Lower anti-Müllerian Hormone Levels Research Articles

The Relationship Between Anti-Müllerian Hormone and Body Composition Components in Patients With Polycystic Ovary Syndrome of Reproductive Age.

To investigate and analyze the relationship between body composition components, including Body Mass Index (BMI), body fat percentage, waist-to-hip ratio, and visceral fat index, and Anti-Müllerian Hormone (AMH) levels in patients diagnosed with Polycystic Ovary Syndrome (PCOS), The study aims to provide a comprehensive understanding of how various aspects of body composition impact AMH levels. This study enrolled 167 women with PCOS of reproductive age. Serum AMH level and body composition were measured, and the correlation between body composition elements and AMH levels was analyzed. AMH level was negatively correlated with body weight, BMI, fat-free mass, body fat percentage, waist-hip ratio, and visceral fat level (P < 0.01). And negatively correlated with skeletal muscle ratio ( P= 0.003). AMH level remained significantly associated with BMI (P = 0.028), body fat percentage (P = 0.040), waist-hip ratio (P= 0.003), and visceral fat level ( P= 0.040) after age was included and a multiple linear regression model was established. After adjusting for age, BMI was still significantly associated with AMH (P = 0.029). At the same time, there was no obvious linear correlation between BSA and AMH. The results showed that AMH levels were significantly different among the three groups (9.53 ± 5.12 vs 6.98 ± 3.35 vs 6.38 ± 3.38, P < 0.001; ng/mL). The level of AMH in the non-central obesity group was higher than that in the central obesity group (9.68 ± 5.22vs7.09 ± 3.83, P < 0.001; ng/mL). In PCOS patients, those who are more obese have lower AMH levels, indicating poorer Ovarian Reserve. BMI may independently affect AMH levels, apart from age, BSA, and other factors. Ovarian function in centrally obese patients is poorer than in those with non-central obesity.

Pharmacological Protection of Ovaries During Program Drug Chemotherapy in Classical Hodgkin Lymphoma and Non-Hodgkin Lymphoma Patients

Aim. To assess the efficacy of ovarian protection and options for fertility preservation with the use of gonadotropin-releasing hormone agonists (a-GnRH) in patients with classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphomas (NHLs) during program drug chemotherapy.&#x0D; Materials &amp; Methods. The study enrolled 247 female patients (187 with cHL and 60 with NHLs) undergoing program drug chemotherapy from 2019 to 2023. The patients were aged 13–42 years (median 24 years). Prior to chemotherapy and after it was completed, the serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels were measured. Besides, antral follicle count was estimated by pelvic ultrasound. To provide ovarian protection during chemotherapy, a-GnRH was administered to 67 (27 %) out of 247 patients. Ovarian reserve was assessed based on ultrasound and AMH, FSH, and estradiol levels in 2–3 months after completing the program of drug chemotherapy or after spontaneous menstrual recovery.&#x0D; Results. Menstrual cycle recovered in 194 (78.5 %) out of 247 patients, regardless of lymphoid malignancy variant. Among them, there were 79.7 % (n = 149) of cHL patients and 75 % (n = 45) of NHL patients. Accordingly, ovarian function was lost in 20.3 % (n = 38) of cHL patients and 25 % (n = 15) of NHL patients. Predictors of ovarian function recovery appeared to be age ≤ 28 years and AMH level &gt; 2.45 ng/mL. Pharmacological protection of ovaries did not impact the probability of menstrual cycle recovery. Regardless of immunomorphological variant of lymphoid malignancy, a regular menstrual cycle was completely restored in 48 (71.6 %) out of 67 a-GnRH recipients and in 146 (81.1 %) out of 180 patients without a-GnRH treatment.&#x0D; Conclusion. Most of cHL and NHL patients of early reproductive age (≤ 30 years) have a fair chance of menstrual cycle recovery after completing the program drug chemotherapy similar to BEACOPP, EACODD(PP)-14, R-CHOP, R-Da-EPOCH and other regimens. Ovarian reserve cannot be preserved by means of a-GnRH administration during chemotherapy. High baseline FSH and low baseline AMH levels indirectly indicate evidence of impaired ovarian reserve. Patients belonging to this category are those who, if intensive combined cytostatic therapy regimens are planned, should undergo prior oocyte/embryo retrieval with subsequent cryopreservation due to the risk of premature loss of ovarian function.

Brca2(p.T1942fs/+) dissipates ovarian reserve in rats through oxidative stress in follicular granulosa cells

Pathogenic variants of BRCA1/2 constitute hereditary breast and ovarian cancer (HBOC) syndrome, and BRCA1/2 mutant is a risk for various cancers. Whereas the clinical guideline for HBOC patients has been organized for the therapy and prevention of cancer, there is no recommendation on the female reproductive discipline. Indeed, the role of BRCA1/2 pathogenic variants in ovarian reserve has not been established due to the deficiency of appropriate animal models. Here, we used a rat model of Brca2(p.T1942fs/+) mutant of Sprague-Dawley strain with CRISPR-Cas9 editing to evaluate ovarian reserve in females. Fertility and ovarian follicles were evaluated and anti-Müllerian hormone (AMH) was measured at 8–32 weeks of age with a comparison between the wild-type and the mutant rats (MUT). MUT revealed a significantly smaller number of deliveries with fewer total pups. Furthermore, MUT showed a significant decrease in primordial follicles at 20 weeks and a low AMH level at 28 weeks. RNA-sequencing of the ovary at 10 weeks detected acceleration of the DNA damage repair pathway, which was accompanied by oxidative stress-induced DNA double-strand breaks, a decrease in PTEN, and an increase in mTOR in follicular granulosa cells. In conclusion, Brca2(p.T1942fs/+) dissipates primordial follicles via early activation of granulosa cells through oxidative stress, leading to earlier termination of fertility.

