazard ratio (HR) or any necessary information to calculate them were provided in the articles. Letters, case reports, review articles including meta-analyses and expert opinions were excluded. For different articles studying the same population, the article with larger scale was selected. FINDINGS We included in our analysis 9 studies and data from 2386 IBD records and matched controls. Comparing with women without IBD, women with IBD had lower anti-mullerian hormone (AMH) levels (SMD = -0.38, 95%CI: -0.67, -0.09); (I2 = 79.0%, p = 0.000). Patients with IBD of different ages showed distinct ovarian reserves, with patients below 30 years old not showing any decline in ovarian reserve compared to the control group (SMD = -0.56, 95%CI: -2.28, 1.16); (I2 = 96.3%; p = 0.000), while patients with IBD over 30 years old (SMD = -0.75, 95%CI: -1.07, -0.43); (I2 = 0.0%; p = 0.608) showed a decline compared to control group. Patients with IBD in remission stage had similar ovarian reserves to population (SMD = -0.10, 95%CI: -0.32, 0.12); (I2 = 0.0%; p = 0.667), while patients in active stage showed an impaired ovarian reserve (SMD = -1.30, 95%CI: -1.64, -0.96); (I2 = 0.0%; p = 0.318). Patients with IBD showed a pregnancy rate after receiving IVF treatment comparable to the control population (OR = 0.87, 95%CI: 0.55, 1.37); (I2 = 70.1%, p = 0.035). INTERPRETATION The result of this study suggest that IBD may reduce reproductive age women's ovarian reserve and IVF treatment might help pregnancy outcomes in patients with impaired fertility. These results should be further validated in additional studies given the heterogeneity and quality of the studies included. FUNDING This study was supported by the National Natural Science Foundation of China (No. 81671423), National Key Research and Development Program of China (No. 2016YFC1000603), 2020 Shenyang Science and Technology Plan Program (No. 20-205-4-006), Scientific and Technological Talents Applied Technology Research Program of Shenyang (No. 18-014-4-56).
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Affiliation(s)
- Honghao Sun
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Jiao Jiao
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Feng Tian
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiansu Bian
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
| | - Rongmin Xu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
- Corresponding authors at: Center of Reproductive Medicine and Department of Pathology, Shengjing Hospital, China Medical University, No. 36, SanHao Street, Shenyang 110004, China.
| | - Xiuxia Wang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Shenyang Reproductive Health Clinical Medicine Research Center, Shenyang, China
- Corresponding authors at: Center of Reproductive Medicine and Department of Pathology, Shengjing Hospital, China Medical University, No. 36, SanHao Street, Shenyang 110004, China.
| | - Hong Shu
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
- Corresponding authors at: Center of Reproductive Medicine and Department of Pathology, Shengjing Hospital, China Medical University, No. 36, SanHao Street, Shenyang 110004, China.
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Anti-müllerian hormone as a predictor for live birth among women undergoing IVF/ICSI in different age groups: an update of systematic review and meta-analysis. Arch Gynecol Obstet 2022; 308:43-61. [PMID: 35907969 DOI: 10.1007/s00404-022-06683-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To update the evidence of anti-müllerian hormone (AMH) as predictive factors for live birth outcome in women undergoing assisted conception and discover the modulating effect of age. METHODS PubMed, Embase, Medline, and Web of Science were searched for studies published until June 2021. We included studies that measured serum AMH levels and reported the subsequent live birth outcomes. Random effects models and hierarchical summary receiver operating characteristics (HSROC) models were used. The QUADAS-2 checklist was employed to assess the quality of the included studies. RESULTS We included 27 studies (27,029 women) investigating the relationship between AMH and live birth outcome after assisted conception. The diagnostic odds ratios (DOR) from random effects models were ruled out due to high heterogeneity. Our findings suggested that AMH was associated with live birth. The DOR was 2.21 (95% CI 1.89-2.59), and 2.49 (95% CI 1.26-4.91) for studies on women with unspecified ovarian reserve and women with low ovarian reserve, respectively. The DOR of those with advanced ages was 2.50 (95% CI 1.87-2.60). For younger women, the DOR was 1.41 (95% CI 0.99-2.02). HSROCs showed that AMH had no predictive ability towards live birth in women with diminished ovarian reserve or younger age. Exclusion of Chinese cohorts lowered the heterogeneity. CONCLUSIONS This study revealed that AMH had better prediction for live birth in advanced-age women. AMH may have implicative predictive value for assisted conception counseling of couples of advanced ages.
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Oncul M, Ozcivit IB, Basibuyuk Z, Cebi C, Sahmay S. Anti-Müllerian hormone, an ovarian reserve marker in hypogonadotropic hypogonadism. Eur J Obstet Gynecol Reprod Biol 2022; 273:54-58. [PMID: 35477042 DOI: 10.1016/j.ejogrb.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/25/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the usefulness of Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) as an ovarian reserve marker in hypogonadotropic hypogonadism (HH) patients and to find a limit value for the gonadotropin levels in the diagnosis of HH patients. STUDY DESIGN It is a retrospective cross-sectional single-center study. One hundred ninety-nine women with HH and 171 healthy controls with no cycle disorders were included into this study. Continuous variables were expressed as mean ± standard deviation. Statistical comparisons were carried out according to the intention to treat by Student's t-test, Mann-Whitney U test, where appropriate. Receiver operating characteristic curve-ROC was used to represent the sensitivity and specificity pair corresponding to decision threshold of FSH and LH levels in HH diagnosis. P < 0.05 was accepted to be statistically significant. RESULTS There was not any statistically significant difference between HH and control group regarding the age (23.94 ± 6.56 vs. 23.92 ± 3.01, respectively; p = 0.09). Serum AMH levels didn't show statistically significant difference between HH and control group (3.26 ± 2.61 ng/mL vs. 3.15 ± 1.46 ng/mL, respectively; p = 0.11). The difference of AFC between HH and control group was statistically significant (6.67 ± 6.33 vs. 10.91 ± 2.92, respectively; p < 0.001). Follicle-stimulating hormone (FSH), Luteinizing-hormone (LH) and Estradiol (E2) levels between the groups were found to be significantly different. Area under the receiver operating characteristic curve-ROC for FSH was 0.98 and for LH was 0.96. For the diagnosis of HH, FSH levels lower than 3.05 IU/L (with a sensitivity of 92% and specificity of 94%) and LH levels lower than 1.55 IU/L (with a sensitivity of 91% and specificity of 92%) can be used. CONCLUSION In conclusion, serum AMH levels reflect the follicle cohort in HH cases validly with negligible underestimation of ovarian reserve. FSH < 3.05 IU/L and LH < 1.55 IU/L could be used with high sensitivity and specificity for the diagnosis of HH.
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Affiliation(s)
- Mahmut Oncul
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Turkey
| | - Ipek Betul Ozcivit
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey.
| | - Zafer Basibuyuk
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey
| | - Ceren Cebi
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey
| | - Sezai Sahmay
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Turkey
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14
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Laqqan M, Yassin M. Anti–Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple–dose protocol. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2022. [DOI: 10.4103/2305-0500.356839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Sun TC, Chen X, Shi C, Tian L, Zhou SJ. The Predictive Levels of Serum Anti-Müllerian Hormone and the Combined Index of the Number of Retrieved Oocytes and Good-Quality Embryos in Advanced-Age Infertile Women. Int J Endocrinol 2022; 2022:4224417. [PMID: 35479662 PMCID: PMC9038402 DOI: 10.1155/2022/4224417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
The primary objective of the study was to assess the values of serum anti-Müllerian hormone (AMH) levels and the combined index for the prediction of number of oocytes retrieved (NOR) and number of good-quality embryos (GQE) in infertile women undergoing IVF/ICSI treatment. A group of 521 infertile women aged 21-46 years were recruited as subject in this study. Serum AMH, hormones, and antral follicle count (AFC) were measured. The infertile women were categorized into three groups: 21-34 years (reproductive age), 35-39 years (reproductive age), and 40-46 years (advanced-age infertile). The predictive accuracy of variables was analyzed by the receiver operating characteristic (ROC) curve. AFC, AFC/age ratio, AMH/age ratio, and ovarian response prediction index (ORPI) decreased gradually, while AMH decreased significantly with increase in age. Moreover, NOR and GQE were positively correlated with AFC, AMH, AFC/age ratio, AMH/age ratio, and ORPI (P < 0.001). A statistical significance was observed in predicted oocyte retrieval including AMH, AMH/age ratio, and ORPI between 21-34 years and 35-46 years; especially in the 35-46 years group, these variables reached a "high" grade in the diagnostic accuracy because area under curve (AUC) ranged from 0.982 to 0.988 significantly. No statistical significance was observed for FSH, AMH, AFC, and related combined index predicting GQE. The predictive value of AFC and AFC/age ratio was limited regarding oocyte retrieval; however, AMH, AMH/age ratio, and ORPI concurrently had an excellent value for predicting NOR in reproductive-age women, especially in advanced-age infertile women.
