Subfertile Women Research Articles

Perceived stress and markers of ovarian reserve among subfertile women

Research questionIs self-reported psychological stress associated with markers of ovarian reserve among subfertile women? DesignObservational study of women (n = 520) seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health study between 2005 and 2019. Women completed the short version of the validated PSS4, which assesses psychological stress. Ovarian reserve markers included AFC and circulating serum levels of day-3 FSH, with AMH assessed in a subset of participants (n = 185). ResultsHigher total PSS4 scores were negatively associated with AFC and serum AMH levels. Analyses adjusted for age, BMI, race, smoking, education, physical activity and type of infertility diagnosis. Women in the second and third tertiles of stress had lower AFC (13.3, 95% CI 12.7 to 13.8; and 13.5, 95% CI 13.0 to 14.1) compared with women in the lowest tertile of psychological stress score (14.3, 95% CI 13.8 to 14.9, both P < 0.05). Women in the second and third tertiles of total PSS4 scores also had lower mean serum AMH compared with women in the lowest tertile (2.99, 95% CI 2.24 to 3.74), and (2.99 95% CI 2.22 to 3.76) versus (3.94 95% CI 3.23 to 4.64). These associations varied by several socioeconomic factors, and were observed among women who were younger, belonging to minority races, with a college degree or with annual household income less than $100,000. ConclusionsHigher perceived stress was negatively associated with AFC and serum AMH levels. These associations varied by several socioeconomic factors.

P171 Subfertility in young patients with Crohn′s disease. A case-control study.

Abstract Background Inflammatory bowel disease (IBD) commonly affects women and men during the reproductive years.The effect of the disease burden on fertility in these patients is a common concern for them. ECCO guidelines establish that active disease is associated with decreased fertility in women but studies regarding this topic are of low quality and outdated. Aims to investigate the effect of CD on fertility, studying ovarian reserve in women as well as global Sertoli cell function in men, - To compare these results of CD patients with the healthy control group. (HC) - To assess the related factors to subfertility in women and males with CD. Methods This was a cross-sectional, prospective and case-control study, including CD patients, aged 18-40 years-old, and HC matched by gender and age (ratio 2:1). Morning baseline IB was measured in men using ELISA. Serum anti-Müllerian hormone (AMH) was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected.Subfertility was defined as IB &amp;lt; 89pg/mL, AMH &amp;lt;1.66 ug/L in 0-24 years old group; &amp;lt;1.18 ug/L in 25-29 years old group; &amp;lt;0.67 ug/L in 30-34 years old group; &amp;lt;0.77 ug/L in 35-39 years old group; and &amp;lt;0.01 ug/L in 40-44 years old group. AMH &amp;lt;2 ug/L in women under 40 was considered low. Results A total of 163 individuals were included: 83 men (58 CD, median 28 years old, RIQ 24-36; 25 HC, median 31 years old, RIQ 26-37) and 80 women (50 CD, median 26 years old, RIQ 21-36; 30 HC, median 28, RIQ 26-32). Sedentary lifestyle was more frequent in women with CD vs HC (46% vs 3,3%, p&amp;lt;0,001). 24% of women with CD and 8% of males had clinical activity (IHB &amp;gt;4). Low AMH (&amp;lt;2ug/L) in women older than 30 was more frequent in CD vs HC: 95% (18/19) vs 44% (4/9) p=0.001, with an OR of presenting AMH &amp;lt; 2 ug/L of 3.28 (IC 95%, 1.6-6.4) for women with CD &amp;gt;30 years old. The average AMH serum level was similar between women with CD and HC [1.83 (1.04-3.34) vs. 2.74 (1.05-4.12) g/L, p=0.4]. Abnormal AMH rate by age rank was not different between groups in global population (11/50, 22% EC vs. 7/30, 23% in CS, p=0.9,). IB levels were significantly lower in men with CD vs HC [169 (140-217) vs 232 ug/L (178-274) p=0.001]. IB &amp;lt;89 pg/mL was not detected in any control vs 6% (n=3) in CD. In multivariate analysis, only AMH was associated with lower levels of IB in CD men, no association with clinical activity or treatments in CD was found. Conclusion Women with CD and &amp;gt;30 years old have a higher risk than general population of presenting low AMH (&amp;lt;2).These data could be helpful at council of women with CD that desire to have progeny. IB concentration was lower in men with CD compared to HC.

