Mean Estradiol Levels Research Articles

7802 A Review of 21 Cases of Kallmann Syndrome

Abstract Disclosure: T. Kashima: None. M. Ishimaru: None. E. Tanimoto: None. S. Fukui: None. C. Nakamura: None. N. Ujita: None. H. Miyagi: None. M. Igarashi: None. H. Doi: None. K. Yoshii: None. Y. Naiki: None. R. Horikawa: None. Kallmann syndrome is the most common form of hypogonadotropic hypogonadism. The incidence is estimated to be 1 in 10,000 birth boys and 1 in 50,000 birth girls. The goals of treatment for childhood puberty are to induce the progression of secondary sexual characteristics close to physiological sexual maturity, to improve psychosocial problems caused by delayed puberty, and to achieve fertility. Methods.Twenty-one patients (fifteen males and six females) with a diagnosis of Kallmann syndrome who visited our Department between August 2004 and November 2023 were included in the study. The electronic medical records were reviewed retrospectively. Results.The median age at first visit was 15 years and 11 months (13 years and 3 months to 17 years and 7 months). The chief complained were secondary sexual characteristics not yet developed, olfactory disturbance, amenorrhea, decreased growth rate, and micropenis. Three adults had symptoms of Kallmann's syndrome and were seen for close examination. 6 had a history of hearing loss. Family history included 2 cases of hypogonadotropic hypogonadism and a sibling with Sjogren-Larsson syndrome. 9 cases had genetic testing, including KAL1, KAL2, FGF8, IL17D, 1 case each, and 2 gene variants of CHD2.At the time of initial examination, the median testicular volume in males was 1.0 mL (1.0-3.0 ml). Five of the six female patients had no breast enlargement.Endocrine examination revealed that the mean basic LH and LHRH test peak values were 0.25 and 3.40 mIU/mL, respectively; the mean basic FSH and peak FSH values were 0.91 and 4.47 mIU/m, respectively; the mean testosterone level in males was 0.09 ng/mL; and the mean estradiol level in females was 5.58 pg/mL.For the 20 patients, excluding children, gonadotropins (HCG+rFSH) for men and estrogen patches for women were both started at low doses and titrated up to Kaufman therapy in women. Median age at initiation of treatment was 16 years and 5 months (14 years and 1 month to 18 years and 6 months). Bone density increased after the start of treatment. One patient diagnosed with micropenis in infancy was treated with testosterone for micropenis at 2 years and 5 months. Two male patients had a baby with their partners. Discussion.The age of diagnosis (age of first examination) is considerably older than the average age of onset of secondary sexual characteristics, so it is necessary to educate the public so that patients can be examined earlier. The patient's fertility was partially confirmed, and a smooth transition to adult/reproductive medical care can be expected through earlier intervention. Presentation: 6/1/2024

Role of estradiol and C-reactive protein levels on genitourinary syndrome in menopausal women.

Menopause leads to decreased estradiol levels affecting tissue health and causing local inflammation in the genital organs and urinary tract. The rise of blood C-reactive protein (CRP) levels in menopausal women may indicate systemic inflammation associated with estradiol decline. The aim of this study was to determine the relationship between serum estradiol and CRP levels on genitourinary syndrome in menopausal women. A cross-sectional study was conducted among menopausal women who had not experienced menstruation for at least 12 consecutive months at Prof. dr. Chairuddin P. Lubis Hospital, Medan, Indonesia, in 2023. Estradiol and CRP levels were measured using enzyme-linked immunosorbent assay (ELISA) and the presence of genitourinary syndrome was assessed using the Menopause-Specific Quality of Life (MENQOL) questionnaire. The mean levels of estradiol and CRP were compared to menopausal women with and without genitourinary syndrome with the Mann-Whitney test. To assess the correlation between estradiol and CRP levels, and between their levels with the presence of genitourinary symptoms, the Spearman correlation test was used. The genitourinary syndrome was reported in 25% of the total included menopausal women. Our data indicated that the mean estradiol levels were not significantly different between menopausal women with and without genitourinary syndrome (9.13±2.47 pg/mL vs 18.96±31.23 pg/mL, p=0.881). The mean serum CRP level of menopausal women with genitourinary syndrome (9.72±6.30 mg/L) was higher than that of women without the syndrome (2.09±1.26 mg/L) with p<0.001. In addition, serum CRP level, not estradiol, was correlated with the symptom score of genitourinary syndrome. This study highlights that to identify and manage genitourinary syndrome, monitoring of CRP levels is essential in menopausal women.

Incidence of breakthrough bleeding in transgender and gender-diverse individuals on long-term testosterone

