Serum FSH Levels Research Articles

Analysis of relationship of hormonal, hematological and biochemical parameters in Indian alcoholics with severity of alcohol dependence

BackgroundAlcohol dependence syndrome (ADS) is a major problem in India. ADS is known to be a systemic disorder involving almost all organ-systems. The evaluation of ADS patients’ needs successive assessment of severity of clinical condition. In this study, we attempted to explore Severity of Alcohol Dependence Questionnaire (SADQ-C) as a severity measure by studying its association with laboratory parameters. MethodsDuring the two months study period 155 diagnosed ADS male patients who had been admitted to the Psychiatric Ward of two zonal level hospitals were enrolled for the study. The participants were examined by the Psychiatrist and the severity of alcoholism ascertained by the SADQ-C scoring. Based on SADQ-C scoring they were divided into three groups: severe alcohol dependence, moderate dependence and mild physical dependence. The patients’ blood samples were collected and tested. ResultsIn our study, morning and evening level of serum cortisol showed positive correlation with increasing SADQ-C scoring. The differences in morning and evening cortisol level also augmented with increasing severity score (r=0.257; p=0.001). Hemoglobin, mean corpuscular volume (MCV) and serum level of LH, FSH and testosterone levels were not shown any statistically significant alterations amongst the studied groups. Serum LH, total bilirubin, direct bilirubin, AST, ALT and GGT level showed positive correlation with SADQ-C scoring but AST/ALT ratio showed negative correlation. ConclusionThis study elaborated relationship between SADQ-C scoring and laboratory parameters in Indian male ADS patients. It highlighted the requirement of incorporation of serum cortisol along with presently evaluated laboratory parameters for ADS severity evaluation.

Impact of Serum Prolactin and Testosterone Levels on Male Infertility in Sulaimanyah City

The appropriateness of the interactions between Prolactin, gonadotrophins and testicular hormones ensures that normal spermatogenesis takes place in the male. So this study is an attempt to classify male infertility depending on WHO criteria of seminal changes and to evaluate serum Prolactin, Testosterone FSH and LH levels in the participants, also determine the association between serum Prolactin, Testosterone levels and subtypes of male infertility. This study involved three hundred infertile males having infertility more than one year (cases group) and three hundred age-matched fertile males with definite paternity in past two years (control group) were included to the study from Jan 2018 -Dec 2020 at Shahid Ali Qader consultant clinic in the Sulaimanyah city. Serum levels of hormones were measured by electrochemiluminescense immunoassay technique. Approximately half of patient's age ranged between 30- 39 years. Sixty eight percentage of cases complained from primary infertility. About 71.3% of patients had infertility duration between 1 - 5 years. This percentage decreased with increasing the infertility years. Most common infertile group was Asthenospermia (34.3%). A higher significant levels of serum Prolactin, FSH and LH found in cases than controls (p<0.001). However, the serum Testosterone levels was significantly lower in cases than controls (p<0.05). Moreover, serum Prolactin levels were found significantly elevated in all infertile subgroups (except Normospermic subgroup) compared to control group, while serum Testosterone levels were significantly decreased in all infertile subgroups (except Normospermic subgroup) compared to control group (p<0.05). So we conclude that; Poor spermatogenesis is associated with high serum Prolactin, FSH,LH levels and low serum Testosterone levels in patients with male infertility. Moreover, elevated serum Prolactin levels and decreased serum Testosterone levels were significantly associated with A, AT, OAT, Azoo and OA infertile males. Keywords: Male infertility, primary and secondary infertility, Prolactin, Testosterone, spermatogenesis.

How Can the Maternal Age and the Basal Level of Serum FSH Predict the ICSI Outcome?

How Can the Maternal Age and the Basal Level of Serum FSH Predict the ICSI Outcome?

Effectiveness of Pharmacological Intervention Among Men with Infertility: A Systematic Review and Network Meta-Analysis.