Age-Related Changes in Low Serum Anti-Müllerian Hormone Levels in Female Adolescents: A Single-Center Retrospective Pilot Study

Study ObjectiveAvailable data on the clinical significance of low serum anti-Müllerian hormone (AMH) levels in female adolescents are limited. The aim of this study was to elucidate age-related changes in low serum AMH levels in adolescents and to identify predictive factors for AMH progression. MethodsA retrospective review was conducted on a series of female adolescents aged 11-19 years with low serum AMH levels (<1.19 ng/mL) who underwent additional AMH tests at least 1 year apart. Participants who showed an increase in the subsequent AMH test (>1.6 ng/mL) (Group 1) were compared with those who did not (Group 2). ResultsAmong 1655 adolescents who underwent AMH testing at least once from 2010 to 2022, 75 participants (4.5%) exhibited low AMH levels (<1.19 ng/mL), excluding primary ovarian insufficiency. A notable increase in serum AMH levels (>1.6 ng/mL) was confirmed in 7 (30.4%) of 23 female adolescents who underwent relevant follow-up testing. Group 1 had higher initial AMH levels and lower initial follicle-stimulating hormone levels than Group 2 (1.0 vs 0.59 ng/mL, P = .001 and 4.4 vs 9.8 mIU/mL, P = .015, respectively). Ovarian volume did not differ between the groups (3.8 vs 4.4 cm3, P = .465). None of the participants with initial AMH levels under 0.75 ng/mL showed an increase in AMH levels during follow-up. ConclusionThese findings suggest that low serum AMH levels in adolescents may have other explanations in addition to being indicative of a low ovarian reserve. Prospective studies involving a larger number of participants will aid in predicting AMH improvement in adolescents.

Correlation of Serum TSH with Ovarian Reserve in Patient of Infertility. A Retrospective Study

Background: Various hormones have different impact in fertility either to predict, to investigate or to treat infertility. Due to hindrance in follicular growth, embryo development, implantation and placental formation thyroid dysfunction affects fertility. Studies suggest that thyroid disorder affecting follicular process is associated with ovarian reserve. Similarly serum FSH is directly related to AMH depicting strong correlation of age with each other. This study was conducted to see the association between thyroid dysfunction and serum Anti Mullerian Hormone (AMH) level. Methods: All the female having infertility between age of 20 to 45 were included in the study. Those who did not undergo hormonal assay were excluded from study. All the data were taken from Opd record and their serum Thyroid Stimulating Hormone, AMH and Day2 Follicle Stimulating Hormone Luteinizing Hormone, Prolactin, Estradiol and Progesterone were evaluated. Result: A total of 292 patients visited infertility clinic at our institution over a period of 1.5 yrs and of them only 80 had undergone all hormonal assay. Majority of women enrolled for the study were in the age group 21-30 and the mean age was 29.98±5.4 yrs. Hypothyroidism was seen in 27.5% (n=22) females while we found no cases of hyperthyroidism in our study. Though 35% of females had TSH &lt;2.5. Low serum AMH levels (&lt;1.6 ng/ml) were noted in 25% (n=20). Among women of age less than 35 yrs and low AMH (&lt;1.6) mean TSH was 7.27±6.93 and with normal AMH (&gt;1.6) mean TSH was 3.61±1.73 which was statistically significant (p-value &lt;0.001). Similarly mean FSH in women with low AMH (&lt;1.6) was 8.66±2.89 and with normal AMH (&gt;1.6) was 5.81±1.36 which was statistically significant (p-value &lt;0.001). Conclusion: TSH and FSH level is inversely related to ovarian reserve infertile women.

Elevated Thyroglobulin Antibody Level is Associated with Decreased Anti-Müllerian Hormone in Women of Reproductive Age.

Women with Hashimoto's thyroiditis (HT) have an increased risk of ovarian insufficiency. However, whether thyroid antibodies affect the ovarian reserve remains controversial. The aim of this study was to explore the possible relationship between anti-Müllerian hormone (AMH) and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels in women of reproductive age. A total of 483 women between 18 and 45 years old who had their TPOAb, TgAb, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and AMH levels measured on the same day were enrolled in this study. The levels of TSH, FT4, TPOAb, and TgAb, the prevalence of overt and subclinical hypothyroidism, and the positive rate of TPOAb and TgAb were compared between patients with low (below the 10th percentile), normal (10th to 90th percentile), and high (higher than the 90th percentile) AMH levels. The median AMH level was 1.72 (0.33-4.27) ng/mL. A total of 9.9% of patients had low AMH levels. The TgAb levels and the prevalence of TgAb positivity were higher in the low AMH group (37.62 (13.10-232.68) IU/mL, 35.42%) than in the normal (12.46 (10.0-67.04) IU/mL, 19.59%) and high (13.61 (10.0-95.74) IU/mL, 23.4%) AMH groups (p=0.001, p=0.040, respectively). Serum AMH levels were inversely correlated with TgAb levels (r = -0.114, p=0.013). The AMH of women of reproductive age is affected by HT. Furthermore, women with the lowest AMH level had higher levels of TgAb and a positive rate of TgAb, and high TgAb levels may cause autoimmune damage to the ovaries.

Cumulative cyclophosphamide dose and serum anti-Mullerian hormone levels in adolescent cancer survivors in Indonesia

Background As both the prevalence and survival rates of cancer in children and adolescents has risen, longer-term effects of cancer treatment must be investigated. High-risk gonadotoxic chemotherapeutic agents such as cyclophosphamide may affect the ovarian reserve and impact female adolescent fertility. Anti-Mullerian hormone is a reliable marker to assess ovarian reserve.&#x0D; Objective To assess for a possible correlation between the cumulative dose of cyclophosphamide and serum anti-Mullerian hormone (AMH) levels among adolescent cancer patients.&#x0D; Methods This cross-sectional study included 12-18-year-old adolescent female cancer patients who had experienced menarche and received cyclophosphamide therapy. We recorded the patients’ full history, including menstrual history, computed the cumulative dose of cyclophosphamide received, and measured serum AMH levels. The correlation test was performed to evaluate for a possible correlation between the cumulative dose of cyclophosphamide and ovarian reserve as represented by AMH levels.&#x0D; Results Out of 12 female adolescent cancer patients, three complained of disturbances in their menstrual cycles. Low levels of AMH (&lt;1.5 ng/mL) were noted in five patients. Median cumulative cyclophosphamide dose was 1,000 mg/m2 (range 1,000 to 5,250 mg/m2). Cumulative cyclophosphamide dose was negatively correlated with serum AMH levels, but this correlation was not statistically significant (r=-0.316, P=0.318).&#x0D; Conclusion This study has not been able to show a correlation between cumulative cyclophosphamide dose and serum AMH level. Regular evaluation of fertility and involvement of fertility team is recommended in adolescents receiving high-risk gonadotoxic chemotherapeutic agents.

