Reserve Parameters Research Articles

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.

A Systematic Review Evaluating the Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients With Poor Ovarian Reserve or Ovarian Insufficiency.

The emergence of autologous platelet-rich plasma (PRP) therapy reflects a break-through for infertile patients with premature ovarian failure. To study the efficacy of intra-ovarian infusion of autologous PRP on the improvement of ovarian reserve parameters and the subsequent artificial reproductive technique (ART) cycle outcomes in infertile women with poor ovarian reserve or premature ovarian insufficiency, a systematic search in electronic databases like Medline (through PubMed), Embase, Scopus, Web of Science, and Cochrane was done using relevant search terms. Except for case series, case reports, and review articles, all other types of studies, those evaluated for the effects of intra-ovarian infusion of PRP in subfertile women for decreased ovarian reserve (DOR) or premature ovarian insufficiency (POI) were included in our systematic review. The data were extracted from each eligible study and cross-checked by two authors. Intra-ovarian PRP infusion appears to be effective in ovarian rejuvenation, and the results of the subsequent intracytoplasmic sperm injection (ICSI) cycle are encouraging. PRP intervention was found to be beneficial in terms of an improvement in ovarian reserve parameters (increase in serum anti-mullerian hormone or antral follicle count or decrease in serum follicular stimulating hormone). ICSI cycle performance in terms of the total number of oocytes retrieved, number of two-pronuclei embryos, fertilization rate, number of cleavage stage embryos, number of good quality embryos, and cycle cancellation rate were found to be improved after intra-ovarian PRP infusion as compared to their previous cycle without PRP infusion.

Measuring IGF-1 and IGFBP-3 profiles in women seeking assisted reproduction; relationship to ovarian reserve parameters, namely AFC and AMH (study 2).

Measuring IGF-1 and IGFBP-3 profiles in women seeking assisted reproduction; relationship to ovarian reserve parameters, namely AFC and AMH (study 2).

Measuring IGF-1 and IGFBP-3 profiles in women seeking assisted reproduction; relationship to ovarian reserve parameters, namely AFC and AMH (study 2).

This is the second of five studies undertaken on women preparing for assisted reproduction, to sequentially examine the relevance of the insulin-like growth factor (IGF) profile (IGF-1, IGFBP-3 and the IGFBP-3/ IGF-1 ratio) which, in children, provides the essential criteria to identify the GH-deficient individual. Whilst our first, published study, focussed on clinical parameters, this study examines its relevance to the two parameters which define the ovarian reserve. The first, that of the antral follicle count (AFC), shows highly significant, sequential changes across 4 age groups ranging from high counts in the younger women <35 years and low counts in the older women, namely those aged 35-39 years, those aged 40-44 years and those aged ≥45 years (p<0.0001). Similarly, the serum levels of anti-Mullerian hormone (AMH), a later introduced marker of ovarian reserve, also showed highly significant sequential changes across the 4 age groups with high levels recorded in the young women and low counts in the older women (p<0.0001). At the higher AFC range, concordance between AFC groups and AMH groups was high at r=0.79 for precise matching and r=0.95 when neighbouring groups were included. The correlation was also clear with inter-quartile AMH levels ranging 27 pmol/L to 50 pmol/L across the higher AFC groups and 8 pmol/L to 10 pmol/L in the lowest groupings. However, IGF profiles showed no significant variations across the entire range, neither for the AFC nor for the AMH groups. Our next study will report on the relevance of the IGF profile to clinical outcomes.

