Women Of Late Reproductive Age Research Articles

Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment.

IntroductionFertility is referred to the capability for having offspring and can be evaluated by fertility rate. Women’s fertility is strictly dependent on individual’s age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35).AimThe aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Müllerian hormone (AMH) levels.Results There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Müllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor-β (TGF-β) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMH’s predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids.Conclusions AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.

Stateof-the-art of realization of the fertility potential in the women of late reproductive age

Biological potential of childbearing in the women of late reproductive age is limited by natural impairment and loss offertility. Despite a considerable progress in clinical application of new diagnostic and reproductive technologies, the problem of infertility remains a most serious challenge. Women's age is one of the main factors responsible for the outcome of in vitro fertilization. The low effectiveness of in vitro fertilization programs is attributed to discoordination in the hypothalamic-pituitary system, depletion of ovarian resources, and deterioration of quality of reproductive material. Bearing in mind the role of melatonin in synchronizing circadian and seasonal biorhythms and regulating physiological and pathological processes, it is natural to suggest its role in the enhancement of efficiency of in vitro fertilization programs for women of late reproductive age.

EFFECT OF OOCYTES QUALITY AND OVARIAN RESERVE ON THE THERAPEUTIC POTENTIAL OF IN VITRO FERTILIZATION IN PATIENTS OF LATE REPRODUCTIVE AGE

The paper discusses the interference of the quality of oocytes and ovarian reserve status in the therapeutic potential of in vitro fertilization in women of late reproductive age. It was substantiated that the age factor decreased both female fertility and possibility of the successful fertilization.

Methods in a longitudinal cohort study of late reproductive age women: the Penn Ovarian Aging Study (POAS)

BackgroundThis report describes the methods utilized in the Penn Ovarian Aging Study (POAS), which is a longitudinal cohort study of hormone dynamics and menopausal symptoms of women in the menopause transition.Methods/DesignThe cohort is a community-based sample of generally healthy women enrolled in the late reproductive years. The study population is a stratified random sample of African-American and Caucasian women, identified by random digit dialing.Of the 1427 women who were identified as potentially eligible, 578 women were eligible after full screening; 75 % of the eligible women enrolled in the study (436/578). At Period 14 (14 years after study enrollment), 67 % remained active and were fully evaluated (293/436). Attrition was non-differential with respect to the sample characteristics.The aims of the project overall are to 1) identify within-woman trends of reproductive hormones (estradiol, follicle stimulating hormone, hormone, lutinizing hormone, inhibin B, dehydroepiandrosterone, testosterone, and anti-mullerian hormone), cofactors such as race, body mass index (BMI), age, physical and behavioral symptoms, and their predictions of menopausal symptoms, and patterns around the final menstrual period; 2) identify associations of hormone dynamics with physical and behavioral symptoms that occur with ovarian aging and identify racial differences in these factors; 3) identify associations of genetic polymorphisms with levels and longitudinal trends in menopausal symptoms. The cohort consists of 436 late reproductive-age women at enrollment, and now has 18 years of approximately annual follow-up assessments. Menopausal stage based on concurrent menstrual dates is identified at each follow-up period.DiscussionStudies of the cohort have shown that hot flashes can occur well before menopause and extend 10 or more years beyond menopause for sizeable numbers of women; provide evidence for new-onset depressed mood in the menopause transition and show that the final menstrual period is pivotal in the increases in depressive symptoms prior to menopause and decreases postmenopausal; suggest that poor sleep is common in the late reproductive years but increases in relation to the final menstrual period in only a small proportion of women; and show effects of obesity on reproductive hormones in the menopause transition. To date, more than 50 studies of the cohort are published in medical journals, demonstrating the relevance of these data to the clinical care of mid-life women.Electronic supplementary materialThe online version of this article (doi:10.1186/s40695-016-0014-2) contains supplementary material, which is available to authorized users.