BackgroundLittle is known about maintenance of amenorrhea in transgender and gender diverse individuals with uteri using long-term testosterone gender-affirming hormone therapy. Emerging data describes breakthrough bleeding in adolescents on long-term testosterone, as well as in adults seeking gender affirming hysterectomy. More studies are needed to better understand breakthrough bleeding patterns in transgender and gender diverse individuals on testosterone with uteri, including the frequency, timing, and etiology, and how these may differ in adults compared to younger populations. ObjectivesThe primary aim of this study was to characterize the incidence and patterns of breakthrough bleeding in a cohort of transgender and gender diverse individuals who had been on testosterone for greater than 12 months and had uteri in situ. Secondary aims included identifying the time to first bleed for those who experienced breakthrough bleeding as well as risk factors associated with breakthrough bleeding on testosterone. Study DesignThis was an IRB approved, single tertiary center, retrospective chart review of transgender and gender diverse individuals who had been on testosterone for at least one year. A primary survival analysis looking at the incidence of bleeding was combined with descriptive analyses and evaluation of factors associated with bleeding. ResultsOf the 279 patients included in the analysis, the median age of testosterone initiation was 22 years (IQR 19-41), with the median follow-up time 34 months (range 12-278). The absolute proportion of individuals who ever experienced breakthrough bleeding on testosterone was 34% (n=96, 95% CI [29, 40]). Patients who experienced breakthrough bleeding initiated testosterone at a younger age (20.5 vs 22.0 years, p=0.04), had lower mean serum testosterone levels (389.14 vs 512.7 ng/dL, p=0.001), were more likely to have a mean testosterone level <320ng/dL (52% vs 48% , p=.001), and had higher mean estradiol levels (62% vs 49%, p=0.003). Survival analyses estimated a breakthrough bleeding incidence rate of 0.09 per year (95% CI [.07-1.0]). While 58 people underwent a hysterectomy during the follow-up period, 64% of the cohort who maintained a uterus eventually experienced breakthrough bleeding. The median time to the initial bleeding episode was 22 (IQR 12-201) months after testosterone initiation. Conclusion(s)These results suggest a substantial fraction of transgender and gender diverse individuals using testosterone will experience at least one episode of breakthrough bleeding, even after their initial year using testosterone. We recommend that clinicians counsel all patients that breakthrough bleeding is a common occurrence, even after the first year on testosterone.

Oral Findings and Gustatory Function of Postmenopausal Indonesian Women with Low Levels of Reproductive Hormones

Menopause is always associated with various problems in the mouth. This study aims to determine oral findings and taste function in postmenopausal women in Indonesia. Descriptive cross-sectional sample of 18 postmenopausal women aged between 53 and 89 years living in nursing homes. Data were collected through demographic questionnaires, oral examination, measuring total saliva volume, assessing saliva pH, checking estradiol and progesterone levels in the blood. Taste tests were carried out the next day with liquids of three different concentrations of four different taste qualities including sweet, salty, sour and bitter. Research results: average age of participants was 75.4+8.6 years, and average DMFT 16.06+2.59. Significant reductions were seen in pH and saliva flow rate, while the most common oral complaints were xerostomia (22%) and pain in the temporomandibular joint (11.1%). Mean estradiol levels were 1.5 + 4.4 pg/mL and progesterone 0.05 + 0.06 ng/mL. Burning Mouth Syndrome and Oral Candidiasis were not found. The majority reported a higher level of taste sensitivity, especially to solutions with the highest concentration, namely bitter taste. This research shows that subjects experienced changes in oral health due to hormonal changes, side effects of medication, and the aging process. Decreased taste function, especially sensitivity to salty, sweet and sour tastes.

Estradiol effects on an emotional interference task in adolescents with current and remitted depression

Attentional biases to emotional stimuli are thought to reflect vulnerability for mood disorder onset and maintenance. This study examined the association between the endogenous sex hormone estradiol and emotional attentional biases in adolescent females with either current or remitted depression. Three groups of participants (mean age ± SD) completed the Emotional Interrupt Task: 1) 20 adolescent females (15.1 ± 1.83 years) currently diagnosed with Major Depressive Disorder (MDD), 2) 16 adolescent females (16.4 ± 1.31 years) who had experienced at least one episode of MDD in their lifetime but currently met criteria for MDD in remission, and 3) 30 adolescent female (15.4 ± 1.83 years) healthy controls. Attentional interference (AI) scores were calculated as differences in target response reaction time between trials with emotional facial expressions versus neutral facial expressions. Estradiol levels were assayed by Salimetrics LLC using saliva samples collected within 30 min of waking on assessment days. Robust multiple regression with product terms evaluated estradiol's main effect on AI scores, as well as hypothesized estradiol × diagnostic group interactions. Although neither mean estradiol levels nor mean AI scores in the current-MDD and remitted-MDD groups differed from controls, the relationship between estradiol and overall AI score differed between control adolescents and the remitted-MDD group. Specifically, the remitted-MDD adolescents performed worse (i.e., showed greater attentional interference) when they had higher estradiol; no significant relationship existed in the current-MDD group. Because this finding was driven by angry and not happy stimuli, it appears higher estradiol levels were associated with greater susceptibility to the attention-capturing effects of negatively-valenced emotional content in girls at risk for MDD from prior history.

Functional Hypothalamic Amenorrhea and Preclinical Cardiovascular Disease.

