Basal Serum Follicle-stimulating Hormone Research Articles

POvaStim: An online tool for directing individualized FSH doses in ovarian stimulation

POvaStim: An online tool for directing individualized FSH doses in ovarian stimulation

Subfertile Chinese patients with diminished ovarian reserve: An analysis of pregnancy outcomes of ART cycles.

To analyze the pregnancy outcomes of patients presenting with infertility solely due to diminished ovarian reserve (DOR) and treated by assisted reproductive technology (ART), including artificial insemination by husband (AIH) and in vitro fertilization (IVF). This was a retrospective study of subfertile patients due to DOR attending the Center for Reproductive Medicine in Guangzhou, China, between January 2010 and October 2015. Patients were assigned into either the AIH or IVF group. Within each group, these patients were further subgrouped based on their serum basal follicle-stimulating hormone (bFSH) level (10 ≤ bFSH ≤ 12IU/L and bFSH > 12IU/L) and age (20-30, 31-35, 36-40, and 41-45 years). The live birth rates were compared among these groups and subgroups. A total of 1,003 patients with a median age of 38.91 (21-45) years were enrolled in the study. The live birth rate following AIH was 5.61% (25/446), which was significantly lower than that following IVF (25.13%; 140/557). In the subgroup analysis, the cumulative live birth rates in AIH group were significantly lower than those in the IVF groups (in the 10-12 IU/L bFSH subgroup, 13.74% vs. 41.13% (P<0.05) for patients aged ≤35 years, and 4.82% vs. 19.77% (P<0.05) for patients aged >35 years; in the >12 IU/L bFSH subgroup, 9.52% vs. 29.91% (P<0.05) for patients aged ≤35 years, and 5.71% vs. 20.55% (P<0.05) for patients aged >35 years). Longitudinal analysis showed that majority of live births, in AIH or IVF groups, were achieved in the first two cycles. In subfertile women with DOR, live birth rates following AIH were significantly lower than IVF, especially for the aged women. Considering the low efficacy of AIH and that majority of live births were achieved in the first two cycles, we suggest no more than two AIH treatment attempts for the aged women with DOR.

A STUDY TO CORRELATE SERUM ANTI MULLERIAN HORMONE, BASAL FOLLICLE STIMULATING HORMONE AND ANTRAL FOLLICLE COUNT IN PRIMARY INFERTILITY AS A MEASURE OF OVARIAN RESERVE

Objectives: This study aims to find the correlation between anti mullerian hormone (AMH) and follicle stimulating hormone (FSH) and to observe the above mentioned hormones relation with antral follicle count (AFC) in patients with primary infertility. Methodology: This is a cross-sectional correlation study in which 60 patients with primary infertility meeting inclusion criteria, attending infertility clinic in Chalmeda Ananda Rao Institute Of Medical Sciences, Karimnagar, between October 2020and April 2022 were enrolled by simple random sampling. Detailed menstrual, obstetric, coital and medical history was obtained. On the third day of the spontaneous cycle, all patients were investigated with a transvaginal scan to assess the number of antral follicles and a fasting venous blood sample was obtained for the measurement of serum AMH and serum basal FSH level. Results: Basal serum FSH shows a moderately strong negative correlation with antral follicle count (AFC) (r=0.65 p=&lt;0.001) and a strong negative correlation with anti mullerian hormone (AMH) (r=0.69 and p=&lt;0.001). However, the strongest correlation between a biochemical marker and biophysical marker of ovarian reserve is between anti mullerian hormone (AMH) and antral follicle count (AFC) with a very strong positive correlation with a correlation co-efficient r=0.89 (p=&lt;0.001). Conclusion: Serum AMH best correlates with the antral follicle count. Antral follicle counts although an efficient test to detect ovarian reserve is uncomfortable for the patient as it has to be done during menstrual flow. Serum AMH with minimal intracycle and intercycle variation is a more convenient marker to assess ovarian reserve while it maintains the accuracy of AFC.

Nomogram for the cumulative live birth in women undergoing the first IVF cycle: Base on 26, 689 patients in China.