Subfertile Chinese patients with diminished ovarian reserve: An analysis of pregnancy outcomes of ART cycles.

To analyze the pregnancy outcomes of patients presenting with infertility solely due to diminished ovarian reserve (DOR) and treated by assisted reproductive technology (ART), including artificial insemination by husband (AIH) and in vitro fertilization (IVF). This was a retrospective study of subfertile patients due to DOR attending the Center for Reproductive Medicine in Guangzhou, China, between January 2010 and October 2015. Patients were assigned into either the AIH or IVF group. Within each group, these patients were further subgrouped based on their serum basal follicle-stimulating hormone (bFSH) level (10 ≤ bFSH ≤ 12IU/L and bFSH > 12IU/L) and age (20-30, 31-35, 36-40, and 41-45 years). The live birth rates were compared among these groups and subgroups. A total of 1,003 patients with a median age of 38.91 (21-45) years were enrolled in the study. The live birth rate following AIH was 5.61% (25/446), which was significantly lower than that following IVF (25.13%; 140/557). In the subgroup analysis, the cumulative live birth rates in AIH group were significantly lower than those in the IVF groups (in the 10-12 IU/L bFSH subgroup, 13.74% vs. 41.13% (P<0.05) for patients aged ≤35 years, and 4.82% vs. 19.77% (P<0.05) for patients aged >35 years; in the >12 IU/L bFSH subgroup, 9.52% vs. 29.91% (P<0.05) for patients aged ≤35 years, and 5.71% vs. 20.55% (P<0.05) for patients aged >35 years). Longitudinal analysis showed that majority of live births, in AIH or IVF groups, were achieved in the first two cycles. In subfertile women with DOR, live birth rates following AIH were significantly lower than IVF, especially for the aged women. Considering the low efficacy of AIH and that majority of live births were achieved in the first two cycles, we suggest no more than two AIH treatment attempts for the aged women with DOR.

Comparing ART outcomes in women with endometriosis after GnRH agonist versus GnRH antagonist ovarian stimulation: a systematic review.

Endometriosis is an oestrogen-dependent disease that can cause subfertility in women who may require assisted reproductive technology (ART) to achieve their pregnancy goals. The aim of this study was to compare ART outcomes in women with endometriosis following the long GnRH-agonist controlled ovarian stimulation (COS) protocol with those taking the GnRH-antagonist COS protocol. MEDLINE, Embase and Web of Science were systematically searched in June 2022. Randomized controlled trials (RCTs) and observational studies comparing the long GnRH-agonist COS protocol and the GnRH-antagonist COS protocol in women with all stages/subtypes of endometriosis were included. Data were synthesized into comprehensive tables for systematic review. The Scottish Intercollegiate Guidelines Network (SIGN) checklists were used for the risk of bias assessment of non-randomized studies and randomized studies, and all the included studies were deemed to have acceptable quality. Eight studies (one RCT and seven observational) with 2695 patients (2761 cycles) were included. Most studies generally reported non-significant differences in clinical pregnancy or live birth rates regardless of the COS protocol used. However, the GnRH-agonist protocol may yield a higher total number of oocytes retrieved, especially mature oocytes. Conversely, the GnRH-antagonist protocol required a shorter COS duration and lower gonadotrophin dose. Adverse outcomes, such as rates of cycle cancellation and miscarriage, were similar between both COS protocols. Both the long GnRH-agonist and GnRH-antagonist COS protocols generally yield similar pregnancy outcomes. However, the long GnRH-agonist protocol may be associated with a higher cumulative pregnancy rate due to the higher number of retrieved oocytes available for cryopreservation. The underlying mechanisms of the two COS protocols on the female reproductive tract remain unclear. Clinicians should consider treatment costs, stage/subtype of endometriosis and pregnancy goals of their patients when selecting a GnRH analogue for COS. A well-powered RCT is needed to minimize the risk of bias and compare the risk for ovarian hyperstimulation syndrome. This review was prospectively registered at PROSPERO under Registration No. CRD42022327604.