Background. Infertility is an emerging health issue for men. Comparative efficacy of different pharmacological interventions on male infertility is not clear. The aim of this review is to investigate the efficacy of various pharmacological interventions among men with idiopathic male infertility. All randomized control trials evaluating the effectuality of interventions on male infertility were included for network meta-analysis (NMA) from inception to 31 April 2020, systematically performed using STATA through the random effect model. The protocol was registered at PROSPERO (CRD42020152891).Results. The outcomes of interest were semen and hormonal parameters. Treatment effects (p < 0.05) were estimated through WMD at the confidence interval of 95%. Upon applying exclusion criteria, n=28 RCTs were found eligible for NMA. Results from NMA indicated that consumption of supplements increases sperm concentration levels [6.26, 95% CI 3.32, 9.21] in comparison to SERMs [4.97, 95% CI 1.61, 8.32], hormones [4.14, 95% CI 1.83, 6.46], and vitamins [0.15, 95% CI −20.86, 21.15)] with placebo, whereas the use of SERMs increased percentage sperm motility [6.69, 95% CI 2.38, 10.99] in comparison to supplements [6.46, 95% CI 2.57, 10.06], hormones [3.47, 95% CI 0.40, 6.54], and vitamins [−1.24, 95% CI −11.84, 9.43] with placebo. Consumption of hormones increased the sperm morphology [3.71, 95% CI, 1.34, 6.07] in contrast to supplements [2.22, 95% CI 0.12, 4.55], SERMs [2.21, 95% CI −0.78, 5.20], and vitamins [0.51, 95% CI −3.60, 4.62] with placebo. Supplements boosted the total testosterone levels [2.70, 95% CI 1.34, 4.07] in comparison to SERMs [1.83, 95% CI 1.16, 2.50], hormones [0.40, 95% CI −0.49, 1.29], and vitamins [−0.70, 95% CI −6.71, 5.31] with placebo. SERMs increase the serum FSH levels [3.63, 95% CI 1.48, 5.79] better than hormones [1.29, 95% CI −0.79, 3.36], vitamins [0.03, 95% CI −2.69, 2.76], and supplements [−4.45, 95% CI −7.15, −1.76] in comparison with placebo.Conclusion. This review establishes that all interventions had a significantly positive effect on male infertility. Statistically significant increased sperm parameters were noted in combinations of zinc sulfate (220 mg BID), clomiphene citrate (50 mg BID), and testosterone undecanoate and CoQ10; tamoxifen citrate and FSH were shown to improve the hormonal profile in infertile males.

P–038 Clinical outcomes of 77 testicular sperm extraction treatment cycles in non-mosaic Klinefelter syndrome patients

Abstract Study question What are the clinical results of patients with azoospermia and nonmosaic Klinefelter syndrome, using fresh and cryopreserved sperm? Summary answer The results showed a recovery rate of testicular sperm in the order of 40% and a life newborn rate of 52% when using fresh sperm What is known already In Klinefelter syndrome (KS), the rates of successful testicular sperm retrieval were shown to be similar either using conventional TESE or micro-TESE (Corona et al., 2017), which highlights that the variability observed between studies is due to differences in patient characteristics. There are a few works with a large number of KS patients elucidating the clinical outcomes using fresh and cryopreserved testicular sperm. However, these studies revealed contradictory outcomes, either revealing better (Greco et al., 2013; Vicdan et al., 2016) or worst (Madureira et al., 2014) results with cryopreserved testicular sperm, or finding no differences (Chen et al, 2019). Study design, size, duration This study includes all patients up to 2019 presenting azoospermia due to non-mosaic Klinefelter syndrome (n = 76) that went for infertility consultations in a private fertility clinic. Patients were evaluated by the same Urologist. The genetic analysis of the patients was performed at an academic institution. At examination patients did not refer other complaints besides infertility, and referred to have not received any hormone replacement therapy in the past. Participants/materials, setting, methods The 76 azoospermic patients with non-mosaic Klinefelter syndrome (KS) were treated by testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI), using fresh and cryopreserved testicular sperm. Most patients used fresh testicular sperm, where others preferred to postpone ICSI treatment cycles and used cryopreserved testicular sperm. Aneuploidy screening in children was performed by prenatal diagnosis and MLPA (Multiplex ligation-dependent probe amplification). Full embryological, clinical and newborn outcomes are provided. Main results and the role of chance Of the 76 patients with non-mosaic Klinefelter syndrome, one repeated the testicular sperm extraction (TESE) procedure. Testicular sperm were recovered in 31/77 (40.3%) of the cases. Comparisons between the 31 cases with successful sperm recover (group–1) and the 46 cases without a successful TESE (group–2) revealed no significant differences regarding age, time of infertility, testicular volume, serum levels of FSH, LH and testosterone, total number of testicular fragments analyzed, and time of search in samples. The mean male age was 34 years. In most of the cases, the testicular volume was reduced (96.1%), the levels of FSH (98.3%) and LH (94.1%) were increased, and the levels of testosterone were normal (77.6%). There were 25 intracytoplasmic sperm injection (ICSI) treatment cycles using fresh testicular sperm and 22 ICSI treatment cycles using frozen testicular sperm. The rates of fertilization (63.5% fresh sperm vs 41.6% frozen sperm), implantation (37% fresh sperm vs 13.2% frozen sperm), clinical pregnancy (60.9% fresh sperm vs 19% frozen sperm), live birth delivery (52.2% fresh sperm vs 19% frozen sperm) and newborn (65.2% fresh sperm vs 23.8% frozen sperm) were higher in the group using fresh testicular sperm. Chromosome analysis of the 21 newborn was normal. Limitations, reasons for caution Although presenting a high number of cases with azoospermic non-mosaic Klinefelter syndrome treated with testicular sperm extraction and intracytoplasmic sperm injection, future studies are needed with a higher number of cycles using frozen testicular sperm, in order to confirm or rebut that the freezing methodology affects negatively the clinical outcomes. Wider implications of the findings: Data adds further information regarding testicular sperm retrieval rates and use of fresh or frozen testicular sperm in Klinefelter syndrome (KS) patients. High newborn rates were obtained only with fresh testicular sperm. Results also reassure KS patients about the safety relative to any abnormal chromosomal transmission to the born children. Trial registration number Not applicable

