scholarly journals Oligo/Amenorrhea Is an Independent Risk Factor Associated With Low Ovarian Response

2021 ◽  
Vol 12 ◽  
Author(s):  
Kai-Lun Hu ◽  
Kwanghann Gan ◽  
Yue Ying ◽  
Junyan Zheng ◽  
Ruixue Chen ◽  
...  
Keyword(s):  
Risk Factor ◽  
Menstrual Cycle ◽  
Independent Risk Factor ◽  
Polycystic Ovary ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Increased Risk ◽  
Normal Menstrual Cycle

CapsuleOligo/amenorrhea is an independent risk factor of low ovarian response but not high ovarian response, particularly in women with low AMH levels.ObjectiveTo investigate the association of menstrual cycle length (MCL) with anti-Müllerian hormone (AMH) and ovarian response.MethodsThis was a retrospective cohort study. A total of 7471 women who underwent ovarian stimulation and oocyte retrieval were enrolled. The main outcome was the number of oocytes retrieved.Main ResultsA total of 5734 patients were eligible for analysis. In women without polycystic ovary syndrome (PCOS), serum AMH levels and antral follicle count were significantly lower in women with short cycles and higher in women with oligo/amenorrhea than those with a normal menstrual cycle. In women with PCOS, compared to women with a normal menstrual cycle, women with short cycles and women with oligo/amenorrhea showed higher antral follicle count and higher serum AMH levels. Compared with the 0-25th range group of AMH levels, 75-100th percentile groups showed a significantly increased rate of oligo/amenorrhea in women with and without PCOS [adjusted odds ratio (OR) =1.9 (1.04, 3.46), 2.4 (1.70, 3.35)]. In women without PCOS, the low ovarian response was more common in women with short cycles and less common in women with oligo/amenorrhea compared to women with normal cycles [OR=3.0 (2.38, 3.78), 0.7 (0.55, 0.96), respectively]. When adjusted for AMH levels, both short cycles and oligo/amenorrhea were associated with an increased risk of low response [adjusted OR=1.3 (1.02, 1.75), 1.3 (0.93, 1.86), respectively]. In women without PCOS and with low AMH levels, the low ovarian response was more common in women with short cycles as well as in women with oligo/amenorrhea [OR=1.5 (1.08, 1.98), 1.7 (1.08, 2.69), adjusted OR=1.2 (0.86, 1.74), 2.2 (1.31, 3.82), respectively].ConclusionAMH levels are significantly associated with increased risk of oligo/amenorrhea in women with and without PCOS. AMH is an indispensable confounder in the association between MCL and ovarian response in women without PCOS. Oligo/amenorrhea is an independent risk factor associated with a low ovarian response in women without PCOS, particularly those with low AMH levels.

scholarly journals Effects of Hydrosalpinx on Endometrial Implantation Failures: Evaluating Salpingectomy in Women Undergoing in vitro fertilization

2021 ◽  
Author(s):  
Antonio Palagiano ◽  
Mauro Cozzolino ◽  
Filippo Maria Ubaldi ◽  
Chiara Palagiano ◽  
Maria Elisabetta Coccia
Keyword(s):  
In Vitro Fertilization ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Endometrial Receptivity ◽  
Vitro Fertilization ◽  
Ovid Medline ◽  
Ultrasonographic Guidance

AbstractHydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF). We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal removal could result in improved implantation rates in IVF. In addition, salpingectomy does not affect the ovarian response, nor reduces the antral follicle count. Further studies are needed to establish the therapeutic value of fluid aspiration under ultrasonographic guidance, during or after oocyte retrieval, in terms of pregnancy rate and ongoing pregnancy.

