Day-3 Serum Research Articles

Sequential estimation of the national early warning score-2 and SERUM PRESEPSIN might discriminate sepsis patients who were vulnerable to death in surgical ICU

ABSTRACT Objectives To evaluate the ability of at-admission (Day 1) estimated serum levels of inflammatory biomarkers and clinical scorings for prediction of survival outcome of sepsis patients admitted to surgical ICU. Patients & Methods One hundred and seventy-eight patients were clinically evaluated and gave blood samples for estimation of serum biomarkers’ levels (Day 1 data) and re-evaluated on Days 2–3 for the National Early Warning-2 (NEWS-2) score and Day 3 for the Sequential organ failure assessment (SOFA) score and serum level of presepsin (PSP). During 28-day, patients were grouped according to survival outcome as Survivors and Non-survivors. Results Day1 clinical scorings and biomarkers’ levels were significantly higher in non-survivors (n = 41) than survivors (n = 137). Day 3 SOFA scores of all patients were significantly higher than Day1 scores with significantly higher scores for non-survivors. Through Day1-3, the number of patients with high-grade risk on NEWS2 was significantly higher among non-survivors. Day-3 serum PSP levels were significantly decreased in survivors, while increased in non-survivors. The statistical analyses defined high NEWS2, SOFA, PSP, and procalcitonin serum levels as the significant predictors of mortality. Diagnostic performance characteristics of combined NEWS score and PSP showed high sensitivity, specificity, and accuracy rates with a 99% negative predictive value for survival outcomes. Conclusion Sequential estimation of NEWS2 score and serum PSP can discriminate between high-risk patients and those prone to die. Coupling of NEWS-2 scoring and estimation of serum PSP allowed more accurate early identification of patients vulnerable to deterioration with high sensitivity and accuracy rates.

Early Changes of VEGF Levels After Zoledronic Acid in Women With Postmenopausal Osteoporosis: A Potential Role of Vitamin D.

Zoledronic acid (Zol) is a widely used intravenous aminobisphosphonate to treat both benign and malignant skeletal diseases, and bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect whose pathophysiology remains poorly understood. Vascular Endothelial Growth Factor (VEGF) has been recognized to mediate BRONJ in cancer patients undergoing Zol treatment, however data on VEGF are lacking in patients with osteoporosis. Increasing evidences demonstrate that vitamin D influences VEGF levels. The aim of this study was to investigate the influence of Zol on VEGF levels and the possible role for vitamin D on the Zol mediated changes of VEGF concentration in women with postmenopausal osteoporosis. Twenty-eight postmenopausal women with osteoporosis were enrolled and randomized into two groups to receive Zol (5 mg) or placebo. At baseline, at day-3 and day-30 VEGF serum levels were measured; bone turnover markers, 25-hydroxyvitamin D [25(OH)D] and serum calcium were evaluated at baseline. In Zol-treated women, VEGF increased significantly on day-3, and then decreased on day-30. In the Zol-treated women, the percent change of VEGF levels between baseline and day-30 (−18% at day-30 vs. baseline, p = 0.01) was significantly associated with serum 25(OH)D values (r = 0.29, p = 0.028). At a stepwise multiple regression analysis, after correcting for age, BMI, time since menopause, femoral neck BMD, osteocalcin, C-terminal telopeptide of type 1 collagen, and baseline VEGF levels, 25(OH)D levels were independently associated with VEGF change (β = 1.7, SE = 0.71, p = 0.03). For the first time, we detected early modifications of circulating VEGF in postmenopausal women receiving Zol for osteoporosis, identifying a vitamin D-dependent modulation of these changes.

Neuron-Specific Enolase Levels in Adults Under Venoarterial Extracorporeal Membrane Oxygenation

