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Rationale: Evidence of the effects of chronic caffeine (CAFF)-containing beverages, alone or in combination with agomelatine (AGO) or quetiapine (QUET), on electroencephalography (EEG), which is relevant to cognition, epileptogenesis, and ovarian function, remains lacking. Estrogenic, adenosinergic, and melatonergic signaling is possibly linked to the dynamics of these substances. Objectives: The brain and ovarian effects of CAFF were compared with those of AGO + CAFF and QUET + CAFF. The implications of estrogenic, adenosinergic, and melatonergic signaling and the brain-ovarian crosstalk were investigated. Methods: Adult female rats were administered AGO (10 mg/kg), QUET (10 mg/kg), CAFF, AGO + CAFF, or QUET + CAFF, once daily for 8 weeks. EEG, estrous cycle progression, and microstructure of the brain and ovaries were examined. Brain and ovarian 17β-estradiol (E2), antimullerian hormone (AMH), estrogen receptor alpha (E2Rα), adenosine receptor 2A (A2AR), and melatonin receptor 2 (MT2R) were assessed. Results: CAFF, alone or combined with AGO or QUET, reduced the maximum EEG peak, which was positively linked to ovarian E2Rα, negatively correlated to cortical neurodegeneration and ovarian MT2R, and associated with cystic ovaries. A large corpus luteum emerged with AGO + CAFF and QUET + CAFF, antagonizing the CAFF-mediated increased ovarian A2AR and reduced cortical E2Rα. AGO + CAFF provoked TTP delay and increased ovarian AMH, while QUET + CAFF slowed source EEG frequency to δ range and increased brain E2. Conclusions: CAFF treatment triggered brain and ovarian derangements partially antagonized with concurrent AGO or QUET administration but with no overt affection of estrus cycle progression. Estrogenic, adenosinergic, and melatonergic signaling and brain-ovarian crosstalk may explain these effects. [ABSTRACT FROM AUTHOR]

To undertake a one-stage meta-analysis of individual patient data from randomized trials comparing individualized dosing of follitropin delta vs. other forms of follitropin (alpha and beta) for live birth (LB) rates (LBR) and safety parameters in women undergoing ovarian stimulation for in vitro fertilization treatment. Systematic review with individual patient data meta-analysis. Not applicable. Women undergoing ovarian stimulation for in vitro fertilization treatment. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Web of Science to identify eligible phase 3 trials between January 1, 2000, and February 1, 2023. All analyses were based on individual participant data. We used a general linear mixed effects logistic regression model using fixed effects for treatment drugs interacting with log (AMH) level, age, and random effects for country and trial to compare the primary efficacy and safety outcomes of LB and early ovarian hyperstimulation syndrome (OHSS) and/or the need for OHSS preventative measures, with ovarian stimulation parameters and neonatal outcomes also assessed. PROSPERO registration: CRD42023399711. Three trials met inclusion criteria and included 2,685 women undertaking 2,682 cycles between October 2013 and May 2020, with LB follow-up through to February 1, 2023. For women with an elevated AMH level (≥15 pmol/L), there was high-quality evidence that the use of individualized dosing of follitropin delta was associated with an increased LB rate (adjusted odds ratio [adj OR] 1.64, 95% confidence interval [CI] 1.14, 2.36). Safety outcomes were also improved with a reduced risk of both early OHSS and/or the need for preventative interventions (adj OR 0.27, 95% CI 0.15, 0.49) and early moderate or severe OHSS (adj OR 0.30, 95% CI 0.16, 0.58). These improvements in outcomes were obtained with a lower total dose of gonadotropin (−48.7 μg, 95% CI −53.7, −43.8) and no adjustments in the daily dose. In contrast, similar LB rates (adj OR 0.86, 95% CI 0.63, 1.17) and safety outcomes (adj OR 1.92, 95% CI 0.76, 4.87) were observed for women with an AMH level of <15 pmol/L. There were no clinically meaningful differences in neonatal outcomes. Using follitropin delta in an AMH level and weight-based algorithm rather than conventional licensed dosing of follitropin alpha or beta for ovarian stimulation in women is associated with improved LB rates and safety outcomes for women with elevated AMH levels. [ABSTRACT FROM AUTHOR]

To investigate the association between serum uric acid and women's ovarian reserve. Retrospective observational study and Mendelian randomization study. University-affiliated in vitro fertilization center. Observational analyses were undertaken using data from 8,257 women with infertility who finished their first in vitro fertilization treatments between May 2017 and December 2021. Mendelian randomization analyses were based on genome-wide association summary statistics from several biobanks of predominantly European ancestries. Observational study involved testing log2 transformed serum uric acid levels (for linear, negative regression, and logistic regression analyses); original uric acid levels (for nonlinear association analyses). Mendelian randomization study involved testing genetically predicted uric acid levels. Biomarkers including antimüllerian hormone, basal antral follicle count, follicle-stimulating hormone, luteinizing hormone, ratio of follicle-stimulating hormone to luteinizing hormone, estradiol; indices of ovarian response to stimulation including poor ovarian response according to different criteria and oocyte yield. In retrospective observational study, all ovarian reserve-related outcomes demonstrated significant differences across serum uric acid quartiles. A two-fold uric acid increase was associated with increased antimüllerian hormone (adjusted β = 0.69; 95% confidence interval [CI], 0.43–0.95), antral follicle count (adjusted incidence rate ratio = 1.10, 95% CI, 1.05–1.14), luteinizing hormone (adjusted β = 0.53, 95% CI, 0.28–0.78), decreased risks of Bologna poor ovarian response (adjusted odds ratio = 0.97; 95% CI, 0.95–0.99) and groups 2–4 Poseidon poor ovarian response (group 2: 0.63, 0.56–0.71; group 3: 0.71, 0.65–0.78; group 4: 0.50, 0.46–0.55), whereas an increased risk of group 1 (1.26, 1.13–1.41). Nonlinear analyses showed a common inflection point at 320–340 μmol/L of uric acid. Interactions between uric acid and antimüllerian hormone and antral follicle count were presented in association with oocyte yield. Mendelian randomization results suggested a significant association between genetically predicted uric acid levels and antimüllerian hormone levels (β = 0.08; 95% CI, 0.04–0.12) but none for uric acid in relation to polycystic ovarian syndrome or other related hormones. Higher uric acid levels were associated with better ovarian reserve and increased levels of antimüllerian hormone albeit an increased risk of unexpected poor ovarian response. [ABSTRACT FROM AUTHOR]

Objective: To report a case with a distinct difference between the ovarian reserve parameters of antimüllerian hormone (AMH) levels, antral follicle count (AFC), and follicle-stimulating hormone levels caused by a novel homozygous missense variant in the exon 1 of the AMH gene [NM_000479.4:c259G>A, p.(Val87Met)]. Design: Case report. Setting: Tertiary referral in vitro fertilization clinic. Patients: A 33-year-old woman, G4P4A0E0L4, with a BMI of 25.33 kg/m2, high AFC, and repeated extremely low systemic AMH levels, was detected and measured using multiple enzyme-linked immunosorbent assays. Interventions: Antimüllerian hormone analysis with multiple assays, whole exome sequencing through next generation sequencing to diagnose the missense variant, and inhibin B measurement. Main Outcomes Measures: Genetic counseling and two subsequent ovarian stimulations for successful fertility preservation. Results: Detection of the [NM_000479.4:c259G>A, p.(Val87Met)] variant in the AMH gene. Retrieval and cryopreservation of four euploid blastocysts and 26 metaphase II oocytes. Conclusions: AMH gene mutations can lead to the absence of systemic AMH levels and might be discordant to other ovarian reserve markers like AFC, follicle-stimulating hormone, and inhibin B, without affecting the ovarian response to ovarian stimulation. Clinicians should not rely exclusively on AMH levels for ovarian stimulation. When severely reduced AMH levels are found in patients with high AFC, AMH variants should be suspected, and fertility treatments should be tailored adequately.

Abstract Background The epidemiologic evidence on the association between acid load potential of diet and the risk of diminished ovarian reserve (DOR) is scarce. We aim to explore the possible relationship between dietary acid load (DAL), markers of ovarian reserve and DOR risk in a case-control study. Methods 370 women (120 women with DOR and 250 women with normal ovarian reserve as controls), matched by age and BMI, were recruited. Dietary intake was obtained using a validated 80-item semi-quantitative food frequency questionnaire (FFQ). The DAL scores including the potential renal acid load (PRAL) and net endogenous acid production (NEAP) were calculated based on nutrients intake. NEAP and PRAL scores were categorized by quartiles based on the distribution of controls. Antral follicle count (AFC), serum antimullerian hormone (AMH) and anthropometric indices were measured. Logistic regression models were used to estimate multivariable odds ratio (OR) of DOR across quartiles of NEAP and PRAL scores. Results Following increase in PRAL and NEAP scores, serum AMH significantly decreased in women with DOR. Also, AFC count had a significant decrease following increase in PRAL score (P = 0.045). After adjustment for multiple confounding variables, participants in the top quartile of PRAL had increased OR for DOR (OR: 1.26; 95%CI: 1.08–1.42, P = 0.254). Conclusion Diets with high acid-forming potential may negatively affect ovarian reserve in women with DOR. Also, high DAL may increase the risk of DOR. The association between DAL and markers of ovarian reserve should be explored in prospective studies and clinical trials.