Endothelial dysfunction is a preclinical cardiovascular disease (CVD) marker. Due to various neuroendocrine aberrations, functional hypothalamic amenorrhea (FHA) may be a sex-specific risk factor for CVD in young women. To investigate endothelial function in women with FHA, compared with eumenorrheic controls and recently menopausal women. We performed a cross-sectional analysis among women with FHA (n = 30), eumenorrheic controls (n = 29), and recently menopausal women (n = 30). FHA was defined as amenorrhea ≥3 consecutive months, estradiol <50 pg/mL, follicle-stimulating hormone (FSH) < 10 mIU/mL, and luteinizing hormone (LH) < 10 mIU/mL, excluding other etiologies. Participants were recruited through obstetrics and gynecology referrals, social media advertising, and review of electronic health records. Preclinical CVD was measured using EndoPAT 2000 to calculate reactive hyperemic index (RHI). RHI ≤1.67 indicates endothelial dysfunction. Mean estradiol levels in women with FHA, as compared with eumenorrheic controls and recently menopausal women, were 29.0 ± 18.1, 46.4 ± 15.7, and 10.9 ± 14.4 pg/mL (P < .0001), respectively. Women with FHA had lower insulin (P = .0095) and higher cortisol (P = .0004) compared with controls. RHI was significantly lower in women with FHA compared with eumenorrheic controls and recently menopausal women (1.8 ± 0.5 vs 2.2 ± 0.5 vs 2.2 ± 0.6, respectively; P = .008), and 35% of women with FHA had RHI ≤1.67, consistent with endothelial dysfunction. These results demonstrate endothelial dysfunction in 1 out of 3 young women with FHA. FHA may be a contributor to preclinical CVD, and it is not explained by hypoestrogenemia alone.

Correlation between Estradiol and Progesterone Hormone Levels and Endometrial Thickness, Pattern and Vascularization in Patients Undergoing In Vitro Fertilization

Introduction: Currently there is a shift in trends in in vitro fertilization programs related to embryo transfer. Embryo transfer is largely determined by the window of implantation related to endometrial receptivity. Endometrial pattern, thickness and vascularity are biomarkers of endometrial receptivity. Estrogen and progesterone are known to have a role in the development of this biomarker.Methods: This study used a cross-sectional design. The study was conducted from January to December 2022 at the Morula IVF Fertility Clinic Padang, RSU Bunda Medical Center (BMC) Padang.Results: At the end of the study, there were 100 respondents with an average age of 25-29 years, most of them were overweight, and almost all of them had primary infertility, and the average duration of infertility was 6.75 ± 3.98 years. At the time of ovulation trigger, the mean estradiol levels were 3070.32 ± 1186.985 pg/ml, progesterone 1.10 ± 0.57 ng/ml, and E2/P4 ratio 3.64 ± 3.10. Most of the respondents had type A endometrial pattern, type I vascularity, and the mean endometrial thickness was 11.58 ± 2.94 mm. There is a statistically significant relationship between estradiol and endometrial thickness and vascularity. In addition, a relationship was also found between progesterone and E2/P4 with endometrial vascularization. However, there is no significant relationship between progesterone and the E2/P4 ratio with the endometrial pattern.Conclusion: Estrogen, progesterone and E2/P4 are related to endometrial vascularization and estrogen is related to thickness. None of these hormones are associated with endometrial pattern.

Comparison of the Effect of Fennel and Evening Primrose Oil on Menopausal Problems and Hormonal Levels: A Randomized Controlled Trial.

Using natural oral supplements is one of the methods of complementary medicine that has been widely welcomed in the last decade Since studies have reported contradictory results for effectiveness of herbal medicines during menopause and no other more effective herbal medicine has been suggested yet, the researchers of this study decided to compare the fennel and Evening Primrose Oil (EPO) and their effect on menopause problems and sex hormones. The present study was a triple-blinded, controlled clinical trial with 125 participants randomly assigned to. An intervention group received fennel, another intervention group received evening primrose oil, and the placebo group received placebo twice daily for 8 weeks. Pre-intervention and post-intervention results were obtained using hormonal assay and the Menopause Rating Scale (MRS). In this study, the mean follicle-stimulating hormone (FSH) and estradiol levels changed significantly in the fennel and EPO groups compared to placebo (p < 0.001). The difference in the mean FSH score between the fennel group and EPO group was not significant (p = 0.304), but the difference in the mean estradiol level between these groups was significant (p = 0.043). Moreover, there was a significant difference in the mean MRS score between the intervention groups before the intervention (p < 0.05). However, the difference in the mean MRS score between the fennel and EPO groups was not significant after the intervention (p = 0.322). Consumption of fennel and EPO can significantly change FSH, estradiol, and psychological menopausal symptoms in postmenopausal women.

Estrus Behaviour and Estrus Intensity Score in Relation to Hormonal Profile in Kankrej Cows at an Organized Farm

The present investigation was undertaken to study the estrus behaviour in Kankrej cattle at an organized farm during 3 different seasons. In each of three seasons, seven (07) Kankrej heifers and seven (07) Kankrej cows showing estrus were considered. In Kankrej cattle, majority of the animals showed acceptance of teaser bull (100%), estrual mucus discharge (88.10%), homosexuality (78.57%), excitement, and edema erythema and wetness of vulva (76.19% each), frequent micturition (59.52%) and bellowing (16.67%). None of the Kankrej cattle went partial or complete off-feed during estrus phase. Overall it was revealed that the estrus signs were manifested more during summer season than monsoon and winter, which shows the heat tolerance capability of the Kankrej cows in the area. Nearly three forth (73.81%) of the total Kankrej cows exhibited normal and above normal estrus intensity score, whereas one forth (26.19%) animals showed weak estrus intensity score. The difference between Kankrej cows and heifers for overall intensity score was found non-significant (p&gt;0.05). The serum estradiol concentrations in Kankrej heifers and cows were significantly higher on the day of estrus than the corresponding levels on 11th day of estrus with inverse trend of serum progesterone in all three seasons. On the day of estrus the mean estradiol level in Kankrej heifers and progesterone levels in cows were higher in summer than winter and monsoon.