We aimed to determine if elevations in serum neuron-specific enolase are associated with brain injury and outcomes in adults who require venoarterial extracorporeal membrane oxygenation. Prospective observational study. Two ICUs of a university hospital, Paris, France. Consecutive adult patients treated with venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock or in-hospital refractory cardiac arrest. None. Serum sampled 1, 3, and 7 days after venoarterial extracorporeal membrane oxygenation cannulation was stored at -80°C and neuron-specific enolase concentrations were measured in batches at the end of the study. The association between neuron-specific enolase concentrations and outcomes (28-d mortality and poor outcome, defined by a score of 4-6 on the modified Rankin scale at 90 d) were explored by multivariable logistic regression, with neuron-specific enolase concentrations dichotomized according to median values. One-hundred three patients were included, of whom 26 (25%) received preextracorporeal membrane oxygenation cardiopulmonary resuscitation. Median (interquartile range) day-1, day-3, and day-7 neuron-specific enolase serum concentrations were 37 μg/L (26-51 μg/L), 25 μg/L (19-37) μg/L, and 22 μg/L (17-31 μg/L). After adjustment for Simplified Acute Physiology Score II, preextracorporeal membrane oxygenation cardiopulmonary resuscitation, and Sepsis Organ Failure Assessment score at time of cannulation, a day-3 neuron-specific enolase greater than 25 μg/L remained independently associated with 28-day mortality (adjusted odds ratio, 4.98; 95% CI, 1.86-13.32) and poor outcome at 90 days (adjusted odds ratio, 4.63; 95% CI, 1.81-11.84). A day-3 neuron-specific enolase threshold greater than 80 μg/L had a 100% specificity for prediction of both mortality (95% CI, 92-100%) and poor functional outcome (95% CI, 89-100%). In a subset of patients who underwent brain CT, neuron-specific enolase concentrations were significantly higher in patients diagnosed with stroke, as compared with those without stroke. In adult patients under venoarterial extracorporeal membrane oxygenation, day-3 serum neuron-specific enolase concentrations are independently associated with short-term mortality and poor functional outcomes. These findings deserve validation in a multicenter setting.

Prediction of Ovarian Response in Women with Premature Ovarian Insufficiency Stimulated By Gonadotrophins Using Day-3 Serum Estradiol: A Retrospective Study

Objective: The aim of this study was to evaluate the potential predictive value of day-3 serum estradiol for follicle growth, ovulation, and pregnancy rate in women with premature ovarian insufficiency.

ABO blood type is associated with ovarian reserve in Chinese women with subfertility.

Ovarian reserve reflects both the quantity and quality of oocytes available for procreation, and is affected by many known and unknown factors. ABO blood type is related to a number of infertility processes, but it is unclear whether and how ABO blood type affects ovarian reserve. Here, we explored the relationship between ABO blood type and ovarian reserve in Chinese women with subfertility. Day-3 serum follicle-stimulating hormone (FSH) levels and blood type were examined in 14,875 women who underwent IVF or ICSI treatment. Blood type proportions in the patient population were as follows: 30.98% type A, 24.54% type B, 7.57% type AB, and 36.91% type O. A higher percentage of women with diminished ovarian reserve (DOR) were blood type O, while a lower percentage had the B antigen (B and AB). Multiple logistic regression analysis revealed that blood type O was associated with a greater risk of DOR than blood type B and B antigen-positive types. By contrast, the B antigen (B and AB) was associated with a lower incidence of DOR than blood type O. These results suggest that blood type O is a risk factor for DOR while the B antigen (blood type B or AB) is a protective factor for ovarian reserve in Chinese women with subfertility. Further studies are needed to confirm this effect and identify the underlying mechanisms.

LH (Trp8Arg/Ile15Thr), LHR (insLQ) and FSHR (Asn680Ser) polymorphisms genotypic prevalence in women with endometriosis and infertility.

To verify if polymorphisms of LH (Trp8Arg/Ile15Thr), LH receptor (insLQ), and FSH receptor (Asn680Ser) are associated with endometriosis and infertility. This is a prospective case-control study. Sixty-seven patients with endometriosis and infertility (study group) and 65 healthy fertile patients (control group) were enrolled in the study between July 2010 and July 2013. All patients had their endometriosis diagnosis made or excluded by laparoscopic surgery; study group was submitted to the surgery for infertility investigation and control group for tubal ligation. Day-3 serum hormones were collected from all patients. Analysis of nucleotide mutations for LH polymorphisms (Trp8Arg and Ile15Thr), LHR polymorphism (insLQ), and FSHR polymorphism (Asn680Ser) were performed by PCR. Day-3 FSH, estradiol and LH serum levels were not different between the groups, while CA-125 was higher in patients with endometriosis and infertility. All polymorphisms studied were in Hardy-Weinberg equilibrium. The prevalence of insLQ was significantly higher in patients with endometriosis and infertility (P = 0.005). Allele occurrence in control group was 0.10 versus 0.25 in infertile endometriosis group (P = 0.001). There was no difference regarding Trp8Arg/Ile15Thr (P > 0.05) and Asn680Ser (P > 0.05) prevalence between groups. This is the first time that prevalence of insLQ was shown to be higher in patients with endometriosis and infertility than in healthy fertile patients. There was no difference in LH and FSHR polymorphisms' prevalence between groups.