Fertility preservation before hematopoetic stem cell transplantation: a case series of women with GATA binding protein 2 deficiency, dedicator of cytokinesis 8 deficiency, and sickle cell disease

ObjectiveTo describe fertility characteristics, outcomes of oocyte cryopreservation cycles, and safety of ovarian stimulation in patients with GATA binding protein 2 (GATA2) deficiency, dedicator of cytokinesis 8 (DOCK8) deficiency, and sickle cell disease (SCD) preparing for hematopoetic stem cell transplantation (HSCT).DesignRetrospective case series.SettingThe National Institutes of Health.Patient(s)Female patients with GATA2 deficiency, DOCK8 deficiency, and SCD aged between 13 and 38 years.Intervention(s)None.Main Outcome Measure(s)Demographic and ovarian reserve parameters, stimulation outcomes, and adverse event occurrences were collected through chart review. Descriptive statistics were used to identify trends within disease subcategories.Result(s)Twenty-one women with GATA2 deficiency, DOCK8 deficiency, and SCD underwent fertility preservation prior to HSCT. Patients with DOCK8 deficiency had the lowest mean age (16.5 years old) and antimüllerian hormone (0.85 ng/mL). Patients with GATA2 deficiency had the highest antral follicle count and antimüllerian hormone (25.77 and 5.07 ng/mL, respectively). Baseline follicle-stimulating hormone, luteinizing hormone, and estradiol were comparable between the cohorts. The duration of stimulation was similar (10.43 to 11.25 days) across all groups. Comparable peak estradiol levels were achieved across the cohorts. Patients with SCD had the highest mature (MII) oocyte yield (10.71). Three patients experienced complications related to stimulation: pain crisis in a patient with SCD, pulmonary embolism, and zero oocytes cryopreserved in a patient with GATA2 deficiency.Conclusion(s)This study offers insight into controlled ovarian stimulation in patients with these conditions prior to HSCT. Oocyte cryopreservation can be performed successfully, although adverse events must be considered. Following the outcomes of gamete use in this cohort will serve to further our knowledge of the true reproductive potential of this population.

Особливості гормонального і цитокінового статусу в жінок, які мали порушення менструальної функції у пубертатний період

Deviations in the formation of reproductive function, and subsequently menstrual irregularities from the age of menarche, ovarian dysfunction and steroidogenesis disorders can be clinically manifested in remote periods after their direct action. The nature and depth of morphofunctional disorders in this case depends on the degree of maturity of the reproductive system, the initial functional state of the regulation centers (hypothalamus, pituitary gland) and ovaries, and the duration of the action of adverse factors. The accumulated specific research experience indicates that in addition to the pituitary gonadotropin hormones, cytokines (interleukins), which can simulate ovarian function and play an important role in ovulation, are of great importance in the normal functioning of the ovaries. The objective: аccording to laboratory and instrumental methods of research, to study the characteristics of hormonal status and the relationship of ovarian hormones with interleukins (IL) in women with menstrual dysfunction in the puberty. Materials and methods. According to the nature of the violations, the main group of women (n=90) who had a pathology of menstrual function in the puberty period was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with a late age menarche, the third – with puberty bleeding. The control group included women (n=30) with the correct rhythm of menstruation in puberty. Results. A clinical study found a decrease in the concentration of progesterone in women with a history of primary oligomenorrhea, a decrease in estradiol in the preovulatory period in women with late menarche. When assessing the concentration of follicle-stimulating hormone in the subgroups, an increase was noted in patients with puberty bleeding compared with the control group, due to the low level of antimuller hormone in the blood serum. The correlation between the indicators of these hormones and interleukins (IL-4, IL-8) indicates the influence of cytokines on folliculogenesis and the formation of the corpus luteum. Ovarian reserve parameters are not reduced. Conclusion. An analysis of the hormonal and cytokine status in women with menstrual dysfunction in the puberty allows us to draw an analogy between the processes of ovulation and the inflammatory response. The cytokines produced by certain immune cells are signaling molecules that affect cell proliferation and apoptosis of ovarian cells, folliculogenesis, hormone secretion and thus play an important role in ovulation. Therefore, the immune system may be an additional local regulator of ovarian function. Estradiol and progesterone are of great importance in the secretory transformation of the endometrium, especially during the «implantation window». Keywords: puberty, menarche, oligomenorrhea, pubertal bleeding, folliculogenesis, progesterone, estradiol, interleukins, pituitary gland, anti-varial antibodies.

Dehydroepiandrosterone supplementation improves ovarian reserve and pregnancy rates in poor responders.

