Basal E2 Research Articles

Anti-Müllerian Hormone in Assisted Reproductive Technology

In recent years, assisted reproductive technology (ART) has undergone marked development and has come to play a central role in reproductive medicine. Although controlled ovarian stimulation (COS) has also improved, assessment of the ovarian reserve has become important for further improving stimulation. Existing methods of ovarian reserve assessment are inadequate, and antiMüllerian hormone (AMH) has recently garnered attention as a marker for ovarian reserve. AMH is not influenced by the menstrual cycle, can be measured at any time by collecting blood, and correlates very strongly with the number of eggs collected during in vitro fertilization. Whereas basal FSH (a conventional marker) changes after actual decreases in ovarian reserve, AMH enables quantitative prediction of ovarian reserve and is important for determining strategies for fertility treatment. Many infertile patients have AMH levels close to zero and are potential cases of premature ovarian failure. As the number of elderly infertile patients is increasing rapidly and fertility treatment is shifting from the reproductive stage to the non-reproductive stage, markers that are unstable during menopause, such as basal FSH and E2, are becoming unreliable. AMH is expected to play an increasingly important role and may become a routine test in fertility treatment.

Luteal phase estradiol versus luteal phase estradiol and antagonist protocol for controlled ovarian stimulation before in vitro fertilization in poor responders

Luteal phase synchronization of follicular growth has been suggested as a means to improve ovarian response in low responders. We compared luteal E2 and antagonist (n=256) with luteal E2 only (n=57) before antagonist protocol in low responders. The addition of GnRH antagonist to luteal E2 for luteal suppression before ovarian stimulation for IVF does not improve IVF outcomes in poor responders.

Luteinizing hormone-releasing hormone (LH-RH) treatment for inducing clomiphene response in anovulatory patients with hypogonadotropic hypogonadism.

LH-RH was administered to anovulatory patients with hypogonadotropic hypogonadism to convert them to clomiphene responders. This synthetic decapeptide was injected intramuscularly in doses of 100 μg twice a week for six weeks. Diagnostic tests of progestin, LH-RH and gonadotropin were performed before and after LH-RH treatment. Seven out of nine patients became clomiphene or clomiphene-hCG responders after one course of treatment. One patient became a clomiphene-hCG responder after one additional course of treatment. One patient with hypothyroidism did not respond to clomiphene citrate with two courses of treatment. The results of the progestin test and gonadotropin test and the basal E2 levels after this treatment were correlated with the ovulatory response to clomiphene therapy or to clomiphene-hCG therapy after LH-RH treatment. But basal gonadotropin levels and the mode of gonadotropin responses of the LH-RH test were not necessarily correlated with the ovulatory response to clomiphene or clomiphene-hCG therapy after LH-RH treatment.

Effect of endogenous progesterone and oestradiol-17β on the incidence of gastro-oesophageal reflux and on the barrier pressure during general anaesthesia in the female dog

ObjectiveTo investigate the potential effect of increased blood progesterone (P4) and oestradiol-17β (E2) concentrations on the barrier pressure (BrP) and the incidence of gastro-oesophageal reflux (GOR) in female dogs under general anaesthesia. Study designProspective, blinded experimental trial. AnimalsSeven female, adult, healthy dogs weighing 14–21 kg and aged 1–7 years. MethodsEach of the animals was studied under the influence of high blood E2 and basal P4 (study O), basal E2 and high P4 (study P) and basal E2 and P4 (study C) concentrations. Animals were premedicated with acepromazine and anaesthesia was induced with thiopental and maintained with halothane. Lower oesophageal pH was monitored continuously for 1 hour after induction. GOR was defined as oesophageal pH >7.5 or <4. Manometry of the posterior oesophageal sphincter (POS) was then performed using the slow pull-through technique. ResultsAcid GOR was detected in only one animal of study O. The three studies did not differ significantly in GOR. Mean BrP was 11.2 (study O), 9.1 (study P) and 11.6 mmHg (study C). No significant differences were detected with respect to mean BrP, intra-gastric pressure and POS pressure. ConclusionsIt is unlikely that the increased concentrations of E2 or P4 during the normal ovarian cycle influence the functional efficiency of the POS as a major barrier to GOR in healthy, female dogs under general anaesthesia. Clinical relevanceThe fact that female dogs undergoing obstetrical surgery represented a substantial sub-group of the animals which developed postoperative benign oesophageal stricture, should probably not be attributed to the effects of increased concentrations of female sex steroid hormones.

