Follicular Phase Follicle-stimulating Hormone Research Articles

Relationship between depression and sex steroid hormone among women with epilepsy.

Sex steroid hormones are emerging significant biomarkers of depression among Women with Epilepsy (WWE) with promising prognostic potential and therapeutic end point. Therefore, the study is aimed at exploring the association between sex steroids hormones, Anti-seizure Medication (ASM) and depression among WWE. A baseline questionnaire was used to obtain socio-demographics and clinical characteristic from one hundred and twelve (112) WWE and 50 age matched healthy control. The diagnosis of epilepsy and Electroencephalography (EEG) description was based on 2017 International League Against Epilepsy (ILAE) criteria. Blood samples were collected from cases and control during Luteal Phase (LP) and Follicular Phase (FP). The Zung Self-Rating Depression Scale (ZSRDS) was used to assess depression. The prevalence of depression among WWE is 18.8%, with a significant difference between the level of formal education (p0.000), age (p0.000), and mean ZSRDS (p0.000) among cases and control. There is a statistical difference in hormonal levels between cases and control with regards to higher testosterone [3.28 ± 9.99 vs. 0.31 ± 0.30; p0.037], lower FP prolactin [16.37 ± 20.14 vs. 17.20 ± 7.44; p0.778], and lower LP prolactin [15.74 ± 18.22 vs. 17.67 ± 7.27; p0.473]. Testosterone (p0.024), FP Follicle Stimulating Hormone (FSH) (p0.009), FP Estradiol (p0.006), LP FSH (p0.031), LP Progesterone (p0.023), and LP Prolactin (p0.000) were associated with depression. However, only prolactin (p0.042) and testosterone (p0.000) predicts depression among WWE. There was higher mean depression score, lower prolactin and higher testosterone level among cases compared to control. Furthermore, there was lower prolactin and higher testosterone level in Carbamazepine (CBZ) group compared to Levetiracetam (LEV) groups.

Serum prolactin and gonadal hormones in hemodialysis women: a meta-analysis

BackgroundA meta-analysis followed by PRISMA 2020 statement was performed aiming to present a whole prolactin and sex hormone profile in hemodialysis women.MethodsLiteratures were searched in PubMed, Cochrane library, Embase, and Web of science before March 11, 2023. Trial sequential analysis (TSA) was performed to test the conclusiveness of this meta-analysis. Egger’s test and trim-and-fill analysis was used to test publication bias. We took standardized mean difference (SMD) as pool effect of hormones values including prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P). This study was registered in PROSPERO and the number was CRD42023394503.ResultsTwenty-two articles from 13 countries were analyzed. Combining the results of TSA and meta-analysis, we found that compared with healthy control, hemodialysis women had higher PRL, follicular FSH and LH values and lower P levels (PRL: I2 = 87%, SMD 1.24, 95% CI: 0.79–1.69, p < 0.00001; FSH: I2 = 0%, SMD 0.34, 95% CI: 0.13–0.55, p = 0.002; LH: I2 = 39%, SMD 0.64, 95% CI: 0.34–0.93, p < 0.00001; P: I2 = 30%, SMD − 1.62, 95% CI: -2.04 to -1.20, p < 0.00001). What’s more, compared with women after renal transplantation, hemodialysis women had higher PRL levels (I2 = 0%, SMD 0.51, 95% CI: 0.25–0.78, p = 0.0001). There was not enough evidence to draw a conclusion on the comparison of hormones between regular and irregular menses hemodialysis women. Egger’s test and trim-and-fill analysis didn’t show significant publication bias.ConclusionsHemodialysis women had higher serum PRL, follicular phase FSH, LH and lower serum P values compared with healthy control. PRL values of hemodialysis women were also higher than that of women after renal transplantation.

Follicle Stimulating Hormone (FSH) as a Predictor of Decreased Oocyte Yield in Patients with Normal Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC).