The association of bisphenol-A urinary concentrations with antral follicle counts and other measures of ovarian reserve in women undergoing infertility treatments

In this prospective cohort of women undergoing infertility treatments, we measured specific-gravity adjusted urinary BPA (SG-BPA) concentrations and used regression models to evaluate the association of BPA with antral follicle count (AFC), day-3 serum follicle stimulating hormone levels (FSH), and ovarian volume (OV). BPA, detected in >80% of women, had a geometric mean (±GSD) of 1.6±2.0, 1.7±2.1, and 1.5±1.8μg/L for the women contributing to the AFC (n=154), day-3 FSH (n=120), and OV (n=114) analyses, respectively. There was an average decrease in AFC of 12% (95% CI: −23%, −0.6%), 22% (95% CI: −31%, −11%), and 17% (95% CI: −27%, −6%), in the 2nd, 3rd, and 4th SG-BPA quartile compared to the 1st quartile, respectively (p-trend: <0.001). No association of SG-BPA with FSH or OV was observed. Among women from an infertility clinic, higher urinary BPA concentrations were associated with lower AFC, raising concern for possible accelerated follicle loss and reproductive aging.

Use of zebrafish larvae's swimming behavior to study brain development

In this prospective cohort of women undergoing infertility treatments, we measured specific-gravity adjusted urinary BPA (SG-BPA) concentrations and used regression models to evaluate the association of BPA with antral follicle count (AFC), day-3 serum follicle stimulating hormone levels (FSH), and ovarian volume (OV). BPA, detected in >80% of women, had a geometric mean (±GSD) of 1.6 ± 2.0, 1.7 ± 2.1, and 1.5 ± 1.8 μg/L for the women contributing to the AFC (n = 154), day-3 FSH (n = 120), and OV (n = 114) analyses, respectively. There was an average decrease in AFC of 12% (95% CI: −23%, −0.6%), 22% (95% CI: −31%, −11%), and 17% (95% CI: −27%, −6%), in the 2nd, 3rd, and 4th SG-BPA quartile compared to the 1st quartile, respectively (p-trend: <0.001). No association of SG-BPA with FSH or OV was observed. Among women from an infertility clinic, higher urinary BPA concentrations were associated with lower AFC, raising concern for possible accelerated follicle loss and reproductive aging.

S5-2: Science for or science based regulation: Is there a missing link?

In this prospective cohort of women undergoing infertility treatments, we measured specific-gravity adjusted urinary BPA (SG-BPA) concentrations and used regression models to evaluate the association of BPA with antral follicle count (AFC), day-3 serum follicle stimulating hormone levels (FSH), and ovarian volume (OV). BPA, detected in >80% of women, had a geometric mean (±GSD) of 1.6 ± 2.0, 1.7 ± 2.1, and 1.5 ± 1.8 μg/L for the women contributing to the AFC (n = 154), day-3 FSH (n = 120), and OV (n = 114) analyses, respectively. There was an average decrease in AFC of 12% (95% CI: −23%, −0.6%), 22% (95% CI: −31%, −11%), and 17% (95% CI: −27%, −6%), in the 2nd, 3rd, and 4th SG-BPA quartile compared to the 1st quartile, respectively (p-trend: <0.001). No association of SG-BPA with FSH or OV was observed. Among women from an infertility clinic, higher urinary BPA concentrations were associated with lower AFC, raising concern for possible accelerated follicle loss and reproductive aging.