Prolonged opportunity for neuroprotection in experimental stroke with selective blockade of cyclooxygenase-2 activity

The post-treatment effects of the selective cyclooxygenase (COX)-2 inhibitor, valdecoxib, were investigated in a rat model of temporary focal ischemia. Valdecoxib reduced basal brain prostaglandin E2 concentrations at dosages that did not affect serum thromboxane B2, consistent with a selective COX-2 effect. Temporary focal cerebral ischemia was produced in rats by middle cerebral artery occlusion for 90 min. There was increased expression of COX-2 protein detected by Western blot and immunocytochemistry within neurons in the ischemic cortex at 4 and 24 h after ischemia. Rats were treated with vehicle or valdecoxib 15 min before or 1.5, 3 and 6 h after cerebral ischemia. Rats were sacrificed and brain infarction volume determined 24 h after ischemia. Valdecoxib treatment was associated with a decrease in infarction volume when administered 15 min before, and 1.5 or 3 h but not 6 h after cerebral ischemia. There were no differences in physiological parameters during the procedure. Valdecoxib administered at 1.5 h after ischemia significantly reduced the concentrations of prostaglandin E2 in ischemic penumbral cortex as compared to the vehicle-treated group and contralateral non-ischemic cortex. These results suggest that COX-2 inhibition with valdecoxib is effective when initiated both before and after middle cerebral artery occlusion.

Depression and its coping strategies in infertile women undergoing in vitro fertilization and embryo transfer

Objective To know prevalence of depression, its coping strategies and risk factors among infertile women with in vitro fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection. Methods Infertile women with IVF-ET were interviewed with center for epidemiologic studies short depression scale (CES-D10) and an abbreviated version of the COPE inventory (brief COPE), and their basal sex hormone values and estradiol ( E2 ) on the day of human chorionic gonadotropin (HCG) administration were monitored, as well as the number of oocytes yielded was counted. Results Prevalence of depression was 20.6% in infertile women, higher in those with more than eight years of marriage, infertility for more than six years, and receiving treatment for at least three years. Risk of depression among the women of infertility with monthly family income less than 3000 yuan was 14 times as those with more than 3000 yuan and risk of depression among them due to the factors of their husbands was 2/5 as those not due to men's. Depressive symptoms in the women increased with increasing of their basal follicle stimulating hormone (FSH) level, counted egg number and scores of denial items. Occurrence of their depressive symptoms decreased with higher basal E2 levels, and scores of substance use and humor. Conclusions Some infertile women with IVF-ET do have depression and preventive intervention should be aimed at related factors for depression to improve their psychological health. Key words: Fertilization in vitro; Mood disorders; Adaptation, psychological

Evaluation of age, basal FSH, LH, FSH/LH ratio and E2 levels in 800 patients as predictors of in vitro fertilization (IVF) outcome

OBJECTIVE: To analyze to what extent age and the basal FSH, LH, FSH/LH ratio and E2 levels affect the results of ovarian stimulation and IVF outcome. Design: Retrospective cohort study. Setting: University hospital infertility centre. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Eight hundred patients undergoing their first cycle of IVF with ovarian stimulation after pituitary desensitization were included in the study. The patients were divided in different study groups according to their age and their basal FSH, LH, FSH/LH ratio and E2 levels. The biological and clinical parameters of the IVF outcome, cancellation rate, implantation rate, and pregnancy rate were evaluated in each group. RESULTS: Both increasing age and basal FSH were associated considerably with reduced numbers of oocytes collected and embryos available for transfer and degreased pregnancy rate. The combined use of age and basal FSH significantly improves the predictive power for these parameters. Increasing basal LH was significantly linked with degreased numbers of mature oocytes. A significant negative correlation was demonstrated between serum FSH concentration and cancellation and pregnancy rate. Elevated FSH/LH ratio was associated with fewer mature oocytes. CONCLUSIONS: Both basal FSH and woman's age are essential predictive factors of the outcome of IVF treatment, mainly for the achievement or not of pregnancy and for miscarriage rate. However FSH is a more important predictive factor. High levels of E2 (>75pg/ml) together with advanced age has great specificity. Elevated FSH/LH ratio in the beginning of the cycle may be vital for the quality of the oocytes and predicts a poor outcome in patients undergoing controlled ovarian stimulation for IVF.

