Ovarian Reserve In Patients Research Articles

How Ovarian Reserve Changes after Deep Infiltrative Endometriosis Surgery?

Study Objective To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Design Prospective cohort-controlled study. Setting Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. Patients or Participants The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Interventions Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Measurements and Main Results Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Conclusion Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age. To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Prospective cohort-controlled study. Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age.

Ovarian reserve in patients with spondyloarthritis: impact of biological disease-modifying anti-rheumatic drugs on fertility status.

Women of childbearing age may be affected by psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The aim was to assess the impact of biological agents (bDMARDs) on the fertility of women with PsA and AS by evaluating the serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinising hormone (LH). Consecutive female patients (18-45 years) affected by PsA or AS starting a bDMARD were retrospectively evaluated at baseline (T0) and after 8 months (T8) of treatment. At both visits, demographic and clinical data were obtained. AMH, LH, and FSH serum levels were measured. A population of fertile women matched for age, body mass index and smoking habit was included as healthy controls (HCs). Twenty-four patients with PsA, 20 with AS, and 44 HCs were included. The median (25th-75th percentile) levels of AMH in patients were 0.74 ng/ml (0.29-2) at baseline and 0.71 ng/ml (0.19-1.9) (p=n.s.) at T8. The median levels of AMH in HCs were 1.56 ng/ml (0.37-2.90), with no difference compared to patients. No correlation was found between the serum AMH levels and the indexes of disease activity for both PsA and AS. No differences were found in the serum levels of FSH and LH before and after treatment with bDMARDs. Our results support the use of bDMARDs in female patients with SpA. AMH levels were not influenced by bDMARDs nor by disease activity. AMH could be useful to assess the quantitative aspect of ovarian reserve in female SpA patients.

IMPACT OF SURGERY ON OVARIAN RESERVE IN PATIENTS WITH ENDOMETRIOMA AMONG INFERTILE WOMEN

To find out the correlation between pre-operative serum AMH and FSH levels and 3 months post-operative levels. The study was conducted in the Reproductive Endocrinology and Infertility Unit of Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh, during July 2018 to December 2019. All admitted patients diagnosed with ovarian endometriomas (>4 cm) and of 20-35 years of age were included. Laparoscopy was the mainstay of surgery but in a few cases laparoscopy followed by laparotomy was done. Cystectomy (complete excision of the capsule) was attempted and adhesiolysis was also performed. Electrocoagulation was needed in few cases for haemostasis, which was performed by monopolar or bipolar diathermy. Carbon dioxide laser vaporization was not available, and cyst drainage was not done. In open cases, reconstruction of the ovary was performed. This study was a descriptive cross-sectional study. Initially for all patients, Serum AMH levels were measured preoperatively. Three months post surgery, Serum AMH was measured again, and data analysis and comparison of these values with ovarian reserve was done. Change in Serum FSH levels was also compared. Student’s t-test, paired and unpaired, were performed for different data. 69 patients were studied. 52.17% had tumours 4-6 cm, >6 cm in 47.83%. Tumour was bilateral in 36.23%. Laparoscopic cystectomy by monopolar cauterization was the 55.0% patients, laparotomy required in 10.14% patients. Average pre-operative serum AMH level in <29 yrs patients was 3.06±1.35 ng/ml, 2.38±1.54 postoperatively (p<0.001). For 30-35 yrs, they were 2.30±1.16 ng/ml and 1.39±1.01 ng/ml respectively (p<0.001). No significant difference in AMH was found in unilateral and bilateral cases (p=0.842), significant differences were found in pre- and postcystectomy AMH levels in these groups (p<0.001 for both). Pre and post-surgery FSH differences were very significant, p<0.001. When analysing the effect of different types of surgery we found that coagulation and excision both have negative effect on serum AMH levels, after 3 months (p<0.001). But there is no significant difference postsurgery between these two groups (p=0.0915). Surgery has a negative impact on ovarian reserve in patients with endometrioma, as evident by analysing different metrics and utilising student’s t-test.