Efficacy of In-utero Infusion of Autologous Platelet Rich Plasma Therapy in Women with Recurrent Implantation Failure: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Introduction: In-utero infusion of autologous Platelet Rich Plasma (PRP) is found to be a novel approach to address the thin, non receptive endometrium leading to recurrent implantation failure. Aim: To estimate the efficacy of intrauterine PRP infusion in subfertile females affected with recurrent implantation failure via the conduction of a systematic review and meta-analysis of the available Randomised Controlled Trials (RCTs). Materials and methods: A systematic literature search was done in electronic databases like Medline (through PubMed), Embase, Scopus, Web of Science, and Cochrane database from January 2000 to November 2020 using keywords like “In-vitro Fertilisation” OR “IVF” OR “Intracytoplasmic sperm injection” OR “ICSI” OR “Embryo transfer” AND “Platelet rich plasma” OR “PRP” OR “Autologous platelet rich plasma” OR “Platelet rich plasma” and “recurrent implantation failure”. The randomised controlled trials, comparing intrauterine infusion of PRP versus no intervention or placebo in a study population of subfertile women with recurrent implantation failure and having medically confirmed pregnancy outcomes like live birth, clinical pregnancy, chemical pregnancy, and miscarriage were included in this systematic review. Studies with inadequate details in the methodology or result section were excluded from this analysis. This meta-analysis involved a pooled data analysis of 335 participants (174 cases and 161 controls) from four RCTs. Results: Compared with the control group, patients in the PRP group were found to have more beneficial effects in terms of implantation rate (Relative risks: 1.51, 95% Confidence interval: 0.94, 2.44; Heterogeneity: Tau²=0.08; I²=44%; Test for overall effect: Z=1.69, p-value=0.09) and clinical pregnancy (Relative risk: 1.88, 95% CI: 1.17, 3.03; Heterogeneity: Tau²=0.12; I²=51%; Test for overall effect: Z=2.62; p-value=0.009). Conclusion: Intrauterine PRP infusion increases the implantation rate and clinical pregnancy rate in women undergoing the frozen embryo transfer cycle.

Evaluation of depression, stress, and anxiety among women with subfertility during the COVID-19 pandemic: A cross-sectional study in Ahvaz, Iran.

Some studies have shown that the levels of stress, anxiety, and depression have increased among subfertile women during the COVID-19 pandemic. This study was designed to evaluate the levels of depression, anxiety, and stress among subfertile women during the COVID-19 pandemic in southwest Iran. This cross-sectional study was conducted on 190 subfertile women from two infertility centers (Imam Khomeini and Jihad) in Ahvaz, Iran. A demographic questionnaire, and the depression, anxiety, stress scale (DASS-21) were used to assess the level of depression, anxiety, and stress of subfertile women during the COVID-19 pandemic. Data collection started in August 2021 and was completed in December 2021. Mean ± SD or N (%), and multiple linear regression were used to analyze the data. Results showed that most women experienced moderate depression, anxiety, and stress. However, the percentage of women who experienced very severe anxiety was more than that for depression and stress, and 75 (39.5%) of women had all three disorders together. Anxiety was 0.176 units lower in women who were not affected by COVID-19 (95% CI: -5.781 to -0.629). The depression was 0.216 units lower in women with good and moderate economic status (95% CI: -5.603 to -1.178). The results of this study showed that most studied women experienced moderate depression, anxiety, and stress, but the percentages of very severe anxiety were more than that for depression and stress. Poor economic status was also a strong predictor of depression among subfertile women. Infection with COVID-19 increased the level of anxiety. Careful evaluation of subfertile women for mental health is recommended especially during crises such as the COVID-19 pandemic.