P–095 Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed TESE in men with non-obstructive azoospermia: results from a multicenter study

Abstract Study question We assessed the outcome and predictors of successful salvage microdissection testicular sperm extraction (mTESE) in non-obstructive azoospermia (NOA) men previously submitted to unfruitful classic (cTESE). Summary answer The sperm retrieval rate at salvage mTESE was almost 50%. Hypospermatogenesis and low FSH values were associated with positive outcomes at salvage mTESE What is known already In men with NOA testicular sperm can be retrieved using cTESE in approximately 50% of cases. mTESE has been proposed as a salvage treatment option for men with a previously failed TESE, but data are scarce. Study design, size, duration Multicenter, cross-sectional study. Complete data from 61 NOA men who underwent mTESE after a failed cTESE between 01/2014 and 10/2020, at 6 tertiary referral centers in Italy were analysed. Participants/materials, setting, methods All men underwent testicular ultrasound, hormonal and genetic blood testing. Histopathological diagnosis from TESE was collected in every man. Semen analyses were based on the 2010 WHO reference criteria. mTESE was performed according to the technique of Schlegel et al. (1999). Descriptive statistics and logistic regression models were used to investigate potential predictors of positive sperm retrieval (SR+) after salvage mTESE. Main results and the role of chance Overall, median (IQR) age and testicular volume were 35 (31–38) years and 10 (6–15) ml, respectively. Baseline serum FSH and total testosterone levels were 17.1 (8.6–30.4) mUI/mL and 4.7 (3.5–6.4) ng/mL, respectively. Sertoli-cell-only (SCO) syndrome, maturation arrest (MA) and hypospermatogenesis were found in 24 (39.3%), 21 (34.4%) and 16 (26.2%) men after cTESE, respectively. Spermatozoa were retrieved in 30 (49.2%) men at salvage mTESE. Patients with a diagnosis of hypospermatogenesis had a higher rate of SR + [12/16 (75%)] than those with MA [12/21 (57.1%)] and SCOS [6/24 (25%)] after salvage mTESE (p &amp;lt; 0.01), which was bilateral in 36 (59%) cases. FSH was higher [16.5 (8–22) vs. 8.9 (5–13) mUI/mL, p &amp;lt; 0.01] in SR- patients compared to SR+. No difference in clinical characteristics was found between patients with SR+ and SR- at salvage mTESE. There were no significant complications after mTESE. Multivariable logistic regression analysis showed that hypospermatogenesis (OR 9.7; p &amp;lt; 0.01) and low FSH levels (OR 0.9, p &amp;lt; 0.001) were independent predictors of SR+ after salvage mTESE, after accounting for age. Limitations, reasons for caution Despite we analysed one of the largest series of salvage mTESE, the samples size is too small to draw general conclusions. Because of the multicenter nature of the study we cannot rely on standardization of surgical techniques for TESE. Wider implications of the findings: This is one of the larger studies on salvage mTESE. The selection of patients for salvage mTESE is of critical importance. Trial registration number na

Therapeutic Effect of Murine Bone Marrow-Derived Mesenchymal Stromal/Stem Cells and Human Placental Extract on Testicular Toxicity Resulting from Doxorubicin in Rats.

Oncotherapeutics like doxorubicin can affect male gonads; as a result, it leads to infertility. This work was conducted to demonstrate the toxic effects of doxorubicin on testes of male albino rats. Fifty male albino rats aged 5-7 weeks were used in this study. The animals were randomly separated into 5 sets (each set containing ten rats). Group I received saline (i.p.) for 4 weeks. Group II was given doxorubicin (DOX), 5 mg/kg BW (i.p.) once/week for 4 weeks. Groups III and IV were treated in the same way as the DOX group, left for one week without medication, and then injected with mesenchymal stromal cells (MSCs) or human placental extract (HPE) therapy in a single dose of 5 × 106 in 200 ml PRP/week or 40 μl placental extract for 4 weeks via the caudal vein. Group V rats were treated in the same way as the DOX group also, left for one week without medication, and then injected with MSC+HPE. A significant decrease in serum testosterone, FSH, and LH levels was observed in rats treated with DOX compared to the control group. A significant elevation was recorded in rats treated with DOX+MSC or DOX+HPE when compared with the DOX group only. Rats that were given MSC+HPE after DOX intoxication showed a significant increase in hormone levels when compared to rats treated with either MSC or HPE. Light and electron microscopic examinations revealed that DOX intoxication initiated degenerative and necrotic changes in seminiferous tubules associated with partial or complete cessation of spermatogenesis. These effects were reversed by the effect of MSC or HPE. Coadministration of MSC and HPE even showed further improvement. Finally, we can say that doxorubicin has a deleterious impact on rat testes; however, therapeutic effects can be induced through MSC and/or HPE administration.

