Effect of autologous platelet rich plasma on anti-mullerian hormone and antral follicle count in sub fertile women with poor ovarian reserve

Background: Ovarian aging may be reversible. Platelet rich plasma (PRP) has growth factors that promote cellular proliferation and folliculogenesis. Recently published studies and case reports suggest that ovarian rejuvenation can be done by PRP treatment. The objective of the study was to evaluate the effect of platelet rich plasma on ovarian reserve markers such as anti mullerian hormone (AMH) and antral follicle count (AFC) in sub fertile women with poor ovarian reserve (POR).Methods: The self-controlled quasi experimental study was carried out on 29 sub fertile women with poor ovarian reserve. They were selected for laparoscopic tubo-peritoneal evaluation as they could not afford in vitro fertilization. During laparoscopy, 5 ml of pre prepared autologous PRP was injected into each ovary. Post-PRP AMH and AFC were measured at every cycle for a period of at least three (3) months and compared with base line values.Results: Mean age of participants was 35.9±3.2 years. Baseline AMH was 0.31±0.17 ng/ml and baseline AFC was 3.41±0.73. AMH was raised on first, second and third cycle from base line values in 58.62%, 86.21% and 91.30% of the study population respectively. AMH changes in all three cycle were statistically significant. Pregnancy occurred in three (10.34%) women during the study period.Conclusions: The injection of autologous PRP into human ovaries is a safe procedure to improve ovarian reserve markers (AMH and AFC) in women with POR.

Poor ovarian reserve and male infertility in a rural in vitro fertilization setup: a case report

Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35. In the female, the number of oocytes decreases with age until the menopause. Oocyte quality also diminishes, due in part to increased aneuploidy because of factors such as changes in spindle integrity. Although older male age affects the likelihood of conception, abnormalities in sperm chromosomes and in some components of the semen analysis are less important than the frequency of intercourse. Age is as accurate as any other predictor of conception with assisted reproductive technology.

Follicular Fluid Perfluoroalkyl and Polyfluoroalkyl Substances Are Associated With Adverse ART Outcomes in Women With Poor Ovarian Reserve

BackgroundPrevious evidence suggests that perfluoroalkyl and polyfluoroalkyl substances (PFASs) adversely affect ovarian function and female fecundity. However, the evidence remains insufficient to infer a direct relationship between PFAS exposure and adverse assisted reproductive technology (ART) outcomes. To fill this gap, we examined follicular fluid PFAS exposure and ART outcomes in patients with poor ovarian reserve (POR) in a prospective study.MethodsIn total, 147 women with POR were included. Eight PFASs were measured in follicular fluid (n=104) samples using simultaneous analysis by ultra-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. The PFAS contamination status of the patients’ follicular fluid and the association between characteristics and ART outcomes were investigated by logistic regression.ResultsAfter adjustment for age and BMI, PFOA, PFNA, PFHxS and ∑PFAS were strongly associated with a decreased probability of pregnancy (PFOA highest vs. lowest tertile: OR=1.95, 95% CI: 1.61, 2.38; PFNA highest vs. lowest tertile: OR= 3.0, 95% CI: 2.46, 3.68; PFHxS highest vs. lowest tertile: OR= 1.95, 95% CI: 1.61, 2.35; ∑PFAS second vs. lowest tertile: OR=3.31, 95% CI: 2.74, 3.89). PFOS and PFUnDA were inversely associated with failed implantation. No relationships were noted between failed implantation and other PFAS analytes. The same result was obtained when using live birth as an outcome measure.ConclusionsIn women with POR, follicular fluid PFAS exposure may decrease the probability of clinical pregnancy and live birth.

Case report of unicornuate uterus with subfertility

Most often the uterine developmental anomalies are missed until later in life presenting as infertility. This case report is of a couple presented with primary infertility of six years. 3D ultrasonography helps in for clinical suspicion of a uterine anomaly. The wife had a left unicornuate uterus with adequate uterine cavity and right rudimentary horn and also poor ovarian reserve. The husband had astheno-teratozoospermia. After a failed IVF frozen embryo transfer the couple were advised and underwent IVF-ICSI of donor oocytes with husband sperm. One 5AB blastocyst transferred and at 5 weeks and 6 weeks scans gestational sac along with yolk sac and foetal heart pulsations were noted, respectively. Single embryo transfer with good quality blastocyst is preferable for a unicornuate uterus since there is a risk of pre term labour.

Predictive Factors for Live Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria

The mechanisms underlying poor ovarian response (POR) in assisted reproductive technology remain unclear, there is no consensus on the management of poor responders, the POSEIDON stratification classifies infertility patients into “expected” or “unexpected” groups to provide a more nuanced picture of POR, but few researchers have discussed the independent predictive factors (smoothed plots and the threshold effect) for live birth in POR patients classified by the new criteria. We conducted a retrospective cohort study using clinical data from 6,580 POR patients classified by the POSEIDON criteria in the First Affiliated Hospital of Zhengzhou University, and explored the live birth based on the results before and after the threshold inflection point of each independent influencing factor. Among 6,580 poor ovarian reserve patients classified by the POSEIDON criteria, 1,549 (23.54%) had live births, and 5,031 (76.46%) did not have live births. Multivariate logistic regression analysis showed that female age (OR 0.901; 95% CI 0.887~0.916; P < 0.001), body mass index (OR 0.963; 95% CI 0.951~0.982; P < 0.001), antral follicle counting (OR 1.049; 95% CI 1.009~1.042; P < 0.001) and controlled ovarian hyperstimulation protocol were independent factors predicting live birth in patients with POR. The threshold effect analysis found that the inflection point of female age was 34 years old, and when age was > 34 years old, the probability of live birth in POR patients dropped sharply (OR 0.7; 95% CI 0.7~0.8; P < 0.001). The inflection point of BMI was 23.4 kg/m2, and BMI had a negative correlation with live birth (OR 0.963; 95% CI 0.951~0.982; P < 0.001). The threshold inflection point of AFC was 8n. Female age, BMI, AFC and COH protocol were independent predictive factors associated with live birth in POR patients classified by the POSEIDON criteria. The smooth curve fit and threshold effect analyses provide clinical management strategies for these patients. In addition, the early-follicular-phase long-acting GnRH-agonist long protocol seems to have a higher live birth rates than other protocols. It is worth highlighting that BMI should be considered as well in the POSEIDON criteria.