Endothelial dysfunction in subfertile women with polycystic ovary syndrome

Research questionIs there an association between post-occlusive reactive hyperaemia (PORH) and ovarian stimulation in women with normoandrogenaemic polycystic ovary syndrome (PCOS)? DesignWomen eligible for IVF at an academic fertility centre were invited to join this prospective study. Microvascular endothelial function was measured as PORH by laser Doppler flowmetry (LDF) before and after ovarian stimulation. Metabolic characteristics, hormone profiles and biochemical markers were analysed. ResultsThirty-four normoandrogenaemic women with PCOS and 36 normoandrogenaemic women without PCOS were included. The PCOS group displayed higher C-reactive protein levels and insulin resistance (P = 0.048 and P = 0.025, respectively). No significant difference was found in microcirculatory function between the groups at baseline. After ovarian stimulation, PORH was enhanced in the control group (slope 7.1 ± 3.3 versus 9.7 ± 4.5; P = 0.007; peak flow 30.7 ± 16.3 versus 43.5 ± 17.3, P = 0.008; however, the PCOS group experienced a blunting response to supraphysiological hormone status (slope 8.2 ± 5.1 versus 7.2 ± 4.3, P = 0.212; peak flow, 38.8 ± 19.4 versus 37.0 ± 21.8, P = 0.895). ConclusionsImpaired microcirculatory function could be found using a non-invasive LDF technique in normoandrogenaemic women with PCOS undergoing IVF, indicating early changes in vascular endothelial dysfunction. Future observational studies should clarify whether PORH measurement might help predict IVF prognosis or obstetric complications.

Time to pregnancy and perinatal outcomes in a cohort of spontaneous pregnancies

BackgroundObstetric and perinatal outcomes depend not only on care during pregnancy, as there is an increasing evidence of their relationship with preexisting conditions. Woman’s age and time to pregnancy (TTP) have been related to the prognosis in reproductive success, but TTP could influence fetal well-being and newborn. According to the World Health Organization, 48 million couples have subfertility globally. MethodsWe analyzed the relationship between TTP and obstetric (premature labor, preeclampsia…), labor (type of delivery, postpartum hemorrhage…), and neonatal outcomes (low birth weight…) in a cohort of 190 spontaneous gestations. Subfertility is a disease defined by the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse. ResultsTTP was >12 months in 23.1 % (95 % CI = 17.57–29.55), however, no correlation was found with the perinatal outcomes (p = 0.24). We observed that 45.2 % of subfertile women had obstetric complications, 13.2 % labor complications, and 34.2 % neonatal complications, whereas non-subfertile women had 29.4 %, 21.0 %, and 21.0 %, respectively. Half of pregnancies have at least one adverse outcome, and obstetric complications were the most frequent. ConclusionSubfertility condition may appear in up to a fifth of our couples. Subfertility may behave as a mild risk factor for adverse perinatal outcomes. Obstetric or perinatal complication may be expected in up to half of the cases. Subfertile women ≥ 35 years of age have a 3-fold increase in their risk of having an obstetric complication when compared to non-subfertile women of the same age.

Changes in the proportion of regulatory T cell subpopulations during menstrual cycle and early pregnancy.

Regulatory T cells (Tregs) play important roles in diseases occurring in women of reproductive age and pregnancy. Tregs are functionally heterogeneous and can be divided into activated Tregs (aTregs), resting Tregs (rTregs), and non-suppressive Tregs (non-Tregs). The purpose of this study is to investigate the change of Treg subpopulations during the menstrual cycle and early pregnancy. Two groups of women were enrolled: healthy women aged 20 to 39 years with normal menstrual cycles and patients scheduled to undergo frozen-thawed blastocyst transfer (FT-BT) (subfertile women). Peripheral blood samples were collected at day 5 of the onset of menstruation (follicular phase), 0-2 days after luteinizing hormone (LH) surge (periovulatory phase), and 7-11 days after LH surge (luteal phase) from 20 healthy women. From 23 subfertile women, samples were collected at day 5 (the day of BT) and day 14 (the day of pregnancy testing) of progestogen administration during FT-BT cycle and 9weeks of gestation if the patient got pregnant. The proportion of total Treg and its subpopulations among CD4+ T cells was analyzed. TTreg and aTreg proportion expanded during periovulatory phase (p<.01) and after pregnancy (p<.05 for tTreg and p<.01 for aTreg). rTreg proportion was significantly high during periovulatory phase (p<.01) and during luteal phase (p<.01). Non-Tregs showed no significant change. RTregs and aTregs, especially in luteal phase and after getting pregnant, showed significant changes and may play important roles in women of reproductive age.

Culturomics to Investigate the Endometrial Microbiome: Proof-of-Concept.

The microbiome of the reproductive tract has been associated with (sub)fertility and it has been suggested that dysbiosis reduces success rates and pregnancy outcomes. The endometrial microbiome is of particular interest given the potential impact on the embryo implantation. To date, all endometrial microbiome studies have applied a metagenomics approach. A sequencing-based technique, however, has its limitations, more specifically in adequately exploring low-biomass settings, such as intra-uterine/endometrial samples. In this proof-of-concept study, we demonstrate the applicability of culturomics, a high-throughput culturing approach, to investigate the endometrial microbiome. Ten subfertile women undergoing diagnostic hysteroscopy and endometrial biopsy, as part of their routine work-up at Brussels IVF, were included after their informed consent. Biopsies were used to culture microbiota for up to 30 days in multiple aerobic and anaerobic conditions. Subsequent WASPLab®-assisted culturomics enabled a standardized methodology. Matrix-assisted laser desorption/ionization–time of flight mass spectrometry (MALDI-TOF MS) or 16S rRNA sequencing was applied to identify all of bacterial and fungal isolates. Eighty-three bacterial and two fungal species were identified. The detected species were in concordance with previously published metagenomics-based endometrial microbiota analyses as 77 (91%) of them belonged to previously described genera. Nevertheless, highlighting the added value of culturomics to identify most isolates at the species level, 53 (62.4%) of the identified species were described in the endometrial microbiota for the first time. This study shows the applicability and added value of WASPLab®-assisted culturomics to investigate the low biomass endometrial microbiome at a species level.

Effectiveness of mind-body intervention on oocyte quality and serum cortisol level in sub-fertile women undergoing IVF treatment in Wardha region: A Study Protocol

The grounds of the contemporaneous examination is to evaluate the association in unite repercussions of mind-body intercession and serum cortisol measures and eggs attributes. The cognizance that psychical stress may avert females from accomplishing and keeping up a gestation has become vastly received. Mind-body intercession incorporates calmness, optimistic make-believe, biofeedback, balm, meditation, rumination, yoga, and more. All these acts work discreetly to help someone alleviate illness. Mind-body interventions (MBIs) may be an efficacious implement to assist females to cope with the ultimatum of infertility pinpointing and ministration Objective of this study is to sensitize all sub fertile females about the study, to investigate serum cortisol level of sub fertile females and to investigate the quality of oocyte of sub fertile females. This non-invasive methodology appends a set down of ministration history and the manifestations. Advice will be given to all the patients for research. Additional convention appends checking of oocytes quality after mind-body intercession in the second cycle of IVF after retrieving poor quality of oocytes in the first cycle and failure of the cycle due to it.

Effectiveness of mind-body intervention on oocyte quality and serum cortisol level in sub-fertile women undergoing IVF treatment in Wardha region: A Study Protocol

In last 4 decades, the treatment of infertility has changed fundamentally and has been used increasingly in the whole world. Fresh embryo transfer and vitrified thawed embryo transfer are the two methods that are preferred. Nowadays, freeze all cycles are much more involved in the treatment of infertility. Maternal complications are found to be lesser in pregnancy arising from the cryopreserved thawed embryo transfers. Women undergoing frozen embryo transfer are found to have good ovarian reserve with a lower risk of preterm birth. But the occurrence of pregnancy-induced hypertension syndrome is found to be more in cryopreserved embryo transfer than in fresh embryo transfer. The ovarian hyperstimulation syndrome is found to be same in both types of embryo transfers. Objective of the study is to correlate the β-HCG outcome of fresh and frozen embryo shifting, to correlate pregnancy complications in patients with fresh and frozen embryo shifting, to identify various reasons for pregnancy complications and to establish criteria for selection of embryo transfer type (Fresh/Frozen). This invasive methodology includes a recording of the treatment history and the indications. Counseling of all the participants for research will be done. The further protocol includes evaluation of outcomes of both the techniques by comparing its complications in pregnancy.