Background: The epidemiologic evidence on the association between acid load potential of diet and the risk of diminished ovarian reserve (DOR) is scarce. We aim to explore the possible relationship between dietary acid load (DAL), markers of ovarian reserve and DOR risk in a case-control study. Methods: 370 women (120 women with DOR and 250 women with normal ovarian reserve as controls), matched by age and BMI, were recruited. Dietary intake was obtained using a validated 80-item semi-quantitative food frequency questionnaire (FFQ). The DAL scores including the potential renal acid load (PRAL) and net endogenous acid production (NEAP) were calculated based on nutrients intake. NEAP and PRAL scores were categorized by quartiles based on the distribution of controls. Antral follicle count (AFC), serum antimullerian hormone (AMH) and anthropometric indices were measured. Logistic regression models were used to estimate multivariable odds ratio (OR) of DOR across quartiles of NEAP and PRAL scores. Results: Following increase in PRAL and NEAP scores, serum AMH significantly decreased in women with DOR. Also, AFC count had a significant decrease following increase in PRAL score (P = 0.045). After adjustment for multiple confounding variables, participants in the top quartile of PRAL had increased OR for DOR (OR: 1.26; 95%CI: 1.08–1.42, P = 0.254). Conclusion: Diets with high acid-forming potential may negatively affect ovarian reserve in women with DOR. Also, high DAL may increase the risk of DOR. The association between DAL and markers of ovarian reserve should be explored in prospective studies and clinical trials. [ABSTRACT FROM AUTHOR]

To examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and ovarian reserve as measured using antimüllerian hormone (AMH) levels. Cross-sectional study. Detroit, Michigan area. Data were obtained from a prospective cohort of self-identified Black or African American women aged 23–35 years at the time of enrollment (N = 1,593), who had no prior diagnosis of polycystic ovary syndrome, were not currently pregnant, and were not missing AMH or 25(OH)D level measures. Serum 25(OH)D. The serum AMH level was the main outcome. Linear regression was used to examine the associations between categorical 25(OH)D levels (<12, 12–<20, 20–<30, and ≥30 ng/mL) and continuous natural log-transformed AMH levels. Associations between 25(OH)D and high (upper 10th percentile: >7.8 ng/mL) or low AMH (<0.7 ng/mL) levels were estimated with logistic regression. Models were adjusted for age, age-squared, body mass index (kg/m2), hormonal contraceptive use, smoking, and exercise. The 25(OH)D levels were low; 70% of participants were below 20 ng/mL. In fully adjusted models, compared with 25(OH)D levels <12 ng/mL, those with 25(OH)D levels of 12–<20, 20–<30, and ≥30 ng/mL had an AMH level that was 7% (95% confidence interval [CI]: −4, 20), 7% {95% CI: −6, 22}, or 11% {95% CI: −7, 34} higher, respectively. Moreover, these groups had lower odds of having low AMH levels (odds ratio [95% CI]: 0.63 {0.40, 0.99}, 0.60 {0.34, 1.07}, and 0.76 {0.35, 1.65}, respectively), and the highest category of 25(OH)D levels had higher odds of having high AMH levels (odds ratio [95% CI]: 1.42 {0.74, 2.72}). Exclusion of participants with either irregular cycles or very high AMH (>25 ng/mL) levels did not alter the associations. Taken together, these results indicate that higher levels of 25(OH)D are associated with slightly higher AMH levels, lower odds of low AMH levels, and higher odds of high AMH levels. This evidence is weak, however, because only a small percentage of participants had high 25(OH)D levels. Future studies should examine populations with a wide distribution of 25(OH)D levels (both high and low), with a clinical trial design, or with longitudinal measures of both 25(OH)D and AMH levels. [ABSTRACT FROM AUTHOR]

Background: Patient disability, relapse rate, and age are used for family planning in multiple sclerosis (MS). However, the need for more accurate biomarkers is widely recognized. We aimed to explore the influence of age on neurofilament light chain (sNfL), which reflects acute inflammation; glial fibrillary acidic protein (GFAP), associated with disability progression independent of relapses; and anti-Müllerian hormone (AMH), reflecting ovarian reserve, to provide a tailored family planning strategy. Methods: This case-control study included 95MS patients and 61 healthy control women (HCW). sNfL and GFAP levels were measured using a sensitive single-molecule array assay. AMH levels were measured by the automated Elecsys ® Anti-Müllerian Hormone Assay. Results: We observed no significant differences in AMH values between MS patients and the control group within any of the age-matched categories. Age exhibited a negative correlation with AMH values in both groups, as expected. Nevertheless, our findings suggest a slight tendency toward reduced ovarian reserve in MS patients (rho MS patients = -0.67, p < 0.0001; rho HCW = -0.43, p = 0.0006). Interestingly, among the 76MS participants under 40 years old, we identified ten individuals (13.1%) with AMH levels below 0.7 ng/ml, indicative of a low ovarian reserve, and an additional six individuals (7.8%) with AMH levels between 0.7 ng/ml and 0.9 ng/ml, suggesting a potential risk of premature ovarian failure. Conversely, sNfL and GFAP levels in the MS group exhibited high variability but showed no significant association with age intervals. Conclusion: We found no significant differences in AMH, sNfL or GFAP values between MS patients and the control group within any of the age-matched categories. The assessment of AMH, sNFL and GFAP levels at MS onset facilitates personalized therapeutic and family planning strategies for childbearing-age women. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of Kirin pill plus vitamin CE and coenzyme Q10 in the treatment of diminished ovarian reserve (DOR). Methods: 145 patients with ovarian reserve hypofunction hospitalized in Xiangyang Central Hospital, Xiangyang City, China from March 2019 to March 2022 were recruited and assigned randomly to receive either vitamin CE and coenzyme Q10 (control group), or vitamin CE and coenzyme Q10 plus Kirin pills (study group). The parameters/indices determined include menstrual recovery, clinical efficacy, sex hormone and serum anti-mullerian hormone (AMH) levels, changes in the number of ovarian sinus follicles, and levels of CD3+, CD4+ and CD8+ T cell. Results: There were no significant differences (p > 0.05) observed among baseline data, pre-treatment sex hormones, serum AMH, ovarian antral follicle count, CD3+, CD4+, and CD8+ T cell levels. After the intervention, administration of the Kirin pill resulted in significantly lower serum follicle stimulating hormone (FSH) and FSH/luteinizing hormone (LH), elevated AMH levels, and better LH and estradiol (E2) levels in patients compared to the administration of vitamin CE and coenzyme Q10 (control group). The study group also showed superior ovarian reserve function and more ovarian basal sinus follicles than the control group (p < 0.05). Conclusion: Kirin pill plus vitamin CE and coenzyme Q10 treatment regimen optimizes the ovarian reserve function of patients with DOR infertility by improving basal sex hormones, menstrual cycle and menstrual volume, AMH and ovarian basal sinus follicle count. Further clinical trials are required prior to application in clinical practice. [ABSTRACT FROM AUTHOR]

BackgroundSeveral studies suggest that women with Crohn disease (CD) have reduced fertility due to decreased ovarian reserve, among other causes. On the other hand, male CD patients could have difficulties conceiving. The present study aimed to test the effect of CD on both male and female fertility potential, Sertoli cell function and ovarian reserve, assessed by inhibin-B (IB) plus IB:FSH ratio (IFR) and antiMüllerian hormone (AMH), respectively. Sexual dysfunction (SD) was studied as secondary endpoint.MethodsWe performed a cross-sectional, case–control study. Serum IB levels plus IFR were measured in 58 men with CD and compared to 25 age-matched healthy controls (HC). Serum AMH levels were measured in 50 women with CD and in 30 HC matched by age. SD was assessed by means of the International Index of Erectile Function (IIFE-15) in males and the Index of Female Sexual Function (IFSF) in women.ResultsA total of 108 CD patients and 55 HC were included. IB serum levels were significantly lower in CD men than in HC (177 ± 58 vs. 234 ± 75 pg./mL, p = 0.001). IFR was also decreased in CD patients compared to HC (58.27 ± 59.5 vs. 91.35 ± 60.04, p = 0.014). Women with CD > 30 years had lower serum AMH levels compared to HC (1.15 ± 0.74 vs. 2.14 ± 1.68 ng/mL, p = 0.033). In addition, CD women >30 years presented a serum AMH 30 years is the single independent predictor of reduced ovarian reserve in women with CD. These results should be confirmed in further studies in order to properly counsel patients with CD and desire for offspring.