[Mechanism of protective effect of resveratrol on poor ovarian response in mice].

This study aims to investigate the therapeutic effects and potential mechanisms of resveratrol(Res) on poor ovarian response(POR) in mice. The common target genes shared by Res and POR were predicted by network pharmacology, used for Gene Ontology(GO) annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment, and then validated by animal experiments. The mice with regular estrous cycle after screening were randomized into normal, POR, and low-and high-dose(20 and 40 mg·kg~(-1), respectively) Res groups. The normal group was administrated with an equal volume of 0.9% sodium chloride solution by gavage, and the mice in other groups with tripterygium glycosides suspension(50 mg·kg~(-1)) by gavage for 2 weeks. After the modeling, the mice in low-and high-dose Res groups were treated with Res by gavage for 2 weeks, and the mice in normal and POR groups with an equal volume of 0.9% sodium chloride solution by gavage. Ovulation induction and sample collection were carried out on the day following the end of treatment. Vaginal smears were collected for observation of the changes in the estrous cycle, the counting of retrieved oocytes, and the measurement of ovarian wet weight and ovarian index. The enzyme-linked immunosorbent assay(ELISA) was employed to measure the levels of anti-mullerian hormone(AMH), follicle-stimulating hormone(FSH), estradiol(E_2), and luteinizing hormone(LH) in the serum. The ovarian tissue morphology and granulosa cell apoptosis were observed by hematoxylin-eosin(HE) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL), respectively. Western blot was employed to determine the protein levels of phosphatidylinositol 3-kinase(PI3K), protein kinase B(AKT), forkhead box O(FOXO) 3a, hypoxia-inducible factor(HIF)-1α, B-cell lymphoma-2(Bcl-2), and Bcl-2-associated X protein(Bax). A total of 222 common targets shared by Res and POR were collected. GO annotation indicated that these targets were mainly involved in oxidative stress response. KEGG enrichment analysis revealed that Res can intervene in POR via PI3K/AKT, HIF-1, and FOXO signaling pathways. Animal experiments showed that the model group had higher rate of estrous cycle disorders, lower number and poorer morphology of normally developed follicles at all levels, more atretic follicles, higher apoptosis of ovarian granulosa cells, lower number of retrieved oocytes, lower ovarian wet weight and ovarian index, higher serum levels of FSH and LH, lower levels of AMH and E_2, higher expression levels of HIF-1α, FOXO3a and Bax, and lower expression levels of PI3K, AKT, and Bcl-2 in the ovarian tissue than the normal group. Compared with the POR group, low-and high-dose Res decreased the rate of estrous cycle disorders, improved the follicle number and morphology, reduced atretic follicles, promoted the apoptosis of ovarian granulosa cells, increased retrieved oocytes, ovarian wet weight and ovarian index, and lowered serum FSH and LH levels. Moreover, Res down-regulated the expression levels of HIF-1α, FOXO3a and Bax, and up-regulated the expression levels of PI3K, AKT and Bcl-2 in the ovarian tissue. In summary, Res can inhibit apoptosis and mitigate poor ovarian response in mice by regulating the PI3K/AKT/FOXO3a and HIF-1α pathways.

Kaempferol exerts antioxidant effects in age-related diminished ovarian reserve by regulating the HSP90/NRF2 pathway.

Kaempferol is the active ingredient of Er-Xian decoction (EXD), a traditional Chinese medicine formula used clinically to treat ovarian dysfunction, but the mechanism of kaempferol relieving age-related diminished ovarian reserve (AR-DOR) is still unclear. In this study, 36 volunteers and 78 DOR patients (37 patients with EXD treatment) were enrolled in the clinical research. Meanwhile, 32-week-old female mice were used to establish the AR-DOR model, and these model mice were intragastrically administered with 100 mg/kg kaempferol in the presence or absence of 200 mg/kg geranylgeranylacetone (GGA) or 1 mg/kg geldanamycin (GDA). The effects of kaempferol on serum hormone levels and oxidative stress-related indexes were detected by enzyme-linked immunosorbent assay. Antral follicle count (AFC) was determined by hematoxylin-eosin staining. The protein levels of HSP90 and nuclear factor erythroid 2-related factor 2 (NRF2) were assayed by Western blot. This study displayed that the serum anti-Mullerian hormone (AMH) level in DOR patients with EXD treatment was higher than that in DOR patients without EXD treatment. Kaempferol treatment reversed the low levels of AMH, estradiol (E2), AFC, superoxide dismutase (SOD), and catalase (CAT), as well as the high levels of follicle-stimulating hormone (FSH), reactive oxygen species (ROS), and malonaldehyde (MDA). The results showed that HSP90 was predicted to have high affinity with kaempferol, and its expression was inhibited by kaempferol, while the expression of NRF2, the target of HSP90, was up-regulated by kaempferol. However, the above effects of kaempferol were reversed by GGA. On the contrary, GDA enhanced the therapeutic effects of kaempferol on AR-DOR mice. Moreover, the treatment of kaempferol resulted in a reduction in the phosphorylation level of heat shock factor 1 (HSF1), the transcription factor associated with HSP90, and an increase in the phosphorylation level of Src, a client protein of HSP90. In summary, kaempferol exerts an antioxidant effect on AR-DOR by inhibiting HSP90 expression to up-regulate NRF2 expression. This study provides a theoretical basis for the clinical application of kaempferol in AR-DOR.

Frequency of diminished ovarian reserve in women with multiple sclerosis in Chile: An exploratory study.

