Evaluation Of Ovarian Reserve Research Articles

Recent Dynamic Ovarian Reserve Modalities

Background: the pool of primordial follicles in the ovary or ovarian reserve is a major factor in the human fertility potential. The ageing ovary is characterized by reduction of the number of primordial follicles and this loss accelerates in the late 30's and precedes the menopause by 10-12 years. Woman's age alone or with combination of biochemical markers, dynamic tests and ultrasound measurement fail to predict this loss accurately. Aim of the Work: this study aimed to assess the recent dynamic ovarian reserve tests including antral follicle count, ovarian volume and ovarian blood flow (OBF) as a predictive value and less cheap method for evaluation of ovarian reserve. Patients and Methods: this randomized controlled trial was conducted on 200 women having unexplained infertility in outpatient clinic at Sohag General Hospital and private clinics during the period from 2016 to 2017 after taking a verbal consent from each case after explanation of the purpose of the study was taken. Results: mean baseline ovarian volume in cycle day 3 of infertility group was 15.28±12.1, while it was 12.6±4.8 in the control group. It also showed that the mean baseline total antral follicle count in cycle day 3 of infertility group was 5.98±1.74. While, it was 10.1±2.5 in the control group. The mean baseline resistance index of ovarian arteries of infertility group was 0.56±0.12. While, it was 0.47±0.058 in the control group. It also showed that the mean baseline pulsatility index of ovarian artery of infertility group was 0.75±0.15, while it was 0.9±0.26 in the control group. The differences between the two groups were significant regarding baseline total AFC, baseline OV and the rest of variables. It was even found that AFC compared to other predictors was considered the strongest predictor. Conclusion: antral follicular count and the mean ovarian volume measured through the transvaginal ultrasonography is a non-invasive method and easy to perform and can be considered as an accurate method for assessment of the ovarian reserve. Ovarian stromal blood flow may also become one of the parameters. Recommendations: perform transvaginal ultrasound at third day of the cycle in women undergoing infertility treatment is a good predictor for ovarian reserve. Early evaluation of ovarian reserve is very important step in the infertility work up especially in infertile women above the age of 35 years, women with unexplained infertility and women with poor response to ovulation induction.

Fertility preservation in a premenarcheal female with sickle cell anemia

The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.

Are age and anti-Müllerian hormone good predictors of ovarian reserve and response in women undergoing IVF?

ObjectiveOvarian reserve evaluation has been the focus of substantial clinical research for several years. This study aimed to examine the associations between markers of ovarian reserve and ovarian response.MethodsThis prospective study included 132 infertile women aged 24-48 years undergoing routine exploration during unstimulated cycles prior to the start of assisted reproductive technology (ART) treatments at our center from July 2015 to January 2017. Descriptive parameters and patient characteristics were reported as mean (SD) or median (range) values depending on the data distribution pattern. Student’s t-test was performed for continuous variables; the Wilcoxon and Pearson’s test were used for data not following a normal distribution; and Fisher’s test was used for categorical variables. p<0.05 was considered statistically significant.ResultsAt the time of the study, the patients had a mean age of 35.7±3.84 years. On day 3 of the cycle, the mean anti-Müllerian hormone (AMH) serum level was 2.84±1.57 ng/mL and the patients had 14.68±4.2 antral follicles (AFC). A significant correlation was observed between AMH and age (r=-0.34 p<.01), follicle stimulating hormone (FSH) serum levels (r=-0.32, p<.01), AFC (r=0.81, p<.00001), total dose of medication during ovarian stimulation (r=-0.28, p<.0003), and ongoing pregnancy rate (p<.05). Age was significantly correlated with FSH (r=0.46, p<.01), AFC (r=-0.34, p<.00001), total dose of medication during ovarian stimulation (r=0.43, p<.0003), and ongoing pregnancy rate (p<.04).ConclusionSerum AMH and age are independent predictors of ovarian reserve and ovarian stimulation outcome in infertile women. Age and serum AMH level may be used to advise subfertile couples of their pregnancy prospects.