Higher serum total testosterone levels correlate with increased risk of depressive symptoms in Caucasian women through the entire menopausal transition

BackgroundDespite the high prevalence of depressive symptoms in women, the precise role of sex hormones in mood changes during the menopausal transition is unclear. Previous studies have been inconsistent with regard to identifying the association of androgens, namely total testosterone, with depressive symptoms. ObjectiveThe objectives of this study were to evaluate changes in serum total testosterone levels and depressive symptoms during the entire menopausal transition, and examine the impact of covariates on the association between concurrent serum total testosterone levels and depressive symptoms during this time period. MethodsA longitudinal cohort study (428 women at baseline with 3634 repeated measures) using data from the Penn Ovarian Aging Study, a population-based cohort of late reproductive-aged women, followed through the menopausal transition. Serum hormone parameters and depression scores using the Center for Epidemiological Studies of Depression scale (CES-D) were measured at each annual visit over a 14-year period. General linear (for testosterone) and a generalized negative-binomial model (for depressive symptoms) for repeated measures were used for analysis. ResultsSerum total testosterone levels increased progressively over the study period and were significantly associated with older age and with current smoking (p<0.001, respectively). In the post menopause total testosterone levels were significantly higher in African Americans compared to Caucasians (p=0.012). The proportion of women with CES-D ≥16 significantly decreased with increasing age and in the post-menopausal period, and were higher in women with a history of depression and hot flashes (p<0.001). The association between concurrent testosterone levels and high depressive symptoms (CES-D ≥16) differed by race (p=0.008). In Caucasians, but not African Americans, higher serum testosterone levels were associated with increased depressive symptoms after controlling for several variables including age, obesity status, hot flashes and menopausal status (RR 1.09, 95% CI 1.00–1.17, p=0.042). ConclusionIn our cohort, testosterone levels were low but progressively increased from premenopause through post menopause. In addition to age and history of depression, we identified race to have a significant interaction between the association of testosterone levels and depressive symptoms. This study further supports the associations between sex hormones and increased risk of having depressive symptoms, although the precise underlying mechanisms for this association remain unclear.

Premature ovarian insufficiency: current point of view

Ovarian AMH expression seems to be absent in primordial follicles, theca cells or oocytes, but is highest in granulosa cells of pre-antral and small antral follicles. Interestingly, AMH is expressed in follicles that have undergone recruitment from the primordial follicle pool but have not been selected for dominance. Serum AMH concentrations, being stable and consistent throughout the menstrual cycle, constitute a reliable marker of ovarian reserve; thus, AMH has already found a role in the clinical practice, particularly when combined with classic markers of ovarian reserve such as age, Follicle Stimulating Hormone (FSH) and antral follicle count (AFC). AMH has emerged as a marker of ovarian reserve and a possible surrogate marker of reproductive aging. There is recent evidence that AMH is a strong predictor of time to menopause in women of late reproductive agewomen (20–49 years). For thosewho reached menopause, serum AMH concentrations six years before the event provided fairly accurate estimates of the age at menopause. Age and smoking are additional, independent predictors of this event.

Prenatal diethylstilbestrol exposure and reproductive hormones in premenopausal women.

Diethylstilbestrol (DES), a synthetic estrogen widely prescribed to pregnant women in the mid-1900s, is a potent endocrine disruptor. Prenatal DES exposure has been associated with reproductive disorders in women, but little is known about its effects on endogenous hormones. We assessed the association between prenatal DES exposure and reproductive hormones among participants from the Harvard Study of Moods and Cycles (HSMC), a longitudinal study of premenopausal women aged 36-45 years from Massachusetts (1995-1999). Prenatal DES exposure was reported at baseline (43 DES exposed and 782 unexposed). Early follicular-phase concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol were measured at baseline and every 6 months during 36 months of follow-up. Inhibin B concentrations were measured through 18 months. We used multivariable logistic and repeated-measures linear regression to estimate odds ratios (OR) and percent differences in mean hormone values (β), respectively, comparing DES exposed with unexposed women, adjusted for potential confounders. DES-exposed women had lower mean concentrations of estradiol (pg/ml) (β=-15.6%, 95% confidence interval (CI): -26.5%, -3.2%) and inhibin B (pg/ml) (β=-20.3%, CI: -35.1%, -2.3%), and higher mean concentrations of FSH (IU/I) (β=12.2%, CI: -1.5%, 27.9%) and LH (IU/I) (β=10.4%, CI: -7.2%, 31.3%), than unexposed women. ORs for the association of DES with maximum FSH>10 IU/I and minimum inhibin B<45 pg/ml--indicators of low ovarian reserve--were 1.90 (CI: 0.86, 4.22) and 4.00 (CI: 0.88-18.1), respectively. Prenatal DES exposure was associated with variation in concentrations of FSH, estradiol and inhibin B among women of late reproductive age.