Multiple Sclerosis (MS) is a chronic disease affecting around 2.8 million people worldwide. Two-thirds are women, and the mean age at diagnosis is about 30 years old. Social trends are moving towards older age at first pregnancy, both in women with and without MS. To determine the frequency of diminished ovarian reserve (DOR) through anti-Mullerian Hormone (AMH) measurement in women with MS at fertile age and Healthy Females (HF) in Chile. Case-control, multicentric, cross-sectional study including relapsing-remitting people with MS (pwMS) between 18 and 40 years and sex and age-matched HF. We obtained a blood sample to determine AMH levels. We defined DOR as AMH <1.5ng/mL and very-low AMH levels as <0.5ng/mL. Also, we performed questions regarding reproductive decision-making. We included 79 sex and age-matched HF and 92 pwMS, median age 32(19-40) years, median disease duration 6 (1-17)years, median EDSS 1.0 (0-6), 95% were receiving disease-modifying therapy (DMT), 70% high-efficacy DMT and 37% with a treatment that contraindicates pregnancy. DOR was observed in 24% (n=22) of the pwMS, compared to 14% (n=11) of the HF (p=0.09), while very-low AMH levels were observed in 7.6% (n=7) of pwMS and none of the HF (p=0.0166). We observed an inverse correlation between age and AMH levels. Age was the only significant risk factor for low AMH levels in pwMS (OR 1.14 95%CI(1.00-1-31), p=0.04), including smoking, body mass index (BMI), hormonal contraception, autoimmune comorbidity, high/low-moderate efficacy DMT, and active disease as covariables. We did not find statistically significant differences in age at diagnosis, BMI, disease duration, EDSS, autoimmune comorbidity, use of hormonal contraception, or percentage of active disease between MS women with normal vs DOR. Over 70% of pwMS desired to become pregnant in the future, while 60% considered that the diagnosis of MS was a limitation for pregnancy planning. No differences in DOR, measured by levels of AMH, were observed between pwMS MS and HF in Chile. As expected, AMH levels were correlated only with ageing. This information may be evaluated early during the disease course to help patients and neurologists with fertility counselling and family planning considerations regarding DMT use.

Higher serum AMH level is associated with better pregnancy outcomes of IVF/ICSI assisted pregnancy in infertile patients under 35 years old.

This study aimed to investigate the effect of anti-Mullerian hormone (AMH) on the pregnancy outcome of infertility assisted by IVF/Micro-Insemination/Embryo Transfer Infertility Assistance (IVF/ICSI-ET). A total of 324 patients under the age of 35 who received IVF/ICSI-ET assistance in our center were included in this analysis. AMH levels of these patients were measured by chemiluminescence method and divided into clinical pregnancy group (175 cases) and non-pregnancy group (149 cases) according to the final pregnancy outcome. The relationship between the two groups' pregnancy outcomes and AMH levels was analyzed. The above association was re-evaluated after excluding patients with polycystic ovary syndrome. There was no significant difference in age, body mass index (BMI), follicle-stimulating hormone (FSH), and 2 pronucleus (PN) between clinical and non-clinical pregnancy groups. Compared with the clinical pregnancy group, the level of AMH in the non-pregnancy group was significantly lower (p < 0.05). A higher AMH level was closely related to better IVF/ICSI-ET assisted pregnancy outcome in vitro. After excluding AMH abnormalities, the AMH level was still significantly associated with pregnancy outcomes of in vitro IVF/ICSI-ET-assisted pregnancy. Our results show a correlation between AMH level and pregnancy outcome of in vitro IVF/ICSI-ET assisted pregnancy. For women under age 35, lower AMH levels may be one of the predictors of adverse pregnancy outcomes. For patients with low AMH level, it is suggested to strengthen monitoring to ensure the safety and smoothness of the pregnancy process.

Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis.

Is serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after ART or in women trying to conceive naturally? Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after IUI or in women trying to conceive without ART. Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian stimulation. It is unclear whether AMH measurement can predict CLB in spontaneous or assisted conception. A systematic review and meta-analysis was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally. A systematic review and meta-analysis was performed using the following keywords: 'AMH', 'anti-mullerian hormone', 'live-birth', 'cumulative live birth'. Searches were conducted from January 2004 to April 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality, and risk of bias assessment as well as data extraction. Odds ratios were estimated using a random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB. A total of 32 studies were included in the meta-analysis. Overall, 27 articles were included in the meta-analysis of the relation between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relation was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown, especially no serum AMH level threshold below which live birth could not be achieved after IVF/ICSI. After IVF-ICSI, only four studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels were shown between patients with and without CLB, but with a high heterogeneity. After exclusion of two studies with high risks of bias, there was no more heterogeneity [I2 = 0%] and the mean AMH level was statistically significantly higher in women with CLB. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART. The systematic review and meta-analysis had some limitations owing to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level thresholds used and the use of various assays for serum AMH. This could explain, in part, the absence of a discriminating AMH threshold found in this analysis. Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established, therefore low serum AMH level should not be used as the sole criterion for rejecting IVF treatment, especially in young patients. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI. No external funding was obtained for this study. There are no conflicts of interest. PROSPERO CRD42021269332.

O-135 Application of AMH determination in preoperative evaluation of micro-TESE in NOA patients