The purpose of the current study was to determine the utility of early follicular phase follicle-stimulating hormone (FSH) testing in patients undergoing in vitro fertilization (IVF). This was a retrospective review of patients from 2012 to 2015 at Mayo Clinic in Rochester, Minnesota, USA. Included subjects had a normal anti-Müllerian hormone (AMH) of 1 to 9 ng/ml and antral follicle count (AFC) of 10 to 29. Patients were stratified by FSH level when associated estradiol was less than 50 ng/ml. In total, 225 patients were categorized into three groups: high FSH (FSH ≥10 IU/L; n= 36), normal FSH (>5 IU/L and <10 IU/L; n=170), and low FSH (FSH ≤5 IU/L; n= 19). ANOVA and multiple logistic regression were used for statistical comparisons and for evaluation of the relationships between variables; significance level was set at <0.05. There were no significant differences in demographics, IVF cycle type, or peak estradiol level between the groups. Patients with a high basal FSH level had a similar clinical pregnancy rate and live birth rate compared to controls and patients with low FSH. High FSH level was associated with decreased follicular development (17 versus 22; p<0.01), oocyte yield (15 versus 18; p=0.02), and embryo yield (8 versus 10; p=0.04) despite higher total doses of gonadotropins. Patients with normal AMH and AFC levels could be further stratified into lower responders and starting doses of medications can be adjusted based on high basal FSH levels. Therefore, it is suggested to counsel patients on pregnancy outcomes which seem to be quite similar regardless of the FSH level.

Ovarian Reserve and Pelvic Ultrasound Assessment in Familial Mediterranean Fever.

IntroductionFamilial Mediterranean fever (FMF) is an inflammatory rheumatic disease that affects people in their reproductive period. The aim of this study was to investigate the number of gravida, ovarian reserve, and ovarian doppler characteristics in FMF patients.MethodsThe study design is cross-sectional. Between November 1, 2018, and October 31, 2019, 40 FMF patients, and 40 age-matched volunteers were included in the study. Early follicular phase follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), progesterone, and anti-Mullerian hormone (AMH) levels, as well as ovarian volume, antral follicle count (AFC), ovarian stromal artery doppler findings, and pelvic pathologies, were evaluated.ResultsThe number of gravida, and the AFC was significantly higher in the control group (16.00 ± 5.22) compared to the patients with FMF (13.00 ± 4.09) (p = 0.026). LH values were significantly higher in the FMF group. Thirteen patients (32.5%) received anakinra and colchicine, and 27 patients (67.5%) received only colchicine. There was no significant difference between the patients receiving anakinra, and the patients receiving colchicine in terms of AMH, FSH, AFC, and E2 values.ConclusionFMF patients were found to have low gravida and AFC, and a significant portion was observed to have pelvic fluid and hydrosalpinx. In conclusion, the presence of pelvic fluid, hydrosalpinx, and low AFC persist in FMF patients despite colchicine and/or anti-interleukin-1 treatments. The low gravida may be related to these pathologies detected in patients with FMF.

Comparison of Cycle Outcomes Among Women with Endometrioma or Non-Functional Cysts Versus Control

OBJECTIVE: This study aimed to compare cycle outcomes among women with endometrioma or non-functional cysts versus control. STUDY DESIGN: Women under 35 years of age with unexplained infertility underwent in vitro fertilization cycle. Two hundred and ninety-nine women were included in this study. Study groups consist of women with endometrioma (n=82) or non-functional ovarian cysts (n=100) and control group (n=117). Women in each group were selected consecutively. Groups were matched for age and ovarian reserve and compared in terms of in vitro fertilization cycle outcome. RESULTS: There were no significant differences among groups in terms of mean age, early follicular phase Follicle-Stimulating Hormone, and anti-müllerian hormone levels (p&gt;0.05). Baseline total antral follicle counts were similar among groups (p&gt;0.05). There were significant differences among groups in terms of mean starting and total gonadotropin dose, peak estradiol level, total oocyte number, and mature oocyte numbers (p&lt;0.05). Clinical pregnancy rates were 10.7%, 17.3%, and 31.6% in groups with non-functional cyst, endometrioma and control group respectively (p&lt;0.05). The presence of a non-functional cystic mass of ovary on the starting day of stimulation was a risk factor for poor cycle outcome in terms of clinical pregnancy rates [OR=0.5 (95 % CI; 0.2-0.9, p=0.03)]. CONCLUSION: Our data showed that the presence of any kind of cystic mass of the ovary especially the non-functional cysts on the starting day of stimulation was a risk factor for poor cycle outcomes in terms of clinical pregnancy rates.