Analysis of Hormonal Profile in Women with Benign Breast Diseases and Women without Breast Pathology at a Tertiary Care Hospital in Lucknow, India: A Cross-sectional Study

Introduction: Disruptions in normal hormonal pathways contribute to the development of various benign breast conditions. Having a general understanding of specific hormonal interactions, such as estradiol, progesterone, and prolactin, among breast tissue, the hypothalamus, the pituitary, and the gonads, can enhance understanding of the causes and manifestations of benign breast conditions such as fibroadenoma, fibroadenosis, breast cyst, abscess, mastitis, galactocele, and phyllodestumour. However, there is limited available information regarding the hormonal environment associated with Benign Breast Disease (BBD). Aim: To compare serum levels of estradiol, progesterone, and prolactin between women with BBD and those without breast pathology. Materials and Methods: This cross-sectional study was conducted in the Department of General Surgery, Era Lucknow Medical College and Hospital (ELMC and H), Lucknow, Uttar Pradesh, India, from January 2021 to January 2023. A total of 80 female subjects were enrolled and divided into two groups: Group A (40 subjects diagnosed with BBD by triple assessment) and Group B (40 subjects with no breast pathology). Serum levels of estradiol, progesterone, and prolactin were tested during the follicular phase and compared between the two groups. Student t-test and Spearman’s correlation with a 95% confidence interval were used for mean comparison between the groups. Receiver Operating Characteristic (ROC) analysis was performed to determine cut-off values, sensitivity, and specificity for the hormones. A p-value of &lt;0.05 was considered as significant. Results: The mean age showed no statistical differences between Group A (26.5 years) and Group B (28.8 years). The mean levels of estradiol and progesterone hormones were significantly higher in Group A (188.38±96.06 pg/mL; 4.34±5.05 ng/mL) than in Group B (103.21±39.52 pg/mL; 0.38±0.30 ng/mL) with a p-value of 0.001. The sensitivity of estradiol was found to be 80% with a specificity of 75% based on ROC analysis when the cut-off was set to &lt;139.5. Furthermore, progesterone showed a sensitivity of 92.50% and specificity of 80% at a cut-off &lt;0.8560. Prolactin showed a sensitivity of 52.50% and specificity of 62.50% at a cut-off &lt;18.96. Conclusion: Authors concluded that steroidal harmones have a significant effect on the development of BBD. The present study had demonstrated that women with BBD exhibit higher levels of estradiol and progesterone compared to women without breast pathology.

Correlation between clinical and laboratory parameters and early pregnancy loss in assisted reproductive technology cycles: A cross-sectional study.

BackgroundThe miscarriage rate after pregnancy resulting from assisted reproductive technology (ART) is about 20%, roughly half of which is biochemical. The correlations between the number and quality of oocytes, estradiol level and early pregnancy loss have not been fully clarified.Objective This study aimed to examine the clinical and laboratory parameter effects on early abortion in ART cycles.Materials and MethodsIn this cross-sectional study, 408 women who were ART candidates and were referred to the Yazd Infertility and Research Center, Yazd, Iran during March 2017 to March 2020 participated. Women who had a fresh embryo transferred and who had a positive beta human chorionic gonadotropin serum test were included in the study. The Anti-Müllerian hormone (AMH) level, embryo quality, oocyte number, progesterone level, estradiol level, and maternal age were extracted from the medical records.ResultsNo significant difference was observed in the age, mean estradiol and progesterone levels on trigger day, number of MII oocytes, and embryo quality between the groups (p = 0.19, 0.42, 0.07, 0.34 and 0.20, respectively). No statistically significant difference was found between the 3 groups of AMH level (p = 0.20). After evaluation using logistic regression, the rate of negative clinical pregnancies was higher in the group with AMH 1 ng/ml. However, this was not found to be statistically significant.ConclusionWe did not find any correlation between early abortion and AMH levels, embryo quality, oocyte number, progesterone level, estradiol level, or maternal age.

The Effect of Chemotherapy on Estradiol Levels in Patients with HER 2-Overexpression Breast Cancer in Dr Moewardi General Hospital, Surakarta, Indonesia

AIM: This study aims to evaluate the effect of adjuvant chemotherapy on estradiol levels in patients with HER 2-overexpression breast cancer in a developing country. METHODS: This comparative study with pre- and post-design model observation approach, involving patients with HER 2-overexpression breast cancer who had undergone surgery and had never received chemotherapy or hormonal therapy before, who were then given adjuvant chemotherapy. Estradiol levels were measured before and after chemotherapy. The study was carried out in the surgical oncology division of RSUD Dr. Moewardi (RSDM) Surakarta from January 2020-December 2020. Descriptive data are presented in a frequency table based on age, menstrual status, parity status, breastfeeding status, contraception, contraception duration, family history, stage, and histological grade. Before and after chemotherapy in patients with breast cancer, the estradiol levels employed the paired sample t-test of the Wilcoxon rank test because the data did not meet the normality assumption. RESULTS: From the total data of 21 patients, 15 patients experienced a decrease in estradiol levels after chemotherapy, while six patients underwent an increase. The mean estradiol level before chemotherapy was 89.41 pg/ml, whereas the mean estradiol level after chemotherapy was 55.90 pg/ml. It indicates a difference in the decrease in estradiol levels of 33.51 pg/ml. The statistical test results also obtained a p-value of = 0.033 (p &lt; 0.05), which signifies a significant difference between estradiol levels before and after chemotherapy. Thus, chemotherapy is effective in lowering estradiol levels in patients with breast cancer. CONCLUSION: Chemotherapy affects decreasing estradiol levels in patients with HER2 overexpression breast cancer.