Ovarian reserve evaluation after laparoscopic cyst enucleation, depending on applied haemostasis technique and with particular consideration of endometrial cysts.

Aim of the studywas an evaluation of the effects, exerted by obtained haemostasis on ovarian reserve, depending on haemostasis technique, applied after laparoscopic enucleation of endometrial cysts.Material and methodsSixty-six female patients, at the age of 20-35 years, were included into the study. The diameters of the cystic lesions were within 40-70 mm. The patients were randomly assigned to two study groups. Group 1 involved patients after laparoscopic enucleation of ovarian cysts, in whom haemostasis was achieved by ovary suturing, while Group 2 included patients with haemostasis achieved by bipolar coagulation technique. Cyst enucleation was performed in all the patients by the stripping method. Ovarian reserve markers: AFC (antral follicle count), AMH (anti-Müllerian hormone), and inhibin B were assayed before and three months after the surgery.ResultsThe preoperative values of AMH, AFC, and inhibin B were similar in both studied groups. After a three-month follow up, the post-operative levels of AMH and inhibin B were significantly lower (p < 0.05), while the numbers of antral follicles did not reveal any statistical differences (p > 0.05). While comparing endometrial and dermoid cysts in the sutured group of patients, the difference, regarding AMH, was statistically significant (2.13 vs. 4.69, p = 0.03). In the group of patients after bipolar coagulation, the corresponding differences did not attain statistical significance (2.21 vs. 6.51, p = 0.86)ConclusionsComparing pre- and post-operative levels of AMH and inhibin B, regardless of the applied haemostasis technique, a statistically significant reduction of the ovarian reserve was observed in either group. Comparing both haemostasis techniques, no method was demonstrated that would have decreased less the levels of AMH, AFC, or inhibin B.

COMPARATIVE STUDY OF THREE DIMENSIONAL AND TWO DIMENSIONAL ULTRASOUND MARKERS OF OVARIAN RESERVE IN WOMEN UNDERGOING INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Background: Over the last two decades, various ultrasound markers have been investigated to evaluate their role in the prediction of ovarian function and hence reserve. The three most common markers that have been specifically addressed are ovarian volume, antral follicle count (AFC) and ovarian vascularity. Objective : To evaluate differences between three-dimensional (3D) and two dimensional(2D) ultrasound markers of ovarian reserve (antral follicle count and ovarian volume ) in women undergoing investigation for subfertility before intra cytoplasmic sperm injection. Patients and methods: This study was a prospective observational study including 50 women who attend the Infertility Clinic at Al-Azhar International Islamic Center for population studies and researches. Intervention: Measurement of cycle day three follicle stimulating hormone (CD3 FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), anti Mullerian hormone (AMH), thyroid stimulating hormone (TSH) and ovarian reserve{antral follicle count (AFC) and ovarian volume (OV) }by transvaginal tow dimensional (2D) and three dimensional (3D) ultrasound , patients were subjected to long ovulation induction protocol. Assessment of follicles number, quality and number of oocyte retrieved was done. Results: There was no difference between 2D and 3D ultrasound in the assessment of antral follicle count. The difference between 2D and 3D ultrasound in the assessment of ovarian volume was minimal and non-significant. Conclusions: Application of transvaginal sonography in evaluation of ovarian reserve proved to be of important value in the assessment of poor and good responders for ICSI treatment, to avoid expensive IVF cycle cancellation.