ObjectivePredictive models of the cumulative live birth (CLB) in women undergoing in vitro fertilization (IVF) treatment are limited. The aim of this study was to develop and validate a nomogram for the CLB in women undergoing the first IVF cycle.MethodsBased on a cross-sectional study in assisted reproduction center of Northwest Women’s and Children’s Hospital, 26,689 Chinese patients who underwent IVF treatment was used to develop and validate a prediction model for the CLB. Among those participants, 70% were randomly assigned to the training set (18,601 patients), while the remaining 30% were assigned to the validation set (8,088 patients). A nomogram was constructed based on the results of the multivariate logistic regression analysis. The model performance was evaluated using the C statistic and the calibration performance was assessed by Hosmer-Lemeshow (HL) χ2 statistics and calibration plots.ResultsMultivariate logistic regression analyses revealed that female age, female body mass index (BMI), tubal factor infertility, male infertility, uterine factor infertility, unexplained infertility, antral follicle count (AFC) and basal serum follicle stimulating hormone (FSH) were significant factors for CLB in women undergoing the first IVF cycle. An area under the receiver operating characteristic curve (AUC) in the prediction model was 0.676 (95% CI 0.668 to 0.684) in the training group. The validation set showed possibly helpful discrimination with an AUC of 0.672 (95% CI 0.660 to 0.684). Additionally, the prediction model had a good calibration (HL χ2 = 8.240, P=0.410).ConclusionsWe developed and validated a nomogram to predict CLB in women undergoing the first IVF cycle using a single center database in China. The validated nomogram to predict CLB could be a potential tool for IVF counselling.

The Effects of City Lockdown Policy on Frozen Embryo Transfer Outcome during COVID-19 Epidemic in Hubei Province, China.

Objective To evaluate whether there is a difference in clinical pregnancy rate and live birth rate between the corresponding period in 2019 and COVID-19 city lockdown period in 2020 in frozen embryo transfer (FET). Methods In one single in vitro fertilization (IVF) center (Shiyan, Hubei province, China), a retrospective cohort analysis was conducted, with a sample size of 59 patients in the lockdown period (2020.1.23-2020.2.23, 2020 group) and 34 patients in the corresponding 2019 period (2019.1.23-2019.2.23, 2019 group). Implantation, biochemical and clinical pregnancy, miscarriage, and live birth rates were all measured. Results Age, basal serum follicle-stimulating hormone (FSH), basal serum luteinizing hormone (LH), basal serum E2, and serum total T were all comparable between the two groups. On the day of progesterone administration, endometrial thickness was similar (8.5 ± 1.3 vs. 8.2 ± 1.4, P = 0.356). The number of transferred blastocysts was not significantly different. The two groups had similar clinical pregnancy rate (61.8% vs. 61.0%, P > 0.05) and live birth rate (47.1% vs. 49.2%, P > 0.05), which did not significantly differ. Nonetheless, there was a significant difference in the cancelled cycle rate between the two groups (0% vs. 28.0%, P = 0.043). Conclusions Lockdown period FET versus corresponding period FET outcome did not show any significant difference in terms of pregnancy rate and live birth rate between two groups of patients. Although there was no significant difference, in the 2020 group, the live birth rate was higher compared with that in the 2019 group. There was a significant difference in the rate of cancelled cycles due to the seal off control. In summary, artificial endometrial preparation is an appropriate protocol for special periods.

Clinical Outcomes of In Vitro Maturation After Oocyte Retrieval With Gynecological Surgery for Refractory Polycystic Ovary Syndrome: A Retrospective Cohort Study.

ObjectiveTo explore the clinical outcomes of unstimulated in vitro maturation (IVM) after oocyte retrieval with gynecological surgery (IVM-surgery) for refractory polycystic ovary syndrome (PCOS) and analyze the influencing factors.MethodsPatients with refractory PCOS who underwent unstimulated IVM-surgery from June 2014 to September 2018 were included in this retrospective cohort study. Matured IVM oocytes were freshly fertilized and subsequently frozen at the blastocyst stage. Frozen-thawed embryo transfer was then conducted according to the desire of patients. Oocytes and embryological outcomes, reproductive outcomes were evaluated. Influencing factors of oocytes and embryological outcomes were analyzed by univariate analysis and multivariate analysis. Receiver operating characteristic curves were used to evaluate the predict value of serum hormone levels for oocytes and embryological outcomes.ResultsA total of 93 patients with refractory PCOS who underwent unstimulated IVM-surgery were included in this study.13 patients (13/85, 15.3%) had spontaneous pregnancy and live birth after surgery. 34 patients (34/93, 36.6%) obtained blastocysts and received embryo transfer, of which 13 patients (13/34, 38.2%) eventually achieved live birth by IVM. Higher anti-Mullerian hormone, antral follicle count and basal serum luteinizing hormone (LH) levels were strongly correlated with higher number of oocytes retrieved (P = 0.004, 0.004, 0.040, respectively). Higher basal serum follicle-stimulating hormone (FSH) and LH were significantly associated with higher oocyte maturation rate (P = 0.001 and P = 0.004, respectively) and blastocyst formation (P = 0.036 and P = 0.003, respectively). There was a significant linear correlation between basal serum FSH and LH (r = 0.500, P <0.001). What is more, basal serum FSH and LH had predictive value for oocytes and embryological outcomes.ConclusionUnstimulated IVM-surgery provided the opportunity for both spontaneous pregnancy and assisted reproductive technology. Basal FSH and LH were significantly associated with oocyte maturation rate and blastocyst formation of unstimulated IVM-surgery.

Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review.

This systematic review aimed to identify baseline patient demographic and controlled ovarian stimulation characteristics associated with a suboptimal response to GnRHa triggering, and available options for prevention and management of suboptimal response. PubMed, Google Scholar, Medline, and the Cochrane Library were searched for keywords related to GnRHa triggering, and peer-reviewed articles from January 2000 to September 2021 included. Thirty-seven studies were included in the review. A suboptimal response to GnRHa triggering was more likely following long-term or recent oral contraceptive use and with a low or high body mass index. Low basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol serum levels were correlated with suboptimal oocyte yield, as was a low serum LH level on the day of triggering. A prolonged stimulation period and increased gonadotropin requirements were correlated with suboptimal response to triggering. Post-trigger LH < 15 IU/L best correlated with an increased risk for empty follicle syndrome and a lower oocyte retrieval rate. Retriggering with hCG may be considered in patients with suboptimal response according to post-trigger LH, as in cases of failed aspiration. Pre-treatment assessment of patient characteristics, with pre- and post-triggering assessment of clinical and endocrine cycle characteristics, may identify cases at risk for suboptimal response to GnRHa triggering and optimize its utilization.

Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI.

IntroductionAge, polycystic ovary syndrome (PCOS), low body mass index (BMI), high antral follicle count (AFC), increased anti-Muller hormone (AMH) levels, and elevated serum estradiol (E2) concentrations are risk factors for ovarian hyperstimulation syndrome (OHSS). However, data on the relationship between risk factors and OHSS severity in patients with PCOS are rare.ObjectiveThis retrospective study examined the risk factors for OHSS and their effect on OHSS severity in patients with PCOS undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodThe records of 2,699 women were reviewed and included in this study. These women were diagnosed with PCOS during their first IVF/ICSI cycle between January 2010 and December 2017. We analyzed the association between each of the interrogated risk factors (including female age, BMI, AFC, basal serum E2, and the number of oocytes retrieved) and OHSS. The effects of each risk factor on OHSS severity were further explored. Logistic regression was performed as part of the above analysis.ResultsOf the 2,699 women with PCOS who underwent assisted reproductive technology (ART), 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% developed OHSS. All OHSS patients were younger and had lower BMIs and basal serum follicle-stimulating hormone (FSH) and E2 levels but higher AFCs than those in the normal group. AFC demonstrated a strong correlation with OHSS, with a cutoff value of 24 in patients with PCOS. A total of 19.5% of the patients had mild OHSS, while 80.5% had moderate OHSS. Compared with those in the moderate OHSS group, those in the mild OHSS group were older and had higher basal serum FSH levels and lower serum E2 and T levels. However, BMI and AFC were not different between the mild and moderate OHSS groups. Basal serum E2 showed a strong correlation with OHSS severity, with a cutoff value of 37.94 pg/ml.ConclusionsAFC is a strong marker of OHSS, and basal serum E2 is the best predictor of OHSS severity in women with PCOS undergoing IVF treatment.