Biomarkers of ovarian reserve as predictors of infertility

Diminished ovarian reserve (DOR), as determined by low antimüllerian hormone (AMH) and high, early follicular phase follicle stimulating hormone (FSH) levels in serum, have been associated with earlier menopause and low egg yield in response to ovarian stimulation. Some studies suggest women with DOR have a lower probability of pregnancy after assisted reproductive technology. Thus, it is presumed that DOR is a cause of infertility. We sought to determine if measures of ovarian reserve would be significantly associated with infertility.

The Effect of Salpingectomy on Ovarian Reserve and Ovarian Function.

The effect of salpingectomy on ovarian reserve and ovarian function is still a controversial issue, and more investigations are needed. The aim of this study was to determine the effect of salpingectomy on ovarian reserve and ovarian function. PubMed, Embase, Medline, Web of Knowledge, and the Cochrane trial register were searched. Studies must have similar study method and be published in English; clear data can be extracted from full test. Data were collected and analyzed by Review Manager 5.3. A total of 13 studies were eligible. The level of anti-müllerian hormone is lower, and early follicular phase follicle-stimulating hormone is higher in salpingectomy groups. The level of early follicular phase estradiol and the ovarian volume of salpingectomy groups are the same as control. The total dose of follicle-stimulating hormone needed during in vitro fertilization and embryo transfer (IVF-ET) treatment cycles, the number of collected oocytes, and the clinical pregnancy rate are similar in salpingectomy and control groups. Salpingectomy does not appear to affect ovarian function, ovarian response to gonadotropin stimulation, or outcome of IVF-ET in the short run. It may, however, impair ovarian reserve in the long run.

Short-Term Impact of Laparoscopic Cystectomy on Ovarian Reserve Tests in Bilateral and Unilateral Endometriotic and Nonendometriotic Cysts

Study ObjectiveTo evaluate the short-term changes in ovarian reserve markers after laparoscopic cystectomy performed for endometriotic and nonendometriotic cysts. DesignProspective case-control study (Canadian Task Force classification II-2). SettingThe Reproductive Endocrinology Clinic of a training and research hospital. PatientsThirty-four women with endometrioma ≥ 4 mm (group 1) and 33 women with nonendometriotic cysts of matched size (group 2) who underwent surgery during the same period. InterventionsThe follicular phase follicle-stimulating hormone (FSH), estradiol (E2), and antimüllerian hormone (AMH) levels and the antral follicle count (AFC) of both groups were analyzed preoperatively and 2 months after laparoscopic cystectomy. The pre- and postoperative values were compared within the same group and between the 2 groups. Measurement and Main ResultsPreoperative FSH and E2 levels were similar in both groups. However, preoperative AMH levels and AFC were significantly lower in group 1 (endometrioma) compared with group 2 (nonendometrioma; p = .004 and p = .025, respectively). In both groups there was a significant decrease in the AMH levels after surgery (3.1 ± 1.9 ng/mL to 2.5 ± 1.6 ng/mL, p < .001, and 5.7 ± 3.7 ng/mL to 4.8 ± 3.3 ng/mL, p = .04). AMH levels exhibited a significant decrease in the unilateral and bilateral endometrioma groups after cystectomy (p < .001 and p = .025, respectively). However, preoperative and postoperative changes in AMH and AFC were similar in groups 1 and 2 for both unilateral and bilateral cysts (p = .586 and p = .267). ConclusionPreoperative AMH and AFC levels are lower in both unilateral and bilateral endometriomas compared with nonendometriotic cysts. The AMH levels decreased after cystectomy in both endometriotic and nonendometriotic cysts. However, in the short-term period the amount of change in ovarian reserve tests in both unilateral and bilateral cysts was similar for both endometrioma and nonendometriotic cysts.