We investigated whether DHEA supplementation had an impact on ovarian reserve parameters and pregnancy rates in patients with poor ovarian response (POR) and primary ovarian insufficiency (POI). A total of 34 people, 6 patients with POI and 28 patients with POR, were included in the study. The patients in the POR group consisted of two different groups: diminished ovarian reserve (DOR) and premature ovarian failure (PMOF). Patients in the POI and POR group were given 50 mg DHEA supplementation daily for 5 months. The primary outcome was to determine spontaneous clinical pregnancy rates. The monthly changes in the serum hormone levels and AFC were recorded for five months. AMH levels were also measured before and after treatment. The total follow-up time was 152 cycles. The number of pregnancies during the follow-up period was 9. The ratio of pregnancies to the number of patients was 26.5% and the rate per cycle was 5.9%. While 8 of 9 pregnancies resulted in a live birth, one resulted in a miscarriage. The rate of abortion was 11.1%. The mean AFC was 0 to 5 before treatment. Following DHEA administration, a significant increase was detected in 30.8% of the patients. There was an increase in AMH levels after DHEA, but this was not significant. The live birth rate and pregnancy rate per cycle were significantly higher in POR patients than those in POF. Patients with POF had no pregnancy. Although the PMOF patients were younger than the DOR patients, the rate of pregnancy (36% vs. 29%), and pregnancy rates per cycle (8.5% vs. 6.35%) were higher in the DOR group. The rates of live birth were the same in the PMOF and DOR groups (29% vs. 29%). Oral DHEA supplementation improves both ovarian reserve and pregnancy rates in women with POR.

The appraisal of body content (ABC) trial: obesity does not significantly impact gamete production in infertile men and women.

As obesity becomes increasingly prevalent, its impact on fertility has been a subject of great debate. Nearly all prior research is retrospective and evaluates obesity utilizing body mass index (BMI), which may overestimate adiposity in individuals with a greater amount of lean muscle and underestimate adiposity in those with less muscle mass. We prospectively evaluated 2013 couples undergoing infertility treatment with in vitro fertilization (IVF). Percent body fat (%BF) was measured by use of a bioelectric impedance analysis (BIA) scale at baseline. BMI was also determined. Ovarian reserve parameters, ovarian response to controlled ovarian hyperstimulation, and semen analyses were measured in correlation with their %BF and BMI. Females classified as obese based on %BF or BMI had lower serum FSH. However, when the analysis was limited to women without PCOS (n = 1706), obesity based on %BF or BMI was associated with lower serum AMH. Female obesity-regardless of a PCOS diagnosis-did not affect number of mature oocytes retrieved. Males who were in obese %BF category were found to have lower TMSC compared with normal weight counterparts (p < 0.05); however, the observed decrease was not significant enough to limit the success of assisted reproductive technologies. These findings suggest that while obesity may affect ovarian reserve in women variably depending on presence of PCOS, it does not affect number of mature oocytes available after COH. Similarly, while a high %BF in males is associated with lower TMSC, the observed difference is unlikely to affect IVF outcomes.

Prediction of significant OHSS by ovarian reserve and ovarian response – implications for elective freeze-all strategy

Ovarian Hyperstimulation Syndrome (OHSS) remains a risk to women undergoing assisted conception despite available preventative measures, which are usually applied on the basis of ovarian response. We performed a retrospective cohort study with robust ascertainment of OHSS cases in women undergoing treatment using GnRH antagonist. FSH dose was based on Anti-Mullerian Hormone concentration. A total of 1492 cycles were carried out over 18 months. Moderate/severe OHSS occurred in 24 cycles (1.6%). AMH of 35 pmol/L and/or AFC of 20 or more identified 18/24 (76%) OHSS cases. The optimal thresholds for predicting OHSS were 22.5 pmol/L for AMH (sensitivity 87.5%, specificity 60.6%), 19.5 for AFC (sensitivity 70.8%, specificity 67%), and 9.5 for egg numbers (sensitivity 83.5%, specificity 62.7%). Peak oestradiol levels had no predictive value. The utility of egg number is limited as it is only known after the ovulatory trigger has been administered. Thus, ovarian reserve parameters are better than ovarian response at predicting the risk of significant OHSS in GnRH antagonist cycles in modern clinical practice. Patients with a high ovarian reserve are at risk of OHSS even if their ovarian response is not excessive. Decisions about preventative measures should be based on ovarian reserve rather than ovarian response.