NOMOGRAM FOR THE CUMULATIVE LIVE BIRTH RATE IN LOW PROGNOSIS PATIENTS ACCORDING TO POSEIDON CRITERIA: A RETROSPECTIVE COHORT STUDY OF 4494 PATIENTS IN CHINA

A small number of prediction model have been previously developed to predict the success of infertility treatment. However, the studies of prediction model for low prognosis patients are limited. The aim of this study was to develop and validate a nomogram for the cumulative live birth rate (CLBR) in low prognosis patients using a single center database in China. Retrospective cohort study. We reviewed the clinical data of 4494 low prognosis patients according to POSEIDON criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment between 2014 and 2018 at Assisted Reproduction Center of Northwest Women’s and Children’s Hospital, Northwest China. Of the eligible participants, 70% were randomly assigned to the training set, while the remaining 30% were assigned to the external validation set. Multivariate analysis using the Logistic regression model was performed. Multivariate analyses revealed that female age, female body mass index (BMI), antral follicle count (AFC), male infertility, uterine factor infertility, and basal serum follicle stimulating hormone (FSH) level were significant factors for CLBR in low prognosis patients. An area under the receiver operating characteristic curve (AUC) in the prediction model was 0.70 (95% CI 0.68 to 0.72) in the training cohort. The validation set showed good discrimination with an AUC of 0.68 (95% CI 0.65 to 0.71). Additionally, Hosmer-Lemeshow chi-square statistic was 5.931 (P = 0.655). We developed and validated a nomogram to predict CLBR in low prognosis patients using a single center database in China. The validated nomogram to predict CLBR could be a potential tool for IVF counselling in low prognosis patients.

Effectiveness of tonifying-kidney and regulating-liver therapy on diminished ovarian reserve: a systematic review and Meta-analysis of randomized controlled trials.

To evaluate the effectiveness of the Traditional Chinese Medicine tonifying-kidney and regulating-liver therapy on diminished ovarian reserve (DOR). The literature was comprehensively searched up to August 2019 using four Chinese and three English electronic databases to extract randomized clinical trials (RCTs) comparing Traditional Chinese Medicine tonifying-kidney and regulating-liver prescriptions (combined with hormone therapy or not) with Western Medicine. Data quality evaluation was conducted using the Cochrane risk of bias tool. Meta-analysis was conducted using Revman 5.3 software with effect estimates presented as mean difference (MD), risk ratio (RR), and 95% confidence interval (CI). A total of nine RCTs with 512 participants were extracted and eligible for Meta-analysis. There were no significant differences between Chinese medicine and Western Medicine on basal serum follicle-stimulating hormone (FSH) level (MD 0.11, 95% CI －0.52 to 0.74, 392 participants, seven trials), anti-Müllerian hormone level (MD 0.48, 95% CI －0.62 to 1.58, 95 participants, two trials), and the FSH and luteinizing hormone ratio (MD 0.01, 95% CI －0.95 to 0.96, 115 participants, two trials). Chinese medicine was more effective at improving Traditional Chinese Medicine symptom scores (TCMSS) (MD －2.39, 95% CI －3.83 to －0.94, 160 participants, three trials), effective rate of TCMSS (RR 1.18, 95% CI 1.02 to 1.36, 160 participants, three trials), antral follicle count (AFC) (MD 0.55, 95% CI 0.05 to 1.04, 155 participants, three trials), and FSH levels at 3 months post-treatment (MD -4.77, 95% CI －6.09 to －3.45, 137 participants, two trials). Compared with Western Medicine, tonifying-kidney and regulating-liver therapy is more effective at relieving symptoms and improving AFC and FSH at 3 months post-treatment.

Acupuncture for premature ovarian insufficiency: a systematic review and meta-analysis