ObjectiveTo evaluate the extent to which uterine fibroids are associated with antimüllerian hormone (AMH) concentrations.DesignCross-sectional study.SettingBaseline data from the Study of the Environment, Lifestyle, and Fibroids, which is a 5-year longitudinal study of African American women.Patient(s)A total of 1,643 women aged 23-35 years without a known history of fibroids.ExposureFibroid presence.Intervention(s)None.Main outcome measure(s)The primary outcome was percent difference in the mean AMH concentration between participants with fibroids and those without fibroids. The secondary outcomes were percent differences in the mean AMH concentrations in participants with different numbers, sizes, types, and positions of fibroids and the percent difference in the mean AMH concentration in participants with different uterine volumes.Result(s)At least 1 fibroid was identified on ultrasound in 362 (22%) participants. There was a small difference in the mean AMH concentrations in participants with fibroids (age-adjusted model: -4.6%, 95% confidence interval (CI): -14.5% to 6.5%; multivariable model: -4.6%, 95% CI: -14.4% to 6.3%). The mean AMH concentrations were found to decrease with increasing fibroid number. Although differences in AMH concentrations were not statistically significant, compared with no fibroids, the mean percent differences in AMH concentrations for 1, 2-3, and ≥4 fibroids were -1.2% (95% CI: -13.2% to 12.5%), -7.1% (95% CI: -23.3% to 12.5%), and -17.5% (95% CI: -38.2% to 10.0%), respectively. There were no consistent associations between AMH concentrations and fibroid location, size, or uterine volume.Conclusion(s)The presence of fibroids was not materially associated with AMH concentrations. Other than a monotonic inverse relationship between fibroid number and AMH concentrations, no other fibroid characteristics were consistently or appreciably associated, although associations were imprecise.

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value 0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more timeconsuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers.

BackgroundPatient disability, relapse rate, and age are used for family planning in multiple sclerosis (MS). However, the need for more accurate biomarkers is widely recognized. We aimed to explore the influence of age on neurofilament light chain (sNfL), which reflects acute inflammation; glial fibrillary acidic protein (GFAP), associated with disability progression independent of relapses; and anti-Müllerian hormone (AMH), reflecting ovarian reserve, to provide a tailored family planning strategy.MethodsThis case-control study included 95 MS patients and 61 healthy control women (HCW). sNfL and GFAP levels were measured using a sensitive single-molecule array assay. AMH levels were measured by the automated Elecsys® Anti-Müllerian Hormone Assay.ResultsWe observed no significant differences in AMH values between MS patients and the control group within any of the age-matched categories. Age exhibited a negative correlation with AMH values in both groups, as expected. Nevertheless, our findings suggest a slight tendency toward reduced ovarian reserve in MS patients (rho MS patients = −0.67, p < 0.0001; rho HCW = −0.43, p = 0.0006). Interestingly, among the 76 MS participants under 40 years old, we identified ten individuals (13.1%) with AMH levels below 0.7 ng/ml, indicative of a low ovarian reserve, and an additional six individuals (7.8%) with AMH levels between 0.7 ng/ml and 0.9 ng/ml, suggesting a potential risk of premature ovarian failure. Conversely, sNfL and GFAP levels in the MS group exhibited high variability but showed no significant association with age intervals.ConclusionWe found no significant differences in AMH, sNfL or GFAP values between MS patients and the control group within any of the age-matched categories. The assessment of AMH, sNFL and GFAP levels at MS onset facilitates personalized therapeutic and family planning strategies for childbearing-age women.

Background:Polycystic ovary syndrome (PCOS) is a common, complex and heterogeneous reproductive endocrinopathy of females throughout the world. Circulating leptin correlates strongly with obesity, which is frequently associated with polycystic ovarian syndrome (PCOS), Adiponectin is a circulating protein produced by adipocytes. Circulating levels of adiponectin are inversely related to adipocyte mass. Aim and Objective: To Study the Association of Leptin and Adiponectin as a predictive marker in Obese And non Obese Women with Polycystic Ovary Syndrome Patients. Material and Methods:This was a case control study carried out in the Department of Biochemistry with collaboration with the Obstetrics and gynaecology Department. The study comprised of 120 patients with PCOS and 120 controls without PCOS.Each group was analysed for the following parameters as TSH, Prolactin, FSH, LH, AMH, Total cholesterol, Systolic/diastolic(BP), BMI, Leptin, Adiponectin, MDA(Malondialdehyde) and SOD(Superoxide dismutase). The validity of leptin toward the diagnosis of PCOS or leptin combined with these parameters was estimated by Descriptive and inferential statistical analysis at 5% level of significance. Results: In the present study increased level of leptin among women with PCOS positively associated with FSH, LH, TSH, Total cholesterol, MDA in PCOS whereas Adiponectin was negatively correlated. However, there was no statistically significant correlation between the Adiponectin Insulin and the Body Mass index with respect to PCOS. Conclusion:The relationships between leptin and adiponectin and insulin resistance and sensitivity, metabolic syndrome, and BMI in women with PCOS suggest that Leptin and Adiponectin potentially could serve as a marker for disease risk and provide opportunity for earlier intervention if knowledge is successfully translated from laboratory to clinical practice. However, further study of the relationship between adiponectin and PCOS is required before there can be direct application to clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value <0.05 was considered statistically significant at a 5% confidence level. Results: A total of 114 patients were enrolled in the study, of which 9.64% dropped out midway, while the remaining 103 (90.36%) patients were part of the study until its completion. The mean age of the participants was 33 years and six months. There was no significant intergroup variation in preoperative, 3rd month, and 6th month mean Antimullerian Hormone (AMH) values (p>0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more timeconsuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers. [ABSTRACT FROM AUTHOR]

To investigate the association between antimüllerian hormone (AMH) and preterm birth risk in a larger cohort of patients who underwent either in vitro fertilization or ovulation induction with intrauterine insemination at a US academic fertility center. Retrospective cohort study. Single academic fertility center. Live singleton births from patients who underwent in vitro fertilization or ovulation induction between 2016 and 2020 at a single academic fertility center were included in this study. Patients were excluded if they had a missing prepregnancy AMH level, a pregnancy using donor oocytes or a gestational carrier, multiple gestations, a delivery before 20 weeks gestation, or a cerclage in place. AMH level. The primary outcome was the proportion of preterm delivery. Secondary outcomes included the rate of pregnancy-induced hypertension, gestational diabetes, and small for gestational age. In the entire cohort (n = 875), 8.4% of deliveries were preterm. The mean AMH values were similar between those with term and preterm births (3.9 vs. 4.2 ng/mL). Similar proportions of patients with term and preterm deliveries had AMH levels greater than the 75th percentile (25% vs. 21%). The odds of preterm birth were similar by AMH quartile after adjusting for the history of preterm birth. Similarly, in the polycystic ovary syndrome (PCOS) cohort, there was no difference between mean AMH values of term and preterm births (n = 139, 9.6 vs. 10.0 ng/mL). The proportions of patients with PCOS with AMH levels greater than the 75th percentile were similar between those with term and preterm deliveries (25% vs. 22%). The odds of preterm birth were similar by the AMH quartile after adjusting for the history of preterm birth. Elevated AMH levels were not associated with an increased risk of preterm birth in patients who conceived after in vitro fertilization and ovulation induction, including patients with PCOS. Although studies suggest that AMH levels may help stratify the risk of preterm birth in this population, our findings indicate that further studies are needed before clinical application. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the changes in AMH levels longitudinally over time and their relationship with both body composition, particularly abdominal adiposity, and milestones of pubertal development in female children.DesignSecondary analysis of a prospective, longitudinal study.SettingUniversity affiliated research center and laboratories.PatientsEighty-nine females were examined between 1990 and 2015 to study child growth and development.InterventionsDemographic, anthropometric, growth, and pubertal milestone data with serum samples stored and subsequently analyzed for AMH.Main outcome measuresLongitudinal change in AMH and predicted AMH levels based on body composition, age, and pubertal milestones including, pubarche, thelarche, and menarche.ResultsNatural log-transformed AMH (AMHlog) levels appeared to have a nonlinear relationship with age, decreasing between 10 and 14 years of age, increasing until 16 years. A mixed effect linear model demonstrated that increased abdominal adiposity (waist/height ratio, WHtR) was significantly associated with the predicted increased AMHlog levels (β=1.37). As females progressed through the Tanner stages, the model predicted decreasing AMHlog values when adjusting for age and WHtR.ConclusionsDeclining AMH levels during puberty may not be reflective of diminished ovarian reserve as observed in adults, but may suggest a permissive role of AMH in the activation of the hypothalamic-pituitary-ovarian axis.