Benefits of Nigella sativa Extract Protecting Ovary Due to Cisplatin Chemotherapy

BACKGROUND: Cisplatin (CIS) is an important chemotherapy agent which is widely used for the treatment of many types of solid tumors, which can cause decreased ovarian function. Nigella sativa has been shown to have an anti-inflammatory and anti-oxidant activity that might protect the ovaries from damage due to CIS. AIM: This study aims to understand the benefits of N. sativa protecting the ovaries due to CIS chemotherapy. METHODS: Thirty-two female Rattus norvegicus aged 8 weeks weighing 160–200 g were divided into four groups: Negative control, Positive control, Treatment-1 (CIS 6 mg/KgBW and NS 500 mg/KgBW/day), and Treatment-2 (CIS 6 mg/KgBW and NS 1000 mg/kgBW/day) for 2 weeks. On the 14th day the rats were sacrificed, blood was drawn from the heart, followed by taking ovaries. RESULTS: There was lower mortality and morbidity in CIS + NS 1000 and CIS + NS 500 mg group (p = 0.01 and 0.001). The mean estradiol levels, follicle-stimulating hormone levels, and anti-mullerian hormone levels were not statistically significant among the four groups. The highest number of primary, secondary, tertiary follicles are seen at the CIS + NS 500 mg and CIS + NS 1000 mg groups (p = 0.05). The lowest number of atretic follicles is seen at the CIS + NS 1000 mg group, and the highest number of atretic follicles was in CIS only. CONCLUSION: There is a trend that N. sativa is beneficial in protecting the ovaries from damage caused by CIS.

P–796 Trial of Autologous Marrow derived Stem Cell Ovarian Transplantation (TAMSCOT) in young infertile women with diminished ovarian reserve for ovarian rejuvenation – HOPE still persists

Abstract Study question Does autologous bone marrow derived stem cell (BMDSC) ovarian transplantation optimize ovarian reserve parameters in young infertile women with diminished ovarian reserve (DOR) ? Summary answer The autologous stem cell ovarian transplantation (ASCOT) improves AFC and AMH by facilitating the recruitment of existing dormant follicles in young women with DOR. What is known already Oocyte donation is the practical therapeutic option when patients with premature ovarian ageing desire pregnancy. It involves significant psychological burden in terms of not able to have their own biological child. ASCOT has opened new doors in poor responders and premature ovarian insufficiency through its beneficial effects on ovarian reserve and IVF outcomes. However recent studies have shown contradictory results in terms of its efficacy. No prior study has been contemplated in DOR group Study design, size, duration An open label non randomized controlled trial was conducted at Division of Reproductive Medicine in collaboration with stem cell facility at tertiary care institute. Forty two infertile women less than 35 years age with DOR (AFC&amp;lt;5, AMH&amp;lt;1.2ng/ml and /or high FSH&amp;gt;8IU/l) were enrolled in the study during a period from January 2020 to December 2020. 20 women who did not opt for the intervention were treated as control group whereas 22 women received the intervention. Participants/materials, setting, methods Baseline hormonal profile ( Day 2 FSH, estradiol, AMH and AFC) was done in all patients. Women with abnormal uterine cavity, endometriosis, prior ovarian surgery, abnormal karyotype were excluded. Bone marrow aspiration followed by mesenchymal stem cells isolation was performed. The stem cells were transplanted in both the ovaries through transvaginal route on the same day. Follow up visits were planned at one and six months to assess ovarian reserve parameters. Main results and the role of chance The mean age, BMI and duration of infertility were comparable between the control and study group (29.5±3.34vs29.36±2.95years, 21.51±1.40vs21.87±1.93kg/m2, 6.9±1.94vs7. 04±3.67 years) . The positive response in terms of improved AMH and AFC was seen in 68% (15/22) patients. The mean number of stem cells injected in these women were 77.71±25.33 million. At first follow up, there was no significant difference between mean FSH, estradiol levels and mean right and left ovarian volume (9.23±3.95 vs 9.02±3.92mIU/l, 61.46±29.25 vs 68.12±62.52 pg/ml, 2.82±2.18 vs 2.44±1.25 cc, 2.02±1.54 vs 2.72±1.06 cc, p &amp;lt; 0.05). There was significant increase in AMH and AFC values as compared to baseline (0.79±0.43 vs 1.26±0.82ng/ml, p = 0.03; 3.47±1.30 vs 6.40±2.23, p &amp;lt; 0.001). At second follow up visit, the significant increase in ovarian reserve persisted for AMH and AFC (0.79±0.43 vs 1.22±0.76 ng/ml, p = 0.02; 3.47±1.30 vs 6.93±1.71,p&amp;lt;0.001). There was no significant difference between serum FSH , Estradiol and ovarian volume. None of the patients developed any complication and the improvement in AFC and AMH persisted during 10 month follow up period. Limitations, reasons for caution The limitation of present study is small sample size and non randomization. However, time period for which positive effect lasts has not been documented in earlier studies. This study is currently being endeavored, and women with improved ovarian reserve are followed up for any spontaneous conception or following assisted reproduction. Wider implications of the findings: The present study demonstrates beneficial role of stem cells in improving ovarian reserve parameters in women with DOR with no acquired cause. If supported by future randomized clinical studies, it could represent a paradigm shift for fertility treatment in these women providing an opportunity to have their own biological child. Trial registration number CTRI/2020/01/022726