To analyze the effect of acupuncture versus hormone replacement therapy (HRT) for premature ovarian insufficiency (POI). China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), Web of Science, Cochrane Library, PubMed, and Excerpta Medica Database (EMBASE) were searched up to January 31st, 2019 to identify randomized controlled trials (RCTs) evaluating the effect of acupuncture for POI. The primary outcome was the level of basal serum follicle-stimulating hormone (FSH). Secondary outcomes included serum levels of luteinizing hormone (LH), estradiol (E2) and anti-Mullerian hormone (AMH). Two authors extracted data independently and assessed the risk of bias and the methodological quality using the Cochrane’s tool. Meta-analysis was conducted by RevMan version 5.3. Eight eligible RCTs with a total of 496 POI patients were included in the meta-analysis. The pooled results showed that there was a significant reduction in the basal serum FSH level (MD=−5.82, 95%CI: −9.76 to −1.87, I2=82%, P=0.004) and a remarkable elevation in the basal E2 level (SMD=0.93, 95%CI: 0.34 to 1.52, I2=88%, P=0.002) in the acupuncture group when compared with the control. Subgroup analysis showed that compared with HRT, a significant decrease in the FSH level was observed in both acupuncture alone (MD=−4.53, 95%CI: −8.96 to −0.10, I2=73%, P=0.04) and acupuncture plus HRT (MD=−9.60, 95%CI: −17.60 to −1.61, I2=50%, P=0.02), while a remarkable elevation of E2 was only found in acupuncture plus HRT (SMD=1.43, 95%CI: 1.03 to 1.82, I2=0%, P<0.00001). There was no significant difference in the LH level between acupuncture and HRT (MD=−3.16, 95%CI: −9.41 to 3.10, I2=0%, P=0.32), only one trial reported AMH, and no significant difference was found between acupuncture and HRT. The present study indicated that acupuncture had an advantage over HRT in reducing serum FSH level and increasing serum E2 level in women with POI. However, evidence supporting the finding is limited due to the small sample size, potential methodological flaws and significant heterogeneity. Hence, this conclusion still needs to be verified by high-quality RCTs.

Intrafollicular melatonin concentration is elevated in patients with ovarian hyperstimulation syndrome (OHSS) and can serve as an important predictor of OHSS.

Melatonin is an important factor in regulating numerous processes in human female reproduction. The aim of the present study was to compare melatonin levels in the follicular fluid (FF) of ovarian hyperstimulation syndrome (OHSS) women with those of non-OHSS women undergoing in vitro fertilization (IVF)-embryo transfer and to evaluate the relationship between FF melatonin levels and IVF outcomes in these women. We determined FF melatonin levels in 20 OHSS women and 23 non-OHSS women on oocyte retrieval day. OHSS patients had significantly higher melatonin levels as compared to the non-OHSS women (P<0.001). In addition, melatonin levels of the patients were significantly positively correlated with antral follicle count (AFC), serum anti-Müllerian hormone (AMH) levels, serum estradiol (E2) levels on human chorionic gonadotropin (HCG) administration day, number of retrieved oocytes, total fertilized oocytes, normally fertilized oocytes, cleaved zygotes, top quality embryos on day 3, blastocysts obtained and embryos suitable for transplantation (day 3 embryos+day 5/6 blastocysts) (P<0.05). While, the intrafollicular melatonin levels were significantly negatively correlated with age, basal serum follicle-stimulating hormone (FSH) levels, serum FSH levels on HCG administration day (P<0.01). Since younger women with more AFC, higher AMH levels, higher serum E2 levels and larger number of retrieved oocytes are much easier to encounter OHSS, while FF melatonin levels are significantly correlated with these five indices in our study, we propose that intrafollicular melatonin concentration can also be an important predictor of OHSS. This is the first demonstration that FF melatonin levels were significantly higher in OHSS patients than in non-OHSS group and FF melatonin levels may serve as an important predictor of OHSS.

Melatonin concentration in follicular fluid is correlated with antral follicle count (AFC) and in vitro fertilization (IVF) outcomes in women undergoing assisted reproductive technology (ART) procedures

The aim of the present study was to evaluate the possible relationship between melatonin levels in the follicular fluid (FF) and in vitro fertilization (IVF) outcomes in women undergoing assisted reproductive treatment. Sixty-three females (20 to 40 years old) scheduled for IVF were divided into three groups based on their antral follicle count (AFC). We determined FF melatonin concentrations in group A (AFC≦6, n = 21), group B (7≦AFC≦14, n = 22), group C (AFC≧15, n = 20) on oocyte retrieval day. Patients in group C had significantly higher melatonin levels as compared to patients in groups A and B (p < .001). Melatonin levels of the patients were significantly positively correlated with antral follicle count (AFC, p < .001), serum anti-Müllerian hormone(AMH) levels (p =.001), serum estradiol (E2) levels on human chorionic gonadotropin (HCG) administration day (p = .001), total follicle-stimulating hormone (FSH) dose (p = .002), starting FSH dose (p = .035), number of retrieved oocytes (p < .001), total fertilized oocytes (p < .001), normally fertilized oocytes (p < .001), cleaved oocytes (p < .001), number of high-quality day 3 embryos (p = .004), blastocysts obtained (p = .007) and total embryos obtained (day3 embryos + day5/6 blastocysts) (p = .005). The levels were significantly negatively correlated with age (p < .001), basal serum FSH levels (p = .003), serum FSH (p = .001) and serum luteinizing hormone (LH) levels (p = .003) on HCG administration day. This is the first demonstration of a significant positive correlation of melatonin concentrations with AFC in patients undergoing IVF. We propose that FF melatonin levels may influence the IVF outcomes.