Implication of ABO Blood Type on Ovarian Reserve in Indian Women

ABSTRACTBackgroundTo explore the association between ABO blood type and ovarian reserve, as reflected by early follicular phase follicle stimulating hormone (FSH) levels.Materials and methodsIn this cross-sectional observational study, early follicular phase (day 3) serum levels of FSH (IU/L) and information on blood types (O, A, B, AB), patient age, and body mass index (BMI) were collected from 300 female patients, who were undergoing fertility evaluation at Vydehi Institute of Medical Sciences and Research Centre (VIMS &amp; RC), Bengaluru. Serum FSH &gt; 10 IU/L was taken as a measure of decreased ovarian reserve (DOR). Data distribution for FSH, age, BMI were analyzed and nonparametric tests were used for comparison across blood groups. Pearson's correlation test was used to determine the relationship between elevated FSH and blood types after adjusting for age and BMI.ResultsProportions of blood types O, A, B, and AB were 42, 24.3, 28.7, and 5% respectively. Mean age (years) and BMI (kg/m2) among study group were 34.08 ± 3.48 and 24.34 ± 2.56 respectively. Out of 300 women, 240 women had serum FSH &lt; 10 IU/L and 60 women had serum FSH &gt; 10 IU/L. Women with blood type “O” (32 out of 60) were twice as likely to exhibit FSH &gt; 10 IU/L (p = 0.02) compared to “A” and “B” blood type.ConclusionOur results have shown that there is an association between ABO blood type and DOR among Indian women. Blood group “O” appears to be associated with DOR that is independent of advancing age and BMI.How to cite this articleChandana C, Shankarappa C. Implication of ABO Blood Type on Ovarian Reserve in Indian Women. Int J Infertil Fetal Med 2016;7(2):49-51.

Implications of Blood Type for Ovarian Reserve and Infertility - Impact on Oocyte Yield in IVF Patients.

Introduction: Diminished ovarian reserve (DOR) has been linked to certain subpopulations and distinct gene polymorphisms. It has even been hypothesized that the AB0 blood group system could be linked to ovarian reserve (OR) as reflected by early follicular phase follicle stimulating hormone (FSH) levels. Although estimation of OR is routinely done using levels of anti-Müllerian hormone (AMH), FSH, estradiol or inhibin B, the diagnostic accuracy of these markers is often limited. The aim of this study was to evaluate whether there is any correlation between IVF patients' AB0 blood group system and ART outcome. Methods: In this retrospective observational single-center study we investigated the outcome of 1889 IVF cycles carried out between 2005 and 2012 with regard to blood type and OR in different age groups (21-36 years and 37-43 years). The number of cumulus oocyte complexes (COCs) and metaphase II oocytes obtained after ovarian stimulation, fertilization rate (FR), pregnancy rate (PR) and birth rate (BR) were evaluated with respect to maternal age (21-36 and 37-43 years, respectively). Results: We found no significant differences in the average number of COCs after ovum pick-up in either of the age groups. Moreover, the mean number of MII oocytes and 2PN stages were similar for all blood type groups. As regards IVF outcome measured in terms of PR and BR, no significant differences were observed between the different blood groups. In conclusion, no correlation was found between blood type and female fertility. Discussion: The most precise definition of OR is determining the number of competent oocytes. Based on the finding of our study, the hypothesis that there is a correlation between OR and AB0 blood group system can be dismissed for Caucasian IVF patients.

Within-woman variability in early follicular phase follicle stimulating hormone (FSH) is associated with moderate/severe hot flashes in the menopause transition

Within-woman variability in early follicular phase follicle stimulating hormone (FSH) is associated with moderate/severe hot flashes in the menopause transition

Anti-mullerian hormone, follicular phase follicle stimulating hormone and antral follicular count as predictors of ovarian response in assisted reproductive technique cycles