Background: Endometriosis is common in reproductive age women, which contributes to infertility. This study aims to build a model including antimüllerian hormone (AMH) to predict spontaneous pregnancy within one year after laparoscopy combined with hysteroscopy in women with minimal to mild endometriosis-associated infertility. Methods: There were 220 women included in the study, and a generalized linear model was constructed. The women enrolled in the study were experienced symptoms of endometriosis, and underwent combined laparoscopy and hysteroscopy between January and September 2016. All participants were diagnosed with minimal to mild endometriosis following surgery. Results: The predictive power (sensitivity, specificity, area under the curve (AUC)) of the model for spontaneous pregnancy rate after surgery was measured and compared with the endometriosis fertility index (EFI). The AUC for prediction model of postoperative spontaneous pregnancy was 0.697 (95% confidence interval (95% CI): 0.626–0.768). The best cut-off point was 0.629 (sensitivity: 78.4%; specificity: 54.5%). While the AUC for EFI as the spontaneous pregnancy predictor was 0.573 (95% CI: 0.498–0.648). The best cut-off point was 7.5 (sensitivity: 42.3%; specificity: 74.8%). Conclusions: We suggest that laparoscopy combined with hysteroscopy may offer better fertility outcomes to patients with minimal to mild endometriosis-associated infertility. The nomogram visualized the points of variate in the generalized linear model may provide a simple and convenient method for clinicians in making decisions for individual patients.

Research question: Clomiphene citrate (CC) is one of the first-line treatments for ovulation induction in women with anovulatory polycystic ovary syndrome (PCOS). However, nearly 1 out of 2 women is resistant to 50 mg/day of CC. The objective of this study is to investigate the clinical, biological, and/or ultrasound factors that may predict the resistance to 50 mg/day of CC in the first cycle of treatment in women with anovulatory PCOS. This would make it possible to identify PCOS patients to whom the dose of 100 mg/day would be offered as of the first cycle. Design: A retrospective and monocentric study was conducted on 283 women with anovulatory PCOS who required the use of ovulation induction with CC (903 cycles). Results: During the first cycle of treatment, 104 patients (36.8%) were resistant to 50 mg/day of CC. Univariate regression analysis showed that patients who resisted 50 mg/day of CC had significantly higher BMI, waist circumference, serum levels of AMH, total testosterone, Δ4-androstenedione, 17-OHP, and insulin (p < 0.05), compared to patients ovulating with this dose. Serum levels of SHBG were significantly lower in patients resistant to 50 mg/day (p < 0.05). After multivariate analysis, only AMH and SHBG remained statistically significant (p = 0.01 and p = 0.001, respectively). However, areas under the ROC curves were weak (0.59 and 0.68, respectively). Conclusion: AMH and SHBG are the only two parameters significantly associated with the risk of resistance to 50 mg/day of CC. However, no satisfactory thresholds have been established to predict resistance to 50 mg CC. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve. Objectives: To evaluate which hemostatic approach after stripping cystectomy shows less damage on ovarian reserve. Search Strategy: Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference abstracts, and International Clinical Trials Registry Platform were searched from inception until April 2022. Selection Criteria: Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches. Data Collection and Analysis: Relevant data were extracted and tabulated. Network meta‐analysis based on random‐effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3 months after surgery. Main Results: Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle‐stimulating hormone levels (SUCRA, 88.70%). Conclusions: Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher. Synopsis: Achieving hemostasis by suturing the ovary seems the best method to avoid ovarian reserve reduction after laparoscopic stripping excision of endometrioma. [ABSTRACT FROM AUTHOR]

Abstract Reproductive aging is characterized by a decline in oocyte quantity and quality, which is directly associated with a decline in reproductive potential, as well as poorer reproductive success and obstetrical outcomes. As women delay childbearing, understanding the mechanisms of ovarian aging and follicular depletion have become increasingly more relevant. Age-related meiotic errors in oocytes are well established. In addition, it is also important to understand how intraovarian regulators change with aging and how certain treatments can mitigate the impact of aging. Individual studies have demonstrated that reproductive pathways involving antimullerian hormone (AMH), vascular endothelial growth factor (VEGF), neurotropins, insulin-like growth factor 1 (IGF1), and mitochondrial function are pivotal for healthy oocyte and cumulus cell development and are altered with increasing age. We provide a comprehensive review of these individual studies and explain how these factors change in oocytes, cumulus cells, and follicular fluid. We also summarize how modifiers of folliculogenesis, such as vitamin D, coenzyme Q, and dehydroepiandrosterone (DHEA) may be used to potentially overcome age-related changes and enhance fertility outcomes of aged follicles, as evidenced by human and rodent studies.

The aim of this study was to reveal (1) the determination of the serum antimüllerian hormone concentrations in cats with ovarian remnant syndrome and ovarian cyst, (2) the effectiveness of the serum antimüllerian hormone concentrations in detecting gonadectomy status, and (3) ovarian expression of the antimüllerian hormone in the ovarian cysts and ovarian remnant tissue. For this purpose, a total of 31 domestic cats older than 1 year, including ORS (n = 9), OC (n = 3), spayed (n = 8), and intact (n = 11), were used in the study. Serum and intrafollicular AMH concentrations were determined by the electrochemiluminescence immunoassay, and expression of the AMH was determined by the immunohistochemical method. The serum AMH concentration in the ORS group was 1.49 ± 1.24 ng/ml (0.10–3.63 ng/ml) whereas it was 1.78 ± 0.92 ng/ml (0.8–2.63 ng/ml) in the OC group. AMH concentration in the intrafollicular fluid was determined as 0.023 ng/ml in a cat with an ovarian cyst. While the serum AMH concentration was below 0.01 ng/ml in spayed cats, it was 5.80 ± 3.30 ng/ml (1.88–11.86 ng/ml) in the intact cats. There was a significant difference between the spayed and intact groups in terms of serum AMH concentration (p < 0.05). Moreover, in cats with ovarian cyst and ovarian remnant syndrome, no difference was found between the groups in terms of serum AMH concentration (p > 0.05). No difference was found between the ovarian remnant syndrome and intact cats in terms of serum AMH concentration (p > 0.05). In immunohistochemical staining, ovarian cysts were found to be negative for AMH while a moderate (+2) AMH positivity was observed in other follicles. Furthermore, in cats with ovarian remnant syndrome, severe (+3) AMH positivity was observed. As a result, it was determined that gonadectomy status can be accurately diagnosed by the AMH measurement. Ovarian remnant syndrome cannot be diagnosed accurately by AMH measurement. In addition, it was found that AMH did not seem to play a role in the pathogenesis of ovarian cysts in cats. • Gonadectomy status can be diagnosed with the AMH in domestic queens. • Ovarian cysts can't be diagnosed with the AMH measurement in domestic queens. • Antimüllerian hormone doesn't have any roles in pathogenesis in feline ovarian cysts. • Ovarian remnant syndrome can't be diagnosed with the AMH measurement in domestic queens. • Immunohistochemical analysis can be used for confirming the ovarian suspected tissues in thethe the feline with ORS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Polycystic ovary syndrome is an anovulatory infertility problem that requires the treatment of ovulation induction. Clomiphene citrate is a first-line regimen for ovulation induction. The antimüllerian hormone is produced by granulosa cells of small, growing follicles in the ovary. Folliculogenesis is an essential process for ovarian function. Endometrial thickness is important throughout a female's life, especially concerning medications for ovulation induction. OBJECTIVE: This study aimed to determine the role of basal antimüllerian hormone and midcycle endometrial thickness in predicting follicular maturation and pregnancy in patients with polycystic ovary syndrome treated with clomiphene citrate. STUDY DESIGN: This was a prospective cohort study that was conducted at El-sir Abualhassan's Fertility Center (September 2020 to August 2021). The study included 197 patients with polycystic ovary syndrome diagnosed using the Rotterdam criteria. The patients were treated with a dosage of 100 mg of clomiphene citrate. Data were collected using a questionnaire that was filled out after informed consent was provided by the patients. The basal antimüllerian hormone level was measured using enzyme immunoassay, and endometrial thickness and follicular size were measured before and after clomiphene citrate treatment using transvaginal ultrasound. The data were analyzed using SPSS (version 23; IBM Corporation, Armonk, NY). Moreover, the correlation was performed using the chi-square test. RESULTS: Almost two-thirds of the participants have normal antimüllerian hormone levels. Before clomiphene citrate was used as the treatment regimen, 95.40% of the patients had an endometrial thickness of ≤5 mm and a follicular size of 1 to 6 mm. After clomiphene citrate treatment, 74.60% of the patients had an endometrial thickness of 6 to 10 mm, and 46.20% of the patients had a follicular size of 7 to 12 mm. A significant correlation was found between basal antimüllerian hormone, follicular maturation, and pregnancy (P=.001). There was a significant association between endometrial thickness after clomiphene citrate treatment and achieving pregnancy (P=.001). CONCLUSION: Clomiphene citrate is a first-line regimen for patients with polycystic ovary syndrome with normal antimüllerian hormone levels. After clomiphene citrate treatment, there was a correlation between antimüllerian hormone and follicular maturation and pregnancy. Moreover, there was a correlation between midcycle endometrial thickness and pregnancy.