Therapeutic Efficacy of Catheter-directed Ethanol Sclerotherapy and Its Impact on Ovarian Reserve in Patients with Ovarian Endometrioma at Risk of Decreased Ovarian Reserve: A Preliminary Study

To investigate the therapeutic efficacy of catheter-directed ethanol sclerotherapy (CDS) and its effect on ovarian reserve in patients with endometrioma at risk of decreased ovarian reserve. Retrospective study. Teaching hospital. We evaluated 18 patients with ovarian endometrioma measuring ≥3 cm and preprocedural serum antimüllerian hormone (AMH) levels of <2 ng/mL. An 8.5-F catheter was inserted either transabdominally or transvaginally into the endometrioma. After aspiration, sclerotherapy with 99% ethanol was performed, with a subsequent 20-minute ethanol retention. Ultrasonography was performed preprocedurally and 6 months after CDS to evaluate any recurrence or changes in cyst size. Furthermore, serum AMH levels, cancer antigen 125 (CA-125) levels, and the visual analog scale scores for dysmenorrhea were obtained to analyze the ovarian reserve and treatment efficacy, preprocedurally and at 6 months after CDS. The mean cyst size on ultrasonography and serum CA-125 levels decreased 6 months after CDS (p <.001 and p = .001, respectively). All patients reported a decreased visual analog scale score for dysmenorrhea (p <.001). However, the difference in serum AMH levels before and after CDS was statistically insignificant (p = .875). CDS was efficacious in reducing pain and serum CA-125 levels in patients with low AMH levels without adversely affecting their ovarian reserve.

Role of TNF-a and Interleukin 6 Serum against Ovarian Reserve in Endometriosis Cysts

Objective: To investigate the correlation between proinfl ammatory factors (TNF-alpha and IL-6) with ovarian reserve in patients with endometriosis cysts. Methods: This is a cross sectional study. The number of samples is 25 people. Sampling technique consecutive sampling. The study began in June 2019 until the number of samples was fulfi lled at the Obstetrics and Gynecology Polyclinic of the Dr. General Central Hospital M. Djamil Padang and at the Biomedical Laboratory of the Faculty of Medicine, Andalas University, Padang. To determine the correlation of TNF-alpha, IL-6, and AMH in patients with endometriosis cysts. Examination of TNF-alpha, IL-6, and AMH levels was carried out in a quantitative manner, using the ELISA method.Result: The mean AMH level was 2 ± 0.40 pmol / L andTNF-alpha level was 11.16 ± 4.79 pg / ml. Correlation of AMH level with TNF-alpha indicates the value of r = -0.049 which has weak strength and negative pattern means that the higher the TNF-alpha level, the lower the AMH level. The analysis showed that there was no correlation between TNF-alpha levels and AMH levels in patients with endometriosis cysts (p&gt;0.05). Correlation of AMH levels with IL-6 shows the value of r = 0.35 which has moderate strength and positive pattern means that the higher the IL-6 level, the higher the AMH level. The analysis showed that there was no correlation between IL-6 levels and AMH levels in patients with endometriosis cysts (p&gt; 0.05). Conclusions: There is a negative correlation of TNF-alpha levels with AMH levels in patients with endometriosis cysts, namely the higher TNF-alpha levels, the lower AMH levels and there is a positive correlation of IL-6 levels with AMH levels in patients with endometriosis cysts. Where the higher levels of IL-6, the higher levels of AMH. Keywords: AMH, endometriosis, TNF-alpha, IL-6.

Can Endometriosis-Related Oxidative Stress Pave the Way for New Treatment Targets?