Comparative Study between Measuring FSH, LH and E2 on Day Two and on Any Day of the Cycle

Background: evaluation of ovarian reserve has become an essential part of the treatment assessment of woman to undergo assisted reproductive technique. Aim of the Work: this work was conducted to measure FSH, LH and E2 at any day of the whole menstrual cycle compared to day2 with measurement and establishing an actual negative correlation between FSH & E2. Patients and methods: observational analytical prospective study on 50 women attending the Gynecology Outpatient Clinics of Maternity Hospital, Ain-Shams University in 2016. Results: there was a significant negative correlation between E2/FSH on the 3rd, 5th and 10th days of the cycle. Also there was insignificant negative correlation on day 21. Conclusion: there was negative correlation between basal day2 E2/FSH which was equivalent or similar to that ratio on days (5,10,21) so there was no need to wait for hormonal analysis to the next cycle (day 2 or 3) to save time specially in patients >35years; for them there was importance of cycle day3 for evaluation of ovarian reserve and prior ovulation induction and subsequent pregnancy potential during the infertility work up. Recommendations: during the infertility work up, rigid adherence to cycle day3 collection, no longer seems necessary ,no need to wait for hormonal analysis to Estradiol and FSH to the next cycle as there was equivalent negative correlation between E2/FSH on menstrual cycle days (3,5,10,21) aiming for saving time.

Is day 3 follicle stimulating hormone (fsh) useful in patients with normal antimullerian hormone (AMH) and antral follicle count (AFC)?

Obtaining an early follicular phase serum FSH can be an inconvenience to patients, lead to increased costs and delay infertility treatments. The goal of this study was to determine the utility of the cycle day 3 FSH in patients with otherwise normal ovarian reserve tests. Retrospective cohort study. A review of patient's records who underwent IVF from 2012 to 2015 was performed. Subjects included in the study had AMH levels ≥1 ng/ml and AFC ≥10. Cycle day 3 serum FSH levels were categorized into three separate groups: high ≥10 IU/L, normal >5 IU/L and< 10 IU/L, and low ≤5 IU/L. Subjects with an elevated day 3 estradiol (≥80 ng/mL) obtained at the time of FSH and high responders (AMH ≥10 ng/ml and/or AFC ≥30) were excluded. Baseline demographics and IVF cycle parameters and outcomes were compared among the three groups using ANOVA and chi-square test where applicable. A total of 225 subjects were identified. The majority of the subjects (91%) utilized a GnRH antagonist cycle, and type of cycle utilized was not different based on FSH group (p=0.84). Those in the high group received a higher mean total dose of gonadotropins (3977 IU) compared to the normal (3335 IU) and low groups (3746 IU) (p=0.01). Comparison among the three groups is presented in table 1.Table 1Comparison of three FSH groupsHigh (n=36)Normal (n=170)Low (n=19)p valueAge33.3 ± 4.532.9 ± 4.631.2 ± 5.50.26BMI24 ± 426 ± 628 ± 70.06AMH2.6 ± 1.52.9 ± 1.63.2 ± 2.10.38AFC18 ± 519 ± 620 ± 50.19% started on 450 IU13 (36%)33 (19%)7 (37%)0.001*Peak estradiol (pg/ml)2270255323870.36No. of follicles recruited17 ± 1022 ± 925 ± 100.01*No. of oocytes retrieved15 ± 818 ± 921 ± 80.02*No. of 2PN embryos8 ± 410 ± 612 ± 50.04*Clinical pregnancy rate13/25 (52%)71/113 (63%)3/6 (50%)0.53Live birth rate10/25 (40%)53/113 (47%)2/6 (33%)0.69 Open table in a new tab An isolated elevated cycle day 3 FSH was associated with decreased follicular development and lower oocyte yield despite normal AMH and AFC. Although clinical pregnancy rate and live birth rate were not different statistically when looking at a single cycle, this may impact cumulative pregnancy rates and long term outcomes for these patients. Based on the findings from this study, we will continue to recommend a complete ovarian reserve evaluation to determine the of optimal initial gonadotropin dose and properly counsel patients on IVF outcomes.