P–645 Abnormal thyroid hormone levels are associated with biochemical primary ovarian insufficiency and low ovarian reserve: a cross-sectional study

Abstract Study question To address whether there was a correlation between thyroid parameters and primary ovarian insufficiency. Summary answer Thyroid dysfunction was related with bPOI and LOR. What is known already In our daily clinical work, there seems to be a link between thyroid disease and POI. A recent study reported that subclinical hypothyroidism was associated with lower ovarian reserve during later reproductive age. Animal studies demonstrated that thyroid hormones played important roles in ovarian functions, and both maternal hypothyroidism and hyperthyroidism were related with reduced primordial, primary and secondary follicle number in rats. However, others reported that thyroid autoimmunity (TAI) and hypothyroidism were not associated with DOR. In all, accumulative animal and epidemiological studies indicated the connection between thyroid function and ovarian reserve, but the results were still inconsistent. Study design, size, duration This is a cross-sectional study with consecutive women performed ovarian reserve assessment and thyroid test in the Second Hospital of Zhejiang University School of Medicine from April 2016 to March 2019. A total of 2109 women were included, with 111 with bPOI and 1771 without bPOI. To exclude the influence of age the participants were categorized into low ovarian reserve (LOR) and non-LOR groups based on age-specific AMH, including 78 LOR and 2031 non-LOR. Participants/materials, setting, methods At the outpatient, a doctor carried out an interview, recorded age, body mass index (BMI), past history, and current treatment, and made a diagnosis. Serum AMH, FSH, TPOAb, TgAb, Tg, TT3, FT3, TT4, FT4, and TSH levels were measured with electrochemiluminescence method. Main results and the role of chance TT3, FT3, FT4 was significantly positively correlated with serum AMH level. Further logistic regression analysis found that abnormal TT3, FT3 and TT4 levels were related to increased risks of bPOI and LOR. Chi-square analysis also proved that the incidence of abnormal TT3, FT3 and TT4 increased significantly in women with bPOI or LOR. The incidence of bPOI and LOR increased significantly in women with 2 or 3 abnormal thyroid hormones. The above analyses demonstrate in multiple aspects that thyroid dysfunction is related with decreased ovarian reserve. Limitations, reasons for caution Since this is a retrospective cross-sectional study, we only got the correlation between factors, and we could not achieve causal relationship. Further prospective cohort or randomized controlled trial (RCT) studies are required to make the results more robust. Wider implications of the findings: The present study demonstrated that thyroid dysfunction was related with bPOI and LOR. It might be thyroid hormones, not TSH or thyroid antibodies, played the major role in ovarian reserve impairment. The treatment of euthyroxine may improve the ovarian reserve function. Trial registration number Not applicable

P–587 Highly purified human menopausal gonadotrophin (HP-hMG, Menopur) as a ready-to-use solution for injection in pre-filled pen is bioequivalent to HP-hMG powder for reconstitution

Abstract Study question Are serum FSH levels after single subcutaneous dosing of HP-hMG in a liquid formulation and a powder formulation bioequivalent? Summary answer The 90% CIs for the geometric mean ratios of serum FSH AUCt and Cmax were both within 0.8000–1.2500, thus the two formulations are bioequivalent. What is known already For several decades, HP-hMG (Menopur) has been used for the treatment of infertility; its efficacy and safety compared to other gonadotropins have been consistently demonstrated in several prospective, randomised controlled trials and meta-analyses (Deeks et al 2018; Bordewijk et al 2019). Menopur powder for reconstitution is available in multidose and single dose formulations. Up to 3 single dose vials (each containing 75 IU) may be dissolved into 1 mL solvent for administration. Recently, and for the first time, Menopur has been successfully formulated in a stable, ready-to-use solution for injection, which may be administered by a pre-filled pen. Study design, size, duration This was a randomised, two-way crossover, single dose, bioequivalence trial comparing Menopur liquid injected by pre-filled pen, with Menopur powder injected by conventional syringe and needle. The primary endpoints were AUCt and Cmax of baseline-adjusted FSH. Pituitary-suppressed, healthy women were randomised to receive one treatment sequence including a single subcutaneous injection of 450 IU Menopur liquid (600 IU/0.96 mL) and of 450 IU Menopur powder by two subcutaneous injections of 225 IU in 1 mL. Participants/materials, setting, methods Blood samples were collected pre- and post-dose, until 9 days after each injection. The PK parameters of FSH and hCG were assessed by noncompartmental methods with adjustment for endogenous pre-dose levels. Highly sensitive and specific electrochemiluminescence immunoassays were used for quantification and the LLOQ of the FSH and hCG assays were 1.47 mIU/mL and 0.5 mIU/mL, respectively, and the total validated CV was within 5% for both assays. Main results and the role of chance In total, 76 women were randomised and 56 completed the trial. The main reason for discontinuation was insufficient pituitary suppression prior to the second administration of HP-hMG. The mean FSH and hCG serum concentration-time profiles were comparable between the two HP-hMG formulations. The geometric mean ratios and 90% confidence intervals of FSH for HP-hMG liquid versus HP-hMG powder were 1.12 [1.0562; 1.1889] for AUCt and 1.17 [1.0946; 1.2490] for Cmax, showing that the two formulations were bioequivalent. Maximal serum FSH concentrations were reached at 18.19 h for HP-HMG liquid and 15.55 h for HP-hMG powder. In addition to FSH, the PK parameters for hCG were compared between the two HP-hMG formulations. The geometric mean ratios and 90% confidence intervals for HP-hMG liquid versus HP-hMG powder were 0.93 [0.86; 1.01] for AUCt and 0.94 [0.86; 1.02] for Cmax. There was no difference between the two groups in the incidence or severity of adverse events, and both preparations were well tolerated. Mild injection site reactions were less common after administration of HP-hMG liquid by a single injection compared to HP-hMG powder by two injections and were mostly related to pain and erythema after drug administration. Limitations, reasons for caution This bioequivalence study is based on the comparison of single dose administrations in healthy female volunteers of reproductive age. Wider implications of the findings: The new HP-hMG solution for injection in a pre-filled pen will deliver the efficacy and safety of Menopur in a convenient delivery device. Trial registration number NA