Does early follicular serum prolactin levels effect IVF cycle outcomes?

OBJECTIVE: The aim of this study was to evaluate the effect of high early follicular phase serum prolactin levels on ovarian stimulation dynamics and outcomes in patients undergoing in vitro fertilization treatment. DESIGN: Retrospective analysis. MATERIALS AND METHODS: A total of 1009 patients who undergone IVF treatment, during 2006-2008 were analyzed. Basal prolactin, FSH, LH and E2 levels were measured in IVF cycles just before ovarian stimulation. Controlled ovarian stimulation was performed using the daily GnRH antagonist and recombinant FSH preparates. Patient with high basal FSH levels (≥18 mIU/ml) and older than 42 years of ages were excluded. Patients were cathegorized into two groups; study group (n=205); with PRL levels ≥ 25 ng/mL, and the control group (n=804); with normal PRL levels (<25 ng/mL). IVF cycle outcome parameters were evaluated. RESULTS: 1009 couples with different infertility etiologies included in this study. 911 embryo transfer cycle was performed. There were no significant differences seen in the age, infertility duration, basal LH levels, basal E2 levels, TSH, FT4, FT3, thyroid antibody levels between two groups. Basal FSH levels were significantly lower in the study group. Although there were no statistically differences, total dosage of recFSH was lower in study group than control group. Also daily dosage of rec FSH was significantly lower. The pregnancy rates were similar (39.2% vs 41.7%) in both groups. Results are given in Table.1. It has been shown that there is a negative correlation between PRL and basal FSH (p<0.01). Also the negative correlation was shown between PRL and total dosage of gonadotropins used (p<0.05) and daily dosage of gonadotrophins(p<0.01). CONCLUSIONS: These data confirm that there is a negative correlation between PRL and FSH levels. PRL may play beneficial effect on ovarian stimulation in IVF cycles.Table 1MeansStudy Group(n=205)Control Group(n=804)p valuesAge32.6±4.633.2±4.70.10B.FSH7.0±2.77.7±3.00.001∗B.LH5.4±2.45.3±2.60.61B.E250.4±26.447.5±16.90.13B.PRL34.7±12.914.5±4.8<0.001∗TSH1.9±1.61.7±1.00.08Total recFSH dose2267±6822370±7330.06Daily recFSH dose316±64327±680.03∗Days of Stimulation7.2±1.37.3±1.40.40Peak E21382±9021353±9330.68No.of retrieved oocytes9.7±7.48.8±7.10.12No.of MII oocytes7.8±6.07.3±5.90.27No.of transferred embryos2.6±0.72.5±0.70.25Pregnancy Rate39.2%41.7%0.16 Open table in a new tab

The ovary-mediated FSH attenuation of the LH surge in the rat involves a decreased gonadotroph progesterone receptor (PR) action but not PR expression

