Total Antral Follicle Count Research Articles

Association between sleep quality and ovarian reserve in women of reproductive age: a cross-sectional study

ObjectiveTo evaluate the association between sleep quality and ovarian reserve among women of reproductive age. DesignCross-sectional study SettingNot applicable. PatientsA total of 1070 female participants aged 20–40 years enrolled from February 2023 to January 2024. InterventionNot applicable. Main Outcome MeasuresA questionnaire was administered to the participants to collect baseline information related to reproductive and lifestyle factors. Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. Assessment was conducted on ovarian reserve, including total antral follicle count (AFC), anti-Müllerian hormone (AMH) level, and basal sex hormone level. ResultsThe study sample of 1070 women had a mean age of 31.67 ± 4.41 years. A total of 314 participants (29.35%) were classified under the poor sleep group (PSQI score > 5).Significant differences were observed in the follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone(T),AFC, and AMH between the two groups (P < 0.05). The poor sleep group exhibited significantly lower levels of AMH and AFC (P < 0.01). The FSH levels in the poor sleep group were higher (P < 0.01).After the adjustment for confounding factors, multivariate regression analysis results indicated that the per-unit increase in PSQI score was associated with increased odds of diminished ovarian reserve (adjusted odds ratio [AOR] of 1.28 for AMH < 1.1 ng/ml, 95% confidence interval [CI]: 1.20– 1.37; AFC < 7, AOR: 1.34 ,95% CI: 1.25– 1.43;FSH ≥10mIU/mL,AOR:1.16 ,95%CI 1.08–1.25;AMH < 1.1 ng/ml or AFC < 7 or FSH ≥10mIU/mL, AOR: 1.29, 95%CI:1.22– 1.37). Compared with the PSQI ≤ 5 group, subjects with PSQI > 5 had increased odds of diminished ovarian reserve (odds ratio [OR]: 3.80, 95% CI: 2.82– 5.13; AOR: 4.43, 95% CI: 3.22–6.14). After stratification by age and body mass index (BMI), compared with the PSQI ≤ 5 group, all subgroups of the PSQI > 5 group had increased odds of diminished ovarian reserve, especially <35-year-old and BMI ≤ 18.4 kg/m2 subgroups. ConclusionsPoor sleep quality is associated with diminished ovarian reserve in women of reproductive age.

P-700 Modelling individual follicle growth rates during ovarian stimulation in medically assisted reproduction cycles to enable prediction of final follicle profiles

Abstract Study question Can the growth of individual follicles during ovarian stimulation in medically assisted reproduction (MAR) cycles be modelled to enable prediction of final follicle profiles? Summary answer Mean follicle growth rate is 1.35 mm per day. Our model reliably forecasts follicle size profiles on the final scan within ±2mm with 75.1% accuracy. What is known already Follicle growth rates during ovarian stimulation are believed to be linear with various mean growth rates reported between 1 to 4 mm per day. Follicles are believed to grow faster during ovarian stimulation than in the natural menstrual cycle. The change in mean follicle size was 1.69 mm per day with ovarian stimulation in 131 MAR cycles, and 1.4 mm per day in 50 natural cycles. However, there are only very limited data using individual follicle sizes to model follicle growth to enable prediction of future follicle size profiles. Study design, size, duration We conducted a retrospective cohort study of 12,950 patients from 11 European clinics (2005-2023). First IVF/ICSI cycles with at least three follicles and two scans were analysed. Using 8,564 cycles with scans one or two days apart, 98,029 follicles were modelled to estimate follicle growth rates per day. Stratification by age, weight, total antral follicle count (AFC), initial FSH dose, and suppressant protocol was performed. Predictive modelling was conducted using 39,698 scans including 434,082 follicles. Participants/materials, setting, methods Assessment of Follicle Growth: Follicles were ranked and the difference in corresponding follicle sizes over consecutive scans estimated, and the impact of baseline characteristics evaluated. Prediction of follicle size profile on final scan: A kernel density estimator and random forest model were developed using the same training data. Both approaches estimated future follicle growth from the initial scan. The two predictions were combined using maximum-likelihood adjustments. Generalisation error was estimated using independent test data. Main results and the role of chance The mean growth rate of individual follicles was 1.350 mm per day (95% CI 1.346 – 1.353 mm per day), which was lower than the previously reported mean follicle growth rate during ovarian stimulation (1.7 mm per day). The large number of patient-cycles and follicles assessed enabled a precise estimate of follicle growth per day during ovarian stimulation. Age, total AFC, initial FSH dose, bodyweight, and suppressant protocol had no statistically significant effect on the estimated mean growth rate. Using only the follicle sizes from the initial scan during ovarian stimulation, our model had 75.1% accuracy for predicting follicle sizes on the final scan within ±2mm. Including follicle size data from the first two scans improved the accuracy of the model to predict the follicle sizes on the final scan to 80.4%. In a confirmatory analysis, we cross-validated our findings across each of 11 individual clinics, and similar estimates for the generalisation error as for the standard test/train split were maintained, suggesting suitable generalisability of these findings. Limitations, reasons for caution A key simplifying assumption in this study is that follicles demonstrate monotonic growth patterns. Specifically, the relative ordering of follicle sizes is preserved over the entire cycle. This assumption enables straightforward extraction of growth statistics from the observed data but assumes that follicles do not regress in size. Wider implications of the findings We have used a large high-quality dataset, allied to advanced modern machine learning techniques, to precisely estimate follicle growth rates during ovarian stimulation, and use this to reliably predict future follicle size profiles during ovarian stimulation. This supports the design, personalisation, streamlining and success of future assisted conception cycles. Trial registration number None