P–710 The possible relation between kisspeptin and apoptosis on granulosa cells of PCOS patients

Abstract Study question Does kisspeptin administration affect the apoptotic factors of granulosa cells of Polycystic Ovary Syndrome (PCOS) patients? Summary answer Kisspeptin administration significantly increased apoptosis related factors. What is known already Kisspeptin plays a critical role in central gonadotropin secretion by acting on GnRH neurons in the hypothalamus. Kisspeptin receptors are also expressed on the ovaries. Kisspeptin–54 has recently been known as a prominent agent in oocyte maturation. Although there are many studies on the possible roles of kisspeptin administration in vivo on hypothalamic gonadotropin secretion and ovarian function and the possible roles of these effects in the pathogenesis of PCOS, there is not enough information about the effect of in vitro application of kisspeptin on ovarian function and conditions that lead to the development of PCOS. Study design, size, duration This basic research study was an in vitro experimental approach involving the use of granulosa cell from a PCOS and normal cases between July to December in 2020. 32 women were included in both control and PCOS groups. Participants/materials, setting, methods Women with (n = 16) and without (n = 16) PCOS were included in the study. Granulosa cells, follicular fluids and blood samples were collected on oocyte pick-up day. Cells were isolated from follicular fluids. Kisspeptin–54 levels were determined by ELISA in serum and follicle fluids. Also, FSH and LH levels were determined in serum. Kisspeptin–54 administrated in vitro to the half of the samples. Fluorescence spectrophotometer and laser scanning confocal microscope were used to evaluate calcium concentrations Main results and the role of chance The serum kisspeptin level was found significantly higher in PCOS patients compared to the control group (p &amp;lt; 0.05). Also, the level of kisspeptin in follicular fluid was statistically significantly higher in PCOS patients compared to the control group (p &amp;lt; 0.05). The mean serum FSH level of PCOS patients was found to be significantly lower than the control group (p &amp;lt; 0.05). Furthermore, the mean serum LH level of PCOS patients was significantly higher than control groups (p &amp;lt; 0.05). The intracellular calcium concentration in granulosa cells obtained from PCOS patients was significantly lower than the control group (p &amp;lt; 0.05). Limitations, reasons for caution The KISS1, KISS1R, BCL–2, CASPASE–3, FSHR, LHCGR, STAR, ESR1, ESR2, INHBA gene expression levels of apoptotic process is still under analyses. The protein expression analyses of these genes may strength the results. Wider implications of the findings: Using kisspeptin antagonists may be supposed as an additional treatment for patients with PCOS. Trial registration number OMU KAEK 2019 /724

O-112 Outcomes of random-start ovarian stimulation protocols as a possible evidence of the theory of antral follicles continuous recruitment