Abstract Study question To investigate the value of anti-Müllerian hormone(AMH) determination for estimating the sperm retrieval rate(SRR) of microdissection testicular sperm extraction(micro-TESE) in non-obstructive azoospermia(NOA) patients. Summary answer NOA with low AMH would have more opportunity to present heterogeneous seminiferous tubules when micro-TESE was performed and had higher SRR, especially in idiopathic cases. What is known already For infertile patients with NOA, micro-TESE is considered to have higher SRR than traditional surgery methods. However, serum inhibin B, follicle-stimulating hormone (FSH) and various clinical parameters are not reliable predictors for the presence of focal spermatogenesis and SRR. In male, AMH is a glycoprotein secreted by Sertoli cells and facilitate the regression of Müllerian structures in the developing foetus. It is still controversial that whether AMH level has value to predict the SRR of micro-TESE. Study design, size, duration This was a retrospective case-control study. From September 2014 to May 2022, 502 NOA patients treated with micro-TESE were divided into different groups according to their surgery outcome and seminiferous tubules appearance. Age, testis volume, serum AMH, FSH and testosterone level were compared between the different groups. The differences of SRR and AMH level in NOA patients with different etiologies were also compared. Participants/materials, setting, methods Micro-TESE was performed at x10 to x20 magnification. An attempt was made to identify seminiferous tubules that were larger and more opaque than others. The procedure was terminated when sperm were retrieved. If all tubules were seen to have an identical appearance, at least three samples (upper, middle, and lower) were extracted. Venous blood samples were drawn from each patient (7–10 AM) after an overnight fast. FSH and AMH were measured by electrochemiluminescence immunoassay. Main results and the role of chance Testicular sperms were successfully retrieved in 270 cases (SRR=53.8%). There were no statistical differences in age, testicular volume, FSH and testosterone levels between the patients who succeeded and failed to obtain sperm (all P&amp;gt;0. 05). The patients who obtained sperms had lower serum AMH level than those without sperm [0.81(0.16, 3.26)μg/L vs.1.37(0.21, 4.84)μg/L, P&amp;lt;0.05]. Patients with orchitis or AZFc deletion, cryptorchidism, KS, idiopathic azoospermia would have different AMH level [0.15(0.01, 0.41)μg/L, 5.71(3.57, 8.26)μg/L, 2.29(1.36, 3.81)μg/L, 0.15(0.05, 0.39)μg/L, 2.46(0.75, 5.49)μg/L, P&amp;lt;0.05]. Idiopathic azoospermia patients who obtained sperms had higher age but lower testosterone and AMH level than those without sperm [(35.2±8.9) years vs. (32.5±5.5) years, P&amp;lt;0.05, (3.1±1.4)μg/L vs. (3.7±2.1)μg/L, P&amp;lt;0.05; 1.63(0.35, 3.84)μg/L vs.3.00(1.20, 6.68)μg/L, P&amp;lt;0.05], there were no statistical differences in testicular volume and FSH level between the two groups (P&amp;gt;0.05). Receiver operating characteristic (ROC) curve showed that cut-off of serum AMH for successful sperm retrieval of idiopathic azoospermia patients was determined to be 2.96, with a sensitivity of 0.710 and specificity of 0.523, area under the curve (AUC) was 0.649. In the cases presenting heterogeneous seminiferous tubules during micro-TESE had lower AMH level and higher SRR than those presenting homogeneous seminiferous tubules [0.55(0.12, 2.05)μg/L vs.2.99(0.76, 6.11)μg/L, 75.9%(236/311)vs. 17.8%(34/191), all P&amp;lt;0.05]. Limitations, reasons for caution Pathology analysis should be involved in the following study. Randomized controlled trial comparing micro-TESE and traditional TESE would demonstrate that whether idiopathic azoospermia patients with higher serum AMH level would have less benefit by microsurgery than patients with lower AMH level. Wider implications of the findings Recently, in our pathologic research, NOA patients with extremely lower serum AMH level were observed to have more opportunity to present severe hyalinization in their seminiferous tubules. Tubules with severe hyalinization have less Sertoli cells and seem very thin. Therefore, tubules with spermatogenesis would be easy to identify during micro-TESE. Trial registration number not applicable

Live birth rate per transfer is not impacted by the proportion of smooth endoplasmatic reticulum aggregates oocytes.

Despite the data published to date, prognostic factors and the clinical impact of ICSI cycles with smooth endoplasmatic reticulum aggregates (SERa) positive oocytes remain unclear. Are the clinical outcomes of an ICSI cycle impacted by the proportion of oocytes with SERa? Retrospective study (2016-2019), including data from 2468 ovum pick-ups, performed in a tertiary university hospital. Cases are categorised based on the rate of SERa positive oocytes compared to the total number of MII oocytes: 0% (n=2097), <30% (n=262) and ≥30% (n=109). Patient characteristics, cycle characteristics and clinical outcomes are compared between the groups. Compared to SERa negative cycles, women with ≥30% SERa positive oocytes are older (36.2y vs. 34.5y, p<0.001), have lower anti-mullerian hormone levels (AMH) (1.6ng/ml vs. 2.3ng/ml, p<0.001), have received more gonadotropins (3227U vs. 2858IU, p=0.003), have a lower number of good quality day 5 blastocysts (1.2 vs. 2.3, p<0.001) and face more blastocyst transfer cancellation (47.7 vs. 23.7%, p<0.001). Women with <30% SERa positive oocytes are younger (33.8y, p=0.04), have higher AMH levels (2.6ng/ml, p<0.001), have more oocytes retrieved (15.1, p<0.001), have a higher number of good quality day 5 blastocysts (3.2, p<0.001) and have less transfer cancellations (14.9%, p<0.001) compared to SERa negative cycles A multivariate analysis shows no significant difference in cycle outcomes between the categories. Treatment cycles with ≥30% SERa positive oocytes are less likely to result in an embryo transfer when only non-SER oocytes are used. However, live birth rate per transfer is not affected by the proportion of SERa positive oocytes.

Ovarian reserve in reproductive-aged patients with cancer before gonadotoxic treatment: a systematic review and meta-analysis.

Does cancer itself, before any gonadotoxic treatment, affect ovarian function in reproductive-aged patients? Our study revealed that women with cancer may have decreased ovarian reserve markers even before cancer therapy. With the field 'oncofertility' improving rapidly, cancer therapy-mediated ovarian damage is well characterized. However, there is a controversy about whether cancer itself affects ovarian function before gonadotoxic treatment. We conducted a systematic meta-analysis investigating the association between cancer and ovarian function prior to gonadotoxic treatment. Titles or abstracts related to ovarian reserve (e.g. anti-Müllerian hormone (AMH), antral follicle count (AFC), or basal follicle-stimulating hormone (FSH)) combined with titles or abstracts related to the exposure (e.g. cancer*, oncolog*, or malignan*) were searched in PubMed, Embase, and Web of Science databases from inception to 1 February 2022. We included cohort, case-control, and cross-sectional studies in English that examined ovarian reserve in reproductive-aged patients (18-45 years) with cancer compared to age-matched controls before cancer treatment. The quality of the included studies was assessed by ROBINS-I. Fixed or random effects were conducted to estimate standard or weighted mean difference (SMD or WMD, respectively) and CI. Heterogeneity was assessed by the Q test and I2 statistics, and publication bias was evaluated by Egger's and Begg's tests. The review identified 17 eligible studies for inclusion. The results showed that cancer patients had lower serum AMH levels compared to healthy controls (SMD = -0.19, 95% CI = -0.34 to -0.03, P = 0.001), especially women with hematological malignancies (SMD = -0.62, 95% CI = -0.99 to -0.24, P = 0.001). The AFC was also decreased in patients with cancer (WMD = -0.93, 95% CI = -1.79 to -0.07, P = 0.033) compared to controls, while inhibin B and basal FSH levels showed no statistically significant differences. Serum AMH and basal FSH levels in this meta-analysis showed high heterogeneity, and the small number of studies contributing to most subgroup analyses limited the heterogeneity analysis. Moreover, the studies for specific cancer subtypes may be too small to draw conclusions; more studies are needed to investigate the possible impact of cancer type and stage on ovarian function. Our study confirmed the findings that cancer per se, especially hematological malignancies, negatively affects serum AMH level, and AFC values of reproductive-aged women. However, the lower AMH levels and AFC values may also be due to the changes in ovarian physiology under oncological conditions, rather than actual lower ovarian reserves. Based on the meta-analysis, clinicians should raise awareness about the possible need for personalized approaches for young women with cancer who are interested in pursuing fertility preservation strategies before anticancer treatments. This work was financially supported by the National Natural Science Foundation of China (nos 81873824, 82001514, and 81902669) and the Applied Basic Research Program of Wuhan Municipal Bureau of Science and Technology (2019020701011436). The authors declare that they have no conflicts of interest. PROSPERO (CRD42021235954).