Random Postoperative Day-3 Cortisol Concentration as a Predictor of Hypothalamic-Pituitary-Adrenal Axis Integrity after Transsphenoidal Surgery

To determine whether a random postoperative day-3 cortisol value of 10 μg/dL or greater is predictive of adrenal sufficiency 3 to 10 weeks after transsphenoidal surgery (TSS) and during long-term clinical follow-up. We retrospectively reviewed the case records of patients who underwent TSS at our institution between 1991 and 2008. Inclusion criteria were as follows: random cortisol measured on the morning of postoperative day 3, adrenal dynamic testing performed 3 to 10 weeks after TSS, and clinical assessment of the hypothalamic-pituitary-adrenal (HPA) axis at least 6 months after TSS. A total of 466 patients underwent TSS at our institution during the study period. Eighty-three patients met study inclusion criteria. Sensitivity of a random postoperative day-3 serum cortisol value of 10 μg/dL or greater for the prediction of adrenal sufficiency at a median follow-up of 42 days was 64.81% (95% confidence interval, 50.6%-77.32%), with an odds ratio of 3.1 (95% confidence interval, 1.08-8.58). Specificity was 62.1% (95% confidence interval, 42.3%-79.3%). At a median follow-up of 500 days, only 2 patients with a postoperative day-3 cortisol value of 10 μg/dL or greater required hydrocortisone replacement, both of whom had multiple anterior pituitary hormone deficiencies and evidence of pituitary dysfunction during the perioperative period. In the appropriate clinical context, a postoperative day-3 cortisol value of 10 μg/dL or greater accurately predicts the integrity of the HPA axis. The final decision regarding corticosteroid replacement should be personalized, considering the postoperative day-3 cortisol level, the clinical context in which the measurement was obtained, and any evidence of concomitant pituitary dysfunction in the perioperative period.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles

To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles. Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day3 of the menstrual cycle before controlled ovarian hyperstimulation. Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV. Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

Early follicular anti-mullerian hormone as a predictor of ovarian response during ICSI cycles

Abstract Objective To evaluate the use of AMH in predicting the ovarian response in ICSI cycles compared to other markers of ovarian function. Design Prospective study. Setting IVF/ICSI Unit; Enjab Hospital for infertility, Gulf Medical College and Research Centre (UAE) and Biochemistry department, Faculty of Pharmacy for Girls, Al-Azhar University (Egypt). Subject(s) A total of 220 infertile women attending an ART program (ICSI) for the first time during the period from June 2007 to October 2009 who met the inclusion criteria were our subjects . On day-3 of the menstrual cycle, serum levels of AMH, FSH, LH, E2, and inhibin B were measured for each woman. Early antral follicles were evaluated by vaginal ultrasound. Thereafter, the patients were classified according to oocyte count into two groups; Good responders (those with ⩾4 oocytes) and poor responders (those with Intervention(s) None. Main outcome measure(s) Comparison of day-3 serum AMH levels in both groups. Antral follicle count, basal FSH, LH, E2 and inhibin B were also compared. Results The serum level of AMH, AFC and FSH levels were significantly different in both groups. Parameters such as serum LH, E2 and inhibin B levels were not significantly different between the two groups. Ovarian response was significantly correlated with basal AMH levels, FSH levels and AFC. However, AMH levels were highly correlated with the number of retrieved oocytes (P Conclusion Serum AMH levels may reflect ovarian response better than the usual hormone markers.

Evaluation of Ovarian Reserve by Measurement of the Serum Levels of Anti-Mullerian Hormone and Follicle-Stimulating Hormone in Intracytoplasmic Sperm Injection Cycles

Background It is important to evaluate ovarian reserves prior to intracytoplasmic sperm injection (ICSI) treatment. The aim of this study is to determine the accuracy of anti-mullerian hormone (AMH) as a marker for ovarian reserve and to compare it with day-3 serum follicle-stimulating hormone (FSH) levels. Materials and methods In this analytic, corss-sectional study, sequential sampling was done on 70 infertile women who underwent ICSI treatment at Imam Khomeini Hospital, Ahvaz, Iran. Initially, 5cc of venous blood was drawn from each patient to measure serum AMH and FSH levels on the day-3 cycle. Patients were divided into two subgroups according to the numbers of oocytes retrieved. Patients were classified as good responders if there were four or more oocytes retrieved, whereas patients with less than four oocytes were poor responders. Results The basal AMH level correlated with the number of oocytes retrieved (linear Pearson correlation coefficient=0.599), however the basal FSH level had a weakly reverse correlation (correlation coefficient = -0.11). AMH levels had a sensitivity of 85% and specificity of 61.5%, with a cutoff value equal to 2.3 ng/ml which was higher than FSH. Conclusion AMH serum levels are good predictors of ovarian reserve in comparison with FSH.