P–599 random antral follicle count, performed at any day of the menstrual cycle, demonstrates the same predictive value for ovarian response in in vitro fertilization cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Razafintsalama ◽  
M Bah ◽  
G Amand ◽  
L Vienet-Lègue ◽  
C Pietin-Vialle ◽  
...  
Keyword(s):  
Menstrual Cycle ◽  
In Vitro Fertilization ◽  
Predictive Value ◽  
Ovarian Response ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Follicular Phase ◽  
Vitro Fertilization ◽  
Early Follicular Phase

Abstract Study question Does antral follicle count (AFC) retains its predictive value for ovarian response to stimulation for in vitro fertilization (IVF) throughout the whole menstrual cycle? Summary answer AFC is strongly correlated to anti-mullerian hormone (AMH) and highly predictive of good ovarian response whatever the day of cycle the ultrasound is performed. What is known already Usually performed in the early follicular phase (at day 2–3 of the menstrual cycle), AFC and AMH are the most accurate markers of ovarian reserve. They are routinely used to predict ovarian response to ovarian stimulation for IVF and eventually to individualize the gonadotropin starting dose. Study design, size, duration Retrospective cohort study performed between January, 2017 and December, 2019. Participants/materials, setting, methods 410 consecutive women aged 20 to 42 years were included. Random AFC (r-AFC) was performed during the fertility workup whatever the day of their menstrual cycle was: early follicular phase i.e. day 1 to day 6 (eFP-AFC), mid follicular phase i.e. day 7 to 12 (mFP-AFC) and luteal phase i.e. day 13 or after (LP-AFC). A second AFC was performed before the start of the stimulation (SD1-AFC). AMH was measured in the early follicular phase. Main results and the role of chance Random AFC (r-AFC) was correlated to AMH (r = 0.692; p < 0.001), SD1-AFC (r = 0.756; p < 0.001) and number of oocytes retrieved (r = 0.491; p < 0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was significantly higher for the LP-AFC, (LP-AFC) (r = 0.853) than for the eFP-AFC (r = 0.657; p < 0.001) and for the mFP-AFC (r = 0.668). The correlation with SD1-AFC was similar regardless of the time of performance of r-AFC (r = 0.739, 0.783, 0.733, respectively for eFP, mFP and LP-AFC). Moreover, the ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively) as well as for AMH and SD1-AFC (AUC 0.74 and 0.74, respectively). Limitations, reasons for caution This is a retrospective analysis, however data were prospectively collected and the method for ultrasound acquisition of AFC was standardized. Wider implications of the findings: The absence of significant variation of AFC across the menstrual cycle allows to its random performance. Ultrasound performed besides early follicular phase discloses informations on ovaries, the uterus and the endometrium. It is more comfortable and convenient for women and physicians by limiting targeted appointment during menstruation and reiterated examination. Trial registration number Not applicable

scholarly journals Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

2021 ◽  
Author(s):  
Bruno Ramalho de Carvalho ◽  
Geórgia Fontes Cintra ◽  
Taise Moura Franceschi ◽  
Íris de Oliveira Cabral ◽  
Leandro Santos de Araújo Resende ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Stimulation ◽  
Ovarian Tumor ◽  
Ex Vivo ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Malignant Cell ◽  
Borderline Ovarian Tumor ◽  
Increased Risk

AbstractWe report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ∼ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained. We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

Association of Retinol-Binding Protein 4 with Arteriovenous Fistula Dysfunction in Hemodialysis Patients

2021 ◽  
pp. 1-8
Author(s):  
Yuanhao Wu ◽  
Fan Wang ◽  
Tingting Wang ◽  
Yin Zheng ◽  
Li You ◽  
...  
Keyword(s):  
Risk Factor ◽  
Arteriovenous Fistula ◽  
Independent Risk Factor ◽  
Binding Protein ◽  
Retinol Binding Protein ◽  
Youden Index ◽  
Serum Concentrations ◽  
Retinol Binding Protein 4 ◽  
Kaplan Meier ◽  
Increased Risk