Abstract Study question We tried to validate the possibility and efficiency of ovarian stimulation (OS) started on any day of the menstrual cycle, based on a theory of continuous recruitment of antral follicles. Summary answer Formation of a pool of follicles with higher sensitivity to gonadotropic stimulation occurs several times during the menstrual cycle (MC). What is known already According to classical concepts and fundamental positions formulated in the middle of the last century, follicular recruitment occurs only once during the menstrual cycle - in the early follicular phase. Nowadays there is increasing evidence to suggest that there are multiple (two or three) antral follicular waves of recruitment during the MC. Also some researchers state that the process of follicle recruitment is continuous. Study design, size, duration This prospective clinical study was conducted at the V.I. Kulakov NMRC for OG&amp;Pof Russia. The study included female cancer patients seeking retrieval and cryopreservation of oocytes and/or embryos before cancer treatment. 240 patients were selected for the study. The patients were divided into 5 groups depending on the cycle day on the moment when ovarian stimulation was initiated. All patients signed an informed consent form approved by the Ethics Committee. Participants/materials, setting, methods The 1st group consisted of patients who started standart OS from 1 to 5 days of the cycle (n = 65); the 2nd - from 6 to 10 (n = 36), the 3rd - from 11 to 15 (n = 45), the 4th - from 16 to 22 (n = 44), the 5th - from 23 to 28 (n = 50). In the late follicular and luteal phase we performed OS without a pituitary modulator. The comparative analysis included features of oo-, embryogenesis and steroidogenesis. Main results and the role of chance The mean age, BMI and AMH were not different among groups. There were no LH rise or OHSS signs noticed in any groups, despite that OS in late follicular and luteal phase of the MC was performed with no GnRH antagonist addition.There was no statistically significant difference in the duration of stimulation, starting doses, total dose of FSH and HMG. The largest number of oocyte cumulus complexes was obtained in the 5th group (11 (9–21) vs 7 (3,5–15,5) in the 1st group, p = 0,030). The greatest number of mature oocytes was obtained in the 4th and 1st groups. In the 2nd group the largest number of immature oocytes was obtained (37 (9.1%)). A smaller number of mature oocytes (165 (61.8%) vs 492 (72.9%) and 314 (77.5%), p = 0.001) was obtained in group 2 (compared with the 1st and the 4th groups), when stimulation was started in the presence of a dominant follicle . These periods coincided with higher estradiol and lower FSH serum levels. Based on our data the optimal moment for effective OS initiation starts with the decrease in serum estradiol which is approximately 48 hours before the menstrual bleeding. Limitations, reasons for caution The presented results could be applied mainly to young patients with high and normal ovarian reserve, who were in the main study group. In patients with low ovarian reserve, short menstrual cycle and early ovulation an issue of favorable time points for the initiation of OS should be resolved individually. Wider implications of the findings The data collected during our research could possibly contribute to future personification of OS protocols. Tailoring the ovarian stimulation protocols to the needs of the patients could decrease time needed for completing the protocol without affecting oocyte yield or their maturity. Trial registration number none

Nonobstructive azoospermia, when we can find spermatozoa, is FSH as a marker of succes?

Azoospermia is the absence of spermatozoa in ejaculate even after semen centrifugation at least two times. Azoospermia due to spermatogenic failure – non-obstructive azoospermia (NOA) observed in 1% of population and in 10–15% of infertile men. Predictive factors for the presence of spermatozoa in testis are still under debate. The development of ICSI revolutionized management of azoospermia. In our practice we advised TESA as a first step and FSH can predict the success. According serum FSH levels we divided our men in three groups: FSH &lt; 10 mU/ml, 10–15 mU/ml and &gt; 15 mU/ml. We tried to evaluated SRR in accordance serum FSH level and find significant difference. In 117 men with FSH &lt; 10 mU/ml SRR was 66% (in 77 cases), in 89 men which FSH was 10–15 mU/ml SRR was 27 % and finally SRR was 35% when FSH was &gt; 15 mU/ml (45 cases from 131). At the same time, we make embryologist personal assessment (EPA) and try to show embryologist crucial role in tissue assessment after TESA. Another crucial point of discussion – histomorphology within the testis in NOA and indications for re – TESA after 3–6 months.

Acupuncture-moxibustion treatment by stages based on the theory of "transformation of yin and yang" for premature ovarian insufficiency

To compare the efficacy between acupuncture-moxibustion treatment by stages and femoston for premature ovarian insufficiency (POI). A total of 66 patients with POI were randomly divided into an observation group (33 cases, 3 cases dropped off) and a control group (33 cases, 2 cases dropped off). The patients in the observation group, based on the theory of "transformation of yin and yang", were treated with acupuncture-moxibustion by stages in the postmenstrual period, ovulatory period, premenstrual period and menstrual period, once every other day, 3 times a week. The patients in the control group were treated with oral administration of femoston (estradiol tablets/estradiol and dydrogesterone tablets, 1 tablet per day). Both groups were treated for 3 menstrual cycles. The ovarian function (serum follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol [E2], anti-mullerian hormone [AMH] and antral follicle count [AFC]) and perimenopausal symptoms [modified Kupperman index (KI) scale score] were observed before and after treatment, and the menstrual improvement of the two groups was compared. Compared before treatment, the serum levels of FSH and LH were decreased (P<0.01), the levels of E2 were increased (P<0.01) in the two groups after treatment; the serum level of AMH and AFC in the observation group were increased after treatment (P<0.01). After treatment, the serum level of AMH and AFC in the observation group were higher than those in the control group (P<0.05). After treatment, there was no significant difference in the menstrual return rate and menstrual regularity rate between the amenorrhea patients of the two groups (P>0.05). After treatment, the modified KI scale scores in the two groups were reduced (P<0.01), and the modified KI scale score in the observation group was lower than that in the control group (P<0.05). Acupuncture- moxibustion treatment by stages based on the theory of "transformation of yin and yang" has similar efficacy with femoston in improving serum sex hormone level and menstrual symptoms in patients with POI, and has advantages in improving serum AMH level, AFC and perimenopausal symptoms.