Correlation of Follicle-stimulating Hormone, Anti-Mullerian Hormone, and Antral Follicle Count with Age in Ovarian Reserve Testing.

Ovarian reserve and hence ovarian response has a key role in assisted reproductive technology and predicting response to gonadotrophins in controlled ovarian hyperstimulation. Various tools, namely follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), estradiol, etc., have been studied to discover the best determinant of ovarian reserve. The aim of our study is to correlate different reproductive hormones with age of women to estimate ovarian reserve and to evaluate reliable marker for aiding infertility treatment. It is an observational study performed for 6 months, with 88 women (aged 21-39 years) having a complaint of infertility, enrolled in the infertility clinic of a tertiary care hospital. Baseline scan for AFC was done for every patient and their blood was sent for serum FSH, AMH analysis. Statistical procedures were employed to determine the association between age and reproductive hormones (i.e. FSH and AMH) as independent variables and AFC as a dependent variable. A strong negative correlation was noted between FSH and AMH and between age and AMH (r = -0.492 and r = -0.498, respectively). A weak negative correlation was seen between AMH and total AFC (r = -0.241). A moderate positive correlation was seen on comparing age and FSH (r = 0.331), whereas no correlation was seen on comparing FSH with AFC and AMH with AFC. The presence of ovarian cyst did not affect AMH or AFC but reduced FSH values significantly. In the quest to determine a panel test for ovarian reserve testing we conclude, FSH and AFC should perform fairly in poor resource and low socioeconomic setting. The combination of FSH with AMH and AFC might aid in better determination of ovarian reserve in tertiary centers with available resources.

Correlation of FMR4 expression levels to ovarian reserve markers in FMR1 premutation carriers.

Fragile X-associated primary ovarian insufficiency (FXPOI), characterized by amenorrhea before age 40 years, occurs in 20% of female FMR1 premutation carriers. Presently, there are no molecular or biomarkers that can help predicting which FMR1 premutation women will develop FXPOI. We previously demonstrated that high FMR4 levels can discriminate between FMR1 premutation carriers with and without FXPOI. In the present study the relationship between the expression levels of FMR4 and the ovarian reserve markers was assessed in female FMR1 premutation carriers under age of 35 years. We examined the association between FMR4 transcript levels and the measures of total antral follicle count (AFC) and serum anti-müllerian hormone (AMH) levels as markers of ovarian follicle reserve. Results revealed a negative association between FMR4 levels and AMH (r = 0.45) and AFC (r = 0.64). Statistically significant higher FMR4 transcript levels were found among those FMR1 premutation women with both, low AFCs and AMH levels. These findings reinforce previous studies supporting the association between high levels of FMR4 and the risk of developing FXPOI in FMR1 premutation carriers.