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Affiliation(s)
- Tie-Cheng Sun
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
| | - Xi Chen
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Cheng Shi
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Li Tian
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Shan-Jie Zhou
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
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16
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Chen Y, Niu A, Feng X, Zhang Y, Li F. Prediction of pregnancy outcome in fresh in vitro fertilization/intracytoplasmic sperm injection treatment in patients with poor ovarian reserve. Aging (Albany NY) 2021; 13:18331-18339. [PMID: 34273144 PMCID: PMC8351725 DOI: 10.18632/aging.203282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
We retrospectively analyzed the clinical data from 39,185 cycles who undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in the First People's Hospital of Shangqiu, these poor ovarian reserve patients were further categorized into the "unexpected" group (n=3337) and the "expected" group (n=2667) based on POSEIDON classification. In "expected" group, logistic regression analysis showed that female age (OR 0.920; 95% C.I 0.902~0.939; P < 0.001), treatment cycles (OR 0.693; 95% C.I 0.560~0.859; P = 0.001), duration of Gn administered (OR 1.077; 95% C.I 1.027~1.129; P = 0.002) and transferable embryos (OR 1.377; 95% C.I 1.319~1.437; P < 0.001) is independent predictive factors of live birth. In "expected" group, logistic regression analysis showed that female age (OR 0.874; 95% C.I 0.848~0.900; P < 0.001), AFC (OR 1.285; 95% C.I 1.131~1.461; P < 0.001), total dosage of Gn administered (OR 1.001; 95% C.I 1.000~1.002; P < 0.001), duration of Gn administered (OR 0.784; 95% C.I 0.639~0.961; P = 0.019), MII number (OR 0.841; 95% C.I 0.717~0.986; P = 0.032) and transferable embryos (OR 2.057; 95% C.I 1.762~2.400; P < 0.001) is independent predictive factors of live birth. We also established a smooth curve fit to predict the probability of live birth among the POSEIDON "unexpected" and "expected" group. These independent predictive factors on the pregnancy outcome of IVF/ICSI and the successful establishment of smooth curve fit can provide valuable reference for treats poor ovarian reserve patients in clinical work.
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Affiliation(s)
- Ying Chen
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - AiQin Niu
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - XingMei Feng
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - YaLi Zhang
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - Fei Li
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
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17
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Abstract
PURPOSE OF REVIEW In this review, we will summarize research looking into anti-Müllerian hormone (AMH) as a measure of oocyte quality. RECENT FINDINGS AMH is a key factor involved in embryogenesis but also in the development of early follicles. Owing to its relatively small inter and intracycle variability, it has become a widely used method of ovarian reserve testing. In the realm of assisted reproductive technology, it has demonstrated a reliable ability to gauge the number of oocytes obtained during an in-vitro fertilization cycle. For these purposes, AMH is a readily measured quantitative tool. However, its qualitative role is as yet undefined. SUMMARY Although levels of this hormone have been associated with fertilization, blastulation, implantation, and clinical pregnancy rates, there is no clear link with live-birth rates. Furthermore, AMH levels do not appear to correspond with risk of fetal trisomy. AMH does show significant predictive value for the risk of premature ovarian insufficiency and time to onset of menopause.
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18
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Sun TC, Zhou SJ, Song LL, Li JH, Chen X, Tian L. High anti-Müllerian hormone levels might not reflect the likelihood of clinical pregnancy rate in IVF/ICSI treatment. JBRA Assist Reprod 2021; 25:266-271. [PMID: 33710839 PMCID: PMC8083848 DOI: 10.5935/1518-0557.20200094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate if high anti-Müllerian hormone (AMH) concentration is a useful tool to predict the outcome of assisted reproductive treatment. Methods: Retrospective cohort study involving 520 patients who underwent IVF/ICSI procedures in a university hospital. We measured the serum AMH level on day 3 of the menstrual cycle. Based on AMH levels, we divided the patients into three groups as follows: low (<25th percentile) AMH group, average (25th to 75th percentile) AMH group and high (>75th percentile) AMH group. We recorded the fertilization rate (FR), the number of oocytes retrieved, the number of good quality embryos (GQEs) and the clinical pregnancy rate (CPR). Results: There was no difference between the three AMH groups in terms of maternal age, body mass index (BMI), follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH) and testosterone (T) in the IVF/ICSI cycles. The women in the high serum AMH group had a higher number of retrieved oocytes than those in the low or average AMH groups (p < 0.01) in the IVF/ICSI cycles. Compared with the low or average AMH groups, the women with high AMH levels had a higher number of good quality embryos (GQEs) in the IVF/ICSI cycles (p < 0.01). However, high AMH women had no significantly higher clinical pregnancy rate (CPR) compared to the women in the low or average AMH groups. In addition, for the prediction of CPR, the AMH levels alone were not an independent predictor of CPR for IVF and ICSI cycles in the ROC curve analysis. Conclusions: High anti-Müllerian hormone levels are an independent predictor of the number of retrieved oocytes and good quality embryos (GQEs), but might not reflect the likelihood of higher clinical pregnancy rates (CPR) in IVF/ICSI treatment.
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Affiliation(s)
- Tie-Cheng Sun
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, 102206, China
| | - Shan-Jie Zhou
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, 102206, China
| | - Ling-Li Song
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, 102206, China
| | - Jian-Hua Li
- Center of Reproductive Medicine and Genetics, Seventh Medical Center of PLA General Hospital, Beijing 100027, China
| | - Xi Chen
- Reproductive Medicine Centre Peking University Second Affiliated Hospital, Beijing, 100044, China
| | - Li Tian
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, 102206, China.,Reproductive Medicine Centre Peking University Second Affiliated Hospital, Beijing, 100044, China
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19
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Wu S, Wang Y, Ding H, Sun N, Liu Y, Wang L, Sheng F, Zhang H, Yang F, Li W. The Efficacy and Safety of the mTOR Signaling Pathway Activator, MHY1485, for in vitro Activation of Human Ovarian Tissue. Front Genet 2021; 11:603683. [PMID: 33613618 PMCID: PMC7890121 DOI: 10.3389/fgene.2020.603683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023] Open
Abstract
Background Premature ovarian insufficiency (POI) is characterized by abnormal ovarian function before the age of 40. POI showed that primordial follicles developed in disorder. mTOR signaling plays a vital role in the process of follicle development. It has been verified that the mTOR signaling pathway activator, MHY1485, can promote primordial follicle development in mice. We considered that MHY1485 would be a promising fertility preservation method for POI patients. Methods The fragmented ovarian tissues of normal woman was cultured with activator MHY1485 in vitro, and then the control and activated ovaries were transplanted into the kidney capsules of ovariectomized mice. We then used the Infinium Human Methylation EPIC BeadChip to verify the DNA methylation level of ovarian tissues, thus exploring the effectiveness of them. Results MHY1485 stimulated mTOR, S6K1, and rpS6 phosphorylation. Cultured with MHY1485, ovarian weights increased and endocrine function was restored. The number of growing follicles was increased. The in vitro activation process did not induce histological changes or abnormal DNA methylation occurrence. Conclusion MHY1485 for in vitro activation (IVA) is effective for ovarian rejuvenation and is a potential therapeutic treatment for POI patients.
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Affiliation(s)
- Shuang Wu
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yining Wang
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haixiang Ding
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ningxia Sun
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yan Liu
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fei Sheng
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Honghong Zhang
- Department of Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fu Yang
- Department of Medical Genetics, Second Military Medical University, Shanghai, China
| | - Wen Li
- Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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20
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Ben-Nagi J, Kasaven LS, Jones BP, Saso S, Norris G, Green J, Petrie A, Odia R, Serhal P, Yasmin E. Oocyte yield in social, medical and donor oocyte cryopreservation cycles. HUM FERTIL 2020; 25:508-515. [PMID: 33272064 DOI: 10.1080/14647273.2020.1855369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To determine if oocyte yield in women undergoing cryopreservation for social (SOC), medical (MOC) and oocyte donation (OD) cycles is comparable when matched for age. 315 oocyte retrievals were performed for SOC, 116 for MOC and 392 for OD. Non-parametric Kruskal-Wallis tests and Poisson regression were used to assess the impact of age stratification. The median ages of women undergoing SOC, MOC, and OD were 38, 31 and 26 years respectively. The median (IQR) number of oocytes in the three categories was 7, 10, and 12. The oocyte yield was significantly higher in women aged 30-34 years undergoing SOC, compared to the MOC group. For the SOC group, age in years, oestradiol levels per 1000 pmol/and follicle count >12mm on the day of trigger were significant predictors of oocyte yield. Women embarking on SOC are significantly older than those undergoing MOC and OD, and thus oocyte yield is reduced when stratified for age. This study highlights the significant predictors of oocyte yield amongst women undergoing oocyte cryopreservation for specific indications. The findings can be used to optimise the yield and overall chance of successful livebirth.