Aromatase inhibitor letrozole: a novel treatment for ectopic pregnancy

To study the use of the aromatase inhibitor letrozole for treatment of ectopic pregnancy compared with methotrexate. Nonrandomized prospective cohort study. University hospital. A series of 42 consecutive patients with undisturbed ectopic pregnancy. Counseling on treatment options, including surgical treatment (control group) versus medical treatment with methotrexate (group 1) or letrozole (group 2). Primary outcome: complete resolution of ectopic pregnancy determined by serum human chorionic gonadotropin (β-hCG) levels below laboratory immunoassay detection. changes in the biochemical parameter of ovarian reserve, antimüllerian hormone (AMH), and hematologic changes associated with the two medical treatments compared with surgical treatment. Each treatment group included 14 patients, and each patient made her own treatment choice. Complete resolution of ectopic pregnancy occurred in an equal number of patients: 12 out of 14 (86%) in each of the two medical treatment groups. Methotrexate treatment was associated with statistically significantly higher liver enzymes and lower blood platelets count. The decline in β-hCG levels was faster in the letrozole group when compared with the methotrexate group. Three months after treatment, AMH levels were lower in the methotrexate group when compared with the letrozole and the surgery groups. However, the decline in β-hCG and AMH levels was not statistically significant. To our knowledge, this is the first report in the literature on the success of letrozole for the medical treatment of ectopic pregnancy. The promisingly high resolution rate and better safety profile that letrozole has compared with a chemotherapeutic agent such as methotrexate should encourage further studies.

Feasibility of the Energy Expenditure Prediction for Athletes and Non-Athletes from Ankle-Mounted Accelerometer and Heart Rate Monitor

Due to the nature of micro-electromechanical systems, the vector magnitude (VM) activity of accelerometers varies depending on the wearing position and does not identify different levels of physical fitness. Without an appropriate energy expenditure (EE) estimation equation, bias can occur in the estimated values. We aimed to amend the EE estimation equation using heart rate reserve (HRR) parameters as the correction factor, which could be applied to athletes and non-athletes who primarily use ankle-mounted devices. Indirect calorimetry was used as the criterion measure with an accelerometer (ankle-mounted) equipped with a heart rate monitor to synchronously measure the EE of 120 healthy adults on a treadmill in four groups. Compared with ankle-mounted accelerometer outputs, when the traditional equation was modified using linear regression by combining VM with body weight and/or HRR parameters (modified models: Model A, without HRR; Model B, with HRR), both Model A (r: 0.931 to 0.972; ICC: 0.913 to 0.954) and Model B (r: 0.933 to 0.975; ICC: 0.930 to 0.959) showed the valid and reliable predictive ability for the four groups. With respect to the simplest and most reasonable mode, Model A seems to be a good choice for predicting EE when using an ankle-mounted device.