A retrospective Comparison of Clinical Outcome Following Conventional In-Vitro Fertilization (c-IVF) vs Intracytoplasmic Sperm Injection (ICSI) for 100% Teratozoospermia Patients

Objectives: To investigate whether ICSI could improve the clinical outcomes of the 100% teratozoospermia patients. Methods: This study contained 200 IVF-ET and 216 ICSI-ET cycles from January 2013 to January 2016. The first cycle patients aged <40 years, with cycle day 3 FSH <10 mIU/mL and 8-12 antral follicles were included. Main outcome measure(s): clinical, obstetric and neonatal outcome. Results: The characteristics of the patients showed no significant differences in the female’s age, Gn administration, Gn does, basal serum follicle-stimulating hormone, basal E2 value, endometrial thickness, infertile time, the number of retrieved oocytes and the number of transferred embryos between two groups (p>0.05). The proportion of blastocyst transfers was significantly higher in c-IVF group than ICSI group (41.00 versus 28.70%; p=0.008). We observed that the implantation (53.80 versus 44.85%; p=0.016) and clinical pregnancy (67.00 versus 60.19%; p=0.149) rates were higher in c-IVF group than those in ICSI group. In addition, the abortion (7.46 versus 16.15%; p=0.028) and ectopic pregnancy (0.75 versus 5.38%; p=0.028) rates were significantly lower in c-IVF group compared with ICSI group. The two groups showed no significant differences in obstetrical and neonatal outcomes (p>0.05). Conclusions: For isolated 100% teratozoospermia patients, ICSI should not be considered to improve the clinical outcomes if the semen meet c-IVF standard in the first cycle.

Age-specific nomograms for follicle stimulating hormone and anti-Mullerian hormone: A pilot study in Ile-Ife, Nigeria

Assessment of ovarian reserve is one of the steps in the management of infertile couples. Follicle Stimulating hormone (FSH) and anti-Müllerian hormone (AMH) are commonly used ovarian reserve markers in Africa. However, there is paucity of age-specific reference values for FSH and AMH among the African population. This study aimed at conducting a pilot study for generation of age-specific nomograms for FSH and AMH among fertile women in Ile-Ife, Nigeria. A pilot cross-sectional study that involved 65 fertile women within the age range of 18-45 yr were prospectively and consecutively recruited from November 2014 to January 2015. Peripheral blood samples were taken for basal serum FSH and random serum AMH. The samples were processed using enzyme linked immunosorbent (ELISA) assays. Age-specific FSH nomogram showed a gradual increase which became steeper at age 35 yr with an average yearly increase of 0.2 IU/L in basal serum FSH, while age-specific AMH nomogram showed a peak at 25 yr and then; an average yearly decrease of 0.11 ng/ml in random serum AMH from 25 yr. The age-specific nomograms generated by this pilot study suggest that AMH may be an earlier marker of reduced ovarian reserve; which if validated by future multicenter population based studies may facilitate counseling of women on their reproductive potentials.

The Correlation of Basal Serum FSH, Antral Follicle Count with Ovarian Response in Women with Advanced Reproductive Age