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Affiliation(s)
- Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | | | | | | | - Guy Norris
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College Hospital, London, UK
| | | | - Aviva Petrie
- Eastman Dental Institute, University College London, London, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, London, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, London, UK
| | - Ephia Yasmin
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College Hospital, London, UK
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21
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Ciepiela P, Dulęba AJ, Kario A, Chełstowski K, Branecka-Woźniak D, Kurzawa R. Oocyte matched follicular fluid anti-Müllerian hormone is an excellent predictor of live birth after fresh single embryo transfer. Hum Reprod 2020; 34:2244-2253. [PMID: 31725884 DOI: 10.1093/humrep/dez186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/15/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the relationship between the anti-Müllerian hormone (AMH), gonadotropin and androgen concentrations within a single follicle and live birth after ICSI and a transfer of an embryo developed from the matched oocyte? SUMMARY ANSWER Among the analysed markers on the day of oocyte retrieval, AMH concentration in follicular fluid (FF) is a predictor of live birth after single embryo transfer (SET). WHAT IS KNOWN ALREADY High serum concentrations of AMH and low FSH concentrations have been associated with a high chance of pregnancy after ART. Whether there are differences in the hormonal milieu for individual follicles and whether this impacts the laboratory and clinical outcomes for the individual oocyte developing within that follicle are unknown. STUDY DESIGN, SIZE, DURATION This prospective cohort study included 322 individual FF samples from 199 infertile women scheduled for ICSI/SET over an 18-month period. Of these women, 76 provided a single FF sample, while 123 women contributed two FF samples taken from two different follicles. PARTICIPANTS/MATERIALS, SETTING, METHODS The first follicle aspirated in each ovary on the day of oocyte retrieval had the FF aspirated; the individual cumulus-oocyte complex (COC) was tracked, and the associated FF was stored at -80°C. FF AMH, FSH, LH, testosterone (T) and androstenedione (A2) levels were measured by mass spectrometry (androgens) and immunoassays. The laboratory and clinical outcomes for each individual oocyte were related to their unique follicle hormone concentrations. MAIN RESULTS AND THE ROLE OF CHANCE Of the 322 oocytes with paired FF samples, 70 (21.7%) oocytes did not fertilise. From the remaining 252 2PN embryos, 88 (34.9%) were transferred as single embryos on Day 3; of the remaining 164, 78 developed into blastocysts, and 18 single blastocyst transfers were performed. Thus, a total of 106 transferred embryos had matching FF samples. An analysis of these individual FF concentrations revealed that AMH concentrations were higher in follicles in which the oocyte developed into a top quality (TQ) blastocyst (6.33 ± 5.52 ng/ml) and whose transfer led to live birth (7.49 ± 5.03 ng/ml) than those in which there was a failure of fertilisation (3.34 ± 2.21 ng/ml). In contrast, follicular FSH concentrations were the lower for oocytes that resulted in a TQ blastocyst (5.36 ± 2.20 mIU/ml) and live birth (5.60 ± 1.41 mIU/ml) than for oocytes that failed to fertilise (9.06 ± 3.36 mIU/ml). FF AMH was the only studied marker that increased the chance of live birth (odds ratio: 1.93 [95% CI: 1.40-2.67], P < 0.001). The receiver operating characteristic analysis showed that FF AMH levels predicted live birth with a very high sensitivity (91.2%), specificity (91.7%) and an excellent AUC value of 0.954, whereas serum AMH level only had a fair (AUC = 0.711) significance as a predictor for live birth after ICSI/SET. The predictive capabilities of the interfollicular markers were not limited to the TQ embryos or blastocysts; they applied to all SET cycles. LIMITATIONS, REASONS FOR CAUTION Whether an altered intrafollicular hormonal environment reflects the developmental capacity of the oocyte or defines cannot be determined from this cross-sectional analysis. Inclusion of 21 subjects with polycystic ovary syndrome (PCOS) may have biased the findings due to a unique intrafollicular milieu associated with PCOS. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that highly competent human oocytes have an FF composition of AMH, FSH, T and A2 that is close to that in a natural cycle. Also, the relationships between intrafollicular AMH, gonadotropin and androgen levels in the same follicle support the hypothesis that FF AMH concentration may reflect granulosa cell proliferation during gonadotropin-stimulated follicle growth. Finally, the serum AMH concentration is markedly lower than the FF AMH concentration, with a moderate correlation between serum and FF AMH, implying ovarian follicle autonomy with regards to its secretory products. STUDY FUNDING/COMPETING INTEREST(S) The National Science Centre of Poland supported this work (grant number: N N407 217 040). The authors declare that there is no conflict of interest regarding the publication of this article.
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Affiliation(s)
- P Ciepiela
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland.,The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - A J Dulęba
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - A Kario
- The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - K Chełstowski
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Aleja Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - D Branecka-Woźniak
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland
| | - R Kurzawa
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland.,The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
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22
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Pohler KG, Reese ST, Franco GA, Oliveira RV, Paiva R, Fernandez L, de Melo G, Vasconcelos JLM, Cooke R, Poole RK. New approaches to diagnose and target reproductive failure in cattle. Anim Reprod 2020; 17:e20200057. [PMID: 33029221 PMCID: PMC7534570 DOI: 10.1590/1984-3143-ar2020-0057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Reproductive failure and pregnancy loss in cattle are some of the largest economic burdens to cattle producers and one of most perplexing factors influencing management decisions. Pregnancy loss may occur at any point during gestation with the largest percentage of loss occurring in the first 30 days and, subsequently, decreasing as the pregnancy progresses. Losses may be attributed to numerous factors, predisposed issues or environmental conditions such as nutritional stressors or disease. From a research perspective, determining the exact causes of pregnancy loss or embryonic mortality in cattle have been difficult, due to limitations of accurately determining early gestation pregnancy status. Until methods that precisely determine embryo success early in gestation are available, our understanding of in vivo pregnancy loss will lack clarity necessary to develop management strategies to decrease such loss. In this review, we will briefly discuss the pivotal periods of pregnancy loss affecting beef and dairy cattle, methods and technologies to determine pregnancy status and embryo viability and potential opportunities to decrease reproductive failure.
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Affiliation(s)
- Ky Garrett Pohler
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Sydney Taylor Reese
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Gessica Araujo Franco
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Ramiro Vander Oliveira
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Rafael Paiva
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Lohana Fernandez
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Gabriela de Melo
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | | | - Reinaldo Cooke
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
| | - Rebecca Kyle Poole
- Department of Animal Science, Pregnancy and Developmental Programming Area of Excellence, Texas A&M University, College Station, TX, United States
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23
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Seshadri S, Morris G, Serhal P, Saab W. Assisted conception in women of advanced maternal age. Best Pract Res Clin Obstet Gynaecol 2020; 70:10-20. [PMID: 32921559 DOI: 10.1016/j.bpobgyn.2020.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/14/2020] [Indexed: 11/18/2022]
Abstract
A delay in childbearing to later in life has increased the number of women of advanced maternal age (AMA) opting for assisted reproduction. Women should be made aware that there are age-related changes to fertility, including a decline in oocyte reserve and quality, in addition to an increase in the number of oocyte chromosomal aberrations. Success rates of assisted reproductive technology (ART) cycles decrease with advanced maternal age. There are different fertility options for women of AMA, including fertility preservation (oocyte or embryo freezing), in vitro fertilisation (IVF treatment) with or without preimplantation genetic screening and oocyte or embryo donation. Detailed counselling needs to be offered to these women with regard to the risks, success rates, ethical and legal implications of these fertility treatment options. Women of AMA should be screened for underlying medical conditions that could have an impact on maternal and neonatal morbidity and mortality.
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Affiliation(s)
- S Seshadri
- The Centre for Reproductive and Genetic Health (CRGH), London, UK.
| | - G Morris
- St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - P Serhal
- The Centre for Reproductive and Genetic Health (CRGH), London, UK
| | - W Saab
- The Centre for Reproductive and Genetic Health (CRGH), London, UK
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24
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Wu W, Wang X, Li Y, Zhang Y. Analysis of the women with the AMH concentrations below the limit of reference range but with the ideal number of retrieved oocytes. Arch Gynecol Obstet 2020; 301:1089-1094. [PMID: 32179967 DOI: 10.1007/s00404-020-05491-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Serum anti-Mullerian hormone (AMH) shows a strong positive correlation to the number of oocytes retrieved but the patients undergoing assisted reproductive technology (ART) with lower AMH concentrations also could retrieve an ideal number of oocytes sometimes. The aim of the current study was to assess the performance of this population. METHODS This retrospective study included a total of 44 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles as test group, in which their AMH levels were below the limit of reference range but more than 7 eggs were retrieved, and 103 control cases enrolled from May 2016 to December 2018 after matched with the same range of age from 24 to 38 years old and the same number range of retrieved oocytes from 7 to 18 and chosen randomly according to clinical ovarian stimulation protocols by the ratio of 3:7. Several parameters, which include age, basal endocrine status, number of oocytes, the maturation rate of eggs, 2PN fertilization rate, 3PN rate, total fertilization rate, cleavage rate, 8-cell embryo rate of D3 and the utilization rate of embryo, were compared and evaluated between two groups by Wilcoxon rank-sum test and t test for two independent samples. RESULTS Although the same age range from 24 to 38 years and the same retrieval eggs from 7 to 18, compared with the control group, the test group showed less number of oocytes collected (9.455 vs 10.767, p = 0.016), younger ages (28.36 vs 32.59, p = 0.000), and higher FSH of basal endocrine status (9.783 vs 7.338, p = 0.021). Between the two groups, there were no significant differences in parameters such as the mature eggs (7.05 vs 7.92, p = 0.079), the mature oocyte rate (74.189% vs 73.916%, p = 0.924), the number of 2PNs (5.36 vs 5.91, p = 0.236), 2PN rate (73.678% vs 75.125%, p = 0.769), the number of 3PNs (0.39 vs 0.50, p = 0.773), 3PN rate (5.104% vs 5.592%, p = 0.697), number of total fertilizations (6.77 vs 7.35, p = 0.241), total fertilization rate (96.461% vs 93.166%, p = 0.332), cleavage rate (82.003% vs 81.382%, p = 0.673), the number of 8-cells on D3 (1.59 vs 1.91, p = 0.227), the rate of 8-cell on D3 (36.259% vs 41.084%, p = 0.551) and the utilization rate of embryo (62.853% vs 61.824%, p = 0.806). CONCLUSIONS These findings indicate that there are no significant differences in the maturation of oocytes and the embryo quality for the women with low AMH level and ideal retrieval eggs but they should undergo IVF treatment and achieve successful pregnancy as soon as possible due to the higher basal FSH, the relatively fewer number of retrieval eggs and the possibility of coming diminished ovarian reserve (DOR) or poor respond (PR) despite their younger ages.