<b><i>Background:</i></b> Arteriovenous fistula (AVF) is the most common vascular access for patients undergoing hemodialysis (HD). Neointimal hyperplasia (NIH) might be a potential mechanism of AVF dysfunction. Retinol-binding protein 4 (RBP4) may play an important role in the pathogenesis of NIH. The aim of this study was to investigate whether AVF dysfunction is associated with serum concentrations of RBP4 in HD subjects. <b><i>Methods:</i></b> A cohort of 65 Chinese patients undergoing maintenance HD was recruited between November 2017 and June 2019. The serum concentrations of RBP4 of each patient were measured with the ELISA method. Multivariate logistic regression was used to analyze data on demographics, biochemical parameters, and serum RBP4 level to predict AVF dysfunction events. The cutoff for serum RBP4 level was derived from the highest score obtained on the Youden index. Survival data were analyzed with the Cox proportional hazards regression analysis and Kaplan-Meier method. <b><i>Results:</i></b> Higher serum RBP4 level was observed in patients with AVF dysfunction compared to those without AVF dysfunction events (174.3 vs. 168.4 mg/L, <i>p</i> = 0.001). The prevalence of AVF dysfunction events was greatly higher among the high RBP4 group (37.5 vs. 4.88%, <i>p</i> = 0.001). In univariate analysis, serum RBP4 level was statistically significantly associated with the risk of AVF dysfunction (OR = 1.015, 95% CI 1.002–1.030, <i>p</i> = 0.030). In multivariate analysis, each 1.0 mg/L increase in RBP4 level was associated with a 1.023-fold-increased risk of AVF dysfunction (95% CI for OR: 1.002–1.045; <i>p</i> = 0.032). The Kaplan-Meier survival analysis indicated that the incidence of AVF dysfunction events in the high RBP4 group was significantly higher than that in the low-RBP4 group (<i>p</i> = 0.0007). Multivariate Cox regressions demonstrated that RBP4 was an independent risk factor for AVF dysfunction events in HD patients (HR = 1.015, 95% CI 1.001–1.028, <i>p</i> = 0.033). <b><i>Conclusions:</i></b> HD patients with higher serum RBP4 concentrations had a relevant higher incidence of arteriovenous dysfunction events. Serum RBP4 level was an independent risk factor for AVF dysfunction events in HD patients.

Effect of resveratrol administration on ovarian morphology, determined by transvaginal ultrasound for the women with PCOS

2021 ◽  
pp. 1-18
Author(s):  
Amir Pejman Hashemi Taheri ◽  
Behnaz Moradi ◽  
Amir Reza Radmard ◽  
Milad Sanginabadi ◽  
Mostafa Qorbani ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Polycystic Ovary ◽  
Transvaginal Ultrasound ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Volume ◽  
Exact Test ◽  
Ovarian Morphology ◽  
The Mean

Abstract Background: Intake of resveratrol has been associated with improved ovarian morphology under in vitro and in the animal models; however, this finding has not been confirmed in trials. The aim of our study was, therefore, to use a placebo-controlled approach with the detailed assessment of the ovarian morphology by applying transvaginal ultrasound to examine the effectiveness of this therapeutic approach in this group of women. Methods: Forty-one women with polycystic ovary syndrome (PCOS) were randomly assigned (1:1) to 3 months of daily 1000 mg resveratrol or placebo. Random assignment was done by blocked randomisation. Our primary endpoints were the change in the ovarian volume, stromal area and antral follicle count per ovary (FNPO) from the baseline to 3 months. Secondary endpoints were improvement in the distribution of follicles and ovarian echogenicity. Differences between the resveratrol and control groups were evaluated by Chi-square, fisher’s exact test and repeated-measures of ANOVA. Results: The mean age of all participants was 28.61 ± 4.99 years, with the mean BMI of 28.26 ± 5.62 kg/m2. Resveratrol therapy, as compared with placebo, was associated with a significantly higher rate of improvement in the ovarian morphology (p= 0.02). Women who received resveratrol had a more dominant follicle than those getting placebo, with a significant reduction in the ovarian volume (p<0.05). However, the number of FNPO, stromal area, ovarian echogenicity and distribution of follicles were not significantly altered (P>0.05). Conclusions: Treatment with resveratrol significantly reduced the ovarian volume and PCOM, thus suggesting a disease-modifying effect in PCOS. Trial registration: IRCT, IRCT2017061917139N2. Registered 7 July 2017, http://irct.ir/trial/15836.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

2018 ◽  
Vol 118 (12) ◽  
pp. 2162-2170 ◽  
Author(s):  
Kamilla Steensig ◽  
Kevin Olesen ◽  
Troels Thim ◽  
Jens Nielsen ◽  
Svend Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischaemic Stroke ◽  
Independent Risk Factor ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Artery Disease

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

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