Serum antimüllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle are predictive of the fertilization, implantation, and pregnancy in polycystic ovary syndrome patients undergoing assisted reproduction

To determine the possible relationship between serum antimüllerian hormone (AMH) concentrations on day 3 and controlled ovarian stimulation and reproductive outcomes in women with polycystic ovary syndrome. Prospective, clinical trial. University hospital. Sixty women with PCOS. Serum concentrations of AMH measured on cycle day 3. Clinic pregnancy rate (CPR), implantation rate (IR), and fertilization rate (FR). The CPR, IR, and FR were markedly different among the day-3 serum AMH groups (low, moderate, and high AMH groups). The CPR were 33.3, 46.1, and 60.0, respectively, in the low, moderate, and high serum AMH groups on day 3. The embryo IR were 18.6, 26.7, and 36.3, respectively. The FR were 54, 68, and 79, respectively. An AMH level≥3.01 ng/mL was shown to predict FR with a sensitivity of 86.4% and specificity of 75%. An AMH level≥3.2 ng/mL was shown to predict IR and CPR with sensitivity and specificity of 72.1% and 72.7%, and 75.6% and 77.3%, respectively. On day 3 of the in vitro fertilization stimulation cycle, serum concentrations of AMH can be used as a marker for ovarian response as well as reproductive outcome in assisted reproductive cycles of PCOS patients.

Early prediction of sustained virological response at day 3 of treatment with albinterferon‐α‐2b in patients with genotype 2/3 chronic hepatitis C

Albinterferon-alpha-2b (albIFN) is a long-acting fusion polypeptide composed of albumin and IFN-alpha-2b. In a phase 2 study of albIFN 1500 mug q2wk or q4wk in patients with genotype 2/3 chronic hepatitis C, albIFN demonstrated sustained virological response (SVR) rates of 62-77% (intent-to-treat population). To assess the association of initial viral kinetics during albIFN therapy with baseline factors and SVR prediction. In all, 43 patients were treated with albIFN 1500 mug (q2wk/q4wk) plus ribavirin (RBV) 800 mg/day for 24 weeks. Hepatitis C virus (HCV)-RNA levels were measured by real-time polymerase chain reaction, insulin resistance by homeostasis model assessment of insulin resistance (HOMA-IR) and serum albIFN levels by enyzme-linked immunosorbent assay. Prediction analysis was performed in a per protocol 28-patient subset who were > or =80% adherent to albIFN/RBV and had HCV-RNA levels measured at treatment day 3. Day-3 HCV-RNA level and first-phase viral decline as well as second-phase slope of viral decline were significantly associated with SVR. In adherent patients, 82.1% had a day-3 viral load <4.2 log(10) IU/ml or first-phase decline >1.25 log(10) IU/ml, which was predictive of SVR, both positively (95.7%; sensitivity: 100%) and negatively (100%; specificity: 83.3%). As low first-phase decline was associated with a high pretreatment HOMA-IR index (P=0.004) and a low day-3 serum albIFN level (P=0.01). First-phase viral decline with albIFN/RBV was predictive of SVR in this study and may be modulated in part by IR.

The effect of tubal sterilization through electrocoagulation on the ovarian reserve

Background The study was conducted to compare the effects of tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve. Study Design Eighty-eight patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day-3 serum follicle stimulating hormone, luteinizing hormone, estradiol, inhibin-B and antimüllerian hormone and Day-3 total ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups. Results A significant difference between the postoperative 10th-month Day-3 total ovarian volumes and anthral follicle counts was detected between the electrocoagulation and mechanical clips application groups. Conclusion Tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.

Extensive Excision of Deep Infiltrative Endometriosis before In Vitro Fertilization Significantly Improves Pregnancy Rates