Endometriosis is a disease of reproductive age characterized by chronic pelvic pain and infertility. Its pathogenesis is complex and still partially unexplained. However, there is increasing evidence of the role of chronic inflammation, immune system dysregulation, and oxidative stress in its development and progression. The latter appears to be involved in multiple aspects of the disease. Indeed, disease progression sustained by a hyperproliferative phenotype can be related to reactive oxygen species (ROS) imbalance, as numerous experiments using drugs to counteract hyperproliferation have shown in recent years. Chronic pelvic pain is also associated with cell function dysregulation favoring chronic inflammation and oxidative stress, specifically involving macrophages and mast cell activation. Moreover, there is increasing evidence of a role for ROS and impaired mitochondrial function not only as deleterious effectors of the ovarian reserve in patients with endometriomas but also in terms of oocyte quality and, hence, embryo development impairment. Targeting oxidative stress looks to be a promising strategy to both curb endometriotic lesion progression and alleviate endometriosis-associated symptoms of chronic pain and infertility. More investigations are nevertheless needed to develop effective therapeutic strategies for clinical application.

The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

BackgroundBilateral salpingectomy has been proposed to reduce the risk of ovarian cancer, but it is not clear whether the surgery affects ovarian reserve. This study compares the impact of laparoscopic hysterectomy for benign disease with or without prophylactic bilateral salpingectomy on ovarian reserve.MethodsRecords were reviewed for 373 premenopausal women who underwent laparoscopic hysterectomy with ovarian reserve for benign uterine diseases. The serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and three-dimensional antral follicle count (AFC) were assessed before surgery and 3 and 9 months postoperatively to evaluate ovarian reserve. Patients were divided into two groups according to whether they underwent prophylactic bilateral salpingectomy. The incidence of pelvic diseases was monitored until the ninth month after surgery.ResultsThere was no significant difference between the two surgery groups in terms of baseline AMH, E2, FSH, LH, and AFC (all P > 0.05). There was no difference in potential bias factors, including patient age, operative time, and blood loss (all P > 0.05). There was also no significant difference between the two groups 3 months after surgery with respect to AMH (P = 0.763), E2 (P = 0.264), FSH (P = 0.478), LH (P = 0.07), and AFC (P = 0.061). Similarly, there were no differences between groups 9 months after surgery for AMH (P = 0.939), E2 (P = 0.137), FSH (P = 0.276), LH (P = 0.07) and AFC (P = 0.066). At 9 months after the operation, no patients had malignant ovarian tumors. The incidences of benign ovarian tumors in the salpingectomy group were 0 and 2.68 % at 3 and 9 months after surgery, respectively, and the corresponding values in the control group were 0 and 5.36 %. The incidences of pelvic inflammatory disease in the salpingectomy group were 10.72 and 8.04 % at 3 and 9 months after surgery, respectively, while corresponding values in the control group were 24.13 and 16.09 %.ConclusionsProphylactic bilateral salpingectomy did not damage the ovarian reserve of reproductive-age women who underwent laparoscopic hysterectomy. Prophylactic bilateral salpingectomy might be a good method to prevent the development of ovarian cancer. Larger clinical trials with longer follow-up times are needed to further evaluate the risks and benefits.

Comparing the Changes of AMH Level Following Two Methods of Laparoscopic Cystectomy for Evaluating Ovarian Reserve in Patients with Endometrioma

Comparing the Changes of AMH Level Following Two Methods of Laparoscopic Cystectomy for Evaluating Ovarian Reserve in Patients with Endometrioma

The role of mutations in the PI3K/AKT/mTOR- signal pathway in decreasing ovarian reserve in reproductive patients with deep infiltrative endometriosis