Prolidase activity in women with polycystic ovarian syndrome undergoing assisted conception

Background: Prolidase is a manganese (Mn)-dependent cytosolic exopeptidase that degrades imidodipeptides with C-terminal proline or hydroxyproline. Prolidase recycling from imidodipeptides plays a critical role in collagen resynthesis and extracellular matrix (ECM) remodelling. Following an increase in gonadotropins, ovarian and follicular collagen undergo substantial degradation. Abnormal ovarian ECM composition is associated with polycystic ovary syndrome (PCOS). This study aimed to examine prolidase activity in the serum and follicular fluid (FF) of women undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment, comparing those with PCOS to those with normal ovarian function.Methods: This prospective study enrolled 50 participants, of whom 44 were included. PCOS diagnosis followed the Rotterdam consensus criteria, with 20 patients constituting the study group. The control group comprised 24 individuals with mild-to-moderate male infertility. Prolidase enzyme activity in serum and FF was measured using the Chinard reagent via spectrophotometric analysis and compared between the groups.Results: Serum and FF prolidase levels were significantly lower in patients with PCOS (p < 0.05). A direct correlation was observed between serum and FF prolidase levels (p < 0.05). Although blastocyst quality scoring (BQS) significantly decreased in PCOS patients, no statistical difference was observed in the clinical pregnancy rate between the groups (p < 0.05) (p > 0.05). A negative correlation existed between serum prolidase levels and total antral follicle (AF) count (p < 0.05). Conversely, both serum and FF prolidase levels positively correlated with BQS (r = 0.574)(p < 0.05) (r = 0.650)(p < 0.05).Conclusions: Patients with PCOS showed lower serum and FF prolidase levels, indicating abnormal degradation of ovarian and follicular collagen, potentially causing anovulation.

Evaluation of ovarian reserve in unexplained ınfertile cases: a case-controlled study

BackgroundThe aim of this study was to evaluate the effectiveness of current ovarian reserve tests in unexplained infertile cases.Material and methodsThis case–control study was conducted on 70 unexplained infertile women who were included in a tertiary university hospital. Both groups of basal FSH, estradiol, antimullerian hormone (AMH), inhibin B, ovarian volume, total antral follicle count (AFC), ovarian volume, and ovarian stromal blood flow (peak systolic velocity (PSV), S/D (systole and diastole ratio), resistance index (RI), and pulsatility index (PI)) values were compared.ResultsThe mean AMH, inhibin B, PSV, and stromal blood flow values of the control group patients were higher than those in the unexplained infertility group. However, the values of the means of RI and PI of the cases in the control group were lower than those in the infertility group. When PI’s value was ≥ 2.00, its sensitivity was 65.7%, and its specificity was 64.3%. In the case of the RI, its value was ≥ 0.745, its sensitivity was 65.7%, and its specificity was 62.9%. In order to show ovarian reserve in unexplained infertile cases, the sensitivity values can be sorted from high to low as follows: PI > RI > estradiol > FSH > ovarian volume > AFC > inhibin B > stromal blood flow > PSV > S/D.ConclusionIn the unexplained infertile patient group with normal ovarian reserve test results, basal estradiol, decreased PI, and RI values may be used as good ovarian reserve predictors.

Association between polycystic ovarian morphology and insulin resistance in women with polycystic ovary syndrome.

The aim of the present study was to determine whether polycystic ovarian morphology (PCOM) is related to insulin resistance in women with polycystic ovary syndrome (PCOS). A total of 147 Korean women aged 18 to 35 years and diagnosed with PCOS were included in this study. Fasting blood tests and standard 2-hour 75-g oral glucose tolerance tests were performed for all participants. PCOM-related parameters including total antral follicle count (TFC) and total ovarian volume (TOV) were assessed using transvaginal or transrectal ultrasonography. Correlation analysis was conducted to assess the relationships of TFC and TOV with insulin resistance-related clinical and biochemical parameters using Spearman rank correlation coefficients and linear regression analysis, with partial correlations used to control for the effects of confounding covariates. Fasting insulin levels, low-density lipoprotein levels, and insulin sensitivity assessment indices (ISAIs) were significantly correlated with TFC, but neither postprandial blood glucose levels nor insulin levels were significantly associated with TFC. No insulin resistance-related parameter was significantly correlated with TOV. These results did not change after adjustments for other anthropometric covariates. Fasting insulin and some ISAIs differed significantly between groups categorized by the median TFC value (TFC ≤54 and TFC >54). TFC, but not TOV, was found to be related to fasting insulin resistance-related parameters in women with PCOS.