Intake of soy products and soy isoflavones in relation to ovarian reserve

To investigate the association between intake of soy food and isoflavone with ovarian reserve. Previous studies suggest on the relationship between soy intake and human fertility are inconsistent. Some clinical studies suggest that soy and phytoestrogens may not be deleterious to reproduction and may even be beneficial in couples undergoing infertility treatment. However, no studies have evaluated the relationship between soy or isoflavone intake with markers of ovarian reserve other than follicle-stimulating hormone (FSH). Cross-sectional study. An academic fertility center. Patients presenting to an academic fertility center between 2007 and 2019 were invited to participate in the Environment and Reproductive Health Study. Six hundred and sixty seven participants reported their soy food intake and had an antral follicle count (AFC) assessment. Intake of 15 soy-based foods during the previous 3 months was obtained at baseline and intake of isoflavone was estimated. Participants were divided into 5 groups based on soy food and isoflavone intake considering those who did not consume soy as the reference group. Ovarian reserve was assessed using AFC as the primary outcome measure, with antimüllerian hormone (AMH) and FSH as secondary outcome measures. The AFC was measured on the third day of the menstrual cycle. Moreover, FSH and AMH levels were measured in blood samples obtained on the third day and the follicular phase of the menstrual cycle. To evaluate the association between soy intake and ovarian reserve, we used Poisson regression models for AFC and quantile regression models for AMH and day 3 FSH levels by adjusting for confounders. Participants had a median age of 35.0 years. The median intake of soy was 0.09 servings/day and isoflavones was 1.78 mg/day. Moreover, AFC, AMH, and FSH were unrelated to soy intake in crude analyses. We found no association between soy food intake with AFC or day 3 FSH level in multivariable models. However, participants in the highest category of soy food intake had significantly low AMH levels (-1.16, 95% confidence interval: -1.92, -0.41). Soy intake had no association with AFC, AMH, or FSH in sensitivity analyses that included using different cutoff points of soy intake, excluding participants in the highest 2.5 percentile of intake, and additional statistical adjustment for dietary patterns. The results of this study are not consistent with a strong positive or inverse association of soy or isoflavone intakes within the observed range of intake, which substantially overlaps with that in the general population of the United States as well as the ovarian reserve among individuals presenting to fertility centers.

Low anti-mullerian hormone decreased clinical pregnancy and increased risk of poor ovarian response in women over 35 years of age.