Aim: Aim of the study is to correlate Serum Anti-Mullerian Hormone (AMH) levels, Follicular phase Follicle stimulating Hormone (FSH) levels and Antral Follicular Count (AFC) with ovarian response in ART (Assisted reproductive Techniques) cycles. Materials and Methods: Seventy patients undergoing ART cycles for various factors were included in the study. They were divided in two groups according to number of oocytes retrieved at ovum pick up procedures. Four or less number of oocytes were considered as poor response (n=32) and more than four oocytes were considered as good response (n=38). Two groups were compared for their Age, Duration of Marriage, Follicular phase FSH, AMH levels, pregnancy rates and cycle cancellation rate. Results: We found that the age and duration of infertility were not statistically different in two groups. AMH value in poor responders was 1.20ng/ml and in good responders it was 3.38 ng/ml with statistically significant difference (p< 0.05). The difference in FSH levels (7.36 Vs5.99) and AFC (5 Vs 12) was statistically significant. Pregnancy rate in poor responder group was very low as compared to good responders (6.25 Vs 18.42). In good responders none of the cycle got cancelled whereas in poor responders group five cycles got cancelled (15.63%) either due to failure to retrieve mature oocytes or failed fertilization due to poor quality of oocytes. Conclusion: It appears that AMH serum Levels baseline FSH and antral follicular count are associated with ovarian response in ART cycles and can be served as markers for ovarian reserve.

Biomarkers of Ovarian Reserve as Predictors of Reproductive Potential

The size of the oocyte pool, the ovarian reserve, can determine a woman's reproductive stage. Chronologic age, anti-Müllerian hormone (AMH) levels, early follicular phase follicle-stimulating hormone levels, and early follicular phase inhibin B levels are correlated with ovarian reserve. Therefore, these biomarkers of ovarian reserve should serve as predictors of reproductive potential. Clinical and epidemiologic studies suggest that historical and laboratory biomarkers of ovarian reserve are associated with natural and treatment-related fertility. However, controversy remains as to their ability to predict reproductive potential. For infertile women undergoing assisted reproductive technology treatment, these biomarkers tend to be highly specific but not sensitive for cycle failure (nonpregnancy). While these biomarkers are being used as "fertility tests" in the general population, their value as predictors of unassisted fertility is still uncertain. Among laboratory biomarkers, AMH appears to have the most promise; however, further studies are needed to refine cutoff values and to determine test characteristics in the prediction of natural fertility or infertility in the general population.

FSH replaced by low-dose hCG in the late follicular phase versus continued FSH for assisted reproductive techniques

Follicle-stimulating hormone (FSH) - a relatively expensive drug - is commonly used for several days to stimulate the ovaries of women undergoing assisted reproduction. Initial studies have shown that after a few days of using FSH to stimulate the ovaries, it can be replaced by human chorionic gonadotropin (hCG), which is less expensive. In addition to cost reduction, this intervention has a theoretical potential to reduce the risk of ovarian hyperstimulation syndrome (OHSS); though the underlying risk is already very low for most women. We searched the medical literature on in February 2013 for studies that evaluated the effectiveness and safety of using low-dose hCG to replace FSH during the late follicular phase in women undergoing controlled ovarian hyperstimulation (COH) for assisted reproduction, compared to the use of a conventional COH protocol. Five studies evaluating 351 women were included in this review. These studies were funded by fertility centres, universities, or both. We are very uncertain of the effect of this intervention on live birth, OHSS and miscarriage When use of low-dose hCG to replace FSH was compared with conventional COH, there was very low quality evidence compatible with appreciable benefit, no effect or appreciable harm for the intervention, suggesting that for women with a 14% chance of achieving live birth using a conventional COH, the chance of achieving live birth using low-dose hCG would be between 10% and 45%. Similarly, there was very low quality evidence suggesting that for women with a 3% risk of OHSS using a conventional COH, the risk using low-dose hCG was also compatible with either benefit or harm, and would be between 0% and 4%.