The most common reason for patients with endometriosis seeking medical help is infertility, which affects 25-50% of patients with this disease. One of the essential factors of infertility in deep infiltrative endometriosis is the depletion of the ovarian reserve. To study the effect of deep infiltrative endometriosis on the state of the ovarian reserve in patients of reproductive age, as well as to assess the range of mutations in the PIK3CA gene among patients with infiltrative endometriosis. The main group consisted of 50 patients of reproductive age with deep infiltrative endometriosis, 18 of whom with ovarian endometriomas. The comparison group included 25 patients of reproductive age with inconsistency of the uterine scar after cesarean section. The level of anti-Mullerian hormone, follicle-stimulating hormone and estradiol in the blood was determined, as well as the number of antral follicles in the ovaries was counted during trans-vaginal ultrasound. The search for activating mutations of the PIK3CA gene was carried out by the method of new generation DNA sequencing in tissue samples of ovarian endometriomas and in biopsies of healthy ovarian tissue. The anti-Mullerian hormones level was lower in patients with infiltrative endometriosis than in patients in the comparison group by 1.0 ng/ml (2.6 ± 2.2 ng/ml in the main group, 3.6 ± 3.5 ng/ ml in the comparison group), however, the difference did not reach statistical significance, p&gt;0.05. The number of antral follicles according to ultrasound data was significantly lower in the main group (8.5 ± 4.5) than in the comparison group (12.2 ± 4.1), p=0.001. This difference was statistically significant both for patients with ovarian endometriomas (6.0 ± 4.2, p

Ovarian Reserve Assessment after Laparoscopic Ovarian Drilling in women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endo-crinopathy, affecting 4-8% of women in their reproductive age. Menstrual disturbances commonly observed in PCOS include oligomenorrhea, amenorrhea and erratic menstrual bleeding. Objective: To evaluate the effect of laparoscopic ovarian drilling on ovarian reserve in patients with polycystic ovarian syndrome before and after LOD measured by serum anti-mullerian hormone levels, FSH, ovarian volume and AFC. Patients and methods: This study was conducted at Al-Hussein Maternity University Hospital and Ministry of Health Hospitals including 38 patients of polycystic ovarian syndrome candidate for laparoscopic ovarian drilling (clomiphene citrate resistant patients). Polycystic ovarian syndrome was diagnosed according to the Rotterdam criteria. Patients with age 19-35 years, presence of ovarian pathology detected by transvaginal ultrasound were excluded from the study. Results: There was a significant negative correlation between age and difference between pre- and post-LOD serum AMH. There no significant association between obesity or clinical hyperandrogenism (hirsutism and/or acne vulgaris) and any of the differences between pre- and post-LOD values for sonographic or biochemical markers of ovarian reserve. Presence of amenorrhea was significantly associated with higher difference between pre- and post-LOD AFC of the right ovary. The anti-mullerian hormone, AFC & Ovarian Volume after LOD decreased significantly (P<0.001), While the FSH after LOD increased significantly (P<0.001). Conclusion: It could be concluded that PCOS women after LOD these occurs: Anti-mullerian hormone decreased significantly. The FSH increased significantly. AFC & Ovarian Volume decreased significantly.

Активирующие мутации генов PI3K/AKT/mTOR- сигнального пути и состояние овариального резерва у пациенток репродуктивного возраста с глубоким инфильтративным эндометриозом