Prediction value of anti-Mullerian hormone (AMH) serum levels and antral follicle count (AFC) in hormonal contraceptive (HC) users and non-HC users undergoing IVF-PGD treatment

Use of hormone contraceptives (HC) is very popular in the reproductive age and, therefore, evaluation of ovarian reserve would be a useful tool to accurately evaluate the reproductive potential in HC users. We conducted a retrospective cohort study of 41 HC users compared to 57 non-HC users undergoing IVF-preimplantation genetic diagnosis (PGD) aiming to evaluate the effect of HC on the levels of anti-Mullerian hormone (AMH), small (2–5 mm), large (6–10 mm) and total antral follicle count (AFC) and the ability of these markers to predict IVF outcome. Significant differences in large AFC (p = 0.04) and ovarian volume (p < 0.0001) were seen, however, there were no significant differences in small and total AFC or in serum AMH and FSH levels. Oocyte number significantly correlated with AMH and total AFC in HC users (p < 0.001) while in non-HC users these correlations were weaker. In HC users, the significant predictors of achieving <6 and >18 oocytes were AFC (ROC-AUC; 0.958, p = 0.001 and 0.883, p = 0.001) and AMH (ROC-AUC-0.858, p = 0.01 and 0.878, p = 0.001), respectively. The predictive values were less significant in non-HC users. These findings are important in women treated for PGD, in ovum donors and for assessing the fertility prognosis in women using HC and wishing to postpone pregnancy.

Association of skewed X-chromosome inactivation with FMR1 CGG repeat length and anti-Mullerian hormone levels: a cohort study

BackgroundPremutation range CGGn repeats of the FMR1 gene denote risk toward primary ovarian insufficiency (POI), also called premature ovarian failure (POF). This prospective cohort study was undertaken to determine if X-chromosome inactivation skew (sXCI) is associated with variations in FMR1 CGG repeat length and, if so, is also associated with age adjusted antimüllerian hormone (AMH) levels as an indicator of functional ovarian reserve (FOR).MethodsDNA samples of 58 women were analyzed for methylation status and confirmation of CGGn repeat length. Based on previously described FMR1 genotypes, there were 18 women with norm FMR1 (both alleles in range of CGGn=26–34), and 40 women who had at least one allele at CGGn<26 or CGG>34 (not-norm FMR1). As part of a routine evaluation of ovarian reserve, patients at our fertility center have their serum AMH assessed at first visit. Regression models were used to test the association of ovarian reserve, as indicated by serum AMH, with sXCI.ResultssXCI was significantly lower among infertility patients with norm FMR1 (6.5 ± 11.1, median and IQR) compared to those with not-norm FMR1 (12.0 ± 14.6, P = 0.005), though among young oocyte donors the opposite effect was observed. Women age >30 to 38 years old demonstrated greater ovarian reserve in the presence of lower sXCI as evidenced by significantly higher AMH levels (GLM sXCI_10%, f = 11.27; P = 0.004).ConclusionsTogether these findings suggest that FMR1 CGG repeat length may have a role in determining X-chromosome inactivation which could represent a possible mechanism for previously observed association of low age adjusted ovarian reserve with FMR1 variations in repeat length. Further, larger, investigations will be required to test this hypothesis.

Evaluation of ovarian reserve using anti-müllerian hormone and antral follicle count in Sjögren's syndrome: Preliminary study.

The aim of this study was to determine ovarian reserve status using anti-müllerian hormone (AMH) level and antral follicle count (AFC) in patients with Sjögren's syndrome (SS). Twenty-four women with SS diagnosed according to the classification criteria proposed by the American-European Consensus Group and 25 healthy women as controls were enrolled in this study. Ovarian reserve was assessed on clinical findings, AFC, and serum AMH and reproductive hormone levels. Compared with the healthy controls, in the SS patients, the duration of menstrual cycle was significantly shorter (P = 0.043); serum AMH (P = 0.001) and AFC (P = 0.001) were significantly lower, and serum luteinizing hormone (LH) was significantly higher (P = 0.019). The right (P = 0.555) and left ovarian (P = 0.386) volumes were also lower but this did not reach statistical significance. Serum follicle-stimulating hormone (P = 0.327), estradiol (P = 0.241), and prolactin (P = 0.55) were similar between the two groups. Ovarian reserve may be reduced in SS patients. For the assessment of ovarian reserve, serum AMH and ovarian AFC with serum LH may be useful. Further studies with long-term follow-up are required to determine the course of ovarian reserve abnormalities and best possible biomarkers of reduced ovarian reserve in SS patients.