İn Vitro Fertilizasyon/İntrasitoplazmik Sperm Enjeksiyonu Uygulanan Çiftlerde Paternal Yaşın Düşük Oranlarına Etkisi

Aim: The aim of this study was to determine the effect of paternal age on miscarriage rates in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles. Material and Methods: Patients were classified into two groups. The study group consisted of the patients whose pregnancy resulted in a miscarriage (n=73) and a control group in which the patients had a live singleton birth (n=256). Demographic characteristics, treatment indications, duration of infertility, menstruation day 3 follicle stimulating hormone, estradiol, luteinizing hormone, total antral follicle count, anti-Mullerian hormone levels and controlled ovarian stimulation parameters, day of trigger, estradiol and progesterone levels on the day of trigger, the total number of oocytes retrieved, the number of mature oocytes, the number and quality of the embryo, endometrial thickness on the day of trigger, oocyte pick up and embryo transfer, the distance of embryo-fundus and the day of embryo transfer were recorded. Results: Totally 329 women were included in the present study. The number of patients with the diagnosis of unexplained infertility was statistically significantly higher in the study group than in the control group (p=0.020). Maternal age was found statistically significantly higher in the study group than in the control group (p=0.025). When maternal age increased by 1 unit, the risk of miscarriage increased by 8.7% and those with unexplained infertility had a 75.6% higher risk of miscarriage than those without unexplained infertility. Conclusion: Paternal age was not associated with miscarriage whereas maternal age and unexplained infertility had a positive correlation with miscarriage rate.

The follicular output rate in normo-ovulating women undergoing ovarian stimulation is increased after unilateral oophorectomy

Does unilateral oophorectomy modify the antral follicular responsiveness to exogenous FSH, assessed by the Follicular Output RaTe (FORT) in normo-ovulating women? Antral follicle responsiveness to exogenous FSH, as assessed by the FORT index, is significantly higher in women with a single ovary in comparison with the ipsilateral ovary of age-matched controls. Growing evidence indicates that the innovative FORT may be a remarkable tool to evaluate the follicle responsiveness to exogenous FSH, independently of the size of the pretreatment cohort of small antral follicles. It is conceivable that in the unclear compensating mechanisms at play in women having undergone unilateral oophorectomy, an increase in the sensitivity of antral follicles to FSH may be involved. To clarify this issue, we decided to investigate whether the responsiveness of follicles to exogenous FSH, as assessed by the FORT, is altered in unilaterally oophorectomized patients. The study included 344 non-polycystic ovary syndrome, non-endometriotic women, aged 22-43 years old. There were 86 women who had a single ovary as a result of unilateral oophorectomy or adnexectomy (Single Ovary group; average time since surgery: 52 (8-156) months), and each of them was retrospectively matched with three patients having two intact ovaries, according to age (±1 year), year of ovarian stimulation, and FSH starting dose (±50 IU) (Control group, n = 258). Serum anti-Mullerian hormone (AMH) levels and total antral follicle count (AFC) (3-12 mm) were assessed on cycle day 3 in both groups. In all patients, follicles were counted before exogenous FSH administration (baseline) and on the day of oocyte trigger (OT) (dOT; preovulatory follicles; 16-22 mm). Antral follicle responsiveness to FSH was estimated in both groups by the FORT, determined by the ratio of the preovulatory follicle count on dOT × 100 to the small AFC at baseline. FORT in the Single Ovary group was compared to the overall FORT considering both ovaries or the index calculated on the ipsilateral ovary of matched controls. Overall, serum AMH levels and total AFC (1.0 (0.5-2.1) vs 1.8 (1.0-3.3), P < 0.005) and (9.0 (6.0-17.0) vs 13.0 (8.0-21.0), P < 0.001, respectively) were lower in the Single Ovary group compared to the Control group. When considering the FORT calculated on the basis of the overall ovarian response in women with two ovaries, the results were similar when compared to those obtained in patients unilaterally oophorectomized (30.4% (15.6-50.0) vs 32.5% (14.0-50.0), respectively). Interestingly, the comparison of FORT between women with a single ovary and the ipsilateral ovary of age-matched controls, revealed, after adjustment for AMH and AFC, a significantly higher ratio after unilateral oophorectomy (32.5% (14.8-50.0) vs 25.0% (10.0-50.0), P < 0.002, respectively). This study was based on retrospective data in a limited population. In addition, the FORT index has inherent limitations due to its indirect assessment of follicular responsiveness to FSH. The present investigation provides evidence that the responsiveness of antral follicles to exogenous FSH is increased in women having undergone unilateral oophorectomy when compared to the ipsilateral ovary of age-matched controls. This is consistent with the implication of a compensating phenomenon that drives the follicular changes in unilaterally oophorectomized patients. Further studies directly assessing the granulosa cell function and the density of FSH receptors in small antral follicles are required to confirm our findings. The authors have no funding or competing interests to declare. N/A.