Objective. To study the effect of deep infiltrating endometriosis on the status of ovarian reserve in patients of reproductive age and to assess the spectrum of PIK3CA gene mutations among patients with infiltrating form of external genital endometriosis. Patients and methods. The study group included 50 patients of reproductive age with deep infiltrating endometriosis, of whom 18 had deep infiltrating endometriosis combined with ovarian endometriomas. The comparison group included 25 patients of reproductive age who underwent laparoscopic metroplasty of post-cesarean section uterine scar. In all patients, serum levels of anti-mullerian hormone (AMH), follicle-stimulating hormone, and estradiol were determined by enzyme immunoassay, and an antral follicle count in the ovaries was done via transvaginal ultrasound. The search for activating mutations in the PIK3CA gene was performed by next-generation DNA sequencing in the samples of ovarian endometriomas from patients with a combination of infiltrating endometriosis and endometrioid cysts (n = 18) and in biopsy samples of healthy ovarian tissue from all patients in the study (n = 50) and comparison groups (n = 25). Results. Evaluation of the ovarian reserve status in patients from two groups showed that levels of AMH were lower in patients with infiltrating form of external genital endometriosis than in the comparison group by 1.0 ng/mL on average (2.6 ± 2.2 ng/mL in the study group, 3.6 ± 3.5 ng/mL in the comparison group), but the difference was not statistically significant, p &gt; 0.05. The number of antral follicles according to transvaginal ultrasound was significantly lower in the study group (8.5 ± 4.5) than in the comparison group (12.2 ± 4.1), p = 0.001. This difference was statistically significant both for patients with ovarian endometriomas (6.0 ± 4.2, p &lt; 0.001) and for patients without ovarian endometrioid tumors (9.8 ± 4.2, p = 0.04). Our study did not detect PIK3CA gene mutations in any of the ovarian endometrioma tissue samples from patients with a combination of infiltrating endometriosis and endometrioid cysts, and in none of the healthy ovarian tissue biopsy samples from patients in the study and comparison groups. Conclusion. Thus, the presence of deep infiltrating endometriosis is associated with diminished ovarian reserve in patients of reproductive age, regardless of the presence of ovarian endometrioid tumors. Population studies are needed to detect PIK3CA gene mutations in endometriosis, as well as to investigate mutations in other genes encoding regulatory proteins of the PI3K/AKT/mTOR anti-apoptotic signaling pathway to reveal the mechanisms of ovarian reserve depletion in case of infiltrating forms of external genital endometriosis. Key words: infertility, deep infiltrating endometriosis, ovarian reserve, PI3K/AKT/mTOR signaling pathway, ovarian endometrioma

Affected Ovary Relative Volume: A Novel Sonographic Predictor of Ovarian Reserve in Patients with Unilateral Endometrioma-A Pilot Study.

Background: The assessment of ovarian reserve in the case of endometrioma is of pivotal importance for planning a tailored management. However, both the antral follicle count (AFC) and the antimüllerian hormone (AMH) dosage are subject to a fair degree of variability in ovarian endometriosis. This study aimed to identify a sonographic parameter of ovarian reserve that could implement current available markers in patients with unilateral endometrioma. Methods: Patients with unilateral endometrioma admitted to our Endometriosis Center between March 2018 and April 2019 were enrolled. Transvaginal ultrasonography for the evaluation of eight sonographic indicators and AMH level determination were performed. The relationship between AMH level and each indicator was assessed. Results: Thirty-four women were included. There was a positive significant correlation between AMH level and the healthy ovary AFC (HO-AFC) (r = 0.36 p = 0.034). A stronger, negative correlation between AMH level and the ratio between the volume of the affected and the healthy ovary (affected ovary relative volume, AORV) (r = −0.47; p = 0.005) was evidenced. AORV had a satisfactory accuracy (AUC 0.73; CI 0.61–0.90; p = 0.0008), and the cut-off value of 5.96 had the best balance of sensitivity/specificity in distinguishing between patients with a good ovarian reserve (AMH ≥ 2 ng/mL) and those at risk of ovarian reserve depletion after excisional surgery. Conclusion: AORV may be a useful tool to assess ovarian reserve in patients with unilateral endometrioma without previous surgery and to guide physicians in clinical management.

Features of the ovarian reserve of women of reproductive age suffering from autoimmune diseases

The reproductive potential of a woman depends on indicators of the ovarian reserve, such as the anti-Muller hormone (AMH) and the number of antral follicles (NAF). Autoimmune diseases have a significant effect on fertility and contribute to the development of premature ovarian failure.&#x0D; Aim.To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women.&#x0D; Materials and methods.In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women.&#x0D; Results.In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found.&#x0D; Conclusion.The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.

Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort.

Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18-37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = -0.27, P = 0.003; CRP: r = -0.16, P = 0.06). This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. NCT03666091.

Ovarian reserve in patients with ankylosing spondylitis.

The aim of this study was to determine the autoimmune effects of ankylosing spondylitis (AS) on the fertility potential of women by evaluating ovarian reserves of AS patients. A total of 104 patients, 52 in the AS group (study group) and 52 in the control group were included in the study. Ovarian reserve was evaluated by serum anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and baseline serum follicle-stimulating hormone (FSH) levels. The mean serum AMH levels were significantly lower in the study group when compared to the controls (2.203 ± 1.110 vs. 1.188 ± 0.891, p < 0.001). In addition, the mean AFC was also significantly lower in the study group. (10.67 ± 1.81 vs. 9.54 ± 2.50, p = 0.009). Mean FSH levels were calculated to be 6.72 ± 1.14 in the study group and 7.21 ± 1.22 in the control group. The difference was not statistically significant (p = 0.781). This study shows that AS like several other autoimmune conditions has an adverse effect on the female fertility potential. Therefore, an early start and long-term management of AS patients who have fertility desire is recommended. Serum AMH levels can be used in monitoring ovarian reserve and in early detection of reproductive decline of AS patients. NCT04209881.

Ovarian reserve in patients with borderline ovarian tumors after surgical treatment

Borderline ovarian tumors are often diagnosed in women under the age of 40 years (31.8 %), which determines the need to optimize the management of this cohort of patients, taking into account the possibility of maintaining their reproductive function. Purpose of the study. Assessment of the ovarian reserve based on a comprehensive sonographic diagnosis of the ovarian reserve in patients of reproductive age with borderline ovarian tumors. Materials and methods. Group I (n = 103) included patients with borderline serous epithelial ovarian tumors. Group II (n = 95) was formed from women with mucinous epithelial ovarian tumors. Comparison group III (n = 189) included patients with benign ovarian cystadenomas. Ultrasound scanning of the pelvic organs and color Doppler mapping (DLC) were performed using Aloka 3500, Semiens G‑60 ultrasound scanners operating in real time and equipped with a pulsed doppler using a 3.5 MHz convex sensor and a 7.5 MHz transvaginal sensor. Results. The number of antral follicles does not depend on the volume of the ovary. The healthy remaining ovarian tissue of the ovary is most pronounced in groups I and III, significantly less represented in group II (p ≤ 0.0001). Three months after adnexectomy, ovulatory function in the intact (healthy) ovary was preserved in 71% (n = 49) of women from group I; in 89% (n = 73) of patients of group II and in 93% (n = 25) of respondents of group III, with a predominance in group II (φ* = 2.7; p ≤ 0.0010 and φ* = 1.6; p ≤ 0.0500). After a conservative operation, the function of the operated (resected) ovary detected ovulation in 62% (n = 21) of group I participants; 68% (n = 9) of women of group II and 86% (n = 139) of patients of group III. After 6 months, an increase in the number of antral ovaries and the number of ovulations with a predominance of ovarian reserve in group III (p ≤ 0.0010 and p ≤ 0.0001) was generally observed. Conclusions. Integrated ultrasound is a reliable and objective method that evaluates the features of the ovulatory reserve in patients with borderline and benign ovarian tumors, which makes it possible to formulate a prognosis of a woman’s reproductive health after various types of surgical treatment.

Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst.