Abdominal Myomectomy and Ovarian Reserve in Women at Child Bearing Period

Abstract Background: Ovarian reserve is defined as the existent quantitative and qualitative follicular supply found in the ovaries which may turn into mature follicles and assigns a woman's reproductive potential. The commonly appointed tests of ovarian reserve can be divided into static markers (FSH, estradiol, inhibin-B and [AMH] Anti-Mullerian Hormone), dynamic markers (clomi-phene citrate, gonadotrophins and gonadotrophin releasing hormone [GnRh] analogue stimulation tests) and ultrasono-graphic markers (Antral Follicle Count [AFC], ovarian volume and ovarian blood flow). Leiomyomas are the most common genital tract tumors of benign nature and the most frequent benign uterine disorder in women of reproductive period. Aim of Study: The study evaluated the effect of open myomectomy on ovarian reserve. From all ovarian reserve parameters, we use AFC and AMH to determine this effect due to their high specificity and sensitivity. Material and Methods: The study included 90 women in childbearing period with age ranging from 18 to 40 years old with negative pregnancy test and without surgical history of ovarian operation. AFC is determined by counting the number of follicles measuring (2-8mm) by TVS on cycle day 2 before the operation. While AMH is measured using blood sample to be determined by ELISA technique. Myomectomy was done postmenstrual. The 2 parameters were measured again 6 months post-operative with the same method before the operation to evaluate them as markers of ovarian reserve. The data we obtained was summarized, presented in tables and charts and analyzed in detailed methods by computerized system. Results: Our results found that, there were no significant changes in values of AMH and AFC after the operation (p-value is 0.713 for AMH) (p-value is 0.252 for AFC). The correlation or relationship between values of AMH and AFC were studied. From recruited data and after detailed statistical analysis we found positive correlation between AMH and AFC before and after the operation. There was no significant effect of sites and types of myomas on ovarian reserve. Conclusion: From the results we obtained, we found that there was no significant effect of open myomectomy on ovarian reserve parameters.

Serum anti-Mullerian hormone (AMH) concentration has limited prognostic value for density of primordial and primary follicles, questioning it as an accurate parameter for the ovarian reserve

ObjectivesTo evaluate the prognostic value of anti-Mullerian hormone (AMH) levels in estimating the ovarian density of primordial and primary follicles, which can be assumed to reflect the real ovarian reserve. Study designA total of 537 women, average age 30.4 years (range 8.0–43.7 years), underwent ovarian tissue cryopreservation prior to gonadotoxic therapies due to malignant diseases which do not affect ovarian reserve parameters. Standardized ovarian biopsies were obtained, and follicular density was analysed. The prognostic accuracy of serum AMH in estimating ovarian follicle density was evaluated. Main outcome measuresHistologically determined follicle density, AMH serum concentration and their correlation. ResultsIn children, follicle density was high but AMH concentration was low. AMH concentration was predicted to be maximum at the age of 15.5 years. In women aged over 15.5 years, the relationship between AMH concentration and follicle density was evaluated. Crude analysis revealed that serum AMH levels and follicular density were moderately correlated (r = 0.34, p < 0.001). From the adjusted regression model the predicted value of follicle density of women aged 20, 30 and 40 years as well as the associated 50 % and 95 % prediction intervals (50 % PI and 95 % PI, respectively) were calculated. For example, for women aged 40 years with a serum AMH level of 1 ng/ml, a follicle density of 2.3/mm3 (50 %PI: [1.1, 4.6]; 95 %PI: [0.3, 18]) was predicted. These large prediction intervals demonstrate the low predictive value of serum AMH for the ovarian follicle density. ConclusionsSerum AMH levels have limited prognostic value for the follicle density and therefore for the real ovarian reserve.

Modeling of Real-Time Multimedia Streaming in Wi-Fi Networks With Periodic Reservations

An important problem of modern Wi-Fis is the interferences caused by hidden stations active in the same area, or in multihop communications. All these issues significantly degrade the efficiency of the random channel access methods. Recent standardization and research activities are focused on solving coordination problems between various Wi-Fi devices. For example, the ongoing development of Wi-Fi 7 includes a coordinated schedule between the access points as a candidate solution. Consequently, Wi-Fi has many deterministic channel access mechanisms, which schedule channel time in a periodic manner well in advance and, thus, are utilized for streaming QoS sensitive data. However, both random traffic intensity and error-prone nature of the wireless channel complicate choosing such reservation parameters, i.e., the duration and the period of the reserved time intervals, that satisfy QoS requirements while minimizing channel time consumption. This paper introduces a general mathematical framework to solve the problem of choosing appropriate reservations parameters. The comparison of the analytical and simulation results show the high accuracy of the proposed framework. Finally, the paper gives an example of how to use the developed framework to maximize the network capacity.