P-622 Prothrombotic biomarkers during controlled ovarian stimulation for assisted reproductive techniques

Abstract Study question Does the evolution of prothrombotic biomarkers over time differ between antagonist and long agonist stimulation protocols for assisted reproductive techniques (ART) ? Summary answer The hypercoagulable state was higher and persistent in the agonist and antagonist with hCG triggering groups compared to the antagonist with GnRH agonist triggering group. What is known already Controlled ovarian stimulation (COS) for ART is associated with supra-physiological serum estradiol levels, a hypercoagulable state and an increased risk of venous thrombosis. Most thromboembolic events associated with COS occur in the context of ovarian hyperstimulation syndrome (OHSS). The use of hCG for final follicular maturation increases the risk of OHSS. In antagonist protocols, GnRH agonist triggering is known to prevent or reduce OHSS and is therefore widely used in women at risk. The impact of the different IVF protocols on pro-thrombotic biomarkers is unknown. Study design, size, duration In this prospective observational cohort study, infertile women undergoing COS for ART in 2017-2019 at the University Hospitals of Geneva and Lausanne (Switzerland) were included. We evaluated changes in key coagulation parameters (D-dimers, factor VIII, fibrinogen activity, protein S and protein C) and thrombin generation, our primary outcome, (using 5 pM of tissue factor) by calibrated automated thrombinography before stimulation (T1), on the day of ovulation triggering (T2) and seven days after triggering (T3). Participants/materials, setting, methods COS was started without hormonal pre-treatment. Protocols were prescribed according to the standards used in each centre taking into account the risk of OHSS (agonist protocol with hCG trigger in women without OHSS risk (Group 1); antagonist protocol in women at risk of OHSS with hCG trigger (Group 2;) or GnRH agonist trigger (Group 3;); variation of endogenous thrombin potential (ETP) was measured and compared among groups using mixed effects linear regression model. Main results and the role of chance A total of 64 women were included: 24 were in group 1, 16 in group 2, and 24 in group 3. The mean age (SD) was 37.8 (2.8), 35.9(5.2) and 34(4.6) years in groups 1, 2 and 3 respectively. As expected, women in group 1 had a statistically lower level of anti-müllerian hormone (p = &amp;lt; 0.001), a lower antral follicular count (p = &amp;lt; 0.001) and lower number of MII oocytes and embryos obtained (p = &amp;lt; 0.001). Mean serum estradiol levels were 1836 (1160), 1628 (815) and 3754 (2165) ng/L at T2, and 945 (471), 1061 (495) and 413 (729) ng/L at T3, in group 1 to 3, respectively. In multivariable regression analysis, the levels in group 3 were statistically higher at T2 and lower at T3 (overall time*group interaction: p &amp;lt; 0.001). The mean ETP was similar between all groups at T1, and increased in all groups at T2 (1442, 1426 and 1486 nM/min in groups 1, 2 and 3, respectively) (p = 0.013). Overall, ETP evolution over time was statistically different between groups, with the lowest increase of ETP between T1 and T3 in group 3. Protein C and protein S levels were stable, while D-dimers, fibrinogen and factor VIII increased at T2 and T3 in all groups. Limitations, reasons for caution Stimulation protocols were prescribed according to the clinical profile and OHSS risks; groups therefore differ substantially in regards to age and ovarian reserve. Thromboembolic events are rare events after COS, we therefore evaluated biological markers of hypercoagulability and not clinical events. Wider implications of the findings Women with GnRH agonist triggering protocol did not increase mean ETP in the week after ovulation, while women with hCG triggering did. This different prothrombotic profile was independent of the variation of the other coagulation parameters investigated. This effect of ovulation triggering should be confirmed by further studies. Trial registration number NCT04188444

P–622 Prothrombotic biomarkers during controlled ovarian stimulation for assisted reproductive techniques