To the Editor: Infertility affects 15% to 20% of couples worldwide, and assisted reproductive technology (ART) is the most effective treatment strategy. In addition to female age, many other factors, such as antral follicle count (AFC), basal follicle-stimulating hormone (FSH) level, and anti-Mullerian hormone (AMH) level, collectively known as biomarkers for ovarian reserve tests (ORTs), are widely used to predict ovarian responses and assisted-pregnancy outcomes.[1] Among them, AMH and FSH levels were discordant in 20% to 43% of women undergoing ART treatment, and AMH was proven to be superior in predicting live birth rate (LBR).[2] AMH and AFC have long been considered essentially interchangeable and have good performance in predicting ovarian response, while few studies have examined their discordance.[1] Recently, Zhang et al[3] showed that 16.76% (203/1211) of individuals with discordant AMH and AFC levels, and with low AFCs (<7) and normal AMH (≥1.1 ng/mL) level, showed a lower clinical pregnancy rate but a higher incidence of poor ovarian response (POR) than those with normal AFCs and decreased AMH level. Still, there are some limitations, such as a relatively insufficient sample size, failure to comment on LBR, and additional intermediate outcomes with consideration of potential cycle confounders. To determine whether AMH or AFC is associated with pregnancy and neonatal outcomes after ART when the test results are discordant, and to provide clues for optimal fertility counseling, we performed a retrospective cohort study on 44,069 patients who underwent their first autologous oocyte ART cycles. This study was approved by the Ethics Committee of Reproductive Medicine of Shandong University. Written informed consent was obtained from all the participants. Based on the selection process [Supplementary Figure 1, https://links.lww.com/CM9/B100], with an adequate sample size for study design, 44,069 patients with their first autologous oocytes in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) cycles from July 2013 to January 2019 in the Reproductive Hospital Affiliated to Shandong University were selected. The participants were categorized into four cohorts: (A) AFC <7, AMH <1.1 ng/mL; (B) AFC <7, AMH ≥ 1.1 ng/mL; (C) AFC ≥7, AMH <1.1 ng/mL; (D) AFC ≥7, AMH ≥1.1 ng/mL.[3,4] The LBR was the primary endpoint, which was defined as the delivery of at least one live-born infant after 28 weeks of gestation. The secondary outcomes included the POR rate (regarded as the number of oocytes retrieved <4 with only conventional protocols included),[4] oocyte utilization rate (defined as the proportion of embryos suitable for transfer or cryopreservation among retrieved oocytes), clinical pregnancy rate, and pregnancy loss rate. SPSS version 26.0 (IBM Corp, NY, USA) was used for data analysis. Continuous variables were analyzed using variance analysis or Kruskal–Wallis H tests. Categorical variables were analyzed using the chi-squared or Fisher's exact test. To adjust for the influence of confounding factors, binary logistic regression was performed using odds ratios (ORs) and 95% confidence intervals (CI). Statistical significance was defined as a two-tailed P value <0.05. The baseline characteristics are shown in [Supplementary Table 1, https://links.lww.com/CM9/B100]. There were 13.03% women (n = 5740) with discordant AMH and AFC levels; of these, 3.24% (n = 1427) showed less AFC but normal AMH (cohort B), while 9.79% (n = 4313) had normal AFC but low AMH (cohort C). Compared with individuals in cohort C, patients in cohort B had lower body mass index (23.32 ± 3.35 kg/m2vs. 24.03 ± 3.60 kg/m2, P < 0.001) and baseline FSH (7.51 ± 2.45 IU/L vs. 8.14 ± 3.17 IU/L, P < 0.001), as well as higher testosterone levels (22.37 ± 10.96 nmol/L vs. 21.21 ± 11.46 nmol/L, P = 0.005). ART cycle characteristics were compared between cohorts [Supplementary Table 2, https://links.lww.com/CM9/B100]. More agonist suppression and antagonist suppression protocols were applied in cohort B than in cohort C, while no differences were observed in the total gonadotropin dosage, days of ovarian stimulation, and a number of oocytes retrieved. However, the POR rate in cohort B was significantly lower than in cohort C (21.50% vs. 25.05%, P = 0.008). Comparable numbers of similar fresh embryo transfer rates, cryopreserved embryos, and oocyte utilization rates were found between these two cohorts. A total of 63.95% of women underwent fresh embryo transfer, resulting in an LBR of 47.50% per transfer cycle [Supplementary Table 2, https://links.lww.com/CM9/B100]. No differences were observed between cohorts B and C in terms of LBR (39.67% vs. 37.82%, P > 0.05), clinical pregnancy rate (49.03% vs. 46.15%, P > 0.05), ectopic pregnancy rate, and pregnancy loss rate. Furthermore, maternal and neonatal complications were equivalent among cohorts [Supplementary Table 3, https://links.lww.com/CM9/B100]. To evaluate the impact of age, patients with discrepant AMH and AFC were stratified into two age subgroups: <35 and ≥35 years. Confounding factors, such as serum FSH level, cycle type, and timing and number of embryos transferred, were adjusted [Table 1]. For women aged <35 years, LBR (50.35% vs. 46.93%, P-adjusted = 0.073), clinical pregnancy rate (57.19% vs. 54.45%, P-adjusted = 0.135), pregnancy loss rate (11.96% vs. 13.80%, P-adjusted = 0.384), and POR (16.84% vs. 16.67%, P-adj = 0.310) were all insignificant, even after adjustment for confounding factors. For women aged ≥35 years, however, patients in cohort B showed a higher rate of clinical pregnancy (38.82% vs. 35.56%, P-adj = 0.013, OR: 1.349, 95% CI: 1.066–1.707) and a lower rate of POR (27.32% vs. 35.04%, P-adj = 0.001, OR: 0.696, 95% CI: 0.559–0.866) compared with those in cohort C, while the LBR was still similar (26.32% vs. 26.17%, P-adj = 0.322, OR: 1.140, 95% CI: 0.879–1.479). Table 1 - Outcomes of ovarian stimulation and pregnancy in patients with discordant AMH and AFC. <35 years ≥35 years Variables Cohort B (n = 782) Cohort C (n = 2267) P-adjusted Adjusted OR (95% CI) Cohort B (n = 645) Cohort C (n = 2046) P-adjusted Adjusted OR (95% CI) AMH(ng/mL) 2.22 ± 1.08 0.73 ± 0.26 – – 1.95 ± 0.84 0.67 ± 0.27 – – AFC 5.13 ± 1.14 10.48 ± 3.36 – – 5.06 ± 1.16 9.20 ± 2.36 – – Poor response rate 16.84 16.67 0.310∗ 1.132 (0.891–1.437) 27.32 35.04 0.001∗ 0.696 (0.559–0.866) Rate of owning at least two frozen embryos 38.11 38.82 0.220∗ 0.896 (0.752–1.068) 21.86 18.72 0.212∗ 1.159 (0.919–1.461) Clinical pregnancy rate 57.19 54.45 0.135† 1.163 (0.954–1.418) 38.82 35.56 0.013† 1.349 (1.066–1.707) Pregnancy loss rate among clinical pregnancy 11.96 13.80 0.384† 0.839 (0.564–1.247) 32.20 26.39 0.282† 1.247 (0.834–1.866) LBR 50.35 46.93 0.073† 1.197 (0.983–1.456) 26.32 26.17 0.322† 1.140 (0.879–1.479) Data are expressed as mean ± standard deviation or percentage. Cohort B: patients with AFC <7, AMH ≥ 1.1 ng/mL, cohort C: patients with AFC ≥7, AMH <1.1 ng/mL.∗Adjusted P value after correcting for age, BMI, serum FSH level, total testosterone, and cycle type through binary logistic regression.†Adjusted P value after correcting for age, BMI, serum FSH level, total testosterone, cycle type, timing of embryos transferred, and number of embryos transferred through binary logistic regression.AFC: Antral follicle count; AMH: Anti-Mullerian hormone; BMI: Body mass index; CI: Confidence interval; FSH: Follicle-stimulating hormone; LBR: Live birth rate; OR: Odd Ratio. In our study, a 13.03% discrepancy was reported in 44,069 infertile individuals. Women aged ≥35 years with normal AFC but low AMH had credible evidence to have a decreased clinical pregnancy rate and increased risk of POR compared to those with low AFC but normal AMH, implying that AMH is more relevant to outcomes of pregnancy and ovarian response when its levels are discordant with that of AFC in women with advanced reproductive age. This result contradicts with the conclusion made by Zhang et al,[3] but is more convincing due to the larger sample size used. Recently, some randomized controlled trials have suggested that AMH is a strong predictor of oocyte yield. Normal AMH was proven to be associated with a higher probability of supernumerary frozen embryos than lower AMH.[5] Nonetheless, in our study, the number of cryopreserved embryos was similar in women with discordant AMH and AFC levels, even after stratifying patients by age. A possible explanation is that the approximate difference in the number of oocytes retrieved between the inconsistent cohorts might be insufficient to result in significant changes in embryo count, which was also supported by the comparable oocyte utilization rate (38.44 ± 26.01 vs. 40.07 ± 27.68). Further studies evaluating how much of the variance in retrieval outcomes could be explained by AMH vs. AFC in a predictive model are warranted, particularly in women aged >35 years. In addition, several studies have shown that the higher the number of oocytes retrieved, the higher the probability of achieving a live birth after the utilization of all cryopreserved embryos.[6] Although a similar number of frozen embryos and LBRs in the first embryo transfer cycle was observed, the comparison of cumulative pregnancy outcomes per start cycle warrants further exploration. This study has a few limitations. First, baseline characteristics, such as age and basal FSH level, were not comparable among the different groups. Although a binary logistic regression analysis was performed to adjust for confounding factors, intrinsic drawbacks could not be completely avoided. Second, as many studies have shown substantial ethnic/race-related differences in ovarian reserve markers, the cutoff thresholds for AMH and AFC to define abnormal ovarian reserve in the Chinese population remain controversial.[7] Our conclusion was based on the thresholds set at AMH ≥1.1 ng/mL and AFC ≥7 for normal individuals. In summary, our results revealed a 13.03% discordance between AMH and AFC levels in 44,069 autologous IVF/ICSI cycles. With the definition of normal ORT set at AMH ≥1.1 ng/mL and AFC ≥7, low AMH was associated with decreased clinical pregnancy and increased rate of POR in women aged >35 years when it discords with AFC, yet young women (<35 years) with discrepant AMH and AFC levels had comparable pregnancy outcomes. Hence, for women aged ≥35 years who have discrepant AMH and AFC levels, AMH levels may have better directive significance in clinical practice and personalized counseling. Acknowledgements Authors are grateful to all the patients who participated in this study. Funding This work was supported by grants from the National Natural Science Foundation of China (No. 81701406), Shandong Science Fund for Distinguished Young Scholars (No. JQ201720), Taishan Scholars Program for Young Experts of Shandong Province (No. tsqn20161069) and Projects of Medical and Health Technology Development Program in Shandong Province (Nos. 202005010520, 202005010523). Conflicts of interest None.