Objective: To assess the association between anti-müllerian hormone (AMH) and embryo ploidy rates in two cohorts of patients undergoing in vitro fertilization (IVF) with trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A): (1) the general population of women pursuing IVF with PGT-A (Infertile cohort) and (2) women pursuing IVF with preimplantation genetic testing for monogenic disorders (PGT-M) due to risk for hereditary monogenic diseases (Non-infertile cohort).Design: Retrospective cohort study.Setting: Academic center.Patients: Patients undergoing their first cycle of IVF with trophectoderm biopsy and PGT-A or PGT-A and PGT-M in our center between 03/2012 and 06/2020. Patients of advanced maternal age according to Bologna criteria (age ≥40) and patients who underwent fresh embryo transfers were excluded.Intervention: None.Main Outcome Measure: Proportion of euploid, mosaic, and aneuploid embryos per cycle.Results: "Infertile" (n= 926) and "Non-infertile" (n= 214) patients were stratified based on AMH levels, with low AMH defined as <1.1 ng/ml in accordance with the Bologna criteria. Age-adjusted regression models showed no relationship between AMH classification and proportion of euploid, mosaic, and aneuploid embryos in the Infertile or Non-infertile cohorts. In the Infertile cohort, no association between AMH classification and embryo ploidy rates was identified in a subgroup analysis of patients less than 35 years, patients 35-37, and patients 38-39 years old. These findings persisted in a sensitivity analysis of Infertile patients stratified into AMH (ng/ml) quartile categories.Conclusion: AMH is not associated with proportion of euploid, mosaic, or aneuploid embryos in two large cohorts of patients undergoing IVF with PGT-A (Infertile patients) or PGT-A and PGT-M (Non-infertile patients), suggesting that a quantitative depletion of ovarian reserve does not predict the ploidy status of the embryo cohort. [ABSTRACT FROM AUTHOR]

Objective：To discuss the relationship between the different serum levels of anti-mullerian hormone (AMH) and ovarian response and in vitro fertilization-embryo transfer (IVF-ET)-assisted pregnancy outcome of the infertile patients with polycystic ovary syndrome (PCOS), and to clarify the influence of serum AMH level on assisted pregnancy outcome of the PCOS patients, and to provide the basis for the selection of assisted pregnancy treatment in the PCOS patients. Methods：A total of 1 837 patients aged 21－39 years old who underwent IVF-ET-assisted pregnancy were selected and divided into PCOS group (n=910) and non-PCOS group (n=927) according to whether they were diagnosed as PCOS； a total of 437 patients in PCOS group received fresh single high-quality blastocyst transfer, and they were divided into AMH< 7 µg·L－1 group and AMH≥7 µg·L－1 group according to their serum AMH levels；the patients were divided into 20－24 years old group，25－29 years old group，30－34 years old and 35－39 years old group according to their ages. Age，serum levels of AMH, gonadotropin (Gn) dosages, estradiol (E2) values on the human chorionic gonadotropin (HCG) day, number of retrieved oocytes，cancellation transfer rates for preventing ovarian hyperstimulation syndrome (OHSS) and clinical pregnancy rates of the patients in PCOS group and non-PCOS group were compared；the Gn dosages, E2 values on the HCG day, number of retrieved oocytes，cancelation transfer rates of preventing OHSS and clinical pregnancy rates of the patients with different AMH levels in PCOS group were analyzed；the serum AMH levels of the patients with different ages in pregnant group and non-pregnant group were compared. Results：The level of serum AMH and E2 value on the HCG day, number of retrieved oocytes and cancelation transfer rate for preventing OHSS of the patients in PCOS group were higher than those in nonPCOS group (P<0. 05), while the Gn dosage and clinical pregnancy rate were lower than those in nonPCOS group (P<0. 05). The serum AMH level of the patients in PCOS group was positively correlated with the E2 value on the HCG day and number of retrieved oocytes (r=0. 502，P=0. 001；r=0. 233，P= 0. 001)，and negatively correlated with Gn dosage (r=－0. 400，P=0. 001). In PCOS group，compared with AMH< 7 µg·L－1 group, the E2 value on the HCG day, number of retrieved oocytes, and cancelation transfer rate for preventing OHSS of the patients in PCOS group were increased (Z=－3. 952，P= 0. 001；Z=－2. 858，P=0. 004；χ2 = 23. 154，P=0. 001)； the Gn dosage and clinical pregnancy rate were decreased (Z=－6. 727，P=0. 001；χ² = 6. 640，P=0. 010). The serum AMH level of the patients in pregnant group in PCOS group was lower than that in non-pregnant group (Z=－4. 192，P=0. 001)； in 25－29 years old group and 30－34 years old group, the serum AMH levels of the patients in pregnant group were lower than those in non-pregnant group (Z=－2. 197，P=0. 028，Z=－3. 700，P<0. 001). Conclusion：For the PCOS patients with serum AMH level≥7 µg·L－1，the pretreatment should be performed to reduce the AMH level before assisted pregnancy. In the process of IVF-ET-assisted pregnancy, the Gn dosage should be well controlled to reduce the E2 value on the HCG day, reduce the cancellation transfer rate for preventing OHSS, try to have the chance of fresh embryo transplantation and increase the clinical pregnancy rate, and improve the outcome of assisted pregnancy. [ABSTRACT FROM AUTHOR]

Background: Reliable predictive models for predicting excessive and poor ovarian response in controlled ovarian stimulation (COS) is currently lacking. The dynamic (D) inhibin B, which refers to increment of inhibin B responding to exogenous gonadotropin, has been indicated as a potential predictor of ovarian response. Objective: To establish mathematical models to predict ovarian response at the early phase of COS using Dinhibin B and other biomarkers. Materials and methods: Prospective cohort study in a tertiary teaching hospital, including 669 cycles underwent standard gonadotropin releasing hormone (GnRH) antagonist ovarian stimulation between April 2020 and September 2020. Early Dinhibin B was defined as an increment in inhibin B from menstrual day 2 to day 6 through to the day of COS. Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 5-fold cross-validation was applied to construct ovarian response prediction models. The area under the receiver operating characteristic curve (AUC), prevalence, sensitivity, and specificity were used for evaluating model performance. Results: Early Dinhibin B and basal antimüllerian hormone (AMH) levels were the best measures in building models for predicting ovarian hypo- or hyper-responses, with AUCs and ranges of 0.948 (0.887–0.976) and 0.904 (0.836–0.945) in the validation set, respectively. The contribution of the early Dinhibin B was 67.7% in the poor response prediction model and 56.4% in the excessive response prediction model. The basal AMH level contributed 16.0% in the poor response prediction model and 25.0% in the excessive response prediction model. An online website based tool (http://121.43.113.123:8001/) has been developed to make these complex algorithms available in clinical practice. Conclusion: Early Dinhibin B might be a novel biomarker for predicting ovarian response in IVF cycles. Limiting the two prediction models to the high and the very-low risk groups would achieve satisfactory performances and clinical significance. These novel models might help in counseling patients on their estimated ovarian response and reduce iatrogenic poor or excessive ovarian responses. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between ovarian reserve biomarkers and future fertility among late reproductive-age women.Design: Cohort study of participants enrolled in Time to Conceive (TTC), a time-to-pregnancy cohort study of the ovarian reserve biomarkers.Setting: Community.Patient(s): Women aged 30-44 years without a history of infertility who provided a blood sample at enrollment in TTC and who agreed to future follow-up.Intervention(s): Not applicable.Main Outcome Measure(s): The primary outcomes were probability of achieving a live birth >3 years after enrollment in TTC, diagnosis of infertility at any time, and time-to-pregnancy in future pregnancy attempts.Result(s): Women with diminished ovarian reserve, defined as those with an antimüllerian hormone (AMH) level <0.7 ng/mL or follicle-stimulating hormone (FSH) level ≥10 mIU/mL, did not have low risk of future live birth (relative risk [RR], 1.32; 95% confidence interval [CI], 0.95-1.83 and RR, 1.28; 95% CI, 0.97-1.70, respectively) compared with women with normal ovarian reserve after adjusting for age at blood draw, race, obesity, use of hormonal contraception, and year of enrollment in original study. Among women in the cohort that attempted to conceive, there was not a significant association between diminished ovarian reserve, as measured by AMH or FSH, and risk of future infertility (RR, 0.65; 95% CI, 0.21-2.07 and RR,1.69; 95% CI, 0.86-3.31, respectively). Similarly, there was no association between AMH and FSH levels and future fecundability (fecundability ratio, 0.97; 95% CI, 0.59, 1.60; and fecundability ration, 0.86; 95% CI, 0.55-1.36, respectively).Conclusion: Diminished ovarian reserve is not associated with reduced future reproductive capacity. Given the lack of association, women should be cautioned regarding use biomarkers of ovarian reserve as predictors of their future reproductive capacity. [ABSTRACT FROM AUTHOR]