Objective (s): The aim of this study was to find out the correlation between basal serum Follicle Stimulating Hormone (FSH) level, antral follicle count and number of oocytes retrieved during IVF cycle in women with advanced reproductive age.Method: It was a cross sectional observational study which was done between January 2015 and December 2015 in Infertility Management Center, a tertiary center in Dhaka where assisted reproductive technologies are being offered. Eighty nine (89) infertile patients who were between 35 to 45 years of age and have come for IVF treatment for the first time were included in this study. The selected patients had undergone estimation of basal serum FSH by automated immuno assay analyzer and counting of the antral follicles by transvaginal sonography on day two or three. In total sixty nine (69) patients started IVF treatment according to GnRH long agonist protocol. Controlled ovarian stimulation started with 225 IU rFSH. Follicle monitoring was done on day 5 and day 9 and the dosage was kept same or changed according to the patient’s response. After day nine of stimulation, ten women were excluded as they had no mature follicle of 18 mm or more and cycle was cancelled. So in fifty nine (59) cases ovulation was triggered with hCG 5000 IU on the day when at least one mature follicle measuring 18mm was observed. The ovum pickup was done 32 hours after the trigger and the number of collected oocytes was counted under microscope. Outcome measures of this study was to compare basal FSH and antral follicle count as predictors of ovarian reserve by correlating with the number of oocytes retrieved and to correlate the age of the female partner with the number of oocytes retrieved.Results: Most couples in this study (68.33%) have been suffering from primary infertility and majority of them had six to ten years of infertility. Higher proportion of the female partners (75%) was between 35 to 37 years. The majority of infertile couples have male factor infertility (32%). The second commonest cause found was tubal factor in female partner (20%).Stepwise multiple regression analysis was done. Significant positive correlation was noticed between AFC and number of oocytes (b = 0.2413).There was negative correlation between the basal FSH level and the number of oocytes (b= -0.5083). Age of female partner had weak correlation with ovarian reserve.Conclusion: Measurement of antral follicle number in the follicular phase is a better predictor of ovarian reserve in comparison to basal FSH and age of the women.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 20-24

Follicle Stimulating Hormone and Anti-Müllerian Hormone among Fertile and Infertile Women in Ile-Ife, Nigeria: Is there A Difference?

Reduced ovarian reserve predicts poor ovarian response and poor suc- cess rates in infertile women who undergo assisted reproductive technology (ART). Ovarian reserve also decreases with age but the rate of decline varies from one woman to another. This study aims to detect differences in ovarian reserve as measured by basal serum follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) between a matched cohort of fertile and infertile regularly menstruating women, 18-45 years of age. This case-control study involved 64 fertile and 64 subfertile women matched by age at recruitment. Peripheral blood samples were taken from the women recruited from the Gynecological and Outpatient Clinics of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Serum FSH and AMH were quantified using ELISA at the Metabolic Research Laboratory of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. A significant difference existed in the mean FSH of fertile (6.97 ± 3.34) and infertile (13.34 ± 5.24, P=0.013) women. We observed a significant difference in AMH between fertile (2.71 ± 1.91) and infertile (1.60 ± 2.51, P=0.029) women. There was a negative correlation between FSH and AMH in both fertile (r=-0.311, P=0.01) and infertile (r=-0.374, P=0.002) women. The difference in ovarian reserve observed in this study suggests that reduced ovarian reserve in regularly menstruating women may be associated with early ovarian ageing or subfertility.

Effects of three pro-nuclei (3PN) proportion incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles

Purpose: To analyze the three pro-nuclei (3PN) incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles.Methods: This study included 1200 fresh cleavage-stage ET cycles from January 2013 to June 2015. The patients were divided into 3PN = 0% (773 cycles) and 3PN > 0% (427 cycles) group. Main outcomes compared were fertilization, cleavage, normal fertilization, good quality embryo, implantation, clinical pregnancy, and early abortion rate.Results: We observed that there was no significant difference in female's age, the number of retrieved oocytes, the number of transferred embryos, the number of good quality embryos, endometrial thickness, infertile time, basal serum follicle-stimulating hormone, and E2 value between two groups (p > 0.05). The fertilization (89.43 versus 83.90%, p < 0.001) and cleavage (98.34 versus 97.19%, p = 0.048) rates were significantly higher in 3PN > 0% than 3PN = 0% group. However, the normal fertilization (70.05 versus 50.67%, p < 0.001), good quality embryos (37.11 versus 26.47%, p < 0.001), and clinical pregnancy (49.81 versus 43.79%, p = 0.046) rates were significantly higher in 3PN = 0% than 3PN > 0% group. The implantation (35.88 versus 33.78%, p = 0.333) and early abortion (8.83 versus 10.70%, p = 0.474) rates were not significantly different between two groups.Conclusion: 3PN incidence might make a negative effect on clinical outcomes for patients with lower retrieved oocytes in the fresh cleavage-stage ET cycles.

Acquired Hypogonadotropic Hypogonadism (AHH) in Thalassaemia Major Patients: An Underdiagnosed Condition?