Abstract Study question Does the evolution of prothrombotic biomarkers over time differ between antagonist and long agonist stimulation protocols for assisted reproductive techniques (ART) ? Summary answer The hypercoagulable state was higher and persistent in the agonist and antagonist with hCG triggering groups compared to the antagonist with GnRH agonist triggering group. What is known already Controlled ovarian stimulation (COS) for ART is associated with supra-physiological serum estradiol levels, a hypercoagulable state and an increased risk of venous thrombosis. Most thromboembolic events associated with COS occur in the context of ovarian hyperstimulation syndrome (OHSS). The use of hCG for final follicular maturation increases the risk of OHSS. In antagonist protocols, GnRH agonist triggering is known to prevent or reduce OHSS and is therefore widely used in women at risk. The impact of the different IVF protocols on pro-thrombotic biomarkers is unknown. Study design, size, duration In this prospective observational cohort study, infertile women undergoing COS for ART in 2017–2019 at the University Hospitals of Geneva and Lausanne (Switzerland) were included. We evaluated changes in key coagulation parameters (D-dimers, factor VIII, fibrinogen activity, protein S and protein C) and thrombin generation, our primary outcome, (using 5 pM of tissue factor) by calibrated automated thrombinography before stimulation (T1), on the day of ovulation triggering (T2) and seven days after triggering (T3). Participants/materials, setting, methods COS was started without hormonal pre-treatment. Protocols were prescribed according to the standards used in each centre taking into account the risk of OHSS (agonist protocol with hCG trigger in women without OHSS risk (Group 1); antagonist protocol in women at risk of OHSS with hCG trigger (Group 2;) or GnRH agonist trigger (Group 3;); variation of endogenous thrombin potential (ETP) was measured and compared among groups using mixed effects linear regression model. Main results and the role of chance A total of 64 women were included: 24 were in group 1, 16 in group 2, and 24 in group 3. The mean age (SD) was 37.8 (2.8), 35.9(5.2) and 34(4.6) years in groups 1, 2 and 3 respectively. As expected, women in group 1 had a statistically lower level of anti-müllerian hormone (p = &amp;lt;0.001), a lower antral follicular count (p = &amp;lt;0.001) and lower number of MII oocytes and embryos obtained (p = &amp;lt;0.001). Mean serum estradiol levels were 1836 (1160), 1628 (815) and 3754 (2165) ng/L at T2, and 945 (471), 1061 (495) and 413 (729) ng/L at T3, in group 1 to 3, respectively. In multivariable regression analysis, the levels in group 3 were statistically higher at T2 and lower at T3 (overall time*group interaction: p &amp;lt; 0.001). The mean ETP was similar between all groups at T1, and increased in all groups at T2 (1442, 1426 and 1486 nM/min in groups 1, 2 and 3, respectively) (p = 0.013). Overall, ETP evolution over time was statistically different between groups, with the lowest increase of ETP between T1 and T3 in group 3. Protein C and protein S levels were stable, while D-dimers, fibrinogen and factor VIII increased at T2 and T3 in all groups. Limitations, reasons for caution Stimulation protocols were prescribed according to the clinical profile and OHSS risks; groups therefore differ substantially in regards to age and ovarian reserve. Thromboembolic events are rare events after COS, we therefore evaluated biological markers of hypercoagulability and not clinical events. Wider implications of the findings: Women with GnRH agonist triggering protocol did not increase mean ETP in the week after ovulation, while women with hCG triggering did. This different prothrombotic profile was independent of the variation of the other coagulation parameters investigated. This effect of ovulation triggering should be confirmed by further studies. Trial registration number NCT04188444

The Effect of Green Gold Nanoparticles Synthesized with the Achillea millefolium Extract on the Morphometric and Developmental Indices of Preantral Follicles in Immature NMRI Mice

Background: Nanoparticles (NPs) are small-sized particles with dimensions of 1 - 100 nm that have various medical and pharmaceutical technology applications. Objectives: In this study, we aimed to develop a quick, green, and eco-friendly procedure for the synthesis of gold NPs (AMGNPs) using the aqueous extract of Achillea millefolium (AM) and evaluate the effects of them on preantral follicle (PF) maturation in vitro compared to commercially provided GNPs (C-GNPs) and the AM extract alone. Methods: We assessed PF maturation through the morphological assessment of follicles, diameter changes, and estradiol and progesterone levels in PF. We also evaluated the morphometric indices in the control group and groups treated with the AM extract, green GNPs, and C-GNPs. Results: The results showed that the AM extract had positive effects on the PF development by increasing the production of estradiol. The evaluation of PF treated with C-GNPs one to four days after the treatment showed that the mean diameter of follicles was significantly reduced in the C-GNPs group compared to the control group. Moreover, the mean estradiol level increased, and the mean progesterone level decreased in all the experimental (10, 25, 50, and 100 µg/mL of C-GNPs, green GNPs, and the AM extract) groups compared to the control group (P-value &lt; 0.05). The size and concentration of the NPs were 20 nm and 150 µg/mL, respectively. Conclusions: The findings suggest that green GNPs synthesized with the AM extract can minimize the hazardous effects of NPs and have beneficial effects on the development and growth of PF.

GnRH agonist triggering followed by 1500 IU of HCG 48 h after oocyte retrieval for luteal phase support

Research question: Gonadotrophin releasing hormone (GnRH) agonist trigger after GnRH antagonist-based ovarian stimulation protocol for IVF is gaining popularity, because it prevents ovarian hyperstimulation syndrome and allows for near physiological LH and FSH surges. A small dose of HCG (1500 IU) on the day of oocyte retrieval, followed by daily progesterone administration, is currently the preferred way to secure adequate luteal support after GnRH agonist trigger. In the present study, the possibility that a bolus of 1500 IU HCG, given 2 days after oocyte retrieval, may be sufficient to sustain adequate luteal support without additional progesterone treatment was questioned.Design: A non-interventional retrospective cohort study between conducted between April 2017 and August 2018. A total of 154 consecutive patients treated with GnRH agonist trigger followed by day-2 HCG (1500 IU) support only (study group) were included. Data were compared with 155 consecutive patients who were treated with HCG (6500 IU) trigger followed by conventional progesterone luteal support (control group).Results: Pregnancy, miscarriage and live birth rates were comparable between the study and control groups. In patients who became pregnant, mean oestradiol level 14 days after oocyte retrieval was 4719 pmol/l and 2672 pmol/l in the study and control group, respectively (P < 0.001), reflecting robust luteal activity in the study group.Conclusions: A bolus of 1500 IU HCG, administered 2 days after retrieval, can provide excellent luteal support, without the need for further progesterone supplementation.