To evaluate the association between intra cytoplasmic sperm injection (ICSI) success and obstetrics and perinatal outcome after ICSI cycle and elevated antimullerian hormone (AMH) levels. A total of 389 ICSI cycles were included retrospectively. All of the participants had serum AMH levels>3.8 ng/ml. Participants were divided into two groups on the basis of their serum AMH levels: Group 1 (AMH= 3.8-7.9 ng/ml) and Group 2 (AMH≥8 ng/ml). Antagonist protocol with gonadotropin were performed for ovarian stimulation. Oocyte pick-up (OPU) was performed 36 hours after ovulation trigger. Embryo(s) was transferred under ultrasound guidance. If patients exhibited evidence of ovarian hyperstimulation syndrome (OHSS) or were at risk of OHSS, embryo transfer (ET) was cancelled and embryos were cryopreserved and in frozen-thaw cycles, embryos were placed in the uterus. Cumulative rates were calculated until two years after ovum pick up, or exhaustion of preserved embryos before two years, including both fresh ET cycles and subsequent frozen-thaw (FET) cycles. Implantation was defined as positive serum pregnancy test. Clinical pregnancy was defined as a gestational sac with a fetal heart beat detected. Live birth rate was defined as a delivery of a live infant. Abortion was defined as pregnancy loss before 20 weeks of gestation. Gestational complications, anthropometric measures of neonates, admission to neonatal intensive care unit (NICU) and the presence of congenital anomaly were noted. Demographic features were similar between two groups. Gonadotropin dose performed for ovarian stimulation, endometrial thickness on trigger day and asynchronous follicular development rate were similar between groups. Estradiol levels, the number of cumulus ooforus cells, metaphase II and fertilized oocyte were higher in Group 2 than Group 1 (p<0.05). Ovulation trigger agent was different between the groups (p=0.03). Dual trigger was performed in the most of the Group 1 and analog trigger was performed in the most of the Group 2. No embryo transfer (fresh/frozen-thaw) was performed in 8 cases due to cleavage arrest. All of the cause of the cancelled fresh embryo transfer was OHSS or OHSS risk. Fresh ET was performed in 29.5% of Group 1 and 24.8% of Group 2. Frozen-thaw ET was performed in 70.5% of Group 1 and 75.2% of Group 2. ET day and transferred embryo number were similar between two groups. The two groups had similar cumulative implantation, clinical pregnancy, and abortion rates. However live birth rate was decreased in Group 2 than Group 1 (p=0.04). In Group 1, there was two ectopic pregnancy and one stillbirth. In Group 2, there was one ectopic pregnancy and one stillbirth. Preterm delivery, fetal anthropometric measurements, pregnancy complications, presence of congenital anomaly were comparable between groups (Table 1). Increased severe AMH levels (≥8 ng/ml) is related to decreased cumulative live birth rates. [ABSTRACT FROM AUTHOR]

Abstract Objective The current study was undertaken to investigate the relationship between antimüllerian hormone (AMH) and polycystic ovarian syndrome (PCOS) phenotypes and to determine whether AMH is associated with pregnancy outcomes in infertile women undergoing their first in vitro fertilization (IVF) treatment. Methods We performed a retrospective cohort study of 2973 infertile women, including 418 women with PCOS undergoing their first IVF treatment at a private fertility center from January 2014 to March 2018. Women were stratified into three groups using cutoffs defined by the 25th and 75th percentiles of the serum AMH level: 746 women had AMH ≤ 2.25 ng/mL; 1486 women had AMH between 2.25 to 5.71 ng/mL; and 741 women had AMH > 5.71 ng/mL. Endocrine characteristics, PCOS phenotypes, stimulation outcomes, pregnancy outcomes were compared among these groups. When there were any statistical differences (P

ObjectiveTo determine the degree to which E2 hyperresponsiveness to FSH and antimüllerian hormone (AMH) overproduction in normal-weight women with polycystic ovary syndrome (PCOS) correlate with increased antral follicle number (AFN), hyperandrogenism, and/or metabolic dysfunction.DesignProspective cohort study.SettingAcademic medical center.Patient(s)Seven normal-weight women with PCOS (1990 National Institutes of Health criteria) ages 20-34 years and 13 age- and body mass index- (BMI-; 18.5-25 kg/m2) matched normoandrogenic ovulatory women were studied.Intervention(s)All women underwent basal serum hormone and metabolic measurements, FSH stimulation testing with transvaginal ovarian sonography, frequently sampled IV glucose tolerance testing, and whole-body dual-energy x-ray absorptiometry.Main outcome measure(s)Serum hormone/metabolite levels, 24-hour serum E2 response to 150 IU recombinant human (rh) FSH infusion, AFN, insulin sensitivity, and body mass measurements.Result(s)Serum E2 responsiveness to rhFSH and AMH levels were greater in women with PCOS than in BMI- and age-matched control women, as were serum androgen levels, AFN, and abdominal fat mass. In all women combined, serum E2 responsiveness to rhFSH was associated with AFN. Serum AMH levels, however, positively correlated with AFN but remained positively correlated with serum LH and free T levels and negatively correlated with total body fat and percent body fat, adjusting for AFN.Conclusion(s)In normal-weight women with PCOS, serum E2 hyperresponsiveness to rhFSH represents increased AFN, while elevated serum AMH levels reflect opposing effects of stimulatory reproductive (hyperandrogenism and increased AFN) versus inhibitory metabolic (body fat) factors. Given the small number of subjects reported, additional follow-up studies are required to confirm these data.

Objective: To determine the ongoing pregnancy rate among patients with infertility with a low antimüllerian (AMH) level compared with those with a normal AMH level after oral and injectable ovulation induction (OI)/intrauterine insemination (IUI).Design: Retrospective cohort.Setting: Academic center.Patient(s): Patients completing ≥1 medicated OI/IUI cycle at our center between 2015 and 2019 were included. The AMH levels were measured within 12 months of treatment initiation. The cohort was stratified into low AMH (AMH level, <1.0 ng/mL) and normal AMH (AMH level, ≥1.0 ng/mL) groups. All subsequent medicated OI/IUI cycles occurring within 1 year of initial cycle start date were included up to the third completed cycle or until an ongoing pregnancy was recorded. Patients were stratified by age (<35, 35-40, and >40 years), and the relationship between the low and normal AMH groups and each binary endpoint were quantified as risk ratios using the age-adjusted Poisson models.Intervention(s): None.Main Outcome Measure(s): Ongoing pregnancy.Result(s): A total of 3,122 patients completed 5,539 oral antiestrogen cycles, and 1,060 completed 1,630 injectable gonadotropin cycles. For oral antiestrogen treatment, pregnancy outcomes, including ongoing pregnancy rate per cycle, for patients with a low AMH level were comparable with those for patients with a normal AMH level (<35 years, 15.4% vs. 14.9%; 35-40 years, 10.0% vs. 11.0%; and >40 years, 2.8% vs. 3.3%). For injectable gonadotropin treatment, the ongoing pregnancy rate was lower in the low AMH group than in the normal AMH group for the ages of <35 (12.1% vs. 23.5%; relative risk [RR], 0.52 [95% confidence interval {CI}, 0.28-0.97]) and 35-40 (12.5% vs. 18.5%; RR, 0.70 [95% CI, 0.49-0.99]) years but comparable with that for patients aged >40 years (3.0% vs. 4.0%; RR, 0.86 [95% CI, 0.31-2.35]). The proportion of multifetal gestations was similar between the low and normal AMH groups treated with oral antiestrogens (13.1% vs. 10.8%); however, for injectable gonadotropin treatment, patients with a normal AMH level had a higher proportion of multifetal gestations (18.6% vs. 31.1%).Conclusion(s): Compared with normal ovarian reserve, treatment with oral antiestrogens for OI/IUI for patients with low ovarian reserve results in comparable follicular development and ongoing pregnancy rates for all age groups. When patients with low ovarian reserve are treated with gonadotropins for OI/IUI, multifollicular recruitment is less likely resulting in a significantly decreased ongoing pregnancy rate for patients aged <35 and 35-40 years but also a decrease in multifetal gestations. Overall, the ongoing pregnancy rates of 8.7% per oral antiestrogen cycle and 8.1% per injectable gonadotropin cycle in patients with low ovarian reserve are comparable with the expected rates in the general infertility population. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels.Design: Systematic review and meta-analysis.Setting: Not applicable.Patient(s): Patients with endometriomas undergoing cystectomy or ablation.Intervention(s): All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software.Main Outcome Measure(s): The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons.Result(s): Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I2 = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I2 = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I2 = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I2 = 0%).Conclusion(s): Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC.Clinical Trial Registration Number: CRD42020152823;PROSPERO (york.ac.uk). [ABSTRACT FROM AUTHOR]