IntroductionIn males, acquired hypogonadotropic hypogonadism (AHH) includes all disorders that damage or alter the function of gonadotropin-releasing hormone (GnRH) neurons and/or pituitary gonadotroph cells. The clinical characteristics of AHH are androgen deficiency and lack, delay or halt of pubertal sexual maturation. AHH lead to decreased libido, impaired erectile function, and strength, a worsened sense of well-being and degraded quality of life (QOL).Patients and methodsWe studied 11 adult men with thalassemia major (TM) aged between 26 to 54 years (mean ± SD: 34.3 ± 8.8 years) with AHH. Twelve age- and sex-matched TM patients with normal pubertal development were used as a control group. All patients were on regular transfusions and iron chelation therapy. Fasting venous blood samples were collected two weeks after transfusion to measure serum concentrations of IGF-1, free thyroxine (FT4), thyrotropin (TSH), cortisol, luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone (TT), prolactin and estradiol (E2), glucose, urea, creatinine and electrolytes (including calcium and phosphate). Liver functions and screening for hepatitis C virus seropositivity (HCVab and HCV-RNA) were performed. Iron status was assessed by measuring serum ferritin levels, and evaluation of iron concentrations in the liver (LIC) and heart using MRI- T2*. Bone mineral density was measured at the lumbar spine (L1–L4) for all patients with AHH by dual energy X-ray absorptiometry (DXA) using Hologic QDR 4000 machine.ResultsThe mean basal serum LH and FSH concentrations in AHH patients were 2.4 ± 2.2 IU/L and 1.2 ± 0.9 IU/L respectively; these, values were significantly lower compared to the control group. Semen analysis in 5 patients with AHH showed azoospermia in 3 and oligoasthenozoospermia in 2. The percentage of patients with serum ferritin level >2000 ng/ml (severe iron load) was significantly higher in AHH patients compared to controls, 5/11 (45.4 %) versus1/12 (8.3%), p=0.043. Heart iron concentrations (T2* values) were significantly lower in AHH patients compared to controls (p=0.004). Magnetic resonance imaging in the 3 azoospermic patients revealed volume loss and reduction of pituitary signal intensity. Heart T2* values were significantly reduced in the AHH group vs. the controls (p=0.004). On the other hand, liver iron concentration (mg/g dry weight) was not different between the two groups of TM patients. Using DXA, 63.6 % (7/11) of patients with AHH were osteoporotic, and 36.3 % (4/11) were osteopenic.ConclusionsIn this cohort of thalassemic patients iron overload and chronic liver disease appear to play a role in the development of AHH. Treatment of AHH in TM patients is a vital and dynamic field for improving their health and QOL. Early identification and management of AHH are very crucial to avoid long-term morbidity, including sexual dysfunction and infertility. Therapy aims to restore serum testosterone levels to the mid–normal range. Many exciting opportunities remain for further research and therapeutic development.

Nomogram to predict the number of oocytes retrieved in controlled ovarian stimulation.

ObjectiveOvarian reserve tests are commonly used to predict ovarian response in infertile patients undergoing ovarian stimulation. Although serum markers such as basal follicle-stimulating hormone (FSH) or random anti-Müllerian hormone (AMH) level and ultrasonographic markers (antral follicle count, AFC) are good predictors, no single test has proven to be the best predictor. In this study, we developed appropriate equations and novel nomograms to predict the number of oocytes that will be retrieved using patients' age, serum levels of basal FSH and AMH, and AFC.MethodsWe analyzed a database containing clinical and laboratory information of 141 stimulated in vitro fertilization (IVF) cycles performed at a university-based hospital between September 2009 and December 2013. We used generalized linear models for prediction of the number of oocytes.ResultsAge, basal serum FSH level, serum AMH level, and AFC were significantly related to the number of oocytes retrieved according to the univariate and multivariate analyses. The equations that predicted the number of oocytes retrieved (log scale) were as follows: model (1) 3.21–0.036×(age)+0.089×(AMH), model (2) 3.422–0.03×(age)–0.049×(FSH)+0.08×(AMH), model (3) 2.32–0.017×(age)+0.039×(AMH)+0. 03×(AFC), model (4) 2.584–0.015×(age)–0.035×(FSH)+0.038×(AMH)+0.026×(AFC). model 4 showed the best performance. On the basis of these variables, we developed nomograms to predict the number of oocytes that can be retrieved.ConclusionOur nomograms helped predict the number of oocytes retrieved in stimulated IVF cycles.