The feasibility of establishing classification system for ovarian function

The occurrence, development, and decline of ovarian function are the foundation in women's whole life stages, which reflect the process beginning from embryo formation to the aging. Correct assessment of ovarian function is significant for evaluating the potential reproductive ability and predicting the age of menopause, as well as providing both individualized and proper treatment and preventive care based on physiological characteristics of women in different phases. Ovarian reserve (OR) is used to predict the potential fertility of women by evaluating the follicles and the quantity and quality of eggs. Currently, there are multiple indexes used to evaluate ovarian reserve, including anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2), inhibin B, antral follicle count (AFC), etc. Although some scholars combine multiple indexes to evaluate the ovarian function, these indexes are far less accurate, detailed, and comprehensive. To find an ideal method for evaluation of ovarian reserve is the hotspot in research of reproductive endocrine. The present authors, for the first time, put forward a classification system of ovarian reserve function after summarizing numerous cases. It can both accurately and effectively evaluate the ovarian function quantitatively. It is of great help in making clinical decisions and of great significance in future development.

Evaluation of Ovarian Reserve with AMH Level in Patients with Well-Differentiated Thyroid Cancer Receiving Radioactive Iodine Ablation Treatment.

Introduction: Radioactive iodine (RAI) ablation treatment is used for patients diagnosed with well-differentiated thyroid cancer in order to reduce the risk of recurrence. RAI ablation treatment can adversely affect gonads in males and females. In this study, we aimed to determine ovary damage and infertility risk due to RAI, using serum anti-Müllerian hormone (AMH) level, in females who received RAI ablation treatment. Materials and Methods: 45 female patients who have not gone through the menopause and had received RAI ablation treatment for well-differentiated thyroid cancer in premenopausal period, and 40 healthy females as control groups were included in this study. The serum AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid stimulating hormone (TSH) and creatinine levels of the patients included in the study were analyzed and compared to those of the control group with similar demographical characteristics. Results: No differences were found between the patient group and control group in terms of age, height, weight, body mass index, LH, E2 and creatinine. The difference in AMH, FSH and TSH between both groups were found to be significant. There was no statistically significant relation between the age and AMH levels. Similarly, no statistically significant relation between RAI exposure duration and AMH levels was determined. When the patients below and above the age of 35 were compared with regard to AMH (2.95±1.79 and 2.75±1.94, respectively) and FSH (5.45±1.63 and 5.99±3.06, respectively), the difference between them was found to be statistically insignificant. Oligo/anovulation was detected in 7 patients (15.6% of the patient group) after RAI treatment, 8 (17.8%) patients became pregnant after RAI treatment, and none of the patients, who were actively trying to get pregnant, were unable to achieve it. Conclusion: According to these results, it may be concluded that low AMH levels due to RAI treatment can cause damage to the ovaries of patients; nevertheless, considering the AMH levels and the absence of infertility in the patients, the infertility risk was found to be low.

3 to 5 Years Later: Long-term Effects of Prophylactic Bilateral Salpingectomy on Ovarian Function