MODERATE STEP COUNTS ARE ASSOCIATED WITH HIGHER RATES OF LIVE BIRTH IN SUBFERTILE WOMEN

We sought to determine the association between physical activity as measured by a Fitbit accelerometer and live birth in subfertile women.

NEUREGULIN 1 REGULATES CUMULUS-OOCYTE DIFFERENTIATION DURING IVM AND IMPROVES POST-IVF EMBRYO DEVELOPMENT

Although its application has been restricted to specific patient profiles, in vitro maturation (IVM) of germinal vesicle oocytes may represent an alternative to reduce infertility treatment cost and risk/discomfort. The bovine IVM model has been particularly valuable to improve our comprehension about the regulation of cumulus-oocyte maturation, as well as to develop IVM strategies for sub-fertile women. Gradual instead of abrupt activation of the ovulatory cascade during IVM has been proposed to enhance nuclear-cytoplasmic synchrony and cumulus-oocyte communication, thus favoring developmental competence.

DETECTION OF THE OVULATION TIME VIA HORMONE LEVELS IN THE PERIPHERAL BLOOD OF THE SUBFERTILE WOMEN WITH REGULAR MENSTRUAL CYCLE

In order to detect the ovulatory disorders, ovulation physiology is needed to be fully understood, and the cut-off values related to the changes in hormone levels are to be defined. This study aimed to define the cut-off values showing the ovulation with serial evaluation of serum hormone levels of progesterone (P), estradiol (E2), and luteinizing hormone (LH), besides ultrasonographic assessments of the subfertile women having regular menstrual cycle.

Prevalence of endometrioma and deep infiltrating endometriosis at transvaginal ultrasound examination of subfertile women undergoing assisted reproductive treatment

To estimate the prevalence of endometrioma and deep infiltrating endometriosis (DIE), assessed by systematic transvaginal ultrasound examination, in women with subfertility accepted for their first assisted reproductive treatment and to describe the prevalence of endometriotic lesions in different anatomical locations of the pelvis. Cross-sectional study. Reproductive Medicine Center, Department of Obstetrics and Gynecology, University hospital. A total of 1,191 women with subfertility aged 25-39 years accepted for their first assisted reproductive treatment between December 2018 and May2021. All women underwent a systematic transvaginal ultrasound examination. The endometriotic lesions visible on ultrasound examination were described according to the International Deep Endometriosis Analysis group consensus opinion for systematic approach to assess endometriotic lesions. Prevalence of endometrioma and DIE in women with subfertility and prevalence of endometriotic lesions in various anatomical locations of the pelvis. Endometriosis prevalence was 21.8%, with endometriotic lesions found in 260 of the 1,191 women. Overall, 125 (10.5%) women had endometrioma and 205 (17.2%) women had DIE. Of these 260 women, 197 (75.8% of women with endometriosis) did not have any previous knowledge about having endometriosis. The most common location for endometriotic lesions was the uterosacral ligaments, with lesions found in 151 (12.7%) of all women. The second most common location was the ovaries containing endometrioma, found in 125 (10.5%) women. Most women had 1 (n = 121, 10.2%) or 2 (n = 82, 6.9%) endometriotic lesions. The prevalence of endometrioma and DIE in women with subfertility, diagnosed by systematic transvaginal ultrasound examination, was 21.8%. Of these, three-fourth of women had no knowledge about the presence of disease.

The Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study.

There are limited data on how non-infectious risk factors influence tubal patency in women with subfertility. With hormonal shifts influencing tubal secretions, it has been argued that subfertile women with polycystic ovary syndrome (PCOS) have lower tubal patency. In a retrospective study, 216 women, who underwent diagnostic evaluation for PCOS and infertility, were included. Fallopian tube patency was tested using HSG, HyCoSy, and laparoscopic chromopertubation in 171 (79.2%), 28 (13.0%), and 17 (7.9%), respectively. Bilateral patency was found in 193 women (89.4%), unilateral patency in 13 (6.0%) and bilateral occlusion in 10 (4.6%) patients. Women with PCOS phenotypes C (odds ratio, OR 0.179, 95% CI: 0.039–0.828) and D (OR 0.256, 95% CI: 0.069–0.947) demonstrated lower risks for Fallopian tube occlusion. In conclusion, our data suggest that about 5% of infertile women with PCOS also have bilateral tubal occlusion, which seems similar to the rate in non-subfertile women. With 11% of participants having unilateral or bilateral tubal occlusion, this should reassure women with PCOS that their hormonal challenges do not seem to increase their risk for tubal factor subfertility.

Individual dynamics of uterine natural killer cells in natural and stimulated cycles monitored using a new endometrial dating method.

It is important to evaluate the dynamics of uterine natural killer (uNK) cells in hormone replacement therapy (HRT) cycles, given their potential role in implantation and the common usage of HRT cycles with in vitro fertilization (IVF). A total of 132 subfertile patients were evaluated during the secretory phase of either natural ovulation (OV) or HRT cycles, with two biopsies taken on approximately days 5 and 10 after ovulation/progesterone administration in a single menstrual cycle. Immunohistochemical Personal Endometrial Maturation Analysis (PEMA) was used to better quantify secretory-phase endometrial development, in combination with subsequent evaluation of uNK cell density. uNK cell density increased rapidly from the early to mid-secretory phase, with mean uNK densities of 113 and 117 per mm2 in first biopsies and 315 and 387 per mm2 in second biopsies for OV and HRT cycles, respectively. After reassessment of endometrial development with PEMA, the first and second biopsies in HRT and OV cycles were histologically dated to developmental ranges between days 15-20 (first biopsy) and days 19-25 (second biopsy). Subfertile women showed variable endometrial development in PEMA assessment, with uNK cell density correlating with the dating results. Overall, comparable levels of uNK cell density were observed in OV and HRT cycles. Importantly, uNK cell density depends on the histological maturation stage, with similar low coefficients of determination. This observation suggests that aberrant uNK cell results more likely reflect displaced endometrial maturation, rather than an intrinsic anomaly in uNK cell trafficking.

Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome: an umbrella review of meta-analyses of randomized controlled trials.

Numerous meta-analyses have been conducted on the effects of nutritional interventions on various health outcomes in women with polycystic ovary syndrome (PCOS). However, the strength of the evidence and its clinical significance are unclear. This umbrella review aimed to summarize the effects of nutritional interventions on women with PCOS and assess the strength of the evidence. PubMed, Scopus, and Web of Science were searched from inception until March 17, 2021. Meta-analyses of randomized clinical trials (RCTs) that examined the impact of dietary modifications or supplementations on women with PCOS were selected. Data extraction, quality assessments of the meta-analyses, and evaluation of the strength of the evidence were conducted independently by 2 investigators and confirmed by a third. Twenty-eight RCT meta-analyses were included, reporting 40 different outcomes. Lower carbohydrate, Dietary Approaches to Stop Hypertension, or lower glycemic index/load diets in women with PCOS significantly improved some anthropometric and metabolic characteristics (with very low to low certainty). Probiotics/synbiotics reduced fasting plasma glucose, fasting insulin (FI), and homeostasis model assessment-estimated insulin resistance (HOMA-IR) (with moderate to high certainty). Curcumin supplementation decreased fasting plasma glucose, FI, and HOMA-IR (with moderate certainty). Fish oil supplementation decreased FI and HOMA-IR, and omega-3 reduced triglycerides (with moderate certainty). There were also improvements in FI after taking vitamin D or inositol supplements (with moderate certainty). Supplementation with fish oil increased adiponectin (with high certainty), and probiotics/synbiotics reduced total testosterone (with moderate certainty). In subfertile women with PCOS, inositol increased the ovulation rates (with moderate certainty). There was no high-certainty evidence that diets alone in women with PCOS improved health or reproductive outcomes. Supplementation with vitamin D, probiotics/synbiotics, omega-3, inositol, and curcumin showed favorable effects on some metabolic outcomes. Probiotics/synbiotics possibly reduces total testosterone, and inositol stimulates ovulation in women with PCOS. PROSPERO registration no. CRD42021251496.

OP06.07: Prevalence of endometrioma at transvaginal ultrasound in subfertile women

OP06.07: Prevalence of endometrioma at transvaginal ultrasound in subfertile women