Clinical results of long-term use of selective progesterone receptor modulators and gonadotropin releasing hormone agonists in the treatment of uterine leiomyoma

The study was performed to assess the effectiveness of drug treatment of uterine leiomyoma in premenopausal women using progesterone receptor modulator ulipristal acetate (UPA ) in comparison with gonadotropin-releasing hormone agonists (aGnRH). The I group consisted of 30 women with uterine leiomyoma who received aGnRH in extended course plus hormone replacement medication. Group II included 15 women receiving periodic treatments with UPA . The control group included 30 healthy women of late reproductive age. Median follow-up for women was 18 months. The results showed that the UPA provides a longer lasting effect after the end of therapy, unlike aGnRH, leading to the elimination of the uterine leiomyoma symptoms in 86.7% of women

Treatment of genital endometriosis in women of late reproductive and premenopausal age

Treatment of genital endometriosis in women of late reproductive and premenopausal age

Clinical and morphological characteristics of chronic endometritis in women with hysteromyoma

The aim of our research was to identify clinical, morphological features of chronic endometritis among women of reproductive age with a hysteromyoma. 150 patients of reproductive age were surveyed. After which women were divided into three groups. The first group consisted of women at whom the hysteromyoma was combined with a chronic endometritis. The second group - chronic endometritis without hysteromyoma. The third group consisted of apparently healthy women who have addressed to the doctor with questions of contraception and pregnancy planning. It is established that the clinical and morphological picture of a chronic endometritis doesn’t depend on existence at such women of a hysteromyoma. At the women surveyed in both the first and second group almost equally often found inflammatory diseases of the pelvic organs, the bottom department of the genitals, hyperplastic process of endometrium, abnormal uterine bleeding. Special difference in activity of inflammatory process in an endometriya depending on the availability at these women hysteromyoma is not revealed. The combination of chronic endometritis with hysteromyoma is more common for women of late reproductive age, in the anamnesis whicht had childbirth, induced abortion.

Detection of serum antimüllerian hormone in women approaching menopause using sensitive antimüllerian hormone enzyme-linked immunosorbent assays.

Current antimüllerian hormone (AMH) immunoassays are insufficiently sensitive to detect circulating AMH levels in ovulatory women approaching menopause. The aim of this study was to detect serum AMH levels across the menstrual cycle with age, using two new AMH enzyme-linked immunosorbent assay (ELISA) kits with increased sensitivity and differing specificity. Serum AMH levels were determined every 2 to 3 days across the interovulatory interval of menstrual cycles among women of early-mid reproductive age (18-35 y; n = 10) and late reproductive age (45-55 y; n = 17). Two highly sensitive AMH ELISAs (designated 24/32 and 24/37) with differing sensitivities were developed and applied to sera using a recombinant human pro-mature AMH preparation as reference. A third AMH ELISA (Gen II AMH ELISA kit; Beckman Coulter, Brea, CA) used was directed on mature-pro regions of AMH. AMH levels in all cycles were detectable with the 24/32 and 24/37 AMH ELISAs. AMH levels across the menstrual cycle were highly correlated (r = 0.98) between the 24/32 and 24/37 AMH ELISAs and the Gen II AMH ELISA (r = 0.94), but with large intracycle variations observed in older women. In late reproductive age, more than 95% of AMH values were detectable with the 24/32 and 24/37 AMH ELISAs, whereas only 36% of AMH values were detectable with the Gen II AMH ELISA. AMH levels were detected in cycles with lower antral follicle count and at a later age using the 24/32 and 24/37 AMH ELISAs compared with the Gen II AMH ELISA. AMH level correlated with antral follicle count in younger women, but not in older women. The new 24/32 and 24/37 AMH ELISAs have the sensitivity to monitor ovarian follicle profiles in late reproductive age.

Организация медицинской помощи беременным групп высокого риска

Health indicators in the women and children are the most important indicator of the level of socioeconomic situation of the country and the society development. The course of pregnancy, its maternal and neonatal outcomes are associated with age in the primiparous. Condition of importance for safe motherhood and success delivery is an adequate organization of perinatal care by means of modern medical technology. Study of the medicosocial risk factors of reproductive health is especially relevant for the planning of medical care in pregnant women in the region and for individual project of women&amp;#180;s reproductive health, prevention of complications of pregnancy and childbirth. The purposes of the research are to study the medical and perinatal risk factors, the reproductive health of young primiparous and late primiparous of reproductive age in Voronezh and Voronezh region and to organize medical assistance for these categories of women. Historical, sociological, statistical research methods and the method of expert estimations were used. Complex medical and social research of reproductive health, the medical activity of young primiparous and primiparous late of reproductive age in the Voronezh region, assessment of medical assistance to these categories of women were carried out. Level of somatic and gynecological health in young primiparous and late primiparous women of reproductive age was quite low. Pregnancy and childbirth in these age categories often progress to complications. Newborns in the primiparous teen mothers and primiparous women of late reproductive age have poor health. Young primiparous and primiparous of late reproductive age are classified high perinatal risk and require special attention during regular medical observation and delivery.