Study ObjectivePreliminary data on the effects of prophylactic bilateral salpingectomy (PBS) show that postoperative ovarian function is preserved up to 3 months after surgery. The confirmation of PBS safety on ovarian function even many years after surgery is essential to reassure the medical community that this new strategy, recently proposed for the prevention of ovarian cancer, is at least able to avoid the risk of premature surgical menopause. We investigated whether the addition of PBS during total laparoscopic hysterectomy (TLH) causes long-term effects on ovarian function. DesignAn observational study (Canadian Task Force classification II-3). SettingDepartment of Obstetrics and Gynecology, “Magna Graecia” University, Catanzaro, Italy. PatientsSeventy-nine patients who underwent TLH plus salpingectomy between September 2010 and September 2012 at our institution have been recalled to be submitted to ovarian reserve evaluation in February 2015. Eight of 79 women refused to participate in this follow-up study. InterventionsThe ovarian age of PBS patients has been determined through OvAge (OvAge sr., Catanzaro, Italy), a statistical model that combines antimüllerian hormone, follicle-stimulating hormone, 3-dimensional antral follicle count, vascular index, flow index, and vascular flow index values. The control group consisted of a large population of 652 healthy women (with intact uterus and adnexa) previously enrolled to build the OvAge model. Comparisons between ovarian ages of PBS patients and the control group have been assessed by analysis of covariance linear statistical modeling. Measurements and Main ResultsThe main outcome measurement was the differences in the behavior within OvAge/age relation between PBS and control women. Descriptive statistics of those 71 enrolled PBS patients are the following: age, 49.61 ± 2.15 years; OvAge, 49.22 ± 2.57 years; follicle-stimulating hormone, 43.02 ± 19.92 mU/mL; antimüllerian hormone, 0.12 ± 0.20 ng/mL; 3-dimensional antral follicle count, 1.91 ± 1.28; vascular index, 2.80% ± 5.32%; flow index, 19.37 ± 5.88; and vascular flow index, 0.56 ± 1.12. Analysis of covariance disclosed that PBS and control women do not exhibit different behaviors (p = .900) within OvAge/age relation. ConclusionAccording to our model, the addition of PBS to TLH in the late reproductive years does not modify the ovarian age of treated women up to 3 to 5 years after surgery.

Performance characteristics of the Access AMH assay for the quantitative determination of anti-Müllerian hormone (AMH) levels on the Access* family of automated immunoassay systems

ObjectivesAnti-Müllerian hormone (AMH) measurement is useful as an aid in the evaluation of ovarian reserve. In the past, its conventional use was restricted by the low-throughput and variability of existing manual AMH assays. We developed the automated Access AMH assay for the quantitative determination of AMH levels on the Access family of immunoassay systems. The analytical performance of this new assay was evaluated. Design and methodsSensitivity, dilution linearity, assay imprecision, AMH sample stability, lot-to-lot comparison and correlation with AMH Gen II assay (Beckman Coulter, Inc.) were evaluated. Reference intervals for Access AMH were established in healthy females, males, newborns (≤60days) and pediatric males classified by Tanner stages. ResultsThe limit of blank and limit of detection were below 0.0077 and 0.0098ng/mL, respectively. The limit of quantitation was 0.010ng/mL. The total imprecision ranged from 2.4 to 5.2%. Linearity was observed up to 24ng/mL. Sample storage at room temperature up to 48h, at 2–8°C up to 7days and at −20°C up to 15months had no impact on measured AMH. The correlation study gave a coefficient between 0.99 and 1 and a regression slope between 0.89 and 0.92. Excellent lot-to-lot comparability was observed on controls and patient samples with a maximum bias of 3.7% between 2.81 and 15.03ng/mL. ConclusionsThe fully automated Access AMH immunoassay demonstrates excellent analytical performance. As a consequence, the availability of this assay will represent a robust, fast and precise alternative to manual AMH assay testing.

Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours

Can a nomogram be used to predict the individual probability of live birth (LB) in women with borderline ovarian tumours (BOTs) receiving primary fertility-sparing surgery? A nomogram built according to the woman's age, histological subtype (serous versus mucinous), type of ovarian surgical treatment and FIGO stage can accurately predict the probability of LB in women with BOT. Current prediction models determine the probability of pregnancy after medically assisted reproduction (MAR) and form the basis of patient counselling to guide the decision as to whether to consider in vitro fertilization but do not take into account prediction of the LB rate. This was a retrospective multi-centre study including 187 women with fertility-sparing surgery for BOT diagnosed between January 1980 and December 2013. A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. A bootstrapping technique was used for internal validation. Fifty-one women had LB (27.3%). Taking into account multiple pregnancies, the overall LB rate was 40.1% (75/187). Federation International of Gynaecology and Obstetric (FIGO) stage, age at diagnosis, histological subtype and surgery type were included in the nomogram. The predictive model had an AUC of 0.742 (95% CI, 0.644-0.825) and 0.72 (95% CI, 0.621-0.805) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. The retrospective nature of the study cannot exclude all biases. Our nomogram is based on simple criteria, but did not take into account the evaluation of ovarian reserve. It demonstrates a fair relevance, but requires external validation before routine use. Clinicians are increasingly interested in such tools to support the patient in making an informed decision about treatment options. This nomogram contributes to the decision-making by defining simple risk factors of poor LB probability that can help identify good candidates for MAR. No external funding was used for this study. There are no conflicts of interest to declare. N/A.