Reproductive aging is characterized by a decline in oocyte quantity and quality, which is directly associated with a decline in reproductive potential, as well as poorer reproductive success and obstetrical outcomes. As women delay childbearing, understanding the mechanisms of ovarian aging and follicular depletion have become increasingly more relevant. Age-related meiotic errors in oocytes are well established. In addition, it is also important to understand how intraovarian regulators change with aging and how certain treatments can mitigate the impact of aging. Individual studies have demonstrated that reproductive pathways involving antimullerian hormone (AMH), vascular endothelial growth factor (VEGF), neurotropins, insulin-like growth factor 1 (IGF1), and mitochondrial function are pivotal for healthy oocyte and cumulus cell development and are altered with increasing age. We provide a comprehensive review of these individual studies and explain how these factors change in oocytes, cumulus cells, and follicular fluid. We also summarize how modifiers of folliculogenesis, such as vitamin D, coenzyme Q, and dehydroepiandrosterone (DHEA) may be used to potentially overcome age-related changes and enhance fertility outcomes of aged follicles, as evidenced by human and rodent studies. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the protective effect of ozone therapy on ovarian reserve, number of ovarian follicles, ovarian morphology in a rat ischaemia reperfusion (IR) injury model. Twenty-four, Wistar Hannover rats were included. The rats were divided into three groups as control, detorsion-only, and ozone therapy + detorsion groups. There was a statistically significant difference in the follicular damage and inflammation scores between the study groups (p =.019, p =.002, respectively). The highest AMH decrease was observed in the detorsion-only group (p =.012). The total damage score was higher in the detorsion-only group than the ozone therapy + detorsion group. Preantral, small and large antral follicle numbers were less in the detorsion-only group than the ozone therapy + detorsion group. The highest postoperative day 7 TAS level was in the ozone therapy + detorsion group. TOS levels did not differ significantly between the study groups. The combination of the ozone therapy with ovarian detorsion is more effective in protecting the ovarian reserve than ovarian detorsion-only. What is already known on this subject? Adnexal torsion is a common gynecological emergency in reproductive-age women. The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire. What do the results of this study add? The combination of the medical ozone therapy with conventional surgical ovarian detorsion is more effective in the protection of the ovarian reserve compared to surgical ovarian detorsion. What are the implications of these findings for clinical practice and/or further research? This study speculates that medical ozone therapy in addition to conventional surgical ovarian detorsion could preserve ovarian reserve and function if confirmed in further clinical studies. [ABSTRACT FROM AUTHOR]

With the improvement in survival and the reduction in morbidity related to sickle cell disease (SCD), aspects related to reproductive health are emerging as a priority in the care of affected people. We conducted a systematic review looking for evidence describing the functional ovarian reserve levels in women with sickle cell disease. To locate studies, a search was performed in electronic databases, in addition to preprint servers and reference lists of selected publications. Two independent reviewers searched, and the risk of bias in the selected studies was assessed using the Newcastle-Ottawa scale. 1,086 records were initially retrieved, and one article was identified after consulting the reference lists of the screened articles, only four articles met the eligibility criteria. The quality of evidence was rated very low due to the design of the studies; however, the risk of bias was considered low. These are recent studies published between 2015 and 2021, whose main methodology was a cross-sectional or case-control study. All studies reported lower anti-mullerian hormone levels in women with sickle cell disease. Although lower, anti-mullerian hormone levels were within the normal range in young women with sickle cell disease only with supportive care, in those who used hydroxyurea, a decrease in ovarian reserve was observed. support insufficient evidence support a causal relationship between sickle cell disease and reduced ovarian reserve. From anti-mullerian hormone values a trend towards lower levels in women with sickle cell disease compared to healthy women, as reported in the four studies evaluated. Studies that analyze the ovarian reserve based on imaging and biochemical parameters are an important future focus.

Background: Success of assisted reproductive techniques depends on multiple factors including maternal endocrine status, hormonal balance, and paternal sperm quality. A comprehensive pre-treatment evaluation allows better prediction of outcomes and avoidance of unnecessary procedures and expenses., Methods: To examine the impact of female hormonal profiles and sperm DNA damage on the success of assisted reproduction, medical data were extracted from the clinical records of infertile couples including couples' age and levels of maternal anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), as well as the DNA fragmentation index (DFI) in men. Any correlation between these parameters and clinical outcomes was investigated., Results: DFI and FSH independently influenced the rate of high-quality embryos. A decrease in maternal age and PRL levels increased the rate of these embryos. On the other hand, an increase in maternal body mass index (BMI) or AMH levels was associated with a reduced chance of achieving high quality embryos. In addition, any reduction in PRL levels could be associated with a higher fertilization rate. FSH levels above the normal range contribute to a reduced rate of high-quality embryos. Overall, our findings demonstrate the complex interplay between different factors and their influence on fertilization success and emphasize the importance of optimizing these variables to achieve the best possible outcome., Conclusion: Several factors can influence the outcome of infertility treatment. These factors include paternal DFI, maternal age, BMI, AMH, FSH, and PRL levels., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2024 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.)

Study Objective: To evaluate the effectiveness of the Dual Wavelength Laser System (DWLS) diode laser on the treatment of ovarian endometrioma (OMA), with ablation and vaporization of the cystic capsule without performing the stripping technique, in terms of ovarian reserve and recurrence rate., Design: Prospective, single-arm, multicenter, clinical trial., Setting: Multicenter University Hospital., Patients: Seventy patients with symptomatic OMA., Interventions: Patients underwent surgery for primary unilateral or bilateral symptomatic OMA treated with DWLS diode laser vaporization. Following surgical intervention, patients were enrolled in a 12 months surveillance protocol featuring regular clinical assessments aimed at detecting ovarian reserve, pregnancy rate and any recurrence of the cyst and/or symptomatic relapse., Measurements and Main Results: Antimullerian hormone (AMH) levels at the 3-month follow-up exhibited a significant difference from the baseline (p = .034), demonstrating a return to nearly presurgical values in the subsequent months. Antral follicle count (AFC) of the operated ovary showed a significant increase after treatment at the 6-month and 12-month follow-up (p = 0.005 and p = 0.002, respectively). Pregnancies were documented in 48.3% (14/29) of infertile patients who underwent treatment. OMA recurrence was observed in 4 patients (5.7%) at 12 months. No patient exhibited a significant relapse of the analyzed symptoms compared to baseline values., Conclusion: The findings of this study propose that DWLS diode laser presents a good option for treating OMA, demonstrating minimal impact on the surrounding healthy ovarian tissue, favorable pregnancy rate, coupled with low recurrence rates., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the diagnostic role of antimüllerian hormone in polycystic ovary syndrome using an advanced marginal beta-binomial statistical model, and present the optimal cutoff by different age groups, geographical locations, body mass indexes, and other relevant factors., Data Sources: A comprehensive and systematic literature search was conducted in Web of Science, PubMed/Medline, Scopus, Cochrane Library, Embase, and ProQuest until August 2024., Study Eligibility Criteria: Epidemiologic studies that used the Androgen Excess and Polycystic Ovary Syndrome Society, National Institutes of Health, or Rotterdam diagnostic criteria for polycystic ovary syndrome were included in this meta-analysis. Studies were eligible for inclusion if they provided information on the sensitivity and specificity of antimüllerian hormone or related data that allowed for the calculation of these parameters, and/or data on odds ratios and means., Methods: The diagnostic efficacy of antimüllerian hormone was assessed using the marginal beta-binomial statistical model and the summary receiver operating characteristic method in terms of pooled sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval. Pooled weighted mean difference and pooled odds ratios with 95% confidence interval were estimated using a random effects model., Results: A total of 202 observational studies were included in the pooled analysis, of which 106 studies (including 19,465 cases and 29,318 controls) were used for meta-analysis of sensitivity/specificity and 186 studies (including 30,656 cases and 34,360 controls) for meta-analysis of mean difference. The pooled sensitivity, specificity, and diagnostic odds ratio for antimüllerian hormone were 0.79 (95% confidence interval, 0.52-0.97), 0.82 (95% confidence interval, 0.64-0.99), and 17.12 (95% confidence interval, 14.37-20.32), respectively. The area under the curve based on the summary receiver operating characteristic model was 0.90 (95% confidence interval, 0.87-0.93). Antimüllerian hormone levels were significantly higher in women with polycystic ovary syndrome than in control women (weighted mean difference, 4.91; 95% confidence interval, 4.57-5.27). In addition, individuals with higher antimüllerian hormone levels were more likely to be affected by polycystic ovary syndrome (odds ratio, 23.17; 95% confidence interval, 18.74-28.66; I 2 =94%; P<.001). A serum antimüllerian hormone concentration of >5.39 ng/mL was associated with polycystic ovary syndrome (sensitivity, 88.6%; specificity, 92.75%; likelihood ratio for a positive test result, 12.21; likelihood ratio for a negative test result, 0.12)., Conclusion: According to the results of this meta-analysis, serum antimüllerian hormone concentration is a valuable biomarker for the diagnosis of polycystic ovary syndrome. The cutoff points suggested by the current meta-analysis need to be evaluated and validated by future studies before their implementation into clinical practice., (Copyright © 2024. Published by Elsevier Inc.)