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Affiliation(s)
- Wenbin Wu
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
| | - Xingling Wang
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yushan Li
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuchao Zhang
- Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Anti-Müllerian Hormone and Its Predictive Utility in Assisted Reproductive Technologies Outcomes. Clin Obstet Gynecol 2019; 62:238-256. [DOI: 10.1097/grf.0000000000000436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kavoussi SK, Chen SH, Hunn CL, West BT, Wininger JD, Kavoussi KM, Kavoussi PK. Serum Antimüllerian hormone does not predict elevated progesterone levels among women who undergo controlled ovarian hyperstimulation for in vitro fertilization. Reprod Biol Endocrinol 2019; 17:35. [PMID: 30961633 PMCID: PMC6454776 DOI: 10.1186/s12958-019-0477-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/28/2019] [Indexed: 11/12/2022] Open
Abstract
Serum Antimüllerian hormone (AMH) has been shown to predict various in vitro fertilization (IVF) outcomes. AMH and progesterone (P) are products of granulosa cells of the ovary. Since overall granulosa cell number directly correlates with oocyte number and AMH production, the aim of this study is to evaluate whether or not serum AMH is associated with elevated P during controlled ovarian hyperstimulation (COH) for IVF. For this retrospective study, data were abstracted from charts of first IVF cycles of women (n = 201) who had undergone COH between May 2014 and May 2017. Groups were as follows: (A) AMH < 1 ng/mL (n = 32), (B) AMH 1-3.99 ng/mL (n = 109), (C), AMH ≥ 4 ng/mL (n = 60). The primary outcome measure was serum P level at trigger prior to oocyte retrieval. Mean serum P levels among groups A, B, and C were 0.92 ng/mL, 0.96 ng/mL, and 0.84 ng/mL, respectively. One-way ANOVA showed that there was no difference in mean serum P level among groups A, B, and C (p-value = 0.28). Multivariable linear regression with P as the dependent variable showed that total gonadotropin dose and peak estradiol level on day of trigger each had a significant positive relationship with P, and clinical pregnancy had a significant negative relationship. Although AMH is a predictor of certain IVF outcomes, AMH is not a predictor of elevated serum P level at trigger among women who undergo COH for IVF.
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Affiliation(s)
- Shahryar K Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA.
| | - Shu-Hung Chen
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Caitlin L Hunn
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Brady T West
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John David Wininger
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Keikhosrow M Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Parviz K Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
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Jirge PR, Chougule SM, Keni A, Kumar S, Modi D. Latent genital tuberculosis adversely affects the ovarian reserve in infertile women. Hum Reprod 2019; 33:1262-1269. [PMID: 29897442 DOI: 10.1093/humrep/dey117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/13/2018] [Indexed: 01/06/2023] Open
Abstract
STUDY QUESTION What is the effect of latent genital tuberculosis (GTB) on ovarian reserve in infertile women? SUMMARY ANSWER Women with latent GTB have lower ovarian reserves and yield lower numbers of oocytes in IVF. WHAT IS KNOWN ALREADY Limited evidence suggests that women with GTB may have a low ovarian reserve. Infertile women have a high incidence of latent GTB and treatment improves fertility outcomes. STUDY DESIGN, SIZE, DURATION This prospective study from February 2013 to January 2016 compared 431 infertile women diagnosed with latent GTB (Group I) to 453 infertile women without latent GTB (Group II). PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted at Shreyas Hospital, Kolhapur, India, a tertiary referral centre for infertility. Women of both groups were 21-38 years of age. Group I consisted of infertile women with proven tubal patency but with latent GTB diagnosed by DNA PCR testing of an endometrial biopsy. Day 2-4 anti-Mullerian hormone (AMH) and antral follicle count (AFC) were assessed in both groups. All women with latent GTB took antituberculosis therapy (ATT). Gonadotropin dosages and oocyte and embryo details were noted in both groups for those who underwent IVF. MAIN RESULTS AND THE ROLE OF CHANCE Women with latent GTB were younger (29.8 ± 4.4 years vs. 30.8 ± 4.5 years; P = 0.003) and, following adjustment for age, had significantly lower AMH [Median (IQR): 2 (0.9, 4.1) ng/ml vs 2.8 (1.3, 5) ng/ml; P = 0.01] and AFC [Median (IQR): 7 (5, 11) vs 8 (5, 14); P < 0.001]. Post ATT, women with latent GTB yielded fewer oocytes (9.3 ± 7.6 vs. 10.9 ± 8.1; P = 0.01), but had more grade I embryos transferred (1.1 ± 0.5 vs. 0.89 ± 1.0; P = 0.001) and a better implantation rate (26.8% vs. 17.5%; P = 0.004) in IVF compared to women in Group II. Group I had a higher pregnancy rate compared to Group II (51.6% vs. 40.5%; P = 0.001), through various treatment modalities. Considering the adequacy of the sample size and use of robust ovarian reserve markers, the role of chance is minimal. LIMITATIONS REASONS FOR CAUTION The study is limited to an infertile population visiting a tertiary referral centre. The mechanisms by which latent GTB infection would lead to ovarian damage are unclear. WIDER IMPLICATIONS OF THE FINDINGS It is believed that latent GTB is without any clinical significance. However, a low ovarian reserve in young women with latent GTB necessitates considering it as a cause of infertility, in women with prolonged infertility. These women may experience an accelerated decline in ovarian reserve with reduced success in achieving biological parenthood. Clinicians must be aware of this condition and its consequences while managing infertility. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Sushrut Assisted Conception Clinic, Shreyas Hospital, Kolhapur, India. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- P R Jirge
- Deparment of Reproductive Medicine, Sushrut Assisted Conception Clinic, Shreyas Hospital, 6th Lane, Rajarampuri, Kolhapur, India
| | - S M Chougule
- Deparment of Reproductive Medicine, Sushrut Assisted Conception Clinic, Shreyas Hospital, 6th Lane, Rajarampuri, Kolhapur, India
| | - A Keni
- Deparment of Critical Care, & Pulmonology, Aster Aadhar Hospital, 628, B Ward, Shastri Nagar, Kolhapur, India
| | - S Kumar
- Department of Pulmonology and Sleep Medicine, Excelcare Hospital, 27th Cross, Banashankari II Stage, Bangalore, India
| | - D Modi
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), JM Street, Parel, Mumbai, India
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Sefrioui O, Madkour A, Aboulmaouahib S, Kaarouch I, Louanjli N. Women with extreme low AMH values could have in vitro fertilization success. Gynecol Endocrinol 2019; 35:170-173. [PMID: 30324831 DOI: 10.1080/09513590.2018.1505850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Circulating anti-müllerian hormone (AMH) and antral follicle count (AFC) are the best predictors of IVF outcomes. However, in extreme low AMH range especially for young patients, AMH prediction power loose its specificity to give real idea of pregnancy chance with IVF treatments and good prognosis of an extremely reduced ovarian reserve and expected poor response. Indeed, this retrospective study was conducted to evaluate IVF outcomes in patients following IVF-ICSI program with extremely low AMH levels (≤0.4 ng/ml; n = 390) compared to those presenting normal AMH range (1.3-2.6 ng/ml; n = 352) considered as control group. As expected, number of oocytes retrieved per patient, and embryological outcomes were significantly lower in the extremely low AMH levels group compared to control. Moreover, it was same trend concerning clinical outcomes but we have to note that even in extreme low AMH, patients could reach ineligible satisfying clinical pregnancy rate compared to control (17% vs 41%). For patients younger than 35 years, clinical pregnancy rate improved to 27%. Women with extreme low AMH values and especially younger ones, still have reasonable chances of achieving pregnancy, highlighting the default view of this category generally excluded from IVF program.
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Affiliation(s)
- Omar Sefrioui
- a Anfa Fertility Center, Fertility clinic and cryopreservation , Casablanca , Morocco
| | - Aicha Madkour
- b Biochemistry and Immunology Laboratory , Mohammed V University, Faculty of Sciences , Avenue Ibn Batouta Agdal , Rabat , BP 1014 , Morocco
| | - Smahane Aboulmaouahib
- a Anfa Fertility Center, Fertility clinic and cryopreservation , Casablanca , Morocco
- c Labomac, Laboratory of clinical analysis , Casablanca , Morocco
| | - Ismail Kaarouch
- a Anfa Fertility Center, Fertility clinic and cryopreservation , Casablanca , Morocco
- b Biochemistry and Immunology Laboratory , Mohammed V University, Faculty of Sciences , Avenue Ibn Batouta Agdal , Rabat , BP 1014 , Morocco
- c Labomac, Laboratory of clinical analysis , Casablanca , Morocco
| | - Noureddine Louanjli
- a Anfa Fertility Center, Fertility clinic and cryopreservation , Casablanca , Morocco
- c Labomac, Laboratory of clinical analysis , Casablanca , Morocco
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Nyström A, Mörse H, Nordlöf H, Wiebe K, Artman M, Øra I, Giwercman A, Henic E, Elfving M. Anti-müllerian hormone compared with other ovarian markers after childhood cancer treatment. Acta Oncol 2019; 58:218-224. [PMID: 30558460 DOI: 10.1080/0284186x.2018.1529423] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gonadal dysfunction is one of the major late complications after cancer diagnosis and treatment. The best markers of ovarian reserve in clinical practice are antral follicle count (AFC) and ovarian volume. We aimed to study the prevalence of premature ovarian insufficiency (POI) and evaluate anti-Müllerian hormone (AMH) and other serum markers for ovarian function in adult women who were childhood cancer survivors (CCS) in comparison with a control group. MATERIAL AND METHODS Altogether, 167 female CCS were compared to 164 matched controls. Prevalence of POI was documented and serum levels of AMH, inhibin B, follicle stimulating hormone (FSH), and estradiol (E2) were compared with AFC and ovarian volume. RESULTS POI was reported in 22 (13%) of the CCS and in none of the controls. Serum levels of AMH, inhibin B, and FSH, but not E2, correlated significantly with AFC and ovarian volume; AMH showed the highest correlation. There was no difference between CCS and controls regarding the different serum markers as measured by linear regression analysis. ROC curve AUC for primary POI showed the highest values for AMH (0.930) and AFC (0.944). For AFC <10, ROC curve AUC showed highest value for AMH for CCS (0.866) and controls (0.878). In a subgroup of female CCS <40 years (n = 120), the results were similar. CONCLUSION We found POI in 13% among CCS, slightly more than in other studies. Serum levels of AMH, inhibin B, and FSH correlated significantly with AFC and ovarian volume, and no difference was noted between CCS and controls. AMH was the most reliable serum marker for ovarian function in terms of POI and low AFC.
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Affiliation(s)
- Anna Nyström
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Endocrinology, Lund University, Skane University Hospital, Lund, Sweden
| | - Helena Mörse
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hanna Nordlöf
- Department of Clinical Sciences Malmö, Reproductive Medicine, Lund University, Skane University Hospital, Malmö, Sweden
| | - Karin Wiebe
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Endocrinology, Lund University, Skane University Hospital, Lund, Sweden
| | - Maria Artman
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Endocrinology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ingrid Øra
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Oncology and Hematology, Lund University, Skane University Hospital, Lund, Sweden
| | - Aleksander Giwercman
- Department of Clinical Sciences Malmö, Reproductive Medicine, Lund University, Skane University Hospital, Malmö, Sweden
| | - Emir Henic
- Department of Clinical Sciences Malmö, Reproductive Medicine, Lund University, Skane University Hospital, Malmö, Sweden
| | - Maria Elfving
- Department of Clinical Sciences Lund, Pediatrics, Pediatric Endocrinology, Lund University, Skane University Hospital, Lund, Sweden
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Hsu JY, James KE, Bormann CL, Donahoe PK, Pépin D, Sabatini ME. Müllerian-Inhibiting Substance/Anti-Müllerian Hormone as a Predictor of Preterm Birth in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2018; 103:4187-4196. [PMID: 30239805 DOI: 10.1210/jc.2018-01320] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
CONTEXT There is increasing evidence for Müllerian-inhibiting substance (MIS)/anti-Müllerian hormone (AMH) physiologic activity in the human uterus, so it is relevant to study how MIS/AMH levels impact pregnancy. OBJECTIVE To investigate the association of MIS/AMH levels with the risk of adverse obstetric outcomes. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENTS Women who became pregnant through in vitro fertilization between January 2012 and October 2016. Exclusion criteria were: oocyte donation, gestational carrier, multiple gestations, miscarriage before 20 weeks, or medically indicated preterm deliveries. INTERVENTIONS None. MAIN OUTCOME MEASURES There were two primary outcomes, preterm birth and cesarean delivery for arrest of labor. Because MIS/AMH level is highly skewed by certain infertility diagnoses, the preterm birth analysis was stratified by polycystic ovary syndrome (PCOS) diagnosis, and the cesarean delivery for arrest of labor analysis was stratified by diminished ovarian reserve diagnosis. χ2, Mann-Whitney, and t tests were used as appropriate. A P value of <0.05 was considered statistically significant. RESULTS Among women with PCOS, those who delivered prematurely had substantially higher MIS/AMH levels (18 vs 6.4 ng/mL, P = 0.003) than did those who delivered at term. At the highest MIS/AMH values, preterm deliveries predominated; above the 90th percentile in women with PCOS, all deliveries were premature. No effect of MIS/AMH level was observed in women without PCOS. We found no association between MIS/AMH values and cesarean delivery for labor arrest. CONCLUSION In women with PCOS, substantially elevated MIS/AMH levels are significantly associated with preterm birth, suggesting closer follow-up and further studies to elucidate the underlying mechanisms.
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Affiliation(s)
- Jennifer Y Hsu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Patricia K Donahoe
- Harvard Medical School, Boston, Massachusetts
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David Pépin
- Harvard Medical School, Boston, Massachusetts
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary E Sabatini
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Alson SSE, Bungum LJ, Giwercman A, Henic E. Anti-müllerian hormone levels are associated with live birth rates in ART, but the predictive ability of anti-müllerian hormone is modest. Eur J Obstet Gynecol Reprod Biol 2018; 225:199-204. [PMID: 29738982 DOI: 10.1016/j.ejogrb.2018.04.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/21/2018] [Accepted: 04/29/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim was to evaluate the association between serum Anti-Müllerian Hormone (AMH) level and cumulative live birth rates (LBR) in patients undergoing their first in vitro fertilization (IVF) treatment cycle, and to compare serum AMH levels with Antral Follicle Count (AFC) and Ovarian Sensitivity Index (OSI) as predictors of live birth. STUDY DESIGN A prospective cohort study of 454 patients under the age of 40 and with a regular menstrual cycle of 21-35 days, undergoing their first IVF treatment cycles between September 2010 and June 2015. Participants were divided into three groups based on their AMH level, (AMH ≤10, AMH 10-<30 and AMH ≥30 pmol/l). Any difference in AMH-distribution between patients with or without live birth was analyzed using a Mann-Whitney-test, and live birth rates were compared between groups by a chi-squared test for linear trend. The ability of AMH, OSI and AFC as predictors of live birth was assessed by a receiver operating characteristics-analysis and the area under the curve (AUC) was calculated. RESULTS Patients with live birth had a higher AMH, median (range) 26 [0-137] pmol/l, compared with patients without live birth, AMH 22 [0-154] pmol/l, p = 0.035. Mean live birth rate (SD) was 0.36 (0.48) in the total cohort, 0.26 (0.44) in AMH-group <10, 0.34 (0.48) in AMH-group 10-<30, and 0.41(0.49) in AMH-group ≥30. Thus live birth rates increased with 8% per AMH-group (95% CI: 0.02 -0.14, p = 0.015). The AUC for AFC was 0.56, for AMH 0.57 and for OSI 0.63, respectively. CONCLUSION AMH concentration in serum is associated with live birth rates after IVF. Our results suggest that both AMH, AFC and OSI have an equal but modest predictive ability in relation to live birth rate.
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Affiliation(s)
- Sara S E Alson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden.
| | - Leif J Bungum
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Emir Henic
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Lund University, Sweden
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Bleil ME, English P, Valle J, Woods NF, Crowder KD, Gregorich SE, Cedars MI. Is in utero exposure to maternal socioeconomic disadvantage related to offspring ovarian reserve in adulthood? Womens Midlife Health 2018; 4:5. [PMID: 30766715 PMCID: PMC6297989 DOI: 10.1186/s40695-018-0033-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because the ovarian follicle pool is established in utero, adverse exposures during this period may be especially impactful on the size and health of the initial follicle endowment, potentially shaping trajectories of ovarian follicle loss and the eventual onset of menopause. Building on a robust literature linking socioeconomic status (SES) and menopausal timing, the current study examined adverse prenatal exposures related to maternal SES, hypothesizing that greater maternal socioeconomic disadvantage would be associated with lower ovarian reserve in the adult offspring. METHODS In a healthy, community-based sub-sample (n = 350) of reproductive age participants in the OVA Study (2006-2011), prenatal maternal SES was examined in relation to two biomarkers of ovarian reserve, antimullerian hormone (AMH) and antral follicle count (AFC). Prenatal maternal SES was assessed indirectly using maternal addresses abstracted from participant birth certificates, geocoded, and linked to US Census-derived variables, including neighborhood-level characteristics: education (% of individuals with a HS diploma); poverty (% of families below the poverty line); unemployment (% of individuals > 16 years who are unemployed); and income (median family income). RESULTS In separate covariate-adjusted linear regression models (following the backward elimination of main effects with P > .10), greater maternal neighborhood education was related to higher ovarian reserve as marked by higher levels of offspring AMH (beta = .142, P < .001) and AFC (beta = .092, P < .10) with models accounting for 19.6% and 21.5% of the variance in AMH and AFC, respectively. In addition, greater maternal neighborhood poverty was related to lower ovarian reserve as marked by lower offspring AMH (beta = -.144, P < .01), with the model accounting for 19.5% of the variance in AMH. CONCLUSIONS Maternal socioeconomic disadvantage measured indirectly at the neighborhood level was associated with lower ovarian reserve among the adult offspring, independently of offspring SES and other potential confounding factors. This suggests SES-related adversity exposures may have a detrimental impact on the size or health of the initial follicle endowment, leading to accelerated follicle loss over time.