Study Objective We sought to compare the outcomes of in vitro fertilization (IVF) treatments in women with infertility-associated deep infiltrative endometriosis (DIE) who underwent extensive laparoscopic excision of endometriosis before IVF with those who underwent IVF only. Design Prospective cohort study. Setting Infertility clinic and private hospital in São Paulo, Brazil. Patients A total of 179 infertile patients younger than 38 years had symptoms and/or signs of endometriosis and sonographic images suggestive of DIE. Interventions After thorough counseling, 179 women were invited to participate in a prospective cohort study with 2 treatment options: IVF without undergoing laparoscopic surgery (group A, n = 105) and extensive laparoscopic excision of DIE before IVF (group B, n = 64). Ten women were lost to follow-up. The IVF outcomes were compared between the 2 groups. Measurements and Main Results In group B, patients had 5 ± 2 (mean ± SD) DIE lesions excised during laparoscopy. Patient characteristics in groups A and B, respectively, were: age (32 ± 3 vs 32 ± 3 years, p = .94), infertility duration (29 ± 20 vs 27 ± 17 months, p = .45), day-3 serum follicle-stimulating hormone levels (5.6 ± 2.5 vs 5.9 ± 2.5 IU/L, p = .50), and previous IVF attempts (1 ± 1 vs 2 ± 1, p = .01). The IVF outcomes differed between groups A and B, respectively, with regard to total dose of recombinant follicle-stimulating hormone required to accomplish ovulation induction (2380 ± 911 vs 2542 ± 1012 IU, p = .01), number of oocytes retrieved (10 ± 5 vs 9 ± 5, p = .04), and pregnancy rates (24% vs 41%, p = .004), but not number of embryos transferred (3 ± 1 vs 3 ± 1, p = 1). The odds ratio of achieving a pregnancy were 2.45 times greater in group B than in group A. Conclusion Extensive laparoscopic excision of DIE significantly improved IVF pregnancy rates of women with infertility-associated DIE.

Comparison of daily and alternate day recombinant follicle-stimulating hormone stimulation protocols for intrauterine insemination

To determine the efficacy of daily versus alternate-day stimulation for patients undergoing intrauterine insemination (IUI). Retrospective comparative study. University tertiary care center for infertility. Women with anovulatory or unexplained infertility for over 12 months who had not responded to or not conceived with clomiphene citrate treatment. Ovarian stimulation with recombinant follicle-stimulating hormone (FSH; follitropin-beta) given either daily or on alternate days before IUI. Clinical pregnancy at ultrasound 4 weeks after IUI. Secondary outcome measures were duration of stimulation, total gonadotropin dose, ovarian response, and multiple pregnancy rate. Of the 212 women who underwent a first cycle of gonadotropin stimulation, 28 had daily injections and 117 had alternate-day injections of follitropin-beta only for IUI. Female age, antral follicle count, and day-3 serum FSH were comparable. The median duration of stimulation (8 days vs. 8 days) and the median number of follicles over 14 mm (3.5 vs. 3.0) were similar in both groups. However, the total recominbinant FSH dose (825 vs. 625 IU) and endometrial thickness (10.1 vs. 9.3 mm) were greater in the daily injection group. The clinical pregnancy rate per cycle was 42% (12 out of 28) in the daily injection group and 19% (22 out of 117) in the alternate-day group. Daily recombinant FSH stimulation for IUI seems to be associated with a higher clinical pregnancy rate than alternate-day FSH stimulation. Prospective randomized trials would be needed to determine whether this is indeed the case.

A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility

Background. In the present study we evaluated and compared the effects of ovulation and hormonal dynamics induced by anastrozole and clomiphene citrate in women with infertility.Materials and methods. Thirty-three infertile patients, aged 25–41 years, were enrolled. Patients received either anastrozole 1 mg daily (AI group) or clomiphene citrate 100 mg daily (CC group) from cycle day 3 to day 7. Number of mature follicles (≥18 mm), endometrial thickness, pregnancy rate and serial hormone profiles (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone and progesterone) were measured on cycle day 3, day 8, day 10, the day of intrauterine insemination (IUI), day 7 after IUI and day 14 after IUI.Results. Baseline parameters were similar in the two groups, including age, body mass index, infertility duration and day-3 serum hormones except FSH. The mean FSH value on day 3 was significantly different (4.3 mIU/ml in the AI group vs. 6.3 mIU/ml in the CC group; p < 0.05). The women receiving anastrozole had fewer ovulatory follicles (1.2 in the AI group vs. 1.8 in the CC group; p < 0.05) and a thicker endometrium (10.6 mm in the AI group vs. 7.8 mm in the CC group; p < 0.05). The levels of progesterone and testosterone were similar during ovulation stimulation cycles in both groups. On the other hand, the AI group had a significantly higher LH level but a significantly lower E2 level in the stimulation cycle.Conclusion. Anastrozole has a high pregnancy rate, although it induces fewer ovulatory follicles compared with clomiphene citrate. The two drugs gave different responses of FSH, LH and E2 during stimulation cycles.

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.