Evaluation of ovarian reserve in terms of ovarian volume, antral follicule count and hormonal tests in Hashimoto's thyroiditis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Evaluation of ovarian reserve in women with overt or subclinical hypothyroidism.

IntroductionThyroid dysfunction is among the most common autoimmune disorders in women of reproductive age. Previous studies have shown the association between autoimmune thyroid disease (AITD) and infertility. Anti-Müllerian hormone (AMH) is secreted by granulosa cells and is a useful marker for assessment of ovarian reserve. In the present study, we sought to evaluate the ovarian reserves of women with autoimmune thyroid disorder by measurement of AMH values.Material and methodsThis prospective study included women with newly diagnosed AITD aged between 20 and 40 years. Patients were divided into three groups: subclinical hypothyroidism (SCH, n = 21), overt hypothyroidism (OH, n = 21) and controls (CG, n = 32). Study parameters included serum free T4, free T3, thyroid-stimulating hormone, anti-thyroglobulin, anti-thyroid peroxidase antibodies, follicle-stimulating hormone, luteinizing hormone, estradiol and AMH concentrations measured in the early follicular phase. Antral follicle count (AFC) was assessed with ultrasound. Body mass index (BMI) and waist circumference of the patients were noted.ResultsNo significant difference was found among SCH, OH and CG in regard to ovarian reserves measured by AMH values (p = 0.19) and AFC (p = 0.80). A significant negative correlation was found between AMH and BMI (r = –0.382, p = 0.001). Anti-Müllerian hormone and waist circumference (r = –0.330, p = 0.004) were also negatively correlated.ConclusionsAlthough AMH values were not significantly different among groups, AMH values were lower in OH and SCH patients, indicating a possible need for close monitoring of these patients.

Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?

Ovarian reserve reflects the quality and quantity of available oocytes. This reserve has become indispensable for the better understanding of reproductive potential. Measurement of the serum anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve. It has been applied to a wide range of clinical conditions, and it is well established that the measurement of serum AMH levels is more useful than qualitative evaluation based on the menstrual cycle. AMH levels are monitored during infertility treatments; in patients undergoing medically assisted reproductive technology; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumor. It is also useful in the evaluation of iatrogenic ovarian damage. Population-based studies have indicated a potential role for serum AMH in the planning of reproductive health management. While AMH is currently the best measure of ovarian reserve, its predictive value for future live births remains controversial. Furthermore, there is a serious practical issue in the interpretation of test results, as currently available assay kits use different assay ranges and coefficients of variation due to the absence of an international reference standard. The pros and cons of the serum AMH level as a definitive measure of ovarian reserve merits further review in order to guide future research.

Evaluation of ovarian reserve before and after surgery in women with ovarian endometrioma compared to pelvic endometriosis and negative controls: a prospective cohort trial

Evaluation of ovarian reserve before and after surgery in women with ovarian endometrioma compared to pelvic endometriosis and negative controls: a prospective cohort trial

Female hypofertility: collaboration between clinician and biologist.

Hypofertility is defined as the absence of conception after one year of trying. Women's exploration needs biologist attendance for the ovarian reserve evaluation and radiologist attendance for the exploration of the uterus, the fallopian tubes and the ovary. The management of women's treatment as ovarian stimulation combine hormonal levels and transvaginal ultrasonography during all the treatment. The collaboration between clinician and biologist is necessary for the diagnosis and during women's infertily treatment.