Objective:To compare the effects of laparoscopic cystectomy on ovarian reserve between women with endometrioma and dermoid cyst.Materials and Methods:Thirty-six patients were diagnosed as having endometrioma (group A) and 32 patients with dermoid cyst (group B) using ultrasonography. Preoperative anti-mullerian hormone (AMH) levels were measured and unilateral antral follicle counts (AFC) were calculated for the ovary side containing the cyst. Laparoscopic cystectomy was performed using the stripping technique for all participants. After 3 months, all participants were re-evaluated between the third and sixth day of their menstrual cycle to determine AFC and AMH levels.Results:The mean serum preoperative AMH level and AFC level were significantly lower in group A than in group B (p=0.001, p=0.002), respectively. At 3 months after the surgery, serum AMH levels decreased significantly in group A from 2.04±0.68 to 1.47±0.55 (p=0.001), and from 2.60±0.57 to 2.17±0.56 in group B (p=0.001). In group A, unilateral (operated side) AFC levels decreased significantly from 4.05±1.24 to 2.16±0.94 (p=0.001), and in group B, it decreased significantly from 4.93±0.94 to 3.40±0.87 (p=0.001). The decrease in AMH levels was significantly higher in group A than in group B (p=0.033). The decrease in AFC levels was also significantly higher in group A than in group B (p=0.044).Conclusion:Laparoscopic stripping has destructive effects on serum AMH levels and the operated side AFC levels after surgery for patients with endometrioma and dermoid cysts, and laparoscopic excision of endometrioma has more destructive effects on ovarian reserve than dermoid cysts.

Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus

In organ or non-organ-specific autoimmune disorders, human ovary is usually the target of the autoimmune attack. We aimed to demonstrate the correlation between ovarian reserve and DM1, based on the view that women with type-1 diabetes mellitus (DM1) will have lower AMH levels secondary to poor glycemic control and autoimmune attacks. Ovarian functions of 42 patients diagnosed with DM1 who use insulin and 65 healthy volunteers were analyzed. Basal hormone and AMH levels were measured during the follicular phase. Fasting and postprandial blood glucose concentrations, HbA1c and C-peptide levels were evaluated. The mean antral follicle count (AFC) was significantly lower in DM1 patients than in healthy controls (p = .001). The AMH levels were lower in women with DM1 than in the controls (p = .001). The HbA1c values of DM1 patients, who formed the study group, was significantly higher than the control group. Ovarian reserve that is evaluated with serum AMH level is affected by poor glycemic control in type 1 diabetes. Due to the time of the autoimmune damage in the ovaries and the observable effects of this damage, more comprehensive and longer-term studies are needed to be conducted for the follow-up of reproductive abnormalities.

The protective role of the recombinant IL-2 in complex therapy of cystic ovarian endometriosis in patients of advanced reproductive age

Objective: tto estimate the potential of the protective effect of recombinant IL-2 on the ovarian reserve of patients in advanced reproductive age after enucleation of a cystic ovarian endometriosis (COE). Materials and methods : Initially and over a year after laparoscopic ovarian cystectomy using hemostatic material based on oxidized cellulose, 63 patients with a single-sided COE (4-7 cm) were examined, age group: 36-45 years old. The levels of cytokines (IL-6, IL-2, IL-10, TNF), the content of diene conjugates of unsaturated fatty acids, malonic dialdehyde, superoxide dismutase and the level of molecules of average weight were determined in the peritoneal fluid and peripheral blood. The comparative analysis of the ovarian reserve (the antral follicle count (AFC) and the level of Anti-Mullerian hormone (AMH)) was conducted between 32 patients receiving adjuvant dienogest therapy (6 months) with additional administration of recombinant IL-2 and 31 patients receiving only dienogest. Results: When recombinant IL-2 is used in the early postoperative period, AFС (both, in the intact and operated ovary) and the AMH level (later restored to the results of the initial parameters) increase statistically significant. Conclusions: Recombinant IL-2 compensates the initial deficiency of the regulatory cytokine, reduces the proapoptotic effect on ovarian tissue, and activates antioxidant systems. When used in postoperative period of the complex therapy (IL-2 and dienogest), the ovarian reserve remains almost at the initial level, which favors the implementation of reproductive plans and reduces the likelihood of premature menopause.

Effect of Laparoscopic Suturing Versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy.

Effect of Laparoscopic Suturing Versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy.