Follicle stimulating hormone as a predictor of ovarian response in women undergoing controlled ovarian hyperstimulation for IVF

An in silico model using prognostic genetic factors for ovarian response in controlled ovarian stimulation: A systematic review

PURPOSE

To study the use of in silica model to better understand and propose new markers of ovarian response to controlled ovarian stimulation before IVF.

METHODS

A systematic review and in silica model using bioinformatics. After the selection of 103 papers from a systematic review process, we performed a GRADE qualification of all included papers for evidence-based quality evaluation. We included 57 genes in the silica model using a functional protein network interaction. Moreover, the construction of protein-protein interaction network was done importing these results to Cytoscape. Therefore, a cluster analysis using MCODE was done, which was exported to a plugin BINGO to determine Gene Ontology. A p value of < 0.05 was considered significant, using a Bonferroni correction test.

RESULTS

In silica model was robust, presenting an ovulation-related gene network with 87 nodes (genes) and 348 edges (interactions between the genes). Related to the network centralities, the network has a betweenness mean value = 102.54; closeness mean = 0.007; and degree mean = 8.0. Moreover, the gene with a higher betweenness was PTPN1. Genes with the higher closeness were SRD5A1 and HSD17B3, and the gene with the lowest closeness was GDF9. Finally, the gene with a higher degree value was UBB; this gene participates in the regulation of TP53 activity pathway.

CONCLUSIONS

This systematic review demonstrated that we cannot use any genetic marker before controlled ovarian stimulation for IVF. Moreover, in silica model is a useful tool for understanding and finding new markers for an IVF individualization.

PROSPERO

CRD42020197185.

Impact of hemostatic methods on ovarian reserve and fertility in laparoscopic ovarian cystectomy

Impact of hemostatic methods, electrocoagulation versus suture, on ovarian reserve and fertility in laparoscopic ovarian cystectomy was investigated. Eighty patients with bilateral ovarian cysts who underwent laparoscopic ovarian cystectomy were randomly divided into 2 groups based on the hemostatic methods: 40 in suture group and another 40 in electrocoagulation group. Blood samples were drawn from all patients at roughly three time points: Before the surgery, 1 month and 6 months after the surgery. Radioimmunoassay was performed to measure the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti-Mullerian hormone (AMH). Moreover, the vaginal ultrasound examination was performed to obtain the ovarian size, peak systolic velocity (PSV) of ovarian stromal blood flow, and antral follicle count (AFC). In terms of postoperative ovarian reserve, the levels of E2 and AMH slightly decreased while the FSH level slightly increased in the suture group at both 1 and 6 months after surgery. In the electrocoagulation group, however, the levels of E2 and AMH decreased significantly while the FSH level increased significantly at 1 month after surgery. Six months after surgery, these levels all returned slightly showing some recovery of ovarian reserve. In comparison between the suture group and the electrocoagulation group, the differences in levels of E2, FSH and AMH were all statistically significant at both 1 and 6 months after surgery (P<0.05). Six months after surgery, the differences in AFC and PSV between the suture group and the electrocoagulation group were statistically significant (P<0.05). In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture. The use of electrocoagulation for hemostasis should be minimized during the operation, and the suture method should be adopted for hemostasis and shaping of the ovarian wound.

Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis

OBJECTIVE

To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups.

DESIGN

Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy.

SETTING

In vitro fertilization clinics.

PATIENT(S)

A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Excessive response prediction.

RESULT(S)

We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same.

CONCLUSION(S)

We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

Ovarian reserve assessment for infertility investigation

The current trends to postpone motherhood and the increase in demand for assistance in reproductive medicine highlight the need for seeking guidelines for the establishment of individualized treatment protocols. Currently available ovarian reserve tests do not provide sufficient evidence to be solely considered ideal, but they may occupy important place in initial counseling, predicting unsatisfactory results that could be improved by individualized induction schemes and reducing excessive psychological and financial burdens, and adverse effects. In this paper, we revise the role of hormonal basal and dynamic tests, as well as ultrasonographic markers, as ovarian reserve markers, in order to provide embasement for propaedeutic strategies and their interpretation in order to have reproductive success.

Ovarian reserve evaluation: state of the art

PURPOSE

Revise role of hormonal basal and dynamic tests, as well as ultrasonographic measures as ovarian reserve markers, in order to provide better counseling to subfertile couples.

METHODS

Review of publications on the topic, with an emphasis on recent well designed articles.

RESULTS

Currently available ovarian reserve tests do not provide sufficient evidence to be solely considered ideal, even for premature ovarian senescence patients who do not present subfertility complaints. However, these markers occupy important place in initial approach to treatment of subfertile couples, predicting unsatisfactory results that could be improved by differentiated induction schemes and reducing excessive psychological and financial burdens, and adverse effects.

CONCLUSIONS

In order to remedy the limitations due to the scarcity of strong evidence about this topic, future studies should try to clarify predictive value of markers in groups of specific diseases-related subfertility and pay special attention to propaedeutic multivariate models including anti-Müllerian hormone and antral follicle count.