Effects of Selective Serotonin Reuptake Inhibitor Treatment on Ovarian Reserves in Patients with Depression.

Background and Objectives: The goal of this study was to investigate the effect of selective serotonin reuptake inhibitor treatment on the ovarian reserves of women of reproductive age with major depressive disorder. Materials and Methods: The current study is a prospective controlled trial including 48 women with major depressive disorder and 48 age-matched healthy controls. Ovarian reserve tests are performed prior to treatment and after six cycles of selective serotonin reuptake inhibitor treatment in the major depressive disorder group. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, and anti-Müllerian hormone levels were evaluated from blood samples, and endometrial thickness, total antral follicle count, and volume of both ovaries were assessed using transvaginal ultrasonography. Results: When the first measurements were compared, menstrual duration and menstrual bleeding increased (p = 0.007 and 0.005, respectively) and luteinizing hormone decreased (p = 0.045) in the major depressive disorder group, while follicle-stimulating hormone, estradiol, anti-Müllerian hormone, endometrial thickness, total antral follicle count, and mean ovarian volume did not differ significantly between groups (p > 0.05). When the major depressive disorder group's first and final measurements were compared, follicle-stimulating hormone, estradiol, and endometrial thickness increased (p = 0.05, 0.0001, and 0.005, respectively), luteinizing hormone remained constant (p = 0.541), and anti-Müllerian hormone and total antral follicle count decreased (p = 0.024 and 0.042, respectively). Conclusions: In this study, we observed that the ovarian reserve test results of patients diagnosed with major depression for the first time after 6 months of SSRI treatment were significantly different from the results of the pretreatment and control groups.

Investigating the impact of endometrial compaction on clinical pregnancy rate in artificial frozen-thawed embryo transfer cycles

Objective: The aim of our study was to evaluate sonographic endometrial thickness succeeding the estrogen-only stage and on the&#x0D; day when embryo transfer (ET) occurred in artificial frozen embryo transfer (FET) cycles to delve into the effect of endometrial&#x0D; compaction (EC) on clinical pregnancy rate (CPR).&#x0D; Patients and Methods: In the first group endometrial thickness diminished when ET occurred when compared to the end of the&#x0D; estrogen-only phase (n:37). Endometrial thickness increased/did not alter for the second group (n:70).&#x0D; Demographic characteristics were recorded and the following were studied: in vitro fertilization (IVF) treatment indications, hormone&#x0D; levels, total antral follicle count, duration of infertility, embryo quality, embryo-fundus distance, endometrial thickness at the end of&#x0D; estrogen-only phase and on ET day, luteal support, CPR.&#x0D; Results: No significant difference occurred in CPRs (n:107). ET, on day 5 was higher in the first group (p

ADAPTATION OF INFERTIL PATIENTS TO THE COVID-19 VACCINE AND IVF TREATMENT RESULTS

Bu çalışmanın amacı, infertil hastaların Koronavirüs hastalığı-2019 (COVID-19) aşısına bakış açılarını değerlendirmek; uygulanan COVID-19 aşısının kadınların over rezerv testleri üzerine ve in vitro fertilizasyon (IVF) tedavi sonuçlarına etkisini ölçmektir. Prospektif olarak planlanan bu çalışma Hüma Kadın Hastalıkları ve Doğum Hastanesi, Tüp Bebek Ünitesi’nde yapılmıştır. Çalışmaya Nisan 2022-Haziran 2022 tarihleri arasında infertilite nedeniyle başvuran 187 hasta dahil edilmiştir. Hastalar COVID-19 aşısı yaptırıp yaptırmama durumuna göre 2 gruba ayrıldı. Aşı yaptırmayı kabul eden 1. gruptaki 94 hastanın aşı öncesi Folikül Stimülan Hormon (FSH), Estradiol (E2), Anti Müllerian Hormon (AMH) değerlerine ve toplam antral follikül sayılarına (AFS) bakıldı. Aşı yaptırmayı kabul etmeyen 93 hastanın da aynı parametrelerine bakıldı. Aşı yaptıran ve yaptırmayan bu iki grup arasındaki over rezerv testleri ile IVF tedavi sonuçları karşılaştırıldı. Aşı yaptıran hastaların aşı öncesi ve sonrası over rezerv testleri değerlendirildiğinde FSH, AMH, E2 ve AFS bakımından istatistiksel olarak anlamlı bir farklılık bulunamadı. IVF tedavi sürecinde aşı yaptıran grup ile yaptırmayan grup arasında toplanan oosit sayısı, M2 oosit sayısı, fertilizasyon, implantasyon ve klinik gebelik oranlarında anlamlı istatistiksel bir farklılık izlenmedi (p&gt;0.05). COVID-19 aşısı kişileri enfeksiyondan korurken over rezervi üzerinde herhangi bir azalma yapmadığı çalışmamızda gösterilmiştir. İnfertil hastalarda IVF tedavisi öncesi aşı yaptırmanın, tedavi sürecini ve sonuçlarını olumsuz etkilemediği yine bu çalışmada kanıtlanmıştır.