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Affiliation(s)
- Maria E. Bleil
- Department of Family and Child Nursing, University of Washington, Box 357262, Seattle, WA 98195 USA
| | - Paul English
- California Department of Public Health, California Environmental Health Tracking Program, Richmond, CA 94804 USA
| | - Jhaqueline Valle
- California Department of Public Health, California Environmental Health Tracking Program, Richmond, CA 94804 USA
| | - Nancy F. Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 98195 USA
| | - Kyle D. Crowder
- Department of Sociology, University of Washington, Seattle, WA 98195 USA
| | - Steven E. Gregorich
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143 USA
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143 USA
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Bas-Lando M, Rabinowitz R, Farkash R, Algur N, Rubinstein E, Schonberger O, Eldar-Geva T. Prediction value of anti-Mullerian hormone (AMH) serum levels and antral follicle count (AFC) in hormonal contraceptive (HC) users and non-HC users undergoing IVF-PGD treatment. Gynecol Endocrinol 2017; 33:797-800. [PMID: 28454495 DOI: 10.1080/09513590.2017.1320376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Use of hormone contraceptives (HC) is very popular in the reproductive age and, therefore, evaluation of ovarian reserve would be a useful tool to accurately evaluate the reproductive potential in HC users. We conducted a retrospective cohort study of 41 HC users compared to 57 non-HC users undergoing IVF-preimplantation genetic diagnosis (PGD) aiming to evaluate the effect of HC on the levels of anti-Mullerian hormone (AMH), small (2-5 mm), large (6-10 mm) and total antral follicle count (AFC) and the ability of these markers to predict IVF outcome. Significant differences in large AFC (p = 0.04) and ovarian volume (p < 0.0001) were seen, however, there were no significant differences in small and total AFC or in serum AMH and FSH levels. Oocyte number significantly correlated with AMH and total AFC in HC users (p < 0.001) while in non-HC users these correlations were weaker. In HC users, the significant predictors of achieving <6 and >18 oocytes were AFC (ROC-AUC; 0.958, p = 0.001 and 0.883, p = 0.001) and AMH (ROC-AUC-0.858, p = 0.01 and 0.878, p = 0.001), respectively. The predictive values were less significant in non-HC users. These findings are important in women treated for PGD, in ovum donors and for assessing the fertility prognosis in women using HC and wishing to postpone pregnancy.
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Affiliation(s)
- Maayan Bas-Lando
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Ron Rabinowitz
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Rivka Farkash
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Nurit Algur
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Esther Rubinstein
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Oshrat Schonberger
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Talia Eldar-Geva
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
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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: 224] [Impact Index Per Article: 32.0] [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.
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Abstract
Infertility and subfertility, menstrual irregularities, and decreased parity may occur in women with autoimmune diseases due to multiple factors, including underlying inflammatory disease, gonadotoxic medications, and psychosocial issues related to living with chronic disease. Awareness of these factors, as well as validation and support of patients confronting reproductive challenges, is important for providing comprehensive care to these women. An understanding of the expanding options for fertility preservation strategies during gonadotoxic medications is essential. Referral to a reproductive endocrinology clinic is indicated in this patient population.
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Affiliation(s)
- Emily C Somers
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Obstetrics and Gynecology, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Wendy Marder
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA; Department of Obstetrics and Gynecology, University of Michigan, North Campus Research Complex, B014 G236, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800, USA.
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Specific ranges of anti-Mullerian hormone and antral follicle count correlate to provide a prognostic indicator for IVF outcome. Reprod Biol 2017; 17:51-59. [DOI: 10.1016/j.repbio.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/13/2016] [Accepted: 12/24/2016] [Indexed: 11/23/2022]
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Zebitay AG, Cetin O, Verit FF, Keskin S, Sakar MN, Karahuseyinoglu S, Ilhan G, Sahmay S. The role of ovarian reserve markers in prediction of clinical pregnancy. J OBSTET GYNAECOL 2017; 37:492-497. [PMID: 28421902 DOI: 10.1080/01443615.2016.1269730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25-75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (< 0.21 ng/mL) can predict the IVF results among poor responder IVF applicants. Impact statement Various cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options. In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality. In the present study; a cut-off value of 0.33 ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21 ng/mL day 3 AMH values. It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.
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Affiliation(s)
- Ali G Zebitay
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - Orkun Cetin
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - Fatma F Verit
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - Seda Keskin
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - M Nafi Sakar
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - Sercin Karahuseyinoglu
- b Department of Histology and Embryology , Koc University School of Medicine , Sariyer Istanbul , Turkey
| | - Gulsah Ilhan
- a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey
| | - Sezai Sahmay
- c Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology , Istanbul University, Cerrahpasa School of Medicine , Istanbul , Turkey
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Nikmard F, Aflatoonian B, Hosseini E, Aflatoonian A, Bakhtiyari M, Aflatoonian R. A comparative study on the results of agonist and antagonist protocols based on serum AMH levels in patients undergoing intracytoplasmic sperm injection. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.12.769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Kotanidis L, Nikolettos K, Petousis S, Asimakopoulos B, Chatzimitrou E, Kolios G, Nikolettos N. The use of serum anti-Mullerian hormone (AMH) levels and antral follicle count (AFC) to predict the number of oocytes collected and availability of embryos for cryopreservation in IVF. J Endocrinol Invest 2016; 39:1459-1464. [PMID: 27465668 DOI: 10.1007/s40618-016-0521-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
AIM To investigate the predictive value of anti-Mullerian hormone (AMH) and antral follicle count (AFC) on the final number of oocytes retrieved and the availability of embryos for cryopreservation in in vitro fertilization (IVF) cycles. PATIENTS AND METHODS In this prospective study, one hundred and twenty women in their first IVF treatment were enrolled. The short stimulation agonist protocol was used for controlled ovarian hyperstimulation in all cases. Serum AMH levels were measured during the menstrual cycle preceding treatment. AFC was measured in cycle day 2, just before starting ovarian stimulation. RESULTS A strong, positive correlation between AMH, AFC and the number of collected oocytes was found. The patients with available and suitable supplementary embryos for cryopreservation had higher levels of AMH and larger numbers of AFC. CONCLUSION AMH and AFC appear to be valuable markers mainly for ovarian reserve and response to IVF treatment. Serum AMH levels and AFC are significantly associated with the number of retrieved oocytes. Also, a positive correlation with the availability of supernumerary embryos suitable for cryopreservation was observed.
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Affiliation(s)
- L Kotanidis
- Laboratory of Reproductive Physiology - In Vitro Fertilization, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
- , Florou 22A Kordelio, 56334, Thessaloníki, Greece.
| | - K Nikolettos
- Embryokosmogenesis IVF Unit, Alexandroupolis, Greece
| | - S Petousis
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - B Asimakopoulos
- Laboratory of Physiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - G Kolios
- Laboratory of Pharmacology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Nikolettos
- Laboratory of Reproductive Physiology - In Vitro Fertilization, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
- Embryokosmogenesis IVF Unit, Alexandroupolis, Greece
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The effect of serum and follicular fluid anti-Mullerian hormone level on the number of oocytes retrieved and rate of fertilization and clinical pregnancy. North Clin Istanb 2016; 3:90-96. [PMID: 28058394 PMCID: PMC5206471 DOI: 10.14744/nci.2016.02418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the relationship between oocyte yield, fertilization, and clinical pregnancy (CP), and anti-Mullerian hormone (AMH) level in serum and follicular fluid during in vitro fertilization treatment. METHODS Forty-four infertile women who underwent IVF treatment using multiagonist protocol were included in this study. Baseline level of AMH in serum and follicular fluid was measured on third day of menstrual cycle. AMH level in serum and follicular fluid was then measured again on day of oocyte pick-up. Pearson correlation and binary regression tests were used for statistical analysis. For Type 1 error, p=5% was selected as cut-off value for statistical significance. RESULTS Serum AMH level was positively correlated with total number of oocytes retrieved and rate of fertilization and CP (r=0.397, p=0.008; r=0.401, p=0.007; and r=0.382, p=0.011, respectively). There was significantly negative correlation between serum level of follicle-stimulating hormone (FSH) and fertilization rate (r=-0.320; p=0.034), as well as serum FSH level and CP rate (r=-0.308; p=0.042). There were no significant correlations between AMH level in follicular fluid and IVF treatment outcomes. CONCLUSION Serum AMH levels may be more reliable for prediction of total number of oocytes retrieved and rate of fertilization and CP than AMH levels in follicular fluid.
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Mumford SL, Legro RS, Diamond MP, Coutifaris C, Steiner AZ, Schlaff WD, Alvero R, Christman GM, Casson PR, Huang H, Santoro N, Eisenberg E, Zhang H, Cedars MI. Baseline AMH Level Associated With Ovulation Following Ovulation Induction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2016; 101:3288-96. [PMID: 27228369 PMCID: PMC5010565 DOI: 10.1210/jc.2016-1340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anti-Müllerian hormone (AMH) reduces aromatase activity and sensitivity of follicles to FSH stimulation. Therefore, elevated serum AMH may indicate a higher threshold for response to ovulation induction in women with polycystic ovary syndrome (PCOS). OBJECTIVE This study sought to determine the association between AMH levels and ovulatory response to treatment among the women enrolled into the Pregnancy in PCOS II (PPCOS II) trial. DESIGN AND SETTING This was a secondary analysis of data from a randomized clinical trial in academic health centers throughout the United States Participants: A total of 748 women age 18-40 years, with PCOS and measured AMH levels at baseline, were included in this study. MAIN OUTCOME MEASURES Couples were followed for up to five treatment cycles to determine ovulation (midluteal serum progesterone > 5 ng/mL) and the dose required to achieve ovulation. RESULTS A lower mean AMH and AMH per follicle was observed among women who ovulated compared with women who never achieved ovulation during the study (geometric mean AMH, 5.54 vs 7.35 ng/mL; P = .0001; geometric mean AMH per follicle, 0.14 vs 0.18; P = .01) after adjustment for age, body mass index, T, and insulin level. As AMH levels increased, the dose of ovulation induction medication needed to achieve ovulation also increased. No associations were observed between antral follicle count and ovulation. CONCLUSIONS These results suggest that high serum AMH is associated with a reduced response to ovulation induction among women with PCOS. Women with higher AMH levels may require higher doses of medication to achieve ovulation.
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Affiliation(s)
- Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Richard S Legro
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Michael P Diamond
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Christos Coutifaris
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Anne Z Steiner
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - William D Schlaff
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Ruben Alvero
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Gregory M Christman
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Peter R Casson
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Hao Huang
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Nanette Santoro
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Esther Eisenberg
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Heping Zhang
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
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Stojsin-Carter A, Mahboubi K, Costa NN, Gillis DJ, Carter TF, Neal MS, Miranda MS, Ohashi OM, Favetta LA, King WA. Systemic and local anti-Mullerian hormone reflects differences in the reproduction potential of Zebu and European type cattle. Anim Reprod Sci 2016; 167:51-8. [PMID: 26898391 DOI: 10.1016/j.anireprosci.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
Abstract
This study was conducted to evaluate plasma anti-Mullerian hormone (Pl AMH), follicular fluid AMH (FF AMH) and granulosa cell AMH transcript (GC AMH) levels and their relationships with reproductive parameters in two cattle subspecies, Bos taurus indicus (Zebu), and Bos taurus taurus (European type cattle). Two-dimensional ultrasound examination and serum collection were performed on Zebu, European type and crossbreed cows to determine antral follicle count (AFC), ovary diameter (OD) and Pl AMH concentration. Slaughterhouse ovaries for Zebu and European type cattle were collected to determine FF AMH concentrations, GC AMH RNA levels, AFC, oocyte number, cleavage and blastocyst rate. Additionally GC AMH receptor 2 (AMHR2) RNA level was measured for European type cattle. Relationship between AMH and reproductive parameters was found to be significantly greater in Zebu compared to European cattle. Average Pl AMH mean ± SE for Zebu and European cattle was 0.77 ± 0.09 and 0.33 ± 0.24 ng/ml respectively (p = 0.01), whereas average antral FF AMH mean ± SE for Zebu and European cattle was 4934.3 ± 568.5 and 2977.9 ± 214.1 ng/ml respectively (p < 0.05). This is the first published report of FF and GC AMH in Zebu cattle. Levels of GC AMHR2 RNA in European cattle were correlated to oocyte number (p = 0.01). Crossbred animals were found more similar to their maternal Zebu counterparts with respect to their Pl AMH to AFC and OD relationships. These results demonstrate that AMH reflects differences between reproduction potential of the two cattle subspecies therefore can potentially be used as a reproductive marker. Furthermore these results reinforce the importance of separately considering the genetic backgrounds of animals when collecting or interpreting bovine AMH data for reproductive performance.
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Affiliation(s)
- Anja Stojsin-Carter
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
| | - Kiana Mahboubi
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
| | - Nathalia N Costa
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Corrêa 1, Belém, PA 66075-110, Brazil
| | - Daniel J Gillis
- School of Computer Science, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
| | - Timothy F Carter
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
| | - Michael S Neal
- ONE Fertility, 3210 Harvester Rd, Burlington, ON L7N 3T1, Canada
| | - Moyses S Miranda
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Corrêa 1, Belém, PA 66075-110, Brazil
| | - Otavio M Ohashi
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Corrêa 1, Belém, PA 66075-110, Brazil
| | - Laura A Favetta
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
| | - W Allan King
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada.
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Delesalle AS, Robin G, Thomas-Desrousseaux P, Dewailly D, Catteau-Jonard S. Anti-Müllerian hormone serum level and other markers associated with pregnancy outcome in oocyte donation. Reprod Biol Endocrinol 2016; 14:4. [PMID: 26787450 PMCID: PMC4717601 DOI: 10.1186/s12958-016-0138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/12/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Oocyte donation is a medical technique used principally for woman with ovarian failure. Optimizing donor recruitment is essential to obtain the best results with this technique. Understanding how donor parameters influence outcome for the recipients is fundamental. The aim of this study was to determine whether clinical and/or biological parameters in the donors influence the chance of pregnancy in recipients. Our objective was also to verify whether the outcomes of controlled ovarian stimulation (COS) are predictive of pregnancy in the recipients. METHODS A retrospective observational study was conducted in the Department of Reproductive Medicine in the Lille University Hospital. Between September 2005 and April 2014, COS was performed in 145 donors for 308 recipients' cycles. We compared the cycles whose outcome was pregnancy to the cycles without pregnancy. Quantitative variables were compared using the nonparametric Mann-Whitney test. Qualitative variables were compared using a Chi-2 test or Fisher exact test, according to the numbers. Covariance analysis was performed to adjust for potential confounding factors. RESULTS The donors who produced at least one pregnancy had a mean baseline serum anti-Müllerian hormone (AMH) level significantly higher than those who did not (p = 0.001). The mean antral follicle count did not differ between the 2 groups. After covariance analysis controlling for the number of couples attributed to a given donor, this difference remained significant (p = 0.029). Mature follicle number, estradiol serum level at the trigger day, number of mature oocytes and embryo number were significantly higher in the donors who produced pregnancy. CONCLUSION Serum AMH level is associated with pregnancy outcome after oocyte donation.
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Affiliation(s)
- Anne-Sophie Delesalle
- Departments of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., Faculty of Medicine, Université de Lille II, F-59000, Lille, France.
| | - Geoffroy Robin
- Departments of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., Faculty of Medicine, Université de Lille II, F-59000, Lille, France.
| | - Patricia Thomas-Desrousseaux
- Departments of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., Faculty of Medicine, Université de Lille II, F-59000, Lille, France.
| | - Didier Dewailly
- Departments of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., Faculty of Medicine, Université de Lille II, F-59000, Lille, France.
- INSERM U1172 Team 2, JPARC, Université de Lille II, F-59000, Lille, France.
| | - Sophie Catteau-Jonard
- Departments of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., Faculty of Medicine, Université de Lille II, F-59000, Lille, France.
- INSERM U1172 Team 2, JPARC, Université de Lille II, F-59000, Lille, France.
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Park HJ, Lyu SW, Seok HH, Yoon TK, Lee WS. Anti-Müllerian hormone levels as a predictor of clinical pregnancy in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer cycles in patients over 40 years of age. Clin Exp Reprod Med 2015; 42:143-8. [PMID: 26816873 PMCID: PMC4724598 DOI: 10.5653/cerm.2015.42.4.143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/30/2015] [Accepted: 11/20/2015] [Indexed: 12/05/2022] Open
Abstract
Objective The aim of the current study was to determine the predictive value of anti-Müllerian hormone (AMH) levels for pregnancy outcomes in patients over 40 years of age who underwent in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. Methods We retrospectively analyzed the medical records of 188 women aged 40 to 44 years who underwent IVF/ICSI-fresh ET cycles due to unexplained infertility in the fertility center of CHA Gangnam Medical Center. Patients were divided into group A, with AMH levels <1.0 ng/mL (n=97), and group B, with AMH levels ≥1.0 ng/mL (n=91). We compared the clinical pregnancy rate (CPR) in the two groups and performed logistic regression analysis to identify factors that had a significant effect on the CPR. Results The CPR was significantly lower in group A than group B (7.2% vs. 24.2%, p<0.001). In multivariate logistic regression analysis, AMH levels were the only factor that had a significant impact on the CPR (odds ratio, 1.510; 95% confidence interval, 1.172-1.947). The area under the receiver operating characteristic curve for AMH levels as a predictor of the CPR was 0.721. When the cut-off level of AMH was set at 1.90 ng/mL, the CPR was 6.731-fold higher in the group with AMH levels ≥1.90 ng/mL than in the group with AMH levels <1.90 ng/mL (p<0.001). Conclusion Our study showed that AMH levels were predictive of clinical pregnancy in infertility patients over 40 years of age. Further 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)
- Hyun Jong Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Hyun Ha Seok
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
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Impact of pituitary suppression on antral follicle count and oocyte recovery after ovarian stimulation. Fertil Steril 2015; 105:690-696. [PMID: 26696299 DOI: 10.1016/j.fertnstert.2015.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/27/2015] [Accepted: 11/17/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the potential influence of short-term pituitary suppression on antral follicle count (AFC) and correlate the AFC with the number of oocytes retrieved after ovarian stimulation. DESIGN Retrospective study. SETTING University fertility center. PATIENT(S) A total of 1,479 infertile patients. INTERVENTION(S) Patients had baseline AFC, when they were not on any medications known to cause pituitary suppression, and follow-up AFC (suppressed AFC) while on E2, GnRH agonist (GnRH-a), oral contraceptive (OC) pills, or OC pills/GnRH-a in preparation for ovarian stimulation, performed within 6 months of initial baseline AFC. MAIN OUTCOME MEASURE(S) The AFC at baseline, AFC during pituitary suppression, and the number of oocytes retrieved. RESULT(S) Although there was an average unadjusted decline of 0.4, 0.9, 2.2, and 3.0 in AFC while patients were on E2, GnRH-a, OC pills, and OC pills/GnRH-a, respectively, this decline was driven by age, baseline AFC, and the hormones used. Although baseline and suppressed AFC were found to be good predictors of the number of oocytes retrieved after ovarian stimulation, statistically, suppressed AFC was found to be a marginally better predictor. CONCLUSION(S) Short-term pituitary suppression has a negative impact on AFC. This decline in AFC may influence the number of oocytes retrieved, suggesting the suppressive impact of exogenous hormones on the biological capacity of the ovary during stimulation.
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Hamdine O, Eijkemans MJC, Lentjes EGW, Torrance HL, Macklon NS, Fauser BCJM, Broekmans FJ. Antimüllerian hormone: prediction of cumulative live birth in gonadotropin-releasing hormone antagonist treatment for in vitro fertilization. Fertil Steril 2015. [PMID: 26196233 DOI: 10.1016/j.fertnstert.2015.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the accuracy of antimüllerian hormone (AMH) in predicting cumulative live birth rate (CLBR) within 1 year after treatment initiation in GnRH antagonist treatment cycles for in vitro fertilization (IVF). DESIGN Observational (retrospective) substudy as part of an ongoing prospective cohort study. SETTING University medical center. PATIENT(S) A total of 487 patients scheduled for IVF/intracytoplasmic sperm injection (ICSI). INTERVENTION(S) Patients starting their first IVF/ICSI cycle with 150 or 225 IU recombinant FSH and GnRH antagonist cotreatment were included. Serum samples collected before the first IVF treatment were used to determine AMH. Treatment data after treatment initiation for a maximum of 1 year were recorded. MAIN OUTCOME MEASURE(S) Prediction of CLBR with the use of AMH. RESULT(S) The model for predicting CLBR within 1 year included age at first treatment, AMH, type of infertility, and previous assisted reproductive technology treatment leading to live birth. The accuracy in discriminating between women who did or did not achieve a live birth was only 59%. AMH had intermediate added value in the prediction of CLBR as demonstrated by the net reclassification improvement (total 29.8). A nomogram based on age and AMH was developed by which a subgroup of patients could be identified with the poorest pregnancy prospects. CONCLUSION(S) The predictive accuracy of AMH for 1-year CLBR in GnRH antagonist treatment cycles was limited and did not yield much additional value on top of age. Withholding treatment based on predictors such as age and AMH, or a combination, remains problematic. CLINICAL TRIAL REGISTRATION NUMBER www.clinicaltrials.gov, NCT02309073.
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Affiliation(s)
- Ouijdane Hamdine
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marinus J C Eijkemans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eef G W Lentjes
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helen L Torrance
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nick S Macklon
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
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Kavoussi SK, Odenwald KC, Boehnlein LM, Summers-Colquitt RB, Pool TB, Swain JE, Jones JM, Lindstrom MJ, Lebovic DI. Antimüllerian hormone as a predictor of good-quality supernumerary blastocyst cryopreservation among women with levels <1 ng/mL versus 1-4 ng/mL. Fertil Steril 2015; 104:633-6. [PMID: 26144573 DOI: 10.1016/j.fertnstert.2015.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether antimüllerian hormone (AMH) levels predict the availability of good-quality supernumerary blastocysts for cryopreservation. DESIGN Retrospective study. SETTING Two fertility centers. PATIENT(S) First fresh IVF cycles (n = 247) grouped as follows: 40 women <35 year old with AMH <1 ng/mL and 77 women with AMH 1-4 ng/mL; 62 women ≥35 year old with AMH <1 ng/mL, and 68 women with AMH 1-4 ng/mL. INTERVENTION(S) AMH level measured before IVF with ovarian stimulation protocols based on patient age and AMH level, including short gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or GnRH agonist microdose flare; supernumerary good-quality blastocysts cryopreserved on days 5 or 6 after retrieval. MAIN OUTCOME MEASURES(S) Supernumerary good-quality blastocysts for cryopreservation in relation to AMH levels. RESULT(S) Among women <35 years of age, there was a statistically significant difference in the number of patients with supernumerary good-quality blastocysts for cryopreservation between the groups with AMH <1 ng/mL and AMH 1-4 ng/mL (30.0% vs. 58.4%) when adjusted for age. Among women ≥35 years of age, there was a statistically significant difference in the number of patients with supernumerary good-quality blastocyst cryopreservation between groups with AMH <1 ng/mL and AMH 1-4 ng/mL (16.1% vs. 42.6%), when adjusted for age. CONCLUSION(S) Low AMH levels are associated with a statistically significantly lower likelihood of blastocysts for cryopreservation as compared with higher AMH levels. This effect was seen among women both <35 and ≥35 years of age. Patient counseling should include realistic expectations for the probability of good-quality supernumerary blastocysts available for cryopreservation.
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Affiliation(s)
| | - Kate C Odenwald
- Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, Texas
| | - Lynn M Boehnlein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | | | - Thomas B Pool
- Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, Texas
| | - Jason E Swain
- Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, Texas
| | - Jeffrey M Jones
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Mary J Lindstrom
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Dan I Lebovic
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
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Comparing the Effect of Laparoscopic Supracervical and Total Hysterectomy for Uterine Fibroids on Ovarian Reserve by Assessing Serum Anti-Mullerian Hormone Levels: A Prospective Cohort Study. J Minim Invasive Gynecol 2015; 22:637-41. [DOI: 10.1016/j.jmig.2015.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 11/21/2022]
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Tal R, Tal O, Seifer BJ, Seifer DB. Antimüllerian hormone as predictor of implantation and clinical pregnancy after assisted conception: a systematic review and meta-analysis. Fertil Steril 2014; 103:119-30.e3. [PMID: 25450298 DOI: 10.1016/j.fertnstert.2014.09.041] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess whether antimüllerian hormone (AMH) is a predictor of implantation and/or clinical pregnancy in women undergoing assisted reproductive technology. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Women undergoing IVF/intracytoplasmic sperm injection in nondonor cycles. INTERVENTION(S) Measurement of serum AMH level. MAIN OUTCOME MEASURE(S) Diagnostic odds ratio (OR) and summary receiver operating characteristic curve (AUC) for AMH as a predictor of implantation and/or clinical pregnancy. RESULT(S) A total of 525 observational studies were identified, of which 19 were selected (comprising 5,373 women). Studies reporting clinical pregnancy rates in women with unspecified ovarian reserve (n = 11), diminished ovarian reserve (DOR) (n = 4), and polycystic ovary syndrome (n = 4) were included, together with studies reporting implantation rates (n = 4). The OR for AMH as a predictor of implantation in women with unspecified ovarian reserve (n = 1,591) was 1.83 (95% confidence interval [CI] 1.49-2.25), whereas the AUC was 0.591 (95% CI 0.563-0.618). The OR for AMH as a predictor of clinical pregnancy in these women (n = 4,324) was 2.10 (95% CI 1.82-2.41), whereas the AUC was 0.634 (95% CI 0.618-0.650). The predictive ability of AMH for pregnancy was greatest in women with DOR (n = 615), with OR and AUC of 3.96 (95% CI 2.57-6.10) and 0.696 (95% CI 0.641-0.751), respectively. In contrast, AMH had no significant predictive ability in women with PCOS (n = 414), with OR and AUC of 1.18 (95% CI 0.53-2.62) and 0.600 (95% CI 0.547-0.653), respectively. CONCLUSION(S) Antimüllerian hormone has weak association with implantation and clinical pregnancy rates in assisted reproductive technology but may still have some clinical utility in counseling women undergoing fertility treatment regarding pregnancy rates, particularly those with DOR.
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Affiliation(s)
- Reshef Tal
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Oded Tal
- School of Business and Hospitality, Conestoga College, Kitchener, Ontario, Canada
| | - Benjamin J Seifer
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - David B Seifer
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Oregon Health Science University, Portland, Oregon
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Tramišak Milaković T, Panić Horvat L, Čavlović K, Smiljan Severinski N, Vlašić H, Vlastelić I, Ljiljak D, Radojčić Badovinac A. Follicular fluid anti-Müllerian hormone: a predictive marker of fertilization capacity of MII oocytes. Arch Gynecol Obstet 2014; 291:681-7. [PMID: 25205183 DOI: 10.1007/s00404-014-3460-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aimed to correlate anti-Müllerian hormone (AMH) levels in follicular fluid (FF) with oocyte maturity stages, morphological quality of metaphase II (MII) oocyte and fertilization capacity of MII oocytes. METHODS A total of 92 infertile women undergoing controlled ovarian stimulation and intracytoplasmic sperm injection were analyzed. Patients were divided into two groups according to age: <35 years (n = 43) and ≥35 years (n = 49). An FF sample was obtained from a single dominant follicle in each patient for a total of 92 follicular fluid samples analyzed. AMH levels in serum and follicular fluid were measured by enzyme-linked immunosorbent assay. Mature MII oocytes, zygotes, and embryos were assessed for morphological quality. RESULTS Serum AMH levels were significantly higher in patients aged <35 years. No correlation was observed between FF AMH level and oocyte maturation stages or morphological quality of MII oocyte. Significantly lower FF AMH levels were observed in fertilized MII oocytes than in non-fertilized MII oocytes in patients aged <35 years (2.56 ± 2.0 ng/ml vs. 4.81 ± 4.14 ng/ml; p = 0.032). CONCLUSIONS The present study revealed no correlation between FF AMH and oocyte maturity stage or morphological quality of MII oocyte. However, FF AMH might be a predictive marker for fertilization capacity of MII oocytes.
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Affiliation(s)
- Tamara Tramišak Milaković
- Department of Obstetrics and Gynecology, Clinical Hospital Center Rijeka, University of Rijeka, Cambierieva 17/5, 51 000, Rijeka, Croatia,
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