Hormonal changes in women of late reproductive, perimenopausal and postmenopausal age with urogenital disorders

Investigation of hormonal homeostasis in 51 women with urogenital disorders (urogenital prolapse, vaginal atrophy, urinary incontinence) and 10 healthy women (control group) was carried out. There was studied the concentration of pituitary-ovarian hormones, thyroid and adrenal glands hormones. The hormonal research showed a significant reduction of gonadotropins, prolactin, total testosterone, DHEA-S, cortisol in women of late reproductive age with urogenital disorders. In perimenopausal and postmenopausal women with urogenital disorders gonadotropins and TSH rates increased. Levels of prolactine, estradiol, progesterone, testosterone total, DHEA-S and cortisol reduced. In perimenopausal women with urogenital disorders level of total thyroxine (Т4) was significantly elevated.

Voluntary surgical contraception women of late reproductive age suffering from pelvic organ prolapse – features and benefits

Voluntary surgical contraception women of late reproductive age suffering from pelvic organ prolapse – features and benefits

Vitamin D and female fertility

Apart from the well known effects of vitamin D on maintaining calcium homeostasis and promoting bone mineralization, there is some evidence suggesting that vitamin D also modulates human reproductive processes. We will review the most interesting and relevant studies on vitamin D and female fertility published over the past year. In the past year, several observational studies reported a better in-vitro fertilization outcome in women with sufficient vitamin D levels (≥30 ng/ml), which was mainly attributed to vitamin D effects on the endometrium. One randomized controlled trial found an increased endometrial thickness in women with polycystic ovary syndrome (PCOS) receiving vitamin D during intrauterine insemination cycles. Further, vitamin D supplementation had a beneficial effect on serum lipids in PCOS women. Vitamin D treatment improved endometriosis in a rat model and increased vitamin D intake was related to a decreased risk of incident endometriosis. Vitamin D was also favorably associated with primary dysmenorrhea, uterine leiomyoma, and ovarian reserve in late reproductive aged women. In women undergoing in-vitro fertilization, a sufficient vitamin D level (≥30 ng/ml) should be obtained. Vitamin D supplementation might improve metabolic parameters in women with PCOS. A high vitamin D intake might be protective against endometriosis.

“Abnormal” Uterine Bleeding Is Common During the Menopausal Transition

So-called abnormal uterine bleeding is common in women of late reproductive age, but which bleeding patterns should be considered normal and which are

Infiltrating Adenomyosis of the Cervix With Features of a Low-grade Stromal Sarcoma

Adenomyosis is a common, non-neoplastic, chronic gynecologic disorder that is detected in 5% to 70% of hysterectomy specimens. It is characterized by the presence of ectopic endometrial glands and stroma within the myometrium, and it occurs mostly in late reproductive age women. Adenomyosis has a propensity to present in the uterine fundus and is rarely seen in the cervix. At present, the most reliable way to diagnose adenomyosis is by pathologic examination of the hysterectomy specimens. Herein, we report a case of infiltrating adenomyosis in the cervix with unusual clinical and pathologic findings.

Нyperprolactinemia correction in the complex treatment of endometrial hyperplasia

The paper describes the results of the research of hormonal changes in women of late reproductive age with nonatypical endometrial hyperplasia combined with functional hyperprolactinemia. The rationale of complex approach to the treatment of such patients with the use of herbal dophaminergic medication Cyclodynon is substantiated.

Impact of body mass index on the correlation of follicle stimulating hormone and antral follicle count with anti-mullerian hormone to measure ovarian reserve

Studies have shown age-related discordance between follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) and an inverse correlation between AMH with BMI in late-reproductive aged women. The impact of BMI on the correlation between AMH and FSH in the infertile population is not well understood. Our objective was to assess the impact of BMI on ovarian reserve markers in infertile women.

Using of three-dimensional power Dopplerultrasonography of women in late reproductive age with the suspicion of endometrial hyperplasia

We examined a total of 53 cases in late reproductive age with suspicion of endometrial hyperplasia according to 2D ultrasonography data. Three-dimensional power Doppler sonography was made for all women. We have offered the endometrial-uterine vascularization coefficient, endometrial-uterine flow coefficient, endometrial-uterine vascularization-flow coefficient for the improvement of ultrasonic diagnostics of intrauterine pathology.