Qilin Pill Exerts Therapeutic Effect on Resection-Induced Premature Ovarian Insufficiency Rats by Inhibiting the MAPK and PI3K-AKT Signaling Pathways.

BackgroundThe Qilin pill (QLP) is a traditional Chinese compound prescription comprising 15 herbs that has demonstrated significant therapeutic effects on premature ovarian insufficiency (POI) in recent years. However, a pharmacological evaluation of QLP on ovarian function remains to be conducted, and the key mechanism of QLP treatment on POI is unclear.MethodsPremature ovarian insufficiency rats were established by bilateral partial ovariectomy. The model rats were administrated with low (QLP-L), medium (QLP-M) and high (QLP-H) doses of QLP for 4 weeks to evaluate the ovarian function in terms of estrous cycle, hormone level, and follicle count. The mechanism of QLP in the treatment of POI was systematically explored by network pharmacology, and expression levels of the MAPK and PI3K-AKT signaling pathways were verified by Western blotting and molecular docking.ResultsThe rat model of resection-induced POI was successfully established, and QLP could significantly recover the estrous cycle, decrease serum FSH levels, and decelerate follicle depletion after 4 weeks of administration. The optimal dose of QLP in the experiment was preliminarily determined to be 0.9 g/kg. Based on the network pharmacology methods, we constructed the compound-target network and protein protein interaction (PPI) network of QLP for the treatment of POI. The experimental verification of the enrichment analysis showed that QLP inhibited the MAPK and PI3K-AKT signaling pathways, and the key compounds and key targets involved were verified by molecular docking.ConclusionQLP exerted significant therapeutic effects on resection-induced POI rats, and this was achieved by the inhibition of the MAPK and PI3K-AKT signaling pathways. This study is the first to systematically investigate the effects and mechanism of QLP on POI rats, which will provide valuable guidance in clinic.

Correlation Between Serum Ferritin and Gonadotrophins and Sex Hormones in Patients with Transfusion Dependent â-Thalassemia

Background: Patients with transfusion dependent beta thalassemia major develop a number of complications of whichhypogonadism is the most common. In addition, raised serum ferritin level has been associated with hypogonadism.Objective: To determine a correlation between serum ferritin, gonadotrophins and sex hormones in patients with transfusiondependent â-thalassemia syndrome patients.Material and methods: This cross sectional study was designed and conducted at the Institute of Basic Medical Sciences (IBMS),Khyber Medical University (KMU) Peshawar and Fatimid Foundation, blood bank and hematological services Peshawar. Betathalassemia syndrome patients enrolled in the study were 97. Blood samples collected from the study subjects were analyzed atIBMS KMU using chemiluminescence immune assay for determination of serum ferritin and gonadal hormones such as FSH, LH,Estradiol and Testosterone.Results: The mean±SD age of patients was 18.93±3.6 years with a range of 15-32 years. There were 55 (56.7%) males and 42(43.3%) females. Overall hypogonadism was diagnosed in 39 (40.21%) patients. Although we did not find any association betweenserum ferritin level and gonadal function in our study, hypogonadism having males had a higher serum ferritin level (p = 0.02). Astatistically significant negative correlation was found between serum ferritin and serum level of LH, FSH and testosterone in males(p <0.05).Conclusion: The effect of iron overload on serum level of gonadotrophins and gonadal hormones is more pronounced in males ascompared to female thalassemic patients.Keywords: Beta Thalassemia syndrome, Chelation, Ferritin, Hypogonadism, Gonads, Sex Hormones

EFFECT OF OBESTATIN ON PITUITARY GONADAL AXIS, LEPTIN AND MDA LEVELS IN OBESE SPRAGUE DAWLEY RATS

Objective: To determine the effect of obestatin administration on FSH, LH, testosterone, leptin and MDA levels in obese Sprague Dawley Rats.&#x0D; Study Design: Laboratory based animal study.&#x0D; Place and Duration of Study: Physiology department, Army Medical College Rawalpindi, from Mar to Jun 2015.&#x0D; Methodology: This randomized controlled trial was conducted at Physiology Department Army medical college. Male healthy Sprague Dawley rats were randomly divided into 3 groups (n–15 each) i.e. control group (group I) fed with normal pellet diet (NPD), obese group (group II) and obestatin treated obese group (group III) fed with high fat diet (HFD). After 10 weeks, group III was treated with obestatin (1nmol/100ml intraperitoneally). Blood samples were obtained by terminal intracardiac sampling for bioasssays of FSH, LH, testosterone, leptin and MDA by ELISA.&#x0D; Results: Obestatin supplementation in obese rats showed significant increase in LH levels (3.79 ± 0.05) and testosterone levels (2.07 ± 0.22) when compared to the non treated obese rats (2.19 ± 0.07) and (1.37 ± 0.15) respectively while significant decrease in leptin (3.85 ± 0.23) and MDA levels (1.62 ± 0.07) was observed when compared to the non-treated control groups (6.10 ± 1.18) and (1.95 ± 0.07) respectively. However, serum FSH levels remained unchanged among the treated and nontreated groups.&#x0D; Conclusion: Obestatin increases the testosterone levels by augmenting the pituitary gonadal axis through decrease in the oxidative stress and leptin levels in obese rats.