Evaluation of correlation between antral follicle diameters with Follicular Output Rate (FORT) in women under controlled ovarian hyperstimulation for assisted reproductive techniques

Abstract Background This study aimed to determine the association of diametrical antral follicles with the ovarian response by Follicular Output Rate (FORT) ratio in 100 females undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). This study selected 100 women undergoing controlled ovarian hyperstimulation (COH). The number of antral follicles (diameter of 3–10 mm) was calculated with two-dimensional vaginal sonography on days 1–3 of the cycle. Then, on a triggering day with human chorionic gonadotropin (HCG), the number of follicles (with a diameter of 16–22 mm) and the ratio of FORT were determined. The correlation among FORT with age, antral follicle count (AFC), AFC ≤ 5, AFC &gt; 5, number of preovulatory follicles (16–20 mm), number of metaphase II (MII) oocytes, body mass index (BMI), infertility period, and anti-Mullerian hormone (AMH) was assessed. Results There was a significant correlation between FORT and total AFC, AFC &gt; 5, number of preovulatory follicles (16–20 mm), and number of MII oocytes retrieved. There is no significant relationship between FORT and examined two variables (AMH and AFC ≤ 5). Multiple linear regression analysis showed no significant relationship between FORT and examined two variables (AMH and AFC &gt; 5). There was a significant correlation between MII oocytes retrieved and age, total AFC, AFC ≤ 5, AFC &gt; 5, number of preovulatory follicles (16–20 mm), and AMH. A significant positive relationship existed between MII oocytes retrieved and examined two variables (AFC ≤ 5 and AFC &gt; 5). Conclusion There was not much difference in the correlation between the AFC ≤ 5 and AFC &gt; 5, and both positively correlated with the number of MII oocytes retrieved.

Effects of Levonorgestrel-Releasing Intrauterine Device Therapy on Ovarian Reserve in Menorrhagia.

Objective This study aimed to investigate the effects of levonorgestrel-releasing intrauterine device (LNG-IUD) treatment on ovarian reserve in women of reproductive agediagnosed with menorrhagia. Methods This was a prospective controlled trial involving 50 women with menorrhagia and a control group comprising age-matched 50 healthy women.Women who satisfied the LNG group criteria underwent an endometrial pipelle biopsy and LNG-IUD insertion. Ovarian reserve tests were performed prior to and six months after LNG-IUD insertion in the LNG group cases. Results Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian hormone (AMH), endometrial thickness (ET), total antral follicle count (AFC), and mean ovarian volume values before LNG-IUD insertion did not differ between the LNG and control groups. When the final measurements were compared, FSH, AMH, total AFC, and average ovarian volume increased (p=0.05, 0.046, 0.022, and 0.022, respectively), E2 and ET decreased (p=0.034 and 0.001, respectively) in the LNG group, while LH did not differ significantly between the groups (p=0.71). Conclusion We observed that LNG-IUD use effectively improves fertility capacity. In this study, LNG-IUD use in reproductive-age women diagnosed with menorrhagia decreased E2 levels, did not change LH levels, and increased FSH, AFC, and AMH levels.

LBMON234 Ultrasonographic Criteria In The Diagnosis Of Polycystic Ovary Syndrome: A Systematic Review And Meta Analysis

