scholarly journals Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study

2016 ◽  
Vol 7 (1) ◽  
pp. 14-18
Author(s):  
Pratap Kumar ◽  
MR Sandya
Keyword(s):  
Observational Study ◽  
Ovarian Reserve ◽  
Cyst Wall ◽  
Prospective Observational Study ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Histopathological Analysis ◽  
Laparoscopic Cystectomy ◽  
Endocrine Parameters ◽  
The Mean

ABSTRACT Background Endometriosis is one of the most commonly encountered benign problems in gynecology. Ultrasound and endocrine parameters have been widely accepted as markers of ovarian reserve. Anti-Mullerian hormone (AMH) in conjugation with antral follicle counts is now believed to be an excellent measure for detecting ovarian reserve. Surgical approach has a fundamental role in the management of endometriosis. The loss of normal follicles can be studied by histopathological assessment of the cyst wall. The postoperative decline in the ovarian reserve is believed to have a correlation with number of endometriomas and diameter of the cyst wall. Objective This prospective observational study was undertaken to evaluate the effect of laparoscopic cystectomy with respect to number and size of the cyst on ovarian reserve parameters. Materials and methods Fifty patients undergoing laparoscopic endometrioma cystectomy were analyzed. Cysts of <5cm and >5cm and the number of cysts were studied. Statistical analysis was done using Mauchly's test of sphericity. Anti-Mullerian hormone and antral follicle count were estimated prior to and 1 month after surgery. Pre- and postoperative values were compared and analyzed with respect to number and size of endometrioma. Observation and results There was an overall drop of AMH from 3.8 ± 3.01 to 2.67 ± 1.92 ng/ml (p < 0.001). The mean AMH in bilateral and unilateral endometrioma was 2.9 ± 1.7 and 3.9 ± 3.17 ng/ml respectively. Anti-Mullerian hormone dropped from 4.53 ± 3.4 to 3.19 ± 2.18 with <5 cm cyst compared with 2.4 ± 1.2 to 1.7 ± 0.85 with >5 cm cyst (p < 0.01). Overall drop in AFC was 5.17 ± 1.44 and 3.61 ± 1.61 pre- and postoperative respectively (p < 0.01). Mean drop in AFC was 2.2 and 1.2 in cyst <5 and > 5 cm respectively. Histopathological analysis showed loss of follicles in 25% of the cyst walls. This was correlating with the drop in both AMH and AFC postoperatively. Conclusion Size and number of cyst does affect ovarian reserve to the effect that smaller and bilateral cyst leads to a greater decline in the same. How to cite this article Sandya MR, Kumar P. Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study. Int J Infertil Fetal Med 2016;7(1):14-18.

scholarly journals The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis

2019 ◽  
Vol 41 (06) ◽  
pp. 400-408 ◽  
Author(s):  
Clara Micalli Ferruzzi Baracat ◽  
Helizabet Salomão Ayroza Abdalla-Ribeiro ◽  
Raquel Silveira da Cunha Araujo ◽  
Wanderley Marques Bernando ◽  
Paulo Ayroza Ribeiro
Keyword(s):  
Ovarian Reserve ◽  
Meta Analysis ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ultrasonic Energy ◽  
Bipolar Electrocoagulation ◽  
Study Selection ◽  
Bipolar Energy ◽  
Laparoscopic Cystectomy ◽  
The Impact

Objective The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy. Data Sources The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles. Methods of Study Selection We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots. Tabulation, Integration and Results Twelve trials involving 1,047 patients were evaluated. Laparoscopic suture was superior to bipolar coagulation when evaluating serum AMH and AFC, in the 1st, 3rd, 6th and 12th month after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy. Conclusion We recommend suture for hemostasis during laparoscopic cystectomy.

scholarly journals Epinephrine minimizes the use of bipolar coagulation and preserves ovarian reserve in laparoscopic ovarian cystectomy: a randomized controlled trial

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Eun Young Park ◽  
Kyu-Hee Hwang ◽  
Ji-Hee Kim ◽  
San-Hui Lee ◽  
Kyu-Sang Park ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Ovarian Function ◽  
Controlled Trial ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Histopathological Analysis ◽  
Bipolar Coagulation ◽  
Ovarian Cystectomy ◽  
Novel Method ◽  
Group Serum

AbstractWe propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. A total of 179 patients undergoing laparoscopic ovarian cystectomy with stripping were randomly allocated into three groups: the bipolar coagulation group, the Epi-pledget group, and the coagulation after Epi-pledget (Epi & Coagulation) group. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) by ultrasonography were measured to determine the preservation of ovarian function. To evaluate the postoperative ovarian cellular proliferative activity and tissue damage in a mouse model, we operated on the ovaries of mice with an artificial incision injury and applied two hemostatic methods: coagulation and Epi-pledget. Eight weeks after surgery, the AMH rate significantly decreased in the bipolar coagulation group compared with the Epi-pledget group. The AFC decline rate was also significantly greater in the coagulation group than the Epi-pledget group. Specifically, patients with endometrioma had a significantly greater decline of serum AMH in the coagulation group than the Epi-pledget group. In a histopathological analysis in mice, the Epi-pledget group showed ameliorated fibrotic changes and necrotic findings in the injured lesion compared with the bipolar coagulation group. The Epi-pledget method for ovarian stripping has an additional benefit of maximizing the preservation of the ovarian reserve, especially for the endometriotic ovarian cyst type.

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.

scholarly journals Effect of Ayurvedic Treatment Protocol on Diminishing Ovarian Reserve

2020 ◽  
Vol 11 (2) ◽  
pp. 228-234
Author(s):  
Divya U ◽  
Vijayakumar N
Keyword(s):  
Ovarian Reserve ◽  
Reproductive Potential ◽  
Treatment Protocol ◽  
Antral Follicle ◽  
Poor Responder ◽  
Antral Follicle Count ◽  
In Vitro Fertilisation ◽  
Rank Test ◽  
Ayurvedic Treatment

Diminishing ovarian reserve (DOR) is a condition in which the ovary loses reproductive potential, compromising fertility. Nowadays 10-30% of female infertility is due to DOR and considered as “expected poor responder” for In vitro fertilisation (IVF).   Correlation of DOR can be done with Dathukshaya vandya (depletion or inadequate formation of dhatus) explained in Harithasamhita. The objective of the study was to evaluate the effect of Ayurvedic treatment protocol on Diminishing ovarian reserve. The study protocol includes- ashtachurna for deepana (appetiser), pachana (digestives) and kolakulathadi churna for udwarthana (powder massage). Sukumaragrutha used for snehapana (oral administration of medicated ghee), utharabasthi (intrauterine administration) and rasayana (rejuvenation therapy ). Danwantarathaila abhyanga (oleation) and ooshmasweda (sudation) done for 3 days. Sukumaraeranda was used for virechana (therapeutic purgation) and also Yogabasthi (medicated enema). The study design was pre and post interventional study with a sample size of 15 selected as per inclusion and exclusion criteria, conducted at hospital for women and children, Government Ayurveda College, Thiruvananthapuram. Assessment was based on Bologna criteria for DOR. The statistical techniques employed are Wilcoxon’s signed rank test and Paired t test. Results showed statistically significant effect on improving Antral follicle count (AFC) (p- 0.01), Estradiol (p- 0.005), conception (p- 0.014), on regulating amount of bleeding (p- 0.003), menstrual interval correction (p-0.001) and dyspareunia (p-0.005). But insignificant effect on improving Anti Mullerian Hormone (AMH) (p- 0.469) and regularising LH/FSH ratio (p-0.104) was found.

scholarly journals Anaesthesia and Perioperative Care in Remote Health Camps- Patients’ Concerns

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Balkrishna Bhattarai ◽  
A Ghimire ◽  
BK Baral ◽  
A Shrestha ◽  
Y Dhungana
Keyword(s):  
Observational Study ◽  
Perioperative Care ◽  
Local Anaesthesia ◽  
Prospective Observational Study ◽  
Main Concern ◽  
Surgical Experience ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Mean ◽  
Remote Health

INTRODUCTION:Identifying patients' concerns and expectations regarding anaesthesia and perioperative care in mobile surgical camps is relevant for the camp workers. This prospective observational study was conducted to assess knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Nepal.METHODS:A questionnaire with seven items related to anaesthesia and perioperative care was used for interviewing 80 individuals of age > or = 12 years, 20 from each camp at Solukhumbu, Sankhuwasabha, Khotang and Bhojpur districts.RESULTS:Data of two patients were lost leaving only 78 individuals for analysis. The mean age of the subjects was 30.5 (+/- 14.6) years with the male: female ratio of 43: 35. Fifty-eight (74.4%) patients had some gross idea about the modality of administration of anaesthetics. Twenty-six (33.3%) individuals preferred GA over local anaesthesia, whereas 22 (28.2%) were happy either way if there was no pain. Pain was the main concern for 73.1% of the patients. Of the 25 patients expressing fear of GA, death or not being able to wake up anymore was the main concern for 60.0%. Increasing age was associated with lower fear of GA (p < 0.05). Surgical experience was distressing for 17 (21.8%) patients. The overall experience of the anaesthesia and surgery was worse than expected for 25.6% of the patients.CONCLUSIONS:Patients presenting to these health camps have limited knowledge regarding anaesthesia and perioperative care but have valid concerns and expectations in respect of their safety, comfort and outcome.

scholarly journals Role of JIGSAW method of teaching in improving clinical diagnosis among final year medical students – A prospective observational study

2021 ◽  
Vol 12 (12) ◽  
pp. 44-49
Author(s):  
Appandraj S ◽  
Sivagamasundari V ◽  
Varatharajan Sakthivadivel
Keyword(s):  
Observational Study ◽  
Test Score ◽  
Prospective Observational Study ◽  
Coronary Syndrome ◽  
Post Test ◽  
Jigsaw Method ◽  
The Mean ◽  
The Difference ◽  
Didactic Lecture ◽  
Teaching Learning

Background: The Jigsaw method is a form of cooperative learning, in which students are actively involved in the teaching-learning process that improves the long-term retention of acquired knowledge. Aims and Objectives: The objective of this study was to assess the knowledge acquired by students using the Jigsaw learning method in Internal Medicine. Materials and Methods: A prospective observational study was conducted with 100 students. The acute coronary syndrome was taken for 1 h as a didactic lecture, and a pre-test was conducted. The students were divided into five groups and were put for the intervention “Jigsaw.” The pre- and post-test were conducted, and feedback was collected from the students. Paired t-test was used to perform analysis of pre- and post-test. Feedback evaluation was done by a 5-point Liker scale. P<0.05 was considered statistically significant, and the data were analyzed using CoGuide software. Results: The mean pre-test score was 8.44 ± 2.33 ranged (3–14) and the mean post-test score was 11.03 ± 2.07 (ranged 6–15). The difference of 2.39 (95% CI: 2.19–2.59) increase in marks post-test after the Jigsaw method was statistically significant (P<0.001). The satisfaction level was 50–55% on the Likert scale based on the questionnaire given. There was a significant improvement in the post-test scores of the students after Jigsaw. Conclusion: The Jigsaw method improved knowledge in the short-term by engaging students in group work and motivation to learn. Overall response based on the questionnaire about the Jigsaw method was positive.

Value of serum and follicular fluid Sirt1,Sirt2 protein levels in predicting the outcome of assisted reproduction

2020 ◽  
Author(s):  
Lingnv Yao ◽  
Wenqin Lin ◽  
Nan Jiang ◽  
Chuyan Li ◽  
Haifeng Cao ◽  
...  
Keyword(s):  
Assisted Reproduction ◽  
Follicular Fluid ◽  
Ovarian Reserve ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Advanced Age ◽  
Control Group ◽  
Age Group ◽  
Protein Levels ◽  
Study Population

Abstract Background: To explore whether serum and follicular fluid Sirt1, Sirt2 can reflect ovarian reserve and predict the outcome of assisted reproduction. Methods: The study population comprised 125 patients , 39 in OPOI（occult form of premature ovarian insufficiency）group, 49 in advanced age group , and 37 in control group. The levels of serum Sirt1, Sirt2 were measured on the 2nd to 5th day of menstruation (bSirt1,bSirt2) and HCG day. Follicular fluid Sirt1 (FFSirt1) and Sirt2 (FFSirt2), were determined on OPU (oocyte pick up) day. Results: The level of FFSirt2 in the advanced age group was significantly lower than those in other two groups. FFSirt 2 and Sirt 2 (HCG day ) were negatively correlated with age (r=-0.35, r=-0.19), but there were no value of them for assessing DOR (diminished ovarian reserve). The level of bSirt2 in (cumulative) pregnant group was significantly higher (r=0.24, P=0.00). Conclusions: This was the first study to show that FFSirt2 and Sirt2 (HCG day) might be negatively correlated with age and antral follicle count (AFC). bSirt2 could predict cumulative pregnancy outcome together with anti-Mullerian hormone (AMH), AFC and age.

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