Ovarian Reserve and Anti-Mullerian Hormone (AMH) in Mothers of Dizygotic Twins

This study aimed to explore if natural dizygotic (DZ) twinning is associated with earlier menopause and lower anti-Mullerian hormone (AMH) values. We investigated if advanced biological reproductive aging, which can be responsible for the multiple follicle growth in familial twinning, is similar to mechanisms that occur in normal ovarian aging, reflected by earlier menopause in mothers of DZ twins and lower levels of AMH. A total of 16 mothers of DZ twins enrolled with the Netherlands Twin Register (average age at first assessment: 35.9 ± 3.0 years) and 14 control mothers (35.1 ± 3 years) took part in a prospective study. Fifteen years after entry into the study, which included follicle-stimulating hormone (FSH) assessment, AMH was measured in stored serum samples and menopause status was evaluated. Average AMH levels were not significantly different between DZ twin mothers and controls (2.1 ± 2.4 μg/L vs. 1.9 ± 1.9 μg/L). Among the 16 mothers of twins, 7 had an elevated (FSH) value over 10 U/L at first assessment. Their AMH levels were lower than the nine twin mothers with normal FSH values: 0.6 ± 0.4 versus 3.4 ± 2.6 μg/L (p = .01). Of the mothers of twins, eight mothers had entered menopause at the second assessment compared with only one control mother (p = .07). Thus, slightly more DZ mothers were in menopause than the control mothers, although this difference was not significant. The subgroup of DZ twin mothers who had an increased FSH concentration 15 years ago had a limited ovarian reserve as reflected by lower AMH levels. These data indicate that advanced ovarian aging can be a feature in familial DZ twinning, particularly with elevated early follicular phase FSH.

Ovarian reserve in young women with low birth weight and normal puberty: a pilot case–control study

Aim. Studies indicate that women born small for gestational age (SGA) have impaired ovarian function. The origin of this ovarian dysfunction is still debatable. The aim of this study was to compare ovarian ageing between girls born appropriate for gestational age (AGA) and SGA. Therefore, we measured Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), E2, Anti-Müllerian hormone (AMH) levels and the pituitary response to endogenous Gonadotropin-releasing hormone (GnRH) in adolescent girls born SGA and AGA.Methods. A case–controlled pilot study consisting of seven SGA women (birth weight <10th percentile AGA) and 13 AGA women with regular menstrual cycles, age 19.9 (±0.42). Early follicular FSH, LH, Oestradiol (E2) and AMH levels were measured. After baseline samples, 100 μg GnRH was administered intravenously and at 30, 60 and 90 min blood samples were taken to measure gonadotropin levels and to compute the response to endogenous GnRH.Results. Mean follicular phase LH, FSH, E2 and AMH levels did not significantly differ between young women born SGA and AGA. Furthermore, the response to endogenous GnRH showed no significant differences either.Conclusions. We concluded against extension of this pilot study. Based on our observations it seems unlikely that limited ovarian reserve is a predominated problem in adolescent SGA.

Serum markers of ovarian aging are associated with natural fertility

OBJECTIVE: Measures of ovarian aging are used as tests of fertility. We sought to generate estimates of the associations between early follicular phase follicle stimulating hormone (FSH), antimullerian hormone (AMH), inhibin B, and estradiol (E2) and fecundability in the general population.

A Prospective, Comparative Analysis of Anti-Müllerian Hormone, Inhibin-B, and Three-Dimensional Ultrasound Determinants of Ovarian Reserve in the Prediction of Poor Response to Controlled Ovarian Stimulation

Previous studies have shown that antral follicle count (AFC) (determined with conventional two-dimensional ultrasound) and anti-Mullerian hormone (AMH), a conventional endocrine marker of ovarian reserve, provide the highest predictive value for assessing ovarian response to controlled ovarian hyperstimulation (COH) during assisted reproduction treatment (ART) and that these perform equally. More reliable and valid ultrasound data for assessment of AFC are obtained using 3-dimensional (3D) ultrasound. Some investigators have suggested that AFC measured with 3D ultrasound is a better predictor of poor response to COH during ART than AMH. No prior studies have compared the predictive accuracy of AMH and with that of AFC measured with 3D ultrasound data. This prospective study compared the predictive value of AFC and other ovarian parameters using 3D ultrasound with that of AMH and other conventional endocrine markers in determining for the prediction of a poor response to COH during ART. The final study group was comprised of 135 women, with mean age of 33.5 (range: 24–40 years) with regular menstrual cycles and an early follicular phase follicle-stimulating hormone level <12 IU/L, who were undergoing their first cycle of ART using a standard long protocol. All participants underwent venipuncture and a baseline pretreatment 3D ultrasound assessment in the early follicular phase of the spontaneous menstrual cycle before receiving gonadotropin agonists in the luteal phase of the same cycle. Multiple logistic regression and receiver operating characteristic analyses were used to identify significant predictors of poor response and nonconception, which were the primary study outcome measures. Multivariate regression analysis showed that the most significant predictors of poor ovarian response were AFC (Exp(B): 0.65) and AMH (Exp(B): 0.13). Each had similar predictive accuracy; this was demonstrated by their similar area under the curve (AUC) in receiver operating characteristic curve analysis (0.935 and 0.905, for AFC and AMH respectively, P = 0 0.34). The predictive accuracy of AFC and AMH was not significantly improved when used as a combined test (AUC = 0.946). The sensitivity and specificity of AFC for prediction of poor ovarian response was 93% and 88%, whereas the sensitivity and specificity of AMH was 100% and 73%; AFC and AMH were measured at optimum cutoff values of ≤10 and ≤0.99 ng/mL, respectively. The only significant predictor of nonconception was age (Exp(B): 1.191, 95% CI 1.050–1.343; P < 0.01) but its predictive accuracy was low (AUC = 0.674). These findings show that pretreatment AFC measured with 3D ultrasound and AMH are the most significant predictors of poor ovarian response to COH during ART. Although AFC and AMH, either alone or in combination, have similar predictive power, neither is predictive of nonconception which may be dependent on the woman's age.

Mechanisms of FSH synthesis: what we know, what we don't, and why you should care

The pituitary gonadotropin hormones, FSH and LH, are key regulators of reproductive physiology. Though the two hormones are produced by the same cell type, often in response to the same endocrine and paracrine regulators, they sub-serve different biological functions and their synthesis and secretion are differentially regulated. This stems largely from differences in transcriptional, post-transcriptional, and post-translational regulation of their unique beta subunits. That is, both hormones are dimeric glycoproteins and share a common alpha subunit. Their unique beta subunits, however, derive from different genes encoding distinct proteins. Past and recent research indicates synthesis and release of the two hormones are subject to extensive and independent regulation. LH appears to be secreted predominantly via the regulated secretory pathway, whereas FSH release is largely constitutive. As such, investigations of FSH-beta subunit synthesis may lend direct insight into mechanisms underlying patterns of secreted FSH, more so than investigations of the LHbeta subunit. Here, we review recent investigations of transcriptional regulation of the FSH-beta subunit gene from different mammalian species, including humans. The results reveal both conserved and species-specific regulatory mechanisms that might contribute to inter-species variation in FSH release.

Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition

The menopausal transition is characterized by irregular menstrual cycles and unpredictable hormone levels, including dramatic swings in estradiol (E2). An increasing number of studies have found variable high E2 and low luteal phase progesterone occur with progression of Stages of Reproductive Aging Workshop (STRAW)stage, but the cause remains unclear. To explore the causes of the erratic changes in E2, individual within-cycle secretion patterns of E2, progesterone, follicle-stimulating hormone, luteinizing hormone, inhibin A, and inhibin B were explored in detail. Blood samples taken three times per week over 1 1/3 menstrual cycles from 77 women aged 21 to 55 classified as mid-reproductive age (STRAW stages 5 and 4; n = 21), late-reproductive age (STRAW stages 4 and 3; n = 16), early menopausal transition (STRAW stage 2; n = 17), and late menopausal transition (STRAW stage 1; n = 23) were analyzed. Eleven of the 29 (37%) early and late menstrual transition ovulatory cycles exhibited a specific pattern of E2 secretion that was characterized by a second increase in E2 during the mid- and late luteal phases and that continued to a peak during the subsequent menstrual phase. This second rise and fall in E2 was typical in appearance of a normal follicular phase, except that it was superimposed on an existing ovulatory cycle(specifically during the luteal and menstrual phases). The pattern was therefore referred to as a luteal out-of-phase(LOOP) follicular event. In four of these LOOP cycles, a luteinizing hormone peak and ovulatory episode followed the second E2 peak early in the subsequent cycle. Compared with the typical ovulatory cycles, the cycles with LOOP events exhibited lower luteal phase progesterone, higher early cycle follicle-stimulating hormone, and lower early cycle inhibin B. They were also associated with abnormally short (<21 d) or long (>40 d) cycle length. Many of the marked increases in ovulatory cycle E2 and cycle irregularities during the menopausal transition may be due to LOOP events and appear to be triggered by prolonged high follicular phase follicle-stimulating hormone levels.