A Comparative Evaluation of Efficacy of Mustadi Yapan Bastiand Baladi Yapan Basti in the Management of Oligozoospermia-Study Protocol

Background: Nowadays most upcoming disease that affecting 8 to 12% of the world population is Infertility.The affected area of this problem have no bar irrespective of metro cities as well as small towns population..Modern treatment with steroids and other medication and interventions shows limited results.Bastichikitsa itself is the best remedies explained in Ayurved text for the treatment of ksheenshukra.Yapan Basti in Ayurveda is known for its action as balya, i.e. giving strength to the sharirdhatu.Incase of Oligozoospermia there is vitiation and loss of formation process of shukradhatu properly as per Ayurveda. Using YapanBasti,the strength of Shukradhatu can be regain and ultimately correction can be seen in oligozoospermia cases. By doingbastikarma,we are trying to establish and confirm the role of yapanbastiexplained in Ayurvedonoligozoospermia.&#x0D; Aims and objectives: To study the efficacy of MustadiYapan Bastion sperm count sperm motility, semen volume.SemenPH,abnormal sperm count along with serum testosterone,GH and FSH level in the management of Oligozoospermia in comparison with BaladiYapanBasti.&#x0D; Methodology: Age ranging between 25 to 50 years will be considered for the study. Secondly Sperm count &lt; 15 million/ml will be consider for the study, also the patients who shows cardinal symptom i.ePratyatmakaLakshana of KshinaShukra, Pathological sample of Semen sample must suggestive of oligozoospermia will be considered for the study.30 Patients in each group will be given Basti for 16 days as explained in classics of Ayurveda .The process of giving basti will be using bastiputak,Basti will be prepared as per the niruhabasti preparation method.Bastigamankal and bastipratyagamankal will be observed properly.Follow-up will be taken after 28thday from starting of treatment.&#x0D; Results: Results will be drawn from the observations of objective parameters.&#x0D; Conclusion: MustadiYapanBasti will be effective in oligozoospermia.

Association between premature ovarian insufficiency and gut microbiota

BackgroundPremature ovarian insufficiency (POI) is characterized by impairment of ovarian function on a continuum before the age of 40 years. POI is affected by multiple factors. Considering new insights from recent gut microbiome studies, this study aimed to investigate the relationship between gut microbial community structure and POI.MethodsSubjects were recruited at the Shenzhen Maternity & Child Healthcare Hospital. Fecal microbial community profiles of healthy women (n = 18), women with POI (n = 35) were analyzed using 16S rRNA gene sequencing based on Illumina NovaSeq platform.ResultsCompared to the controls, the serum levels of FSH, LH, T and FSH/LH ratio significantly increased in women with POI, whereas E2 and AMH decreased significantly. Higher weighted UniFrac value was observed in POI women compared with healthy women. Phylum Firmicutes, genera Bulleidia and Faecalibacterium were more abundant in healthy women, while phylum Bacteroidetes, genera Butyricimonas, Dorea, Lachnobacterium and Sutterella enriched significantly in women with POI. Moreover, these alterations of the gut microbiome in women with POI were closely related to FSH, LH, E2, AMH level and FSH/LH ratio.ConclusionsWomen with POI had altered microbial profiles in their gut microbiome, which were associated with serum hormones levels. These results will shed a new light on the pathogenesis and treatment for POI.

P0503 - Identifying a genomic region at Chromosome 11p.14.1 that is associated to FSH serum level in men with unexplained male infertility

P0503 - Identifying a genomic region at Chromosome 11p.14.1 that is associated to FSH serum level in men with unexplained male infertility

Investigation the effects of varicocelectomy on sex hormones levels and semen parameters

Background: Varicocelectomy is a type of surgery for varicocele treatment. This may recover fertility properties in males through improvement in semen parameters as well as sexual hormones. In this study, the role of varicocelectomy with focus on semen properties and sexual hormones have been assessed. Methods: In this cross-sectional study, before- after data from fifteen patients with different varicocele grade, regarding to varicocelectomy have been compared. Result: After varicocelectomy, a significant improvement in some semen parameters such as motility and concentration has been showed. However, among sexual hormones, only testosterone has been increased after surgical intervention (p=0.007). Conclusion: Based on our knowledge, varicocele treatment may almost improve fertility potential in males significantly. Accordingly, it seems that varicocelectomy has positive effect on parameters such as testosterone and serum FSH levels as well as sperm count and motility. Therefore, it could be concluded that varicocelectomy is an effective approach to improve male fertility and sexual disorders.