Hyperstimulation of ovarian function with human FSH (hFSH) attenuates the preovulatory surge of LH. These experiments aimed at investigating the mechanism of ovarian-mediated FSH suppression of the progesterone (P(4)) receptor (PR)-dependent LH surge in the rat. Four-day cycling rats were injected with hFSH, oestradiol benzoate (EB) or vehicle during the dioestrous phase. On pro-oestrus, their pituitaries were studied for PR mRNA and protein expression. Additionally, pro-oestrous pituitaries were incubated in the presence of oestradiol-17beta (E(2)), and primed with P(4) and LH-releasing hormone (LHRH), with or without the antiprogestin RU486. After 1 h of incubation, pituitaries were either challenged or not challenged with LHRH. Measured basal and LHRH-stimulated LH secretions and LHRH self-priming were compared with those exhibited by incubated pituitaries on day 4 from ovariectomized (OVX) rats in metoestrus (day 2) injected with hFSH and/or EB on days 2 and 3. The results showed that: i) hFSH lowered the spontaneous LH surge without affecting basal LH and E(2) levels, gonadotroph PR-A/PR-B mRNA ratio or immunohistochemical protein expression; ii) incubated pro-oestrous pituitaries from hFSH-treated rats did not respond to P(4) or LHRH, and lacked E(2)-augmenting and LHRH self-priming effects and iii) OVX reversed the inhibitory effects of hFSH on LH secretion. It is concluded that under the influence of hFSH, the ovaries produce a non-steroidal factor which suppresses all PR-dependent events of the LH surge elicited by E(2). The action of such a factor seemed to be due to a blockade of gonadotroph PR action rather than to an inhibition of PR expression.

Stimulation of salmon calcitonin on secretion of 17β-estradiol by the ovarian follicles of common carp, Cyprinus carpio

The effects of salmon calcitonin (sCT) on the secretion of 17beta-estradiol (E(2)) were examined in female common carp, Cyprinus carpio. Vitellogenic stage fish adapted to high-Ca water were i.p. injected with vehicle, sCT, human chorionic gonadotropin (hCG), or hCG plus sCT. To determine whether ovarian follicles are equipped with CT receptors, a CT binding assay was conducted. In the in vitro experiments, vitellogenic follicles were incubated with stimulators and inhibitors. Administration of sCT increased the basal and hCG-stimulated E(2) release in vivo and in vitro. Binding characteristics of [(125)I]sCT to plasma membrane preparation of carp ovarian follicles showed saturability with high-affinity (K(d)=48.48 pmol/l and B(max)=1.2 pmol/mg protein). To clarify the mechanism of E(2) production by sCT, in vitro effect of sCT and hCG on aromatase activity (conversion of testosterone to E(2)) and cytochrome P450 aromatase (P450arom) gene expression in carp ovarian follicles were investigated. Salmon CT-stimulated both aromatase activity and P450arom gene expression in ovarian follicles of carp. sCT-stimulated E(2) release by the ovarian follicles in vitro was augmented in the presence of dibutyryl cAMP. Inhibitor of protein kinase A (PKA), SQ 22536 inhibited sCT-stimulated steroid production in a dose-dependent manner. Specific inhibitor of protein kinase C (PKC), NPC-15437 dihydrochloride had no inhibitory effects on sCT-induced E(2) release. The present study indicates that sCT binds specifically to carp ovary and stimulates E(2) production by increasing the activity of cytochrome P450 aromatase and P450arom gene expression. The results further suggest that stimulatory action of sCT on E(2) production is mediated through cAMP pathway.

Serum anti-mullerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles

Anti-Müllerian hormone (AMH) is reported to be a reliable marker of the ovarian response to controlled ovarian stimulation (COS). The objective of this study is to determine whether the serum AMH level can predict ovarian hyperstimulation syndrome (OHSS) prior to selection of COS protocols. A cohort of 262 IVF cycles was investigated prospectively, in order to evaluate the predictive value for OHSS by means of certain risk factors, including age, body mass index (BMI), serum estradiol (E2) level, number of retrieved oocytes and basal serum AMH level. The basal serum AMH level predicted OHSS better than age and BMI with a sensitivity of 90.5% and specificity of 81.3%. Both the basal serum AMH level (odds ratio: 1.7856, P = 0.0003) and serum E2 level on the day of HCG administration (odds ratio: 1.0005, P = 0.0455) proved to be significant predictors of OHSS by logistic regression analysis. However, age (odds ratio: 0.9346, P = 0.049) was the only significant factor for prediction of clinical pregnancy. The basal serum AMH level could be utilized effectively to predict OHSS and thus to direct the selection of mild COS protocols.