Gonadal Function in Female Adolescent and Young Adult Survivors of Childhood Cancer.

Childhood cancer survivors (CCSs) are at risk for premature ovarian insufficiency (POI). The aim of this study is to evaluate ovarian function and associated health outcomes in female adolescent and young adult survivors of childhood cancer. Sixty-nine female CCSs were enrolled. Medical records of CCSs were retrospectively reviewed. The subjects were categorized into three groups according to follicular stimulating hormone (FSH) levels (cutoff, 12, 40 IU/L). Anti-müllerian hormone (AMH) level less than 1 ng/mL was considered low AMH level. Of 69 subjects, 14 (20.3%) had POI and 14 (20.3%) had FSH levels between 12 and 40 IU/L. Forty-one of 69 (59.4%) had normal FSH levels. Pelvic irradiation and stem cell transplantation (SCT) were more frequently performed in subjects with POI (p=0.001 and p < 0.001). AMH levels were remarkably low when FSH levels were over 12 IU/L (p < 0.001). In multivariate analysis, cyclophosphamide equivalent dose and SCT were significant treatment factors for developing low AMH levels (p=0.005 and p=0.002, respectively). Total, low-density lipoprotein cholesterol and triglyceride were significantly different in three groups according to FSH levels (p=0.047, p=0.030, and p=0.045). Z-score of femur neck bone mineral density was significantly reduced when FSH levels were increased (p=0.011). Gonadal dysfunction is common in CCSs. Gonadal function was associated with a few treatment factors known to increase the risk of POI. Regular monitoring of gonadal function is needed for better health outcomes.

The influence of timing of oocytes retrieval and embryo transfer on the IVF-ET outcomes in patients having bilateral salpingectomy due to bilateral hydrosalpinx.

The objective of the study was to investigate whether the sequence of oocyte retrieval and salpingectomy for hydrosalpinx affects pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET) patients. There were 1,610 bilateral hydrosalpinx patients who underwent laparoscopy salpingectomy and IVF-ET/intracytoplasmic sperm injection (ICSI) from January 2009 to December 2018. They were divided into two groups: oocyte retrieval first group: 235 accepted oocyte retrieval before salpingectomy; operation first group: 1,375 accepted oocyte retrieval after salpingectomy. The basic information and pregnancy outcomes of the two groups were compared. The pregnancy outcomes and influencing factors were analyzed among patients at different starting times of frozen-thawed embryo transfer (FET) or oocyte retrieval after the salpingectomy. Patients in the oocyte retrieval first group had higher levels of basal follicle stimulating hormone and lower anti-Mullerian hormone levels (P < 0.05). There were no cases of pelvic infection or oocyte and embryo contamination after oocyte retrieval in the oocyte retrieval first group. In the frozen cycle, the clinical pregnancy and miscarriage rates of the oocyte retrieval first group were lower than those in the operation first group (P < 0.05), while the live birth rate was not significantly different (P > 0.05). The live birth rates of patients ≥35 years old in the operation first group and the oocyte retrieval first group were not significantly different (29.3% vs. 23.3%, P = 0.240). After adjusting for age and antral follicle count (AFC), oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates [OR 1.439 (1.045-1.982), P = 0.026; OR 1.509 (1.055-2.158), P = 0.024] and higher accumulated live birth rates [OR 1.419 (1.018-1.977), P = 0.039; OR 1.544 (1.068-2.230), P = 0.021]. No significant difference was observed in the pregnancy outcomes of frozen embryo transfer at different times after salpingectomy (P > 0.05). No contamination of the embryo or infection was observed in patients who underwent oocyte retrieval before the operation. The interval between the operation and frozen embryo transfer did not affect the pregnancy outcomes. After adjusting for age and AFC, patients who underwent oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates and live birth rates.

Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with varied etiologies.

Stepwise mini-incision microdissection testicular sperm extraction (mTESE) is a procedure that attempts to minimize testicular damage. However, the mini-incision approach may vary in patients with different etiologies. Here, we performed a retrospective analysis of 665 men with nonobstructive azoospermia (NOA) who underwent stepwise mini-incision mTESE (Group 1) and 365 men who underwent standard mTESE (Group 2). The results showed that the operation time (mean ± standard deviation) for patients with successful sperm retrieval in Group 1 (64.0 ± 26.6 min) was significantly shorter than that in Group 2 (80.2 ± 31.3 min), with P <0.001. The total sperm retrieval rate (SRR) was 23.1% in our study, and there was no significant difference between Group 1 and Group 2 ( P >0.05), even when the etiologies of NOA were taken into consideration. The results of consecutive multivariate logistic regression analysis (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.38-0.87; P =0.009) and receiver operating characteristic (ROC) analysis (area under the ROC curve [AUC]=0.628) showed that preoperative anti-Müllerian hormone (AMH) level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope (Steps 2-4). In conclusion, stepwise mini-incision mTESE is a useful technique for NOA patients, with comparable SRR, less surgical invasiveness, and shorter operation time compared with the standard approach. Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.