Evaluation of Levels of Estrogen and Progesterone Hormones in Women with Preeclampsia

Introduction: Preeclampsia was defined as new onset hypertension after 20 weeks’ gestation such that systolic blood pressure of ?140 mm Hg, diastolic pressure of ? 90 mm Hg or both were measured on two occasions ? 6 hours apart, with significant proteinuria (300 mg/24 h). Preeclampsia is a transient but potentially dangerous complication of pregnancy that affects 3 to 5 percent of pregnant women. Aims and Objectives: To study the comparison of estrogen and progesterone levels in women with preeclampsia and without preeclampsia. Material and Method: The present study was conducted in the department of biochemistry in collaboration with department of gynaecology in MMIMSR, MMDU Mullana, Ambala. 100 pregnant women visiting in MM superspeciality hospital were considered in our study. They were divided into 2 groups. Group I included 50 hypertensive pregnant women and Group II included 50 healthy pregnant women. Biochemical investigation: Estimation of Serum 17-? E2 (estradiol) and Progesterone were done by ELISA Method. Results: The mean Estradiol level were significantly lower (P&lt;0.001) in study group (36.1±6.9) than in control group (64.8±8.2) and Progesterone levels were significantly lower (p=0.01) in the study group (77.3 ± 10.4) than in control group (113.7 ± 11.38). Conclusion: Levels of Estrogen and progesterone were pathologically and significantly lower in preeclamptic cases than control women with similar age, gestational age and body mass index. This difference indicates a role of progesterone and estrogen in the pathogenesis of preeclampsia. Therefore estrogen and progesterone levels should be evaluated in all pregnant women so as to manage these patients timely and prevent preeclampsia.

The effect of surgical menopause after bilateral oophorectomy on hormonal changes, mucociliary clearance, and quality of life.

The removal of the ovaries for any reason causes surgical menopause. Hormonal changes that occur progressively over 5-10years in natural menopause occur acutely in surgical menopause. Signs of estrogen deficiency appear suddenly and are permanent after this surgery. This study investigated the short- and long-term effects of estrogen deficiency occurring after surgical menopause on both nasal mucociliary activity and sinonasal symptoms. This prospective study included women aged 20-45years who were not in the menopause, who had a planned bilateral oophorectomy and who attended the Gynecology Clinic at the Faculty of Medicine at a university hospital between January 2018 and December 2019. The nasal mucociliary clearance time, and blood Estradiol (E2) and FSH levels were measured once in the preoperative period, and at the postoperative 3rd, 6th, 9th, and 12th months. At the same times, the Sinonasal Outcome Test 22 (SNOT-22) was also applied. The average age of the 47 patients was 41.2 ± 2.7. The mean serum estradiol levels of the women were 164.7 ± 63.4pg/ml in the preoperative period, 14.8 ± 3.7pg/ml at the postoperative 3rd month, 12.5 ± 3.5pg/ml at the postoperative 6th month, 11.6 ± 3.0pg/ml at the postoperative 9th month, and 11.1 ± 2.7pg/ml at the postoperative 12th month. The mean FSH levels of the women were 9.4 ± 2.4 mIU/ml in the preoperative period, 60.5 ± 9.6 mIU/ml at the postoperative 3rd month, 61.9 ± 9.4 mIU/ml at the postoperative 6th month, 63.0 ± 9.3 mIU/ml at the postoperative 9th month, and 64.6 ± 8.7 mIU/ml at the postoperative 12th month. The changes in postoperative mean estradiol and FSH levels over a year were significant and consistent with menopausal symptoms (p < 0.001). The mean mucociliary clearance times were 12.6 ± 1.2 before menopause, 13.2 ± 1.7 at the postoperative 3rd month, 14.5 ± 1.7 at the postoperative 6th month, 17.5 ± 1.6 at the postoperative 9th month, and 19.4 ± 1.9 at the postoperative 12th month. The extension of the mean mucociliary clearance time over 1 year was significant (p < 0.001). The mean scores for the SNOT-22 were 17.3 ± 6.9 before the operation, 17.8 ± 6.0 at the postoperative 3rd month, 19.6 ± 6.9 at the postoperative 6th month, 23.4 ± 10.4 at the postoperative 9th month, and 36.1 ± 10.0 at the postoperative 12th month. The mean scores for rhinologic symptoms were 5.2 ± 1.9 (3-11) in the preoperative period, 5.7 ± 2.0 (3-12) at the postoperative 3rd month, 7.1 ± 2.3 (4-14) at the postoperative 6th month, 9.3 ± 3.3 (4-16) at the postoperative 9th month, and 11.9 ± 3.3 (6-18) at the postoperative 12th month. The 1-year change in the SNOT-22 scores was found to be significant (p < 0.001). After bilateral oophorectomy, menopausal hormonal values were acutely high in women. At the 1-year postmenopausal follow-up, the mean scores for the SNOT-22 had increased significantly. In other words, quality of life decreased in parallel with prolonged nasal mucociliary clearance time.