Enhancement of gastric mucosal integrity by Lactobacillus rhamnosus GG

The gastric mucosa is frequently exposed to different exogenous and endogenous ulcerative agents. Alcoholism is one of the risk factors for the development of mucosal damage in the stomach. This study aimed to assess if a probiotic strain Lactobacillus rhamnosus GG (LGG) is capable of protecting the gastric mucosa from acute damage induced by intragastric administration of ethanol. Pre-treatment of rats with LGG at 109 cfu/ml twice daily for three consecutive days markedly reduced ethanol-induced mucosal lesion area by 45%. LGG pre-treatment also significantly increased the basal mucosal prostaglandin E2 (PGE2) level. In addition, LGG attenuated the suppressive actions of ethanol on mucus-secreting layer and transmucosal resistance and reduced cellular apoptosis in the gastric mucosa. It is suggested that the protective action of LGG on ethanol-induced gastric mucosal lesions is likely attributed to the up-regulation of PGE2, which could stimulate the mucus secretion and increase the transmucosal resistance in the gastric mucosa. All these would protect mucosal cells from apoptosis in the stomach.

The relationship between reproductive outcome measures in DDT exposed malaria vector control workers: a cross-sectional study

BackgroundThe utility of blood reproductive endocrine biomarkers for assessing or estimating semen quality was explored.MethodsA cross-sectional study of 47 DDT exposed malaria vector control workers was performed. Tests included blood basal and post gonadotrophin releasing hormone (GnRH), lutenizing hormone (LH), follicle stimulating hormone (FSH), testosterone, sex hormone binding globulin (SHBG), estradiol (E2) and inhibin; a questionnaire (demographics and general medical history); a physical examination and semen analysis. Semen parameters were determined using either/or or both WHO or the strict Tygerberg criteria. Relationships between semen parameters and endocrine measures were adjusted for age, duration of abstinence before sampling, presence of physical abnormalities and fever in the last two months. All relationships between specific endocrine hormones were adjusted for age and basal SHBG.ResultsMultiple logistic regression showed a consistent positive relationship (prevalence odds ratio (POR) = 8.2, CI:1.4–49.2) between low basal inhibin (<100 pg/ml) and low semen count (< 40 million) and density (< 20 million/ml); consistent positive, but weaker relationships (1> POR < 2) between abnormally low semen count as well as density and baseline and post GnRH FSH; and positive relationships (POR = 37, CI:2–655) between the prevalence of high basal estradiol (> 50 pg/ml) and abnormal morphology (proportion < 5%) and low motility (proportion <50%). Most of the expected physiological relationships between specific endocrines were significant.ConclusionThe study has demonstrated that low basal inhibin, elevated basal FSH and high basal E2 can serve as markers of impaired semen quality.

Danazol inhibits aromatase activity of endometriosis-derived stromal cells by a competitive mechanism

To evaluate the inhibitory effect of danazol on estrogen (E) production in endometriosis. Prospective randomized study. Academic research unit of the department of obstetrics and gynecology in a university hospital. Thirteen patients with endometriosis. Danazol was added to the culture of endometriosis-derived stromal cells or suspensions of microsomes prepared from chocolate cysts. The aromatase activities as well as mRNA and protein levels of aromatase in endometriosis-derived stromal cells or microsomes of endometriosis were examined. Danazol treatment with a concentration greater than 10(-6) M significantly suppressed aromatase activity of endometriosis-derived stromal cells under basal and prostaglandin E(2) (PGE(2))-stimulated conditions. Danazol (10(-5) M) did not affect mRNA and protein levels of aromatase. Danazol competitively inhibited aromatase activity (by 1.7 x 10(-6) M of calculated Ki and 2.9 x 10(-5) M of Ki') of endometriosis microsomes. Danazol competitively inhibited aromatase activity in endometriosis-derived stromal cells without affecting either the mRNA or protein levels of aromatase. These results indicate the efficacy of local application of danazol to endometriotic lesions.

Early follicular antimüllerian hormone as an indicator of ovarian reserve

To determine the predictive value of antimüllerian hormone (AMH) as a marker for ovarian reserve and to compare its value with the markers currently being used. Prospective analysis. In vitro fertilization (IVF) clinic of a tertiary medical center. Fifty women undergoing assisted reproduction cycles. None. Comparison of day-3 serum AMH levels among women with less than five retrieved oocytes and five or more oocytes. Antral follicle count, mature oocyte count, age, basal follicle-stimulating hormone (FSH), estradiol (E2), maximum serum E2 levels, and pregnancy success were also compared. The mean serum AMH levels of patients with more than five retrieved oocytes were found to be higher (0.67 +/- 0.41 vs. 0.15 +/- 0.11 pg/mL). Mature oocyte counts, antral follicle counts, and maximum E2 levels were found to be statistically significantly different in the two groups despite similar ages and levels of basal FSH and E2. Although the receiver operator characteristics analysis revealed that the most sensitive and specific indicator of ovarian reserve is the level of AMH, it does not indicate pregnancy success as well when 0.25 pg/mL is taken as a cut-off value. These data demonstrate an association between early follicular serum AMH and ovarian response, but no association with pregnancy success.

Stimulation of amphiregulin expression in osteoblastic cells by parathyroid hormone requires the protein kinase A and cAMP response element‐binding protein signaling pathway

Parathyroid hormone (PTH), an anabolic agent for bone metabolism, has profound effects on gene expression in the osteoblast. Recently, we identified that amphiregulin (AR), an EGF-like ligand, is an immediate early gene for PTH treatment and has an important role in bone metabolism. In the present report, by using different PTH peptide fragments, protein kinase activators, and inhibitors, we have demonstrated that PTH regulates amphiregulin in a cAMP-protein kinase A (PKA)-dependent manner both in vitro and in vivo. We found that the phosphorylation of cAMP-response element (CRE)-binding protein (CREB) preceded AR transcription after PTH treatment. Moreover, luciferase reporter assays revealed that the binding of phosphorylated CREB to a conserved CRE site in the AR promoter plays an important role in basal, PTH-induced, and prostaglandin E2 (PGE2)-induced AR expression in osteoblastic cells. In summary, our data suggest that PTH-induced AR mRNA expression is mediated primarily through cAMP-PKA-CREB signaling.

Single and Repeated GnRH Agonist Stimulation Tests Compared With Basal Markers of Ovarian Reserve in the Prediction of Outcome in IVF

To study the value of a single or repeated GnRH agonist stimulation test (GAST) in predicting outcome in IVF compared to basal ovarian reserve tests. A total of 57 women was included. In a cycle prior to the IVF treatment, on day 3, an antral follicle count (AFC) was performed and blood taken for basal FSH, inhibin B and E2 measurements, followed by a subcutaneous injection of 100 microg triptorelin for the purpose of the GAST. Twenty-four hours later blood sampling was repeated. All the tests were repeated in a subsequent cycle. From the GAST E2 and inhibin B response were used as test parameters. The outcome measures were poor ovarian response and ongoing pregnancy. Group comparisons were done using the Mann-Whitney or chi-square test. Univariate and multivariate logistic regression was applied to assess which test revealed the highest predictive accuracy as expressed in the area under receiver-operating characteristic curve (ROC(AUC)). Clinical value was compared by calculating classical test characteristics for the best logistic models. All the basal and GAST variables were significantly different in the poor responders (n = 19) compared to normal responders (n = 38). In the univariate analysis on cycle 1 tests the AFC was the best predictor for poor ovarian response, while in cycle 2 the E2 response in the GAST performed best (ROC(AUC) of 0.91 for both). Multivariate analysis of the basal variables led to the selection of AFC and inhibin B in cycle 1, yielding a ROC(AUC) of 0.96. Mean E2 response was selected in a multivariate analysis of the repeated GAST variables (ROC(AUC) 0.91). At a specificity level of -0.90, several logistic models including GAST variables appeared to have a sensitivity (-0.80), positive predictive value (-0.82) and false positive rate (-0.18), comparable to a logistic model containing AFC and inhibin B. None of the test variables showed a significant relation with ongoing pregnancy. The GAST has a rather good ability to predict poor response in IVF. However, comparing the predictive accuracy and clinical value of the GAST with a day 3 AFC and inhibin B, it appeared that neither a single nor a repeated GAST performed better. In addition, the predictive ability towards ongoing pregnancy is poor. Therefore, the use of the GAST as a predictor of outcome in IVF should not be advocated.

Prognostic value of some ovarian reserve tests in poor responders

The objective of this study was to determine the prognostic value of the basal estradiol (E2) and inhibin-B levels, the antral follicle count (AFC), and the clomiphene citrate challenge test (CCCT) of ovarian response in controlled ovarian hyperstimulation (COH), in an outcome with normal follicle-stimulating hormone (FSH) concentration in the early follicular phase of the menstrual cycle. Fifty-two patients undergoing IVF treatment were included in the study. Blood samples were collected for assessment of basal E2, FSH, and inhibin-B levels. Transvaginal ultrasound of an unstimulated cycle was performed to determine the mean antral follicle count (AFC). Serum FSH concentration was measured again on day 10 for CCCT performance. The mean values of women's age, and basal and day 10 FSH levels were significantly higher in cancelled cycles than in the control group, whereas basal inhibin-B and AFC were significantly higher in the latter. The mean basal E2 concentration was similar in both groups. The results from the logistic regression analysis show that CCCT (cut-off point FSH > 12.5 mIU/ml; AUCROC = 0.90) was a better single predictor of poor ovarian response than AFC (AUCROC = 0.85) and inhibin-B (AUCROC = 0.79) with a correct prediction for CCCT (86.5%), antral follicle count (84.6%), and for inhibin-B (82.7%). In women with normal basal FSH level, the determination of E2 has no prognostic value for the outcome of poor responders. However, CCCT, AFC, and inhibin-B tests, when applied separately, produce good prognostic values. CCCT is the best single predictor of poor ovarian response, followed by antral follicle count and basal inhibin-B values. In spite of that, CCCT does not add significantly to the simpler AFC ultrasound test in the prediction of poor ovarian response.

Nitric oxide mediates inhibitory effect of leptin on insulin-like growth factor I augmentation of 17beta-estradiol production in human granulosa cells.

In the present study the authors investigated if the inhibitory effect of leptin in the ovary was mediated via nitric oxide (NO) using human granulosa cells (GCs). Human GCs were obtained from preovulatory follicles of women who underwent IVF. Reverse transcription-polymerase chain reaction (RT-PCR) demonstrated that human GCs expressed mRNA of leptin and mRNA of isoforms of leptin receptor, including one long form and two types of short forms. Exposure of human GCs to leptin at concentrations of 3-30 ng/ml for 60 min dose-dependently increased the fluorescence of 4,5-diaminofluorescein (DAF-2), an NO-sensitive dye. The effect of leptin on DAF-2 fluorescence was inhibited by pretreatment of human GCs with 100 microM nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase (NOS), indicating that the increase in DAF-2 fluorescence properly reflected the intracellular NO production. FSH (1 ng/ ml) and IGF-I (30 ng/ml) stimulated 17beta-estradiol (E2) production in human GCs, respectively. FSH plus IGF-I induced a further increase in E2 production. Leptin did not significantly alter basal or FSH-dependent E2 production, but it inhibited the effect of IGF-I on E2 production and the synergistic effect of IGF-I on FSH-stimulated E2 production. The inhibitory effect of leptin on IGF-I argumentation of E2 production was attenuated by pretreatment of human GCs with 100 microM L-NAME. In conclusion, leptin could induce NO production in human GCs. The inhibitory effect of leptin on IGF-I augmentation of E2 production in human GCs was attenuated by L-NAME, strongly suggesting that NO may mediate the action of leptin in human GCs.

Basal ovarian reserve tests do not estimate follicular development in stimulated cycles of young infertile patients

Many tests have been suggested to predict the ovarian reserve till to now. But most of them were lack of predictive value especially in a population at low risk for poor ovarian reserve, such as women younger than 35 years of age. We tried to evaluate basal ovarian reserve tests to estimate follicular development in stimulated cycles of young low risk infertility patients. Basal FSH and E2 concentrations, ovarian volume measurements and antral follicle count as an ovarian reserve test on day 3 of an ovulation induction cycle in a low risk young infertility population have no predictive value.