Abstract Ultrasonographic evaluation of polycystic ovarian morphology (PCOM) is part of the diagnostic evaluation of polycystic ovarian syndrome (PCOS). The relevance of PCOM as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM. We synthesized evidence on diagnostic test accuracy of ovarian ultrasound features to comprehensively determine the most suitable markers to diagnose PCOS. The primary outcome was diagnostic accuracy measures (e. g., thresholds, sensitivity, specificity) for PCOS using the following ovarian markers: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Databases of PubMed, Web of Science, Scopus, CINAHL, and CENTRAL were searched until 7 November 2021 to identify studies that compared ultrasound markers between women with PCOS to those without PCOS. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. From a total of 1869 records initially identified, 22 studies were included and 18 (N=6,337; [n=2991 PCOS; n= 3346 Control]) were pooled for meta-analysis. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81% to 87%; specificity: 91%, CI: 87% to 94%). OV and FNPS had similar but inferior pooled sensitivity (OV: 81%, CI: 75% to 86%; FNPS: 81%, CI: 70% to 89%) and specificity (OV: 79%, CI: 73% to 84%; FNPS: 83%, CI: 75% to 88%) compared to FNPO. Majority of studies had high risk of bias for patient selection and index test methodology across all markers. Subgroup analysis indicated that stratification based on age, body mass index (BMI), and previously proposed thresholds did not account for the heterogeneity in diagnostic accuracy observed across studies. For FNPO, studies that used a transducer frequency &amp;lt;8MHz or the Rotterdam criteria had improved positive likelihood ratio (+LR) and sensitivity, respectively. European studies had improved diagnostic accuracy (specificity, diagnostic odds ratio, +LR) compared to North American studies for FNPO, potentially due to BMI differences between PCOS populations (North America: 30.29 ± 0.61kg/m2, Europe: 27.62 ± 0.73kg/m2). Our findings support the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS, with OV and FNPS as robust alternatives if total antral follicle counts cannot be obtained. These findings also identify avenues for future research to refine the ultrasonographic definition of PCOM for timely diagnosis of PCOS and investigations into phenotypic variations in pathogenesis and response to treatment in this condition (PROSPERO ID: CRD42021259118). Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

High physical activity and ovarian reserve: a prospective study of normo-ovulatory professional athletes

BackgroundThis study investigated whether high physical activity affects ovarian reserve in normo-ovulatory, reproductive-age women.MethodsThis prospective, observational study compared 31 professional female athletes, with 31 women who did not engage in physical activity. It was conducted 2017–2020 in a tertiary medical center. Normo-ovulatory, professional athletes, ages 20–35 years were recruited from The Wingate Institute—the Israeli National Institute for Sport Excellence. They had high International Physical Activity Questionnaire (IPAQ) scores. Non-physically active women, matched by age and body mass index, were recruited from hospital staff. Women were evaluated for ovarian reserve markers on day 2–5 of the menstrual cycle, including follicular stimulating hormone, antral follicle count, anti-Mullerian hormone and Inhibin B.ResultsThe average age of the high physical activity group was 29.9 ± 4.2 years and the nonactive group 31.6 ± 4.2 years (p = 0.062). Body mass index of both groups were similar (22.5 ± 5.0 vs. 21.4 ± 2.5, respectively; p = 0.1). No differences were observed with respect to follicle stimulating hormone (p = 0.12) and anti-Mullerian hormone (p = 0.16). A trend towards higher total antral follicle count in the high physical activity group vs. the non-active group (34.5 ± 12.9 vs. 28.1 ± 15.2, p = 0.08) and lower Inhibin B (68.1 ± 36.8 vs. 89.4 ± 46.1, p = 0.05). Menarche age correlated with anti-Mullerian hormone (r = 0.387, p = 0.003), as did total antral follicle count (r = 0.368, p = 0.004). IPAQ scores and basal follicle stimulating hormone levels were negatively correlated (r = − 0.292, p = 0.005).ConclusionsAthletic, normo-ovulatory women have ovarian reserves that are at least as good as those of the general population. As this is the first study examining this issue, it could cautiously reassure women engaged in high physical activity regarding ovarian reserve.

Risk factors related to early pregnancy loss in fresh IVF/ICSI: An analysis of 954 embryo transfer cycles.

Early pregnancy loss (EPL) is a common complication of assisted reproductive technology treatment; however, the exact factors involved in EPL are not fully understood. This study aimed to evaluate the risk factors for EPL in fresh in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study was conducted on all couples who underwent clinical pregnancy in fresh IVF/ICSI cycles from January to December 2019 at a single large reproductive medical center. In total, 954 cycles were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate relevant risk factors for EPL. Curve fitting and threshold analyses were used to explore the association between risk factors and EPL. Compared with women with a normal total antral follicle count (AFC) (≥10, <15), those with a low AFC (<10) had a higher risk of EPL (odds ratio 2.97, 95% confidence interval: 1.38–6.38, P < .05). Patients with an estradiol/progesterone ratio (E2/P) ≥ 1.1 had significantly lower odds of EPL than women with E2/P < 1.1 (odds ratio 0.51, 95% confidence interval 0.28–0.91, P < .05). E2/P and serum human chorionic gonadotropin (hCG) levels negatively correlated with EPL. By using a 2-piecewise regression model, the inflection point of serum hCG level was 599.9 IU/L. Our results showed that lower AFC, E2/P, and serum hCG levels were associated with a higher EPL risk in fresh IVF/ICSI cycles.

42 Genome-wide Association Study of Ovary Characteristics in Admixed Beef Heifers Through Comparative Bayesian Approaches

Abstract Reproductive performance of heifers is a key indicator of herd productivity. The objective was to evaluate markers and genes associated with reproductive tract characteristics through a comparative approach. For this study, 295 admixed beef heifers were examined via transrectal ultrasonography at approximately 13 months of age. Exploratory factor analysis of antral follicular count (count per size, side, and total), length, height and diameter for left and right sides of ovaries, and uterine horn diameter revealed a latent variable that included total antral follicle count and ovary diameters per side (n = 3 traits), termed OVARY. Confirmatory factor analysis produced OVARY values per heifer. Quality controls left 116,133 SNP per heifer for association analyses. A marker window-based univariate approach with OVARY was conducted using an empirical Bayesian approach adjusting for nested population structure using marker frequency differences (Method 1) as well as an MCMC Bayesian approach identifying the fraction of SNP to be included with population structure as a fixed effect (Method 2). SNP with high genetic variance in important windows (PPAW &amp;gt; 0.75) were mapped to their closest gene for enrichment analysis. Using Method 1, 2 genes were found to be associated and enrichment analysis identified SMYD2 contributing generally to epigenetic and transcriptional regulatory pathways and GO terms (adjusted P &amp;lt; 0.05). Using Method 2, 11 genes were discovered to be associated with OVARY (adjusted P &amp;lt; 0.05). Three of 11 genes were involved in neural transduction, cornification, epithelial integrity, and adipogenic pathways and GO terms. Eight of 11 genes were involved in reproductive hormonal signaling, post-natal growth, sex determination and reproductive organs development, embryo implantation, and signaling transduction GO terms. Given this, Method 2 provides better insights towards the association of markers and genes for future selection of admixed beef heifers with overall better reproductive characteristics than Method 1.

Follicular activation in women previously diagnosed with poor ovarian response: a randomized, controlled trial

To investigate whether ovarian fragmentation for follicular activation (OFFA) improves ovarian reserve markers and invitro fertilization (IVF) outcomes in women with poor ovarian response (POR). Randomized, controlled trial, with parallel assignment. University hospital. Thirty-four women with POR according to the European Society of Human Reproduction and Embryology criteria. Women with POR were randomly allocated to receive ovarian fragmentation in 1 ovary or to no intervention (control group). Ovarian reserve markers were followed at 2-week intervals for 6 months. Invitro fertilization cycles were initiated when the antral follicle count (AFC) doubled or at the end of follow-up. The primary outcome was the number of metaphase II (MII) oocytes obtained. Antral follicle count, antimüllerian hormone level, and reproductive outcomes were recorded as secondary outcomes. Exploratory outcomes included surgical results and analysis of protein and gene expression. Ovarian fragmentation for follicular activation resulted in an increase in AFC in the intervention ovary compared with the control ovary and an increase in total AFC in the OFFA group compared with controls. Serum antimüllerian hormone and follicle-stimulating-hormone levels did not improve in the OFFA group throughout the follow-up period. Fifteen patients from each arm underwent IVF. In the control group, 33 MII oocytes were retrieved and 18 embryo transfers were performed, with a 20% pregnancy rate and an 18.7% live birth rate per cycle. In the OFFA group, 23 MII oocytes were retrieved and 11 embryo transfers were performed, with a 13.3% pregnancy rate and a 6.7% live birth rate per cycle. Reproductive outcomes did not significantly differ between the groups. Hippo pathway inhibition was confirmed by an 18.8% reduction in the phospho-YAP/YAP (Yes-associated protein 1) ratio and BIRC and CCN overexpression after fragmentation. Ovarian fragmentation for follicular activation in women with POR resulted in an increase in AFC but did not modify IVF outcomes when compared with controls. NCT02354963.

Effect of cigarette smoking on serum anti-Mullerian hormone and antral follicle count in women seeking fertility treatment: a prospective cross-sectional study

ObjectivesThe relationship between smoking and ovarian reserve markers is inconclusive. The primary objective of our study was to assess the effect of cigarette smoking on the quantitative ovarian reserve parameters,...