1
|
Jain S, Shukla RC, Jain M, Mishra RN. Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study. Indian J Radiol Imaging 2023; 33:463-470. [PMID: 37811172 PMCID: PMC10556339 DOI: 10.1055/s-0043-1768964] [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: 10/10/2023] Open
Abstract
Objectives The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18-49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile ( r = - 0.431, p < 0.001) and infertile ( r = - 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling.
Collapse
Affiliation(s)
- Shivi Jain
- Department of Radiodiagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ram Chandra Shukla
- Department of Radiodiagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhu Jain
- Department of Obstetrics & Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rabindra Nath Mishra
- Centre of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
2
|
Wang RR, Su MH, Liu LY, Lai YY, Guo XL, Gan D, Zheng XY, Yang H, Yu SY, Liang FR, Wei W, Zhong Y, Yang J. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14:1028853. [PMID: 36992800 PMCID: PMC10040749 DOI: 10.3389/fendo.2023.1028853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the effect of acupuncture in treating poor ovarian response (POR). METHODS We searched MEDLINE (via PubMed), EMBASE, Allied and Complementary Medicine Database, CNKI, CBM, VIP database, Wanfang Database, and relevant registration databases from inception to January 30, 2023. In this review, both Chinese and English peer-reviewed literature were included. Only randomized controlled trials (RCTs) using acupuncture as an intervention for POR patients undergoing in vitro fertilization were considered. RESULTS Seven clinical randomized controlled trials (RCTs) were eventually included for comparison (516 women). The quality of included studies was generally low or very low. For the meta-analysis, seven studies showed that compared with controlled ovarian hyperstimulation (COH) therapy, acupuncture combined with COH therapy could significantly increase the implantation rate (RR=2.13, 95%CI [1.08, 4.21], p=0.03), the number of oocytes retrieved (MD=1.02, 95%CI [0.72, 1.32], p<0.00001), the thickness of endometrium (MD=0.54, 95%CI [0.13, 0.96], p=0.01), and the antral follicle count (MD=1.52, 95%CI [1.08, 1.95], p<0.00001), reduce follicle-stimulating hormone (FSH) levels (MD=-1.52, 95%CI [-2.41, -0.62], p=0.0009) and improve estradiol (E2) levels (MD=1667.80, 95%CI [1578.29, 1757.31], p<0.00001). Besides, there were significant differences in the duration of Gn (MD=0.47, 95%CI [-0.00, 0.94], p=0.05) between the two groups. However, no statistical variation was observed in improving clinical pregnancy rate (CPR), fertilization rate, high-quality embryo rate, luteinizing hormone (LH) value, anti-mullerian hormone (AMH) value, or reducing the dose of gonadotropin (Gn) values between the acupuncture plus COH therapy group and the COH therapy group. CONCLUSION Acupuncture combined with COH therapy is doubtful in improving the pregnancy outcome of POR patients. Secondly, acupuncture can also improve the sex hormone level of POR women, and improve ovarian function. Furthermore, more RCTs of acupuncture in POR are needed to be incorporated into future meta-analyses. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42020169560.
Collapse
Affiliation(s)
- Rong-Rong Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Meng-Hua Su
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li-Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuan-Yuan Lai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiao-Li Guo
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Di Gan
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Xiao-Yan Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Han Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Si-Yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wei
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Ying Zhong
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| |
Collapse
|
3
|
Kim Y, Lee E, Song JY, Kim Y, Lee S. Association between environmental pollutants and the FSH/AMH ratio as a marker of ovarian reserve. Environ Anal Health Toxicol 2022; 37:e2022029-0. [PMID: 36916042 PMCID: PMC10014749 DOI: 10.5620/eaht.2022029] [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: 08/07/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
The ovarian function decreases with age, and various markers, such as follicle stimulating hormone, inhibin B, antral follicle count, and anti-Müllerian hormone, are used for its evaluation. Recently, exposure to various environmental pollutants in daily life has been reported as an important cause of ovarian function decline. Therefore, the present study aimed to confirm the effect of environmental pollutants on the relationship between age and decline in ovarian function. The exposure levels of 16 environmental pollutants were evaluated in women aged 26-40 years, and the AMH levels and FSH/AMH ratios were used as markers for the decline of ovarian function. The participants were divided into two groups: low-level or high-level for each environmental pollutant if their exposure level was below or above the median respectively. The slope of the decrease or increase in the AMH level and FSH/AMH ratio of each group with age was evaluated. The FSH/AMH ratio better presented the difference in the rate of change with age in each group than did AMH alone. In particular, the rate of change in the FSH/AMH ratio increased 5.2 and 3.7 times (p<0.05) in the group exposed to high levels of the volatile organic compound metabolite, trans, trans-muconic acid and the polycyclic aromatic hydrocarbons metabolite, 2-hydroxynaphthalene, respectively, than in the low-level exposure groups for those metabolites. This study confirmed that environmental pollutants influenced the rate of change in the FSH/AMH ratio with age. Further studies on larger populations are necessary in the future.
Collapse
Affiliation(s)
- Yanghee Kim
- Department of Public Health, Korea University Graduate School, Seoul 02841, Republic of Korea
| | - Eunil Lee
- Department of Public Health, Korea University Graduate School, Seoul 02841, Republic of Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - YunJeong Kim
- Department of Public Health, Korea University Graduate School, Seoul 02841, Republic of Korea
| | - Seoeun Lee
- Department of Biomedical Sciences, Korea University Graduate School, Seoul 02841, Republic of Korea
| |
Collapse
|
4
|
Hua L, Zhe Y, Jing Y, Fujin S, Jiao C, Liu L. Prediction model of gonadotropin starting dose and its clinical application in controlled ovarian stimulation. BMC Pregnancy Childbirth 2022; 22:810. [PMID: 36333671 PMCID: PMC9635211 DOI: 10.1186/s12884-022-05152-6] [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] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background Selecting an appropriate and personalized Gn starting dose (GSD) is an essential procedure for determining the quality and quantity of oocytes in the controlled ovarian stimulation (COS) process of the in-vitro fertilization (IVF) treatment cycle. The current approach for determining the GSD is mainly based on the experience of a clinician, lacking unified and scientific standards. This study aims to establish a prediction model of GSD, based on which good COS outcomes can be achieved with the influencing factors comprehensively evaluated quantitatively. Material and methods We collected a total of 1555 patients undergoing the first oocytes retrieving cycle and conducted correlation analysis to find the significant factors related to the GSD. Two GSD models are built based on two popular machine learning approaches, and the one with better model performance is selected as the final model. Finally, clinical application and validation were conducted to verify the effectiveness of the proposed model. Results (1) Age, duration of infertility, type of infertility, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (bFSH), estradiol (E2), luteinizing hormone (LH), anti-Müllerian hormone (AMH) and COS treatment regimen were closely related to the GSD (P < 0.05). (2) The selected model has good modeling performance in terms of both root mean square error (RMSE) (29.87 ~ 34.21) and regression coefficient R (0.947 ~ 0.953). (3) A comprehensive evaluation of influencing factors for GSD is conducted and shows that the top four most significant factors are age, AMH, AFC, and BMI. (4) The proposed GSD can approximate the actual value well in the clinical application, with the mean absolute error of only 11.26 units, and the recommended results can prompt the number of oocytes retrieved (NOR) close to the optimal number. Conclusion Modeling the GSD value with machine learning approaches is feasible and effective, and the proposed model has good clinical application for determining the GSD in the IVF treatment cycle.
Collapse
Affiliation(s)
- Liang Hua
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Zhe
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Jing
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shen Fujin
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen Jiao
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liu Liu
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
5
|
Abdennebi I, Pasquier M, Vernet T, Levaillant JM, Massin N. Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience. J Gynecol Obstet Hum Reprod 2022; 51:102461. [DOI: 10.1016/j.jogoh.2022.102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022]
|
6
|
OUP accepted manuscript. Hum Reprod 2022; 37:622. [DOI: 10.1093/humrep/deac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
7
|
Wu Y, Yang R, Lin H, Cao C, Jiao X, Zhang Q. A Validated Model for Individualized Prediction of Live Birth in Patients With Adenomyosis Undergoing Frozen-Thawed Embryo Transfer. Front Endocrinol (Lausanne) 2022; 13:902083. [PMID: 35685210 PMCID: PMC9171040 DOI: 10.3389/fendo.2022.902083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to develop a predictive tool for live birth in women with adenomyosis undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment. METHODS A total of 424 patients with adenomyosis who underwent frozen-thawed embryo transfer (FET) from January 2013 to December 2019 at a public university hospital were included. The patients were randomly divided into training (n = 265) and validation (n = 159) samples for the building and testing of the nomogram, respectively. Multivariate logistic regression (MLR) was developed on the basis of clinical covariates assessed for their association with live birth. RESULTS In total, 183 (43.16%) patients became pregnant, and 114 (26.88%) had a live birth. The MLR showed that the probability of live birth was significantly correlated with age [odds ratio (OR), 3.465; 95% confidence interval (CI), 1.215-9.885, P = 0.020], uterine volume (OR, 8.141; 95% CI, 2.170-10.542; P = 0.002), blastocyst transfer (OR, 3.231; 95% CI, 1.065-8.819, P = 0.023), twin pregnancy (OR, 0.328; 95% CI, 0.104-0.344, P = 0.005), and protocol in FET (P < 0.001). The statistical nomogram was built based on age, uterine volume, twin pregnancy, stage of the transferred embryo, and protocol of FET, with an area under the curve (AUC) of 0.837 (95% CI: 0.741-0.910) for the training cohort. The AUC for the validation cohort was 0.737 (95% CI: 0.661-0.813), presenting a well-pleasing goodness-of-fit and stability in this model. CONCLUSIONS This visual and easily applied nomogram built on the risk factors of live birth in patients with adenomyosis provides useful and precise information for physicians on individualized decision-making during the IVF/ICSI procedure.
Collapse
Affiliation(s)
- Yaoqiu Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rong Yang
- Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haiyan Lin
- Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chunwei Cao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuedan Jiao
- Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingxue Zhang
- Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Qingxue Zhang,
| |
Collapse
|
8
|
Adamska A, Tomczuk-Bobik P, Popławska-Kita AB, Siewko K, Buczyńska A, Szumowski P, Żukowski Ł, Myśliwiec J, Zbucka-Krętowska M, Adamski M, Krętowski AJ. Assessment of different markers of ovarian reserve in women with papillary thyroid cancer treated with radioactive iodine. Endocr Connect 2021; 10:1283-1290. [PMID: 34524978 PMCID: PMC8558897 DOI: 10.1530/ec-21-0187] [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: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022]
Abstract
Treatment with radioactive iodine (RAI) in women with differentiated thyroid cancer is associated with decreased serum concentrations of anti-Müllerian hormone (AMH); however, other markers have not been investigated. Therefore, this study aimed to evaluate the effect of RAI treatment on antral follicle count (AFC) and the serum concentration of inhibin B, follicle-stimulating hormone (FSH), and AMH in women with papillary thyroid cancer (PTC) treated with RAI. We examined 25 women at a median age of 33 years treated with a single dose of RAI. We divided the participants into women over (n = 11) and under 35 years of age (n = 14). Serum concentrations of inhibin B, FSH, AMH, and AFC were assessed at baseline and 1 year after RAI treatment. We found decreased AFC (P = 0.03), serum levels of AMH (P < 0.01), inhibin B (P = 0.03), but not FSH (P = 0.23), 1 year after RAI treatment in comparison to baseline in the whole group. When we compared serum levels of AMH in younger vs older women separately, we observed a significant reduction of this hormone's serum level after RAI treatment in both groups (P < 0.01; P = 0.04, respectively). We concluded that RAI treatment significantly impacts the functional ovarian reserve in premenopausal women with PTC.
Collapse
Affiliation(s)
- Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
- Correspondence should be addressed to A Adamska:
| | - Paulina Tomczuk-Bobik
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Anna Beata Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, Białystok, Poland
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Łukasz Żukowski
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Janusz Myśliwiec
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Monika Zbucka-Krętowska
- Department of Gynecological Endocrinology and Adolescent Gynecology, Medical University of Bialystok, Białystok, Poland
| | - Marcin Adamski
- Faculty of Computer Science, Bialystok University of Technology, Białystok, Poland
| | - Adam Jacek Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Białystok, Poland
| |
Collapse
|
9
|
Pasvol TJ, Teh J, Balfoussia D, Hall R, Petersen C, Khan M, Ayres S, Jayasena CN, Foster C, Fidler S. Outcomes of fertility investigations in a cohort of adults with perinatally acquired HIV-1 infection: a UK cross-sectional observational study. AIDS 2021; 35:343-345. [PMID: 33165031 PMCID: PMC7810410 DOI: 10.1097/qad.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
There are no published studies of fertility measurements in people living with perinatally acquired HIV (PaHIV). We performed fertility investigations in 25 adults with PaHIV. Seven (78%) men had sperm morphology normal forms (%) below the fifth centile for the general population with four (44%) having no normal forms. Mean (SD) serum anti-Müllerian hormone level was 19.4 (9.5) pmol/l; lower than expected for this age group. A larger study is needed to verify our findings.
Collapse
Affiliation(s)
- Thomas J. Pasvol
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
- Research Department of Primary Care and Population Health, University College London
| | - Jhia Teh
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Danai Balfoussia
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | - Rebecca Hall
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Claire Petersen
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Maryam Khan
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Sara Ayres
- Imperial College Healthcare NHS Trust, London
| | - Channa N. Jayasena
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | | | - Sarah Fidler
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| |
Collapse
|
10
|
Melado L, Vitorino R, Coughlan C, Bixio LD, Arnanz A, Elkhatib I, De Munck N, Fatemi HM, Lawrenz B. Ethnic and Sociocultural Differences in Ovarian Reserve: Age-Specific Anti-Müllerian Hormone Values and Antral Follicle Count for Women of the Arabian Peninsula. Front Endocrinol (Lausanne) 2021; 12:735116. [PMID: 34745004 PMCID: PMC8567992 DOI: 10.3389/fendo.2021.735116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anti-Müllerian hormone (AMH) and antral follicle count (AFC) age-specific reference values form the basis of infertility treatments, yet they were based upon studies performed primarily on Caucasian populations. However, they may vary across different age-matched ethnic populations. This study aimed to describe age-specific serum AMH and AFC for women native to the Arabian Peninsula. METHODS A retrospective large-scale study was performed including 2,495 women, aged 19 to 50 years, native to the Arabian Peninsula. AMH and AFC were measured as part of their fertility assessment at tertiary-care fertility centres. Age-specific values and nomograms were calculated. RESULTS 2,495 women were evaluated. Mean, standard deviation and median values were calculated for AMH and AFC by 1-year and 5-years intervals. Median age was 34.81 years, median AMH was 1.76ng/ml and median AFC was 11. From the total group, 40.60% presented with AMH levels below 1.3ng/mL. For women <45 years old, the decrease in AFC was between -0.6/-0.8 per year. Up to 36 years old, the decrease of AMH was 0.1ng/ml. However, from 36 to 40 years old, an accelerated decline of 0.23ng/ml yearly was noted. In keeping with local customs, 71.23% of women wore the hijab and 25.76% the niqab. AMH and AFC were significantly lower for niqab group compared with hijab group (p=0.02 and p=0.04, respectively). CONCLUSION This is to-date the largest data set on age-specific AMH and AFC values in women from the Arabian Peninsula aiming to increase clinical awareness of the ovarian reserve in this population.
Collapse
Affiliation(s)
- Laura Melado
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
- *Correspondence: Laura Melado,
| | - Raquel Vitorino
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Carol Coughlan
- Medical Department, Advanced Reproductive Technologies (ART) Fertility Clinics, Dubai, United Arab Emirates
| | | | - Ana Arnanz
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
- Departamento de Biomedicina y Biotecnología, Universidad de Alcalá, Madrid, Spain
| | - Ibrahim Elkhatib
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Neelke De Munck
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Human M. Fatemi
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- Medical Department, ART Fertility Clinics, Abu Dhabi, United Arab Emirates
- Medical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
11
|
Palgamkar J, Jindal D, Sawkar S, Deshmukh S, Katakdhond M, Ishwar C, Athalye A, Shah N, Parikh F. Anti-mullerian hormone levels in indian women seeking infertility treatment: Are Indian women facing early ovarian senescence? J Hum Reprod Sci 2021; 14:380-385. [PMID: 35197683 PMCID: PMC8812391 DOI: 10.4103/jhrs.jhrs_71_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Antimullerian hormone (AMH) is a key marker of ovarian reserve and predictor of response to fertility treatment. Aim: To understand the prevalence of low ovarian reserve in Indian women seeking infertility treatment, compare their AMH with age-matched fertile Indian controls and understand ethnic differences with Caucasian women. Setting and Design: Retrospective observational study done as collaboration between our in vitro fertilization centre and a laboratory with Pan-India presence. Materials and Methods: Women aged 20–44 years were selected as Group A (seeking infertility treatment n = 54,473), Group B (conceived naturally in the past; n = 283) and Group C (data of Caucasian women; n = 718). Serum AMH levels were measured and descriptive analysis done. Statistical Analysis: Descriptive statistics and Chi-square test. Results: In Group A, 28.7%, 48.7% and 70.6% of women aged <30 years, 30–34 years and 35–39 years had serum AMH levels ≤2 ng/mL and the proportions were higher than Group B. The rate at which median AMH decreased was 1.1–2 times faster in Group B as compared to Group C. The decrease in median AMH across age groups in Group A was similar to Group B. Conclusions: Indian women in their late twenties and early thirties visiting fertility centers showed a worrisome trend of low AMH. Our study can be used as a reference for those women considering postponing pregnancy. It may be time to look at intangible cultural factors linked to social habits, ethnicity, diet, genetic predispositions, and environmental factors like endocrine disrupting chemicals contributing to premature ovarian senescence.
Collapse
|
12
|
Moolhuijsen LME, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. J Clin Endocrinol Metab 2020; 105:5890022. [PMID: 32770239 PMCID: PMC7486884 DOI: 10.1210/clinem/dgaa513] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Anti-müllerian hormone (AMH) is produced by granulosa cells of small, growing follicles in the ovary. Serum AMH levels strongly correlate with the number of growing follicles, and therefore AMH has received increasing attention as a marker for ovarian reserve. This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment. EVIDENCE ACQUISITION A PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve. EVIDENCE SYNTHESIS Serum AMH levels are measured to assess the "functional ovarian reserve," a term that is preferred over "ovarian reserve," since AMH levels reflect the pool of growing follicles that potentially can ovulate. Serum AMH levels are used in individualized follicle-stimulating hormone dosing protocols and may predict the risk of poor response or ovarian hyperstimulation syndrome but has limited value in predicting ongoing pregnancy. Serum AMH levels are studied to predict natural or disease-related age of menopause. Studies show that the age-dependent decline rates of AMH vary among women. The generalized implementation of serum AMH measurement has also led to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic. CONCLUSION Serum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.
Collapse
Affiliation(s)
- Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Correspondence and Reprint Requests: J.A. Visser, Dept of Internal Medicine, Rm Ee532, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail:
| |
Collapse
|
13
|
Gao L, Li M, Wang Y, Zeng Z, Xie Y, Liu G, Li J, Zhang B, Liang X, Wei L, Yang X. Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established. J Endocrinol Invest 2020; 43:1221-1228. [PMID: 32221909 DOI: 10.1007/s40618-020-01209-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The clinical outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is diverse in infertility patients with polycystic ovary syndrome (PCOS). The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the live birth rate in PCOS patients. METHODS All women in a public university hospital who attempted to conceive by IVF/ICSI for PCOS infertility from January 2014 to October 2018 were included. The nomogram was built from a training cohort of 178 consecutive patients and tested on an independent validation cohort of 81 patients. PCOS was confirmed in all participants. RESULTS Three variates significantly associated with live birth rate of PCOS patients were BMI, total serum cholesterol (TC) and basal FSH. This predictive model built on the basis of BMI, TC, basal FSH, type of embryo transferred and age showed good calibration and discriminatory abilities, with an area under the curve (AUC) of 0.708 (95% CI 0.632-0.785) for the training cohort. The nomogram showed satisfactory goodness-of-fit and discrimination abilities in the independent validation cohort, with an AUC of 0.686 (95% CI 0.556-0.815). CONCLUSION Our simple evidence-based nomogram presents graphically risk factors and prognostic models for IVF/ICSI outcomes in patients with PCOS, which can offer useful guidance to clinicians and patients for individual adjuvant therapy.
Collapse
Affiliation(s)
- L Gao
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - M Li
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Y Wang
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Z Zeng
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Y Xie
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - G Liu
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - J Li
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - B Zhang
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - X Liang
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - L Wei
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China.
| | - X Yang
- Reproductive Medicine Center, The Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, 510655, China.
| |
Collapse
|
14
|
Lee RWK, Khin LW, Hendricks MS, Tan HH, Nadarajah S, Tee NWS, Loh SF, Tai BC, Chan JK. Ovarian biomarkers predict controlled ovarian stimulation for in vitro fertilisation treatment in Singapore. Singapore Med J 2020; 61:463-468. [PMID: 33043373 DOI: 10.11622/smedj.2020130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ovarian biomarkers have been shown to predict responses to controlled ovarian hyperstimulation (COH) during in vitro fertilisation (IVF) in predominantly Caucasian populations, with limited studies performed in Southeast Asian women in Singapore. METHODS We evaluated the performance of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone and oestradiol levels, antral follicle count (AFC), body mass index, ovarian volume, and age to establish thresholds for the prediction of poor (< 4 oocytes retrieved) and excessive responses (> 19 oocytes retrieved) in 263 women undergoing COH. Univariate and multivariate logistic regression analysis and receiver operating characteristic curves were used to calculate probabilities for poor and excessive responders to COH. RESULTS 36 (13.7%) and 50 (19.0%) women had poor and excessive response to COH, respectively. An AMH value of 0.69 ng/mL predicted poor ovarian response with positive likelihood ratio (LR) of 2.94, compared to an AFC of ≤ 5 when the positive LR is 2.36. Conversely, an AMH value of ≥ 3.06 ng/mL predicted excessive ovarian response with positive LR of 2.24, compared to an AFC cut-off of ≥ 12 with positive LR of 1.93. CONCLUSION AMH levels and AFC are equivalent in the prediction of both poor and excessive ovarian response in women undergoing IVF. Our study highlights the importance of establishing population-specific cut-off biomarker values so that protocols can be tailored to optimise IVF treatment.
Collapse
Affiliation(s)
- Ryan Wai Kheong Lee
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Lay Wai Khin
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | | | - Heng Hao Tan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | - Sadhana Nadarajah
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | - Nancy Wen Sim Tee
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerry Ky Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
| |
Collapse
|
15
|
Ball BA, El-Sheikh Ali H, Scoggin KE, Riddle WT, Schnobrich M, Bradekamp E, Agnew M, Squires EL, Troedsson MHT. Relationship between anti-Müllerian hormone and fertility in the mare. Theriogenology 2018; 125:335-341. [PMID: 30508805 DOI: 10.1016/j.theriogenology.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/29/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
The objectives of this study were to evaluate; 1) the stability of measured serum anti-Müllerian hormone (AMH) concentrations in samples after multiple freeze-thaw cycles, 2) the repeatability of AMH concentrations within mares during the same breeding season as well as across breeding seasons, and 3) the relationship between serum AMH concentrations and fertility (measured as first cycle pregnancy rates) in thoroughbred mares. For the first aim, AMH concentrations (n = 9) were examined across four freeze-thaw cycles with no significant change in measured AMH concentrations. For the second aim, serum AMH concentrations (n = 12) were examined over three successive estrous cycles and over two successive breeding seasons and AMH levels were significantly correlated for individual animals within (r; 0.71-82) or across breeding seasons (r = 0.81). For the third aim, Thoroughbred mares (n = 419) on farms in central Kentucky had blood samples taken during estrus. Pregnancy was determined with transrectal ultrasonography at Days 13-18 after mating and ovulation, and pregnancy outcome was recorded as open, pregnant or twins. The relationships between mare age, serum AMH concentrations and the interaction of age and AMH with pregnancy outcome was examined by nominal logistic regression, and the relationship between serum AMH concentrations and mare age, pregnancy outcome and the interaction of age and pregnancy outcome was examined by ANOVA. Data in this study were then stratified according to quartiles into lower (25%), mid-50% (second and third quartiles combined - 50%) and upper (25%) quartiles for age and serum AMH concentration for further analysis by logistic regression. There were significant effects of mare age and pregnancy outcome, but not their interaction on serum AMH concentrations which were higher (P = 0.04) in pregnant than in open mares (0.65 ± 0.03 vs 0.55 ± 0.04 ng/mL, respectively). Likewise, logistic regression revealed significant effect of mare age and AMH but not their interaction on pregnancy outcome on the first mated cycle. Mares in the lower AMH quartile were more likely to be open at Day 13-18 than mares in the middle (odds ratio (OR) = 1.87)=13 or upper quartile (OR = 2.62) for AMH concentrations. Mares in the mid-50% (OR = 3.91) or upper (OR = 4.97) age quartile were more likely to be open at Day 13-18 compared to mares in the young age quartile. Based upon a Chi-squared analysis, the proportion of pregnant mares differed across age quartiles (P < 0.0001) and was greater (P < 0.05) in the young mare quartile. The proportion of pregnant mares tended to differ across AMH quartile (P = 0.1), and when adjusted for age quartile using the Cochran-Mantel-Haenszel Test, the proportion of pregnant mares differed (P < 0.05) across AMH quartile. In conclusion, mares with peripheral AMH concentrations in the lowest quartile had lower fertility compared to mares in the mid-50% or upper quartile.
Collapse
Affiliation(s)
- B A Ball
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, USA.
| | - H El-Sheikh Ali
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, USA; Theriogenology Department, Faculty of Veterinary Medicine, University of Mansoura, Egypt
| | - K E Scoggin
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, USA
| | - W T Riddle
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - M Schnobrich
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - E Bradekamp
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - M Agnew
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - E L Squires
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, USA
| | - M H T Troedsson
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, USA
| |
Collapse
|