Although follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), antimullerian hormone (AMH), and ovarian volume are commonly used to assess ovarian reserve and ovarian response to stimulation, no test directly indicates this. We aimed to observe how ovarian reserve tests help us in the diagnosis and treatment of women of late reproductive age. We included 190 patients in this prospective cohort study. We took FSH, LH, E2 and AMH blood samples on the third day of menstruation to biochemically evaluate the ovarian reserve of the patients who were planned for hysterectomy and bilateral salpingo-oopherectomy at late reproductive age. We recorded antral follicle counts (AFC) and ovarian volumes by transvaginal ultrasonography for ultrasonographic evaluation and weighed ovarian weights postoperatively. The data of 190 women aged 39-44.9 years revealed that AMH and ovarian volume, ovarian volume and AFS show significant positive correlations, whereas FSH, LH, and E2 levels do not indicate a significant relationship with AFS. AMH, ovarian volume and ovarian weight, and AFC may show us the ovarian reserve with the highest reliability in women of late reproductive age. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether lesional immunostaining of putative biomarkers of recurrence and the extent of lesional and cortical fibroses are correlated with the severity of dysmenorrhea and serum antimüllerian hormone (AMH) levels in women with ovarian endometriomas (OEs).Design: Retrospective cohort study.Setting: Academic hospital.Patient(s): A total of 313 women with histologically confirmed OEs were recruited. Their demographic and clinical information and data on their preoperative AMH levels were collected. Additionally, samples of their lesional tissues and ovarian cortex tissues adjacent to the OE lesions were procured for histologic and immunohistochemistry analyses.Intervention(s): None.Main Outcome Measure(s): All OE tissue samples were stained for phosphorylated nuclear factor κB p65 subunit, progesterone receptor isoform B, Slit2, and α-smooth muscle actin. In addition, the extent of lesional and cortical fibroses was quantitated by Masson trichrome staining. We evaluated the relationship between the lesion size; laterality; extent of lesional and cortical fibroses, along with the putative markers of recurrence; and severity of dysmenorrhea and preoperative serum AMH levels in patients with OE.Result(s): We found that the extent of lesional fibrosis was positively correlated with the severity of dysmenorrhea but had no impact on the AMH levels. On the other hand, the extent of cortical fibrosis, along with age, was negatively correlated with the AMH levels.Conclusion(s): The correlation between lesional fibrosis and the severity of dysmenorrhea and between cortical fibrosis and the AMH levels would call an early intervention once OE is diagnosed or suspected to prevent further pain and diminished ovarian reserve. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundHIV infection has been associated with early menopausal onset, which may have adverse long-term health consequences. Antimüllerian hormone, a biomarker of ovarian reserve and gonadal aging, is reduced in HIV-infected women.ObjectiveWe sought to assess the relationship of antimüllerian hormone to age of menopause onset in HIV-infected women.Study designWe used antimüllerian hormone levels measured in plasma in 2461 HIV-infected participants from the Women's Interagency HIV Study to model the age at final menstrual period. Multivariable normal mixture models for censored data were used to identify factors associated with age at final menstrual period.ResultsHigher antimüllerian hormone at age 40 years was associated with later age at final menstrual period, even after multivariable adjustment for smoking, CD4 cell count, plasma HIV RNA, hepatitis C infection, and history of clinical AIDS. Each doubling of antimüllerian hormone was associated with a 1.5-year increase in the age at final menstrual period. Median age at final menstrual period ranged from 45 years for those in the 10th percentile of antimüllerian hormone to 52 years for those in the 90th percentile. Other factors independently associated with earlier age at final menstrual period included smoking, hepatitis C infection, higher HIV RNA levels, and history of clinical AIDS.ConclusionAntimüllerian hormone is highly predictive of age at final menstrual period in HIV-infected women. Measuring antimüllerian hormone in HIV-infected women may enable clinicians to predict risk of early menopause, and potentially implement individualized treatment plans to prevent menopause-related comorbidities and to aid in interpretation of symptoms.

Objective: To examine the changes in AMH levels longitudinally over time and their relationship with both body composition, particularly abdominal adiposity, and milestones of pubertal development in female children. Design: Secondary analysis of a prospective, longitudinal study. Setting: University affiliated research center and laboratories. Patient(s): Eighty-nine females were examined between 1990 and 2015 to study child growth and development. Intervention(s): Demographic, anthropometric, growth, and pubertal milestone data with serum samples stored and subsequently analyzed for AMH. Main Outcome Measure(s): Longitudinal change in AMH and predicted AMH levels based on body composition, age, and pubertal milestones including, pubarche, thelarche, and menarche. Result(s): Natural log-transformed AMH (AMHlog) levels appeared to have a nonlinear relationship with age, decreasing between 10 and 14 years of age, increasing until 16 years. A mixed effect linear model demonstrated that increased abdominal adiposity (waist/height ratio, WHtR) was significantly associated with the predicted increased AMHlog levels (β=1.37). As females progressed through the Tanner stages, the model predicted decreasing AMHlog values when adjusting for age and WHtR. Conclusion(s): Declining AMH levels during puberty may not be reflective of diminished ovarian reserve as observed in adults, but may suggest a permissive role of AMH in the activation of the hypothalamic-pituitary-ovarian axis.

Female anti-Müllerian hormone (AMH) overexpressing (Thy1.2-AMHTg/0) mice experience fetal resorption (miscarriage) by mid-gestation. This study examined whether the ovary, uterine implantation sites and hypothalamus are potential sites of AMH action, as AMH type-2 receptor (AMHR2) expression is reported in each tissue. Pregnancy in Thy1.2-AMHTg/0 mice was compared to wild-type (WT) mice via histological examination of implantation sites, hormone assays, embryo culture and embryo transfer. Uterine AMH and AMHR2 expression was examined by RT-qPCR and immunohistochemistry. The first signs of fetal resorption in the Thy1.2-AMHTg/0 dams occurred at embryonic day 9.5 (E9.5) with 100% of fetuses resorbing by E13.5. Cultured embryos from Thy1.2-AMHTg/0 dams had largely normal developmental rates but a small proportion experienced a minor developmental delay relative to embryos from WT dams. However, embryos transferred from WT donor females always failed to survive to term when transferred into Thy1.2-AMHTg/0 dams. Amh and Amhr2 mRNA was detected in the gravid uterus but at very low levels relative to expression in the ovaries. Progesterone and estradiol levels were not significantly different between WT and Thy1.2-AMHTg/0 dams during pregnancy but luteinizing hormone (LH) levels were significantly elevated in Thy1.2-AMHTg/0 dams at E9.5 and E13.5 relative to WT dams. Collectively, these experiments suggest that AMH overexpression does not cause fetal resorption through an effect on oