Hormonal Assessment Research Articles

Evaluation of a new multidisciplinary clinic for the endocrine assessment of patients with duchenne muscular dystrophy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Automated extraction of incidental adrenal nodules from electronic health records

BackgroundMany adrenal incidentalomas do not undergo appropriate biochemical testing and complete imaging characterization to assess for hormone hypersecretion and malignancy. With the growing availability of clinical narratives in the electronic medical record, automated surveillance using advanced data analytic techniques may represent a promising method to improve management. MethodsA data provisioning process using a series of structured query language scripts was used to abstract all chest and abdominal computed tomography and magnetic resonance imaging reports from an academic health care system in 2018. The narratives and impressions were queried for key text relating to the identification of adrenal incidentalomas. Patients with a history of extra-adrenal malignancy undergoing staging or surveillance imaging were excluded. The prevalence and radiographic characteristics were analyzed. Patients with adrenal incidentalomas newly identified in 2018 were assessed for biochemical testing and nodule stability through August 2021. ResultsOf 36,618 patients queried, 8,557 were excluded owing to a history of extra-adrenal malignancy. Data from 447 patients were flagged by the structured query language scripts and electronically abstracted. On internal validation, 307/447 (69%) patients were correctly identified as having adrenal nodules (1.1% overall prevalence). The median patient age was 67 years, and 56% were female. The median nodule size was 1.7 (IQR 1.3–2.5) cm, 9% were bilateral, and 63% were low density (unenhanced Hounsfield units <10). Adrenal carcinoma was identified in 10 patients. In 2018, 121 patients were diagnosed with a new adrenal incidentaloma. Of 32 (27%) patients who had follow-up imaging at a median of 1.9 years, 97% of nodules were stable in size. Biochemical testing was performed in 53 patients (44%), of which 31 (26%) had complete hormonal assessment; 14 (26%) were functional nodules: 7 aldosterone-secreting, 4 cortisol-secreting, and 3 pheochromocytoma. ConclusionOnly one-fourth of patients received appropriate biochemical testing after incidental diagnosis of an adrenal nodule, and most nodules with indeterminate imaging characteristics did not undergo follow-up imaging. Advanced data analytic techniques on electronic imaging reports may aid in the clinical identification and improved management of patients with adrenal incidentalomas.

Peer review of the pesticide risk assessment for the active substance flutianil in light of confirmatory data on the endocrine disruption assessment.

The conclusions of EFSA following the peer review of the initial risk assessment carried out by the competent authority of the rapporteur Member State Belgium, for the pesticide active substance flutianil, are reported. The context of the peer review was that requested by the European Commission following the submission and evaluation of confirmatory information with regard to the endocrine disruption potential of the substance. The conclusions were reached on the basis of the evaluation of the representative uses of flutianil as a fungicide on grapevine and ornamental crops. Assessments not finalised, together with the missing information identified as being required by the regulatory framework, are listed.

Effect of weight loss on pregnancy outcomes, neuronal-reproductive-metabolic hormones and gene expression profiles in granulosa cells in obese infertile PCOS patients undergoing IVF-ET.

ObjectiveTo investigate the effect of weight loss on pregnancy outcomes, PCOS related neuronal-reproductive-metabolic hormones and ovarian granulosa cell gene expression profiles in obese PCOS infertile patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods75 patients undergoing IVF-ET due to tubal factors alone collected as the control group (group A), and 352 patients with obese PCOS infertility were divided into four groups according to the amount of weight loss before IVF: 0 kg (group B), 1-5 kg (group C), 5-10 kg (group D), and >10 kg (group E). Six cases of ovarian granulosa cells were collected randomly with the random number table method in each group for detecting mRNA profiling. Pathway networks and biological functions of the differentially expressed genes were analyzed. Validation by RT-PCR was performed.Results(1) The levels of luteinizing hormone(LH), testosterone(T) and homeostasis model assessment insulin resistance(HOMA-IR) in group E were significantly lower than those in groups B and C (P<0.05). (2) Compared with groups A and E, groups B and C showed increased total gonadotropin (Gn) and days of Gn stimulation (P<0.05), and the E2 level on trigger day and number of oocytes obtained in group B was significantly less than that in group E (P<0.05 or 0.01). Embryo implantation rate, clinical pregnancy rate and live birth rate were increased and miscarriage rate was decreased in groups A, D and E compared with group B (P<0.05 or 0.01). (3) There were significant differences among the control group and PCOS groups in some genes that are involved in neuronal-reproductive-metabolic endocrine, transcriptional regulation, cell proliferation and differentiation, etc (P<0.05). RNA-Seq results were validated by real time PCR analysis for the expression of follicle stimulating hormone receptor (FSHR), drosophila mothers against decapentaplegic protein 7(Smad7) and glutathione peroxidase 3(GPX3) genes that are known to have an important role in follicular development. Functional alterations were confirmed by the improvement in the ovarian responsiveness to Gn and embryo quality.ConclusionWeight loss more than 5kg may regulate the neuroreproductive endocrine hormone secretion, insulin resistance and gene expression profiles of ovarian granulosa cells, so as to improve the ovarian responsiveness to Gn, the embryo quality, embryo implantation rate, clinical pregnancy rate, live birth rate, and reduce the spontaneous abortion rate in obese infertile PCOS patients undergoing IVF-ET.Clinical trial registration www.chictr.org.cn, identifier ChiCTR1800018298.

The relationship between polycystic ovary syndrome and irritable bowel syndrome

Introduction: Polycystic ovary syndrome (PCOS) causes endocrine disorders that affect the functioning of the reproductive system and the body's metabolic system. Bowel movement disorders and abdominal pain are common complaints of PCOS patients. Few studies have been performed on the relationship between PCOS and irritable bowel syndrome (IBS), and the association between the two syndromes is unclear.&#x0D; Material and Method: In the study, 72 patients were enrolled at gynecology and obstetric clinic in Turkey. The control group were (n=34) and women with PCOS (n=38). IBS diagnosis was made by using Roma IV criteria.&#x0D; Results: The results showed that IBS prevalence was similar in PCOS (52%) and the control group (50%) (p&gt;0.05). No statistically significant association was found between IBS-PCOS and non-IBS-PCOS in terms of gastrointestinal symptoms (p=0.685). These symptoms were associated with PCOS rather than IBS. Significant differences have been observed between IBS-PCOS and non-IBS-PCOS for fasting insulin (FI), luteinizing hormone (LH) and Homeostasis model assessment for insulin resistance (HOMA-IR) (p

Impact of surgical factors on delayed hyponatremia in patients with nonfunctioning pituitary adenoma after endonasal endoscopic transsphenoidal procedure

PurposeDelayed hyponatremia can occur after pituitary surgery, resulting in prolonged hospitalization. However, the influence of surgical factors after such a procedure has not been well established. The impact of surgery and related factors on delayed hyponatremia was investigated.MethodsThis was a retrospective analysis of 137 consecutive patients who underwent transsphenoidal surgery for a nonfunctioning pituitary adenoma between 2008 and 2019. Preoperative (demographics, comorbidities), intraoperative (resection extent, operation time, blood loss volume, cerebrospinal fluid leak, tumor consistency), and postoperative [hematoma, meningitis, diabetes insipidus (DI), hormonal assessment] data were collected, with statistical analysis of each factor performed.ResultsAmong the 137 patients, delayed hyponatremia occurred in 31 (22.6%). Multivariate analysis revealed that those with hypertension had a significantly higher likelihood of avoiding delayed hyponatremia (p = 0.004). Although no correlations of direct surgical factors with delayed hyponatremia were found, multivariate analysis of indirect surgical factors showed that presence of a firm tumor, transient DI, and meningitis were significantly associated with delayed hyponatremia (p = 0.014, 0.001, and 0.047, respectively). There was also a significant association of severe hyponatremia with appearance of symptoms (p = 0.002).ConclusionThere was a tendency for hypertension to be associated with delayed hyponatremia avoidance, with indirect surgical factors including tumor consistency, transient DI, and meningitis found to have an influence on delayed hyponatremia. It was concluded that attention should be given to non-hypertensive patients with a firm tumor, transient DI, or meningitis after pituitary surgery, as delayed hyponatremia may occur.

Induction of ovulation in women with PCOS using letrozole versus letrozole plus gonadotropin and its effect on spontaneous on going pregnancy rate through multicenter IVF in Beni-Suef city using randomized controlled study

Background: We developed a multicenter randomized observational trial to assess the effectiveness of letrozole monotherapy and the co-therapy of letrozole and gonadotropins on pregnancy outcomes including the ovulation induction, pregnancy rate, estradiol (E2) levels and endometrial thickness in infertile women with polycystic ovarian syndrome (PCOS).Methods:At three in vitro fertilization (IVF) centers in Egypt, we conducted our study since May 2019 until we have recruited the planned number of patients. Infertile PCOS patients were recruited after they met our criteria. We had two intervention groups based on the treatment regimen.Moreover, baseline parameters, outcomes, and hormonal assessment was conducted throughout the study period. Results: We included 90 patients in this study and were equally randomized into two groups; the letrozole monotherapy (Group A) and the letrozole with gonadotropins (Group B) groups. The mean age was significantly higher in group A [26 (±3.5)] than group B [24.2 (±3.1)] (P= 0.015). Both groups showed resulted in similar pregnancy rates (31.1%) (P= 0.079).Moreover, group B [2.4 (±0.8)] resulted in a significantly higher (P= 0.023) mean number of follicles than group A [2.0 (±0.7)]. On the other hand, no statistical significance was estimated in terms of estradiol levels and endometrial thickness (P= 0.209 and 0.485, respectively).

Adrenal bleeding due to pheochromocytoma - A call for algorithm

BackgroundAdrenal hemorrhage is a rare, usually life-threating complication. The most common neoplasm resulting in spontaneous adrenal bleeding is pheochromocytoma and it accounts for nearly 50% of cases. Currently, the recommendations for the diagnosis and management of patients with adrenal bleeding due to pheochromocytoma are unavailable.Materials and methodsWe performed a database search for all pheochromocytoma patients, diagnosed and treated from 2005 to 2021 in tertiary endocrinology center. 206 patients were identified, 183 with complete data were included in the analysis. We investigated clinicopathological characteristics, treatment and outcomes of hemorrhagic pheochromocytoma cases and characterize our approach to perioperative diagnosis and medical management. Finally our experiences and data from previously published articles concerning adrenal hemorrhage were analyzed to propose a diagnostic and therapeutic algorithm for hemorrhagic pheochromocytomas.ResultsIn the whole group, seven patients (4 men and 3 women) with adrenal bleeding were found, (3.8%). Median patient’s age was 49 years (range: 36-78 years). The most common manifestation of adrenal bleeding was acute abdominal pain (5/7). Two patients developed shock. Hormonal assessment was performed in five patients, based on 24-hour urinary fractionated metanephrines with urinary 3-methoxytyramine. Normetanephrine was elevated in all patients, metanephrine and 3-methoxytyramine - in four cases (4/5). Most patients (6/7) had symptoms suggesting pheochromocytoma before hemorrhage – most commonly paroxysmal hypertension (4/7). One patient died, before the diagnosis of adrenal bleeding was made. Diagnostic imaging performed in six out of seven patients revealed adrenal tumor, with median largest diameter equal to 7.4 cm (range: 5-11 cm). Five patients had elective surgery, in one case an urgent surgery was performed. In all cases the diagnosis of pheochromocytoma was confirmed in postoperative histopathology or in autopsy. The perioperative survival rate was 85.7%.ConclusionsDiagnosis of pheochromocytoma should be always considered in patients with adrenal bleeding, especially with accompanying abdominal pain, hemodynamic shock and previous history of pheochromocytoma-associated symptoms. Lack of proper diagnosis of pheochromocytoma before surgery is associated with an additional perioperative risk. To improve the decision making in this life-threatening clinical situation, based on our results and literature data, we proposed a diagnostic and treatment algorithm.

Effects of Short-Term Melatonin or Progestogen with Gonadotropic Treatments on Reproductive Performance, Hormonal Levels and Ovarian Activity of Ewes

The study compares the effects of short-term application of melatonin alone with a commonly used progestogen + gonadotropin on the reproductive performance, serum hormone concentrations, and ovarian activity of Improved Wallachian sheep. To induce ovarian cyclicity, 382 ewes were allocated into two treatment groups. Ewes of treatment group 1 (n=26) received dietary melatonin (5mg/head/day) for 18 days. Ewes of treatment group 2 (n=356) received intravaginal sponges (FGA, flugestone acetate 20mg) for 12 days followed by injection of eCG (equine chorionic gonadotropin, 500IU i.m.) at the time of sponge withdrawal. Forty-eight hours after sponge or melatonin withdrawal, sheep were exposed to rams, and recorded reproductive performance. Six ewes from each group were selected for hormone assessment and their ovaries removed for histological analysis. Ewes receiving melatonin had lower fertility, fecundity, smaller follicles (0 – &lt;1mm), and lower follicular atresia compared to group 2. In addition, the concentration of progesterone and IGF-I, ovulation rate, and the number of healthy follicles were increased compared to FGA+eCG-treated ewes. Our results indicate that short-term application of melatonin is effective in inducing ovarian cyclicity in ewes with an increased ovulation rate despite low fertility and fecundity.

HYPERTROPHY OF THE CLITORIS IN AN ADULT WOMAN (CASE REPORT)

Non-classical congenital adrenal hyperplasia by 21 hydroxylase deficiency is an autosomal recessive disease whose usual presentation is a late virilization. In some African countries like Morocco, there are cultural barriers to gynecological examination in girls, women consult until late for a sexual problem as in the case of our patient who consulted for a clitoris hypertrophy at the age of 22 years and the hormonal assessment found a high level of 17 hydroxerone in favor of a 21 hydroxylase deficiency.

Clitoral Dysesthesia Following Suprapubic Liposuction: A Case Report of Injury to the Nerves Adjacent to the Clitoris

ABSTRACT Introduction Clitorodynia is a bothersome genito-pelvic dysesthesia characterized by atypical sensations such as burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial (hood) area that may be constant, intermittent or occurring only when provoked. Clitorodynia, like other genito-pelvic dysesthesia conditions, may result from a trigger in the end organ (clitoris), pelvic/perineum (pudendal/pelvic nerve neuropathy), cauda equina (Tarlov cyst, annular tear), spine, or brain. While the primary sensory nerve of the clitoris is the dorsal nerve, there are sensory nerves adjacent to the clitoris in the suprapubic area. A 55 year old woman who presented to our sexual medicine clinic for evaluation of clitoral dysesthesia following a suprapubic liposuction in May 2016. She described a 5 year history of unusual, unwanted, unrelenting sensations that felt weird, electrical, uncomfortable, and "nervy", were located to the left side of her clitoris/upper left inner labia, were present all the time at a minimum 5/10 intensity increasing to 7-8/10 that prevented her from focusing on tasks, including sexual activity. Objective We herein describe our evaluation and management of this patient with clitoral genito-pelvic dysesthesia. Methods The evaluation involved a detailed biopsychosocial assessment including: medical history; psychologic assessment; hormone assessment; vulvoscopy with cotton-tip swap testing; neurogenital testing for assessment of the integrity of the pudendal and sciatic nerves; and left clitoral/left inner labia anesthesia testing to assess for clinically significant symptom reduction. Results History was positive for diabetes mellitus, hypercholesterolemia, hypertension, abdominoplasty surgery (2007) and L5-S1 fusion (2010). Physical examination using vulvoscopy with cotton-tip swab testing revealed a focal region of dysesthesia (∼ 4 cm long, ∼2 cm wide) to the left of the clitoris and left upper inner labia associated with significant tenderness (7/10). Pudendal nerve integrity testing was normal. Sciatic nerve integrity testing was abnormal consistent with her previous spine surgery. Cotton-tip swab testing after focal anesthesia of the region of dysesthesia with benzocaine 20%, lidocaine 8% and tetracaine 6% revealed a clinically significant symptom reduction to pain free (0/10). Conclusions Clitoral dysesthesia can occur from injury to the nerves adjacent to the clitoris. This is a case of clitoral genito-pelvic dysesthesia in the end organ following a liposuction procedure to the suprapubic area. The most likely trigger was iatrogenic neuropathic injury of the left anterior labial branch of the genital branch of the genitofemoral nerve and/or left anterior labial branch of the ilioinguinal nerve. These latter nerves course in the suprapubic area and do not innervate the clitoris itself. Nerve testing of the clitoris, innervated by the dorsal nerve branch of the pudendal nerve, was unremarkable. Proposed management of the clitoral dysesthesia will focus on treating the iatrogenic peripheral neuropathy in the end organ and include perineural 5% dextrose injections, low intensity shockwave treatments, platelet rich plasma injections, and/or steroid injections. Disclosure No

Adrenal incidentaloma (AI) - a puzzle not only for endocrinologists

An adrenal incidentaloma (AI) is any lesion ≥ 1 cm in diameter detected during radiological diagnostics unrelated to suspected adrenal pathology. Each case of an AI requires extended hormonal and imaging assessments to accurately determine the nature of the tumor and its hormonal activity. The frequency of this tumor’s diagnostics has increased exponentially due to the continuous progress in the development of imaging methods, especially computed tomography and magnetic resonance imaging. The most common etiology of AIs are hormonally inactive adenomas of the adrenal cortex, but there are also adrenal cortex carAIcinomas, phaeochromocytoma, metastatic or infectious lesions. In the case of confirmation of the type of lesion, the management involves adrenalectomy or a sufficiently long clinical observation. In recent years, new markers of the malignancy of AI tumors have been discovered, both in imaging and biochemical diagnostics, which is associated with improvements in the accuracy of diagnosis and patient management. The aim of this study was to describe the definition, etiology and epidemiology of AIs and to draw attention to the complexity of diagnostics and therapy of accidentally diagnosed adrenal tumors. Current publications and guidelines from scientific societies around the world were reviewed, using keywords that were compatible with MeSH.

Assessment of growth-related hormones in patients with hereditary hemoglobinopathies

Background: Hemoglobinopathies are global public health problems affecting developed and non- developed countries with major consequences for human health as well as economic and social development. Patients with hemoglobinopathies often present with endocrine abnormalities due to iron overload, such as pituitary disease which responsible for growth hormone secretion. Therefore, the aim of this study was to assess the effect of iron over on growth in patients with hemoglobinopathies. Methods: A case control study, that included (140) patients with hemoglobinopathies and (50) healthy participants as a control. Growth hormone (GH), insulin like growth factor- 1 (IGF-1) and insulin like growth factor binding protein (IGFBP) were measured by standard mothed. Results: there were significant decrease level of GH, IGF-1and IGFBP; while there were increase level of ferritin, AST, ALT &amp; LDH in hemoglobinopathies patients. Conclusions: There were decreases level of growth-related hormones and IGF-1 is the more sensitive test in assessing growth retardation due iron overload, which needs treatment at an appropriate age.

Endothelial Function in Postmenopausal Women: The Possible Role of Heat Shock Protein 60 and Serum Androgens.

Background: Heat shock protein 60 (HSP60), a potentially homeostatic antigen, is involved in physiological and non-physiological conditions. Experimental data support the role of HSP60 in placental and mitochondrial steroidogenesis. Furthermore, HSP60 is translocated into the endothelial-cell plasma membrane and the extracellular space under stress conditions, promoting the atherosclerotic process. Therefore, we investigated the association between HSP60 and endothelial function in postmenopausal women, considering the possible atherogenic effect of androgenic hormones. Methods: This study included 123 healthy postmenopausal women. Exclusion criteria were treated hypertension or dyslipidaemia, menopause hormone therapy during the last 6months, and previously diagnosed peripheral vascular disease or cardiovascular disease. Fasting venous blood samples were obtained for biochemical and hormonal assessment and evaluation of HSP60. Sonographic assessment of flow-mediated dilation (FMD) occurred immediately after that in one session. Results: Univariate analysis showed that women with FMD values below median 5.12% had lower logHSP60 values (low vs. high FMD, HSP60 values: 2.01 ± 1.16ng/ml vs. 3.22 ± 1.17ng/ml, p-value = 0.031). Multivariable analysis showed that logHSP60 was associated with FMD (b-coefficient = 0.171, p-value = 0.046), adjusting for traditional cardiovascular risk factors (TRFs) and insulin levels. Further adjustment for testosterone and DHEAS rendered the result non-significant. In the multivariable analysis, FMD was associated with insulin (b-coefficient = -0.166, p-value = 0.034), testosterone (b-coefficient = -0.165, p-value = 0.034), DHEAS (b-coefficient = -0.187, p-value = 0.017), adjusting for TRFs. Discussion: The results of this study indicate that the association between androgens and endothelial function is possibly mediated by HSP60 molecules, in women with low insulin resistance and androgenicity. Further prospective studies are needed to explore the significance of our findings.

Hypertension in children and adolescents.

Definition and management of arterial hypertension in children and adolescents are uncertain, due to different positions of current guidelines. The European Society of Cardiology task-force, constituted by Associations and Councils with interest in arterial hypertension, has reviewed current literature and evidence, to produce a Consensus Document focused on aspects of hypertension in the age range of 6-16 years, including definition, methods of measurement of blood pressure, clinical evaluation, assessment of hypertension-mediated target organ damage, evaluation of possible vascular, renal and hormonal causes, assessment and management of concomitant risk factors with specific attention for obesity, and anti-hypertensive strategies, especially focused on life-style modifications. The Consensus Panel also suggests aspects that should be studied with high priority, including generation of multi-ethnic sex, age and height specific European normative tables, implementation of randomized clinical trials on different diagnostic and therapeutic aspects, and long-term cohort studies to link with adult cardiovascular risk. Finally, suggestions for the successful implementation of the contents of the present Consensus document are also given.

A Review of Non-Invasive Sampling in Wildlife Disease and Health Research: What's New?

Simple SummaryThe interest in wildlife research has increased in the last decades as more scientists work within a One Health framework that regards human, livestock and wildlife health as connected entities. To minimise the impact of research on wildlife, collecting samples with as little disturbance of the animals as possible is important. In our review, we assess the use of so-called non-invasive sampling and summarise which samples can be used successfully when carrying out research on wildlife diseases and health status. Our results show that interest in minimally invasive sampling has steadily increased since the 2010s. Topics able to employ these methods include disease research, but also stress and other hormone assessments, pollution studies, and dietary studies. At the moment, such methods are mainly used to collect samples from land mammals, however, they can also be used in a wide range of other animals. Ever more capable analytical methods will allow for an even wider use of such “animal-friendly” sampling methods.In the last decades, wildlife diseases and the health status of animal populations have gained increasing attention from the scientific community as part of a One Health framework. Furthermore, the need for non-invasive sampling methods with a minimal impact on wildlife has become paramount in complying with modern ethical standards and regulations, and to collect high-quality and unbiased data. We analysed the publication trends on non-invasive sampling in wildlife health and disease research and offer a comprehensive review on the different samples that can be collected non-invasively. We retrieved 272 articles spanning from 1998 to 2021, with a rapid increase in number from 2010. Thirty-nine percent of the papers were focussed on diseases, 58% on other health-related topics, and 3% on both. Stress and other physiological parameters were the most addressed research topics, followed by viruses, helminths, and bacterial infections. Terrestrial mammals accounted for 75% of all publications, and faeces were the most widely used sample. Our review of the sampling materials and collection methods highlights that, although the use of some types of samples for specific applications is now consolidated, others are perhaps still underutilised and new technologies may offer future opportunities for an even wider use of non-invasively collected samples.

Follicular and Hormonal Changes after Estrous Synchronization in Bottlenose Dolphins.

To gain more knowledge about the influence of hormone regulation on follicle development, ovarian ultrasounds were performed, and urinary hormone profiles were determined in ovulating and non-ovulating female bottlenose dolphins (n = 15) following estrus synchronization with altrenogest. Ovarian ultrasounds were conducted daily, post-synchronization to describe follicular recruitment in relation to the endocrine profile. Follicle sizes were grouped into very small (VSM), small (SM), medium (MD) and large (LG). In ovulating females, two follicular waves were identified, and follicular deviation toward establishing a dominant follicle only occurred during the second wave. For non-ovulating females, only the first wave was observed. For all urinary hormones, the non-ovulating group presented significantly lower concentrations of follicle-stimulating hormone (uFSH), luteinizing hormone (uLH), estrone conjugates (uE1-C) and estriol (uE3) but similar progestagen and cortisol concentrations compared to the ovulating group. Concentrations of uE1-C and uE3 and the numbers of MD and LG follicles significantly (P < 0.05) increased, while uFSH concentrations significantly (P < 0.05) decreased as ovulation approached. Urinary LH significantly increased concurrently with increasing numbers of LG follicles and decreasing numbers of SM follicles. The characterization of follicular development and its relationship with hormone assessment complements our understanding of follicular recruitment post-synchronization in bottlenose dolphins and provides new information concerning differences between ovulating and non-ovulating females in response to an estrous synchronization protocol.Lay summaryMany species of fresh and saltwater dolphins and porpoises are facing increasing pressure for food and habitats due to human activities. One of the primary aspects that can be affected by such activities is reproduction. The bottlenose dolphin has been successfully bred in zoos and aquariums for at least 70 years, and they can be trained for several voluntary behaviors that enable medical examinations. Therefore, they represent a unique resource for research and understanding of normal dolphin reproduction. In this research, voluntary ultrasound exams and urine samples from 15 female dolphins were used to describe changes in their ovaries. The resulting descriptions and comparisons provide insight into the unique ovarian physiology of bottlenose dolphins and into the differences between animals after treatment. This information adds to the body of knowledge which one day may be used for developing advanced reproductive techniques to help preserve endangered species of dolphins.

P-572 Hormonal Monitoring and Progesterone Adjustment in Frozen Embryo Transfer Cycles

Abstract Study question We investigated the effect of monitoring and follow-up of serum progesterone, estradiol &amp; luteinizing hormone levels and progesterone supplement adjustments on pregnancy outcomes for FET in programmed HRT cycles. Summary answer Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on overall pregnancy rate. What is known already Frozen Embryo transfer treatment rapidly expanded in recent years. FET can effectively prevent IVF associated complications, such as ovarian hyperstimulation syndrome and multiple pregnancy. In addition, FET serves as a safe &amp; cost-effective way to increase cumulative pregnancy rate. Though progesterone levels on the day of transfer have not yet been studied extensively in humans, tailoring the time of transferring a frozen embryo based on serial P4 values rather than cycle day number alone results in higher pregnancy rates.The value of measuring the serum E2 levels on the day of embryo transfer as an indicator for clinical pregnancy is still doubtful. Study design, size, duration Six Hundred FETs were performed in a randomized prospective manner in an infertility center in Alexandria starting from 2019 till 2021.These were further subdivided based on computer randomization into Group I (Non-intervention) including300 patients with only ultrasound monitoring &amp; Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen &amp; luteinizing hormone as well as progesterone supplement adjustments. Participants/materials, setting, methods Group I (Non-intervention) including300 patients with only ultrasound monitoring &amp; Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen &amp; luteinizing hormone as well as progesterone supplement adjustments which are further subdivided into three groups depending on progesterone level in patient’s serum early in the morning prior to embryo transfer. Group II A: P4 levels &amp;lt; 5ng/dl, Group II B: P4 levels 5-10ng/dl, Group II C: P4 levels &amp;gt;10ng Main results and the role of chance Live birth and overall pregnancy rate showed no significant difference among group monitored with ultrasound only compared to the hormonal monitored group. However, on the day of embryo transfer, serum P4 &amp;gt; 11.83 ng/ml represented a cut-off value above which there is marked increase in OPR/LBR and a sensitivity of 53.7% &amp; specificity of 51.2% in predicting pregnancy. Also, serum E2 value more than 292 pg/ml at day 18 demonstrated an increase in OPR/LBR.In our study, the cut off value of LH level less than of 10.8 IU/L at day13 had a sensitivity of 58.3% &amp; specificity of 50.4% in predicting pregnancy. Regarding pregnancy outcome, monitoring of LH levels didn’t generate useful data with no added prognostic value.Conclusion: Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on live birth, overall pregnancy &amp; abortion rate when compared to ultrasound only in non-intervention group. Limitations, reasons for caution Patients in non-intervention group didn’t have a hormonal pre-transfer assessment so it’s not possible to determine if the progesterone levels are suboptimal or not when compared to intervention group. Also, we didn’t have a post transfer hormonal assessment in case group to determine whether the progesterone dose reached desired levels. Wider implications of the findings Kofinas et al. proposed in his study that in order to optimize pregnancy and rate, P4 levels in FET cycles should be sustained between 10 and 20 ng/ml. This was in accordance to our study where the cut off value of P4 on day of 11.83 ng/ml optimized pregnancy rates. Trial registration number NCT05189145

P-583 PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level on hCG day: a retrospective study of Ten years data

Abstract Study question We aimed to investigate whether serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict the IVF/ICSI outcomes in PCOS patients. Summary answer PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L). What is known already There were several studies suggesting serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict IVF outcomes, and to decide fresh cycle embryo transfer or frozen all. But there was few study focus on PCOS patients. Study design, size, duration This is a single-center retrospective cohort study in PCOS women undergoing the first transfer of an IVF cycle between January 1st 2010 and December 31th 2019. There were 141,539 oocyte retrieval cycles during the study period, and 97,189 cycles were their first IVF cycle. PCOS was diagnosed according to the Rotterdam criteria. Among them, 3,146 cycles full filled the inclusion and exclusion criteria, and all with two embryos transferred on Day 3. Participants/materials, setting, methods We compared the live birth rate of fresh embryo transfer, stratified for serum P level. We looked for interaction between serum P level and live birth rate of fresh cycles. The serum P level within normal range (&amp;lt; 6nmol/L) on the day of hCG trigger day was divided into 4 quartiles. The four quartiles were defined as ≤ 1.35 nmol/L (Q1), &amp;gt;1.35-1.93 nmol/L (Q2), &amp;gt;1.93-2.7 nmol/L (Q3), &amp;gt;2.7 nmol/L (Q4). Main results and the role of chance The baseline characteristics with no different between groups, except BMI. The patients in Q4 group with lowest BMI, significantly higher number of oocytes retrieved and live birth rate (P &amp;lt; 0.05) . The Logistic regression analysis of the relative factors on live birth rate including BMI, basal LH and number of oocytes retrieved [P = 0.003, 0.030, 0.037 respectively, 95%CI (1.022, 1.111), (1.004, 1.076), (1.002, 1.082)]. Limitations, reasons for caution Due to the retrospective nature of this study, a well-designed and matched large sample prospective study is needed. The definition of elevated P level and the method of hormonal assessments were different between studies, this limiting the comprehensive analysis of researches and the further verification of existing results. Wider implications of the findings PCOS patients who with normal range P level on hCG day, got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L). Weight control is important for PCOS patients accepting IVF treatment. Trial registration number NOT APPLICABLE

Anti-mullerian hormone (AMH) reference values in the CALIPER cohort of healthy community children and adolescents

The assessment of anti-mullerian hormone (AMH) pre- and post-gonadotoxic treatment helps define reproductive potential in young female adults facing cancer treatment. Normative childhood AMH levels are not well defined. Our objective was to help establish accurate pediatric reference intervals (RIs) for which AMH can be used to assess AMH in pediatric/adolescent survivors.Healthy female volunteers aged 6–<19 years were recruited from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. 300 serum samples were analyzed for AMH using an automated assay. Basic demographics and menstrual cycle data on the subjects were recorded at time of sample collection. Serum AMH distribution and RIs (2.5th and 97.5th percentiles) were established in four age groups.One recommended RI (0.98–7.84 ng/mL) was established for females aged 6–<19 years after outlier removal. Females 6–<9 years demonstrated significantly lower mean AMH concentration than did females 9–<12 years (Mean ± SD: 3.18 ± 1.62 and 4.16 ± 2.55 ng/mL, respectively), who in turn demonstrated significantly higher AMH concentrations than those aged 12–<15 years (Mean ± SD: 3.75 ± 1.61 ng/mL). Statistical differences are unlikely to be clinically meaningful. Menstrual status and ethnicity did not significantly impact AMH concentrations (p = 0.787 and p = 0.0965, respectively).This is the largest series of its kind using a contemporary, automated, single-batched AMH assay in a healthy pediatric female cohort. In conjunction with future data points and longitudinal data, the RI established may be a useful adjunct to reproductive health counselling delivered to pediatric cancer patients requiring fertility damaging therapies.