Correlation between biochemical, ultrasonographic and demographic parameters with ovarian response to IVF/ICSI treatments in Mexican women

Objective:Ovarian response from a conventional ovarian stimulation protocol is a crucial step in IVF/ICSI treatments. This ovarian response encompasses a wide range of outcomes at the extremes, leading to either excessive responses with the risk of life-threatening conditions like ovarian hyperstimulation syndrome (OHSS), or poor ovarian response (POR) with poor outcomes. This study aims to integrate biochemical, ultrasonographic and demographic parameters into a mathematical formula able to predict ovarian response to stimulation in IVF/ICSI in gonadotropin-releasing hormone (GnRH) antagonist protocols.Methods:This retrospective analysis included 147 patients submitted to an ovarian stimulation protocol combining recombinant FSH and gonadotropin-releasing hormone antagonist. All the parameters were correlated with the Spearman Rho and Pearson´s correlation coefficient. Once the data was normalized, we used the multiple linear regression models, checking the results with the progressive discriminating analysis.Results:We classified the database according to the correlation with the number of oocytes retrieved; the progressive discriminating analysis resulted in the following equation: oocytes retrieved = 2.312-0.130 (FSH) + 0.562 (AFC).Conclusions:The incorporation of 2 ovarian reserve parameters into a regression equation enables knowing the number of retrieved oocytes in each patient with 80.5% sensitivity and 55.4% specificity.

P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography

Abstract INTRODUCTION Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls. METHODS We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. RESULTS Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004). CONCLUSION Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve. echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 &amp;lt;0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 &amp;lt;0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 &amp;lt;0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 &amp;lt;0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 &amp;lt;0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 &amp;lt;0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 &amp;lt;0.001 Abstract P941 Figure. echography (rest/peak) PAH patient

Evaluation of right ventricular contractile reserve with exercise stress echocardiography

Right ventricular (RV) contractile reserve reflects the ability of RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. To assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls, using exercise stress echocardiography (ESE). We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary VTI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. Our patient group was composed by PAH patients, 52 ± 11 years; mean age of our control group was 31 ± 6 years. PAH patients achieved an exercise with a mean workload of 70 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls ( P = 0.17), whereas change in pulmonary VTI, pulmonary output and RV peak systolic strain was highly discriminant (respectively P = 0.03, P = 0.009 and P = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients ( P = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different ( P = 0.005, P = 0.0008, P = 0004). Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve.

Ovarian reserve in women with obesity

BACKGROUND: One of the consequences of obesity for the female body is a decrease in fertility. It is shown that impaired reproductive function in obese patients can be associated, in particular, with a decrease in ovarian reserve.&#x0D; AIMS: To evaluate the ovarian reserve function in female patients of reproductive age with different classes of obesity in comparison with women without obesity.&#x0D; MATERIALS AND METHODS: This study evaluated 320 caucasian women, age 20-30 years, without obesity (BMI30, n=80) and with obesity WHO class I-III (n=80 per class). Anthropometrics, serum concentrations of anti-Mullerian hormone (AMH), inhibin B, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and testosterone were compared on the 2-3 day of menstrual cycle as ovarian volume and antral follicle count (AFC).&#x0D; RESULTS: We reveal statistically significant difference in following parameters in normal BMI women in comparison with obesity women: AMH, testosterone, ovarian volume and AFC. Moreover, we reveal significant difference between patients with different WHO class of obesity. But even in class III obesity parameters remained within reference ranges.&#x0D; CONCLUSIONS: Ovarian reserve function parameters progressively decrease with increase of obesity class in subjects, but ovarian reserve parameters were in normal reference range even in class III obese patients. Further large randomized multicenter studies are required to find influence of obesity in relation to ethnicity and other factors to ovarian reserve function.

Changes in Ovarian Reserve Parameters after Myomectomy in Women at Reproductive Age

Changes in Ovarian Reserve Parameters after Myomectomy in Women at Reproductive Age

OC24.03: Ovarian reserve parameters as indications for ovarian tissue cryopreservation in children suffering from non‐iatrogenic premature ovarian failure

OC24.03: Ovarian reserve parameters as indications for ovarian tissue cryopreservation in children suffering from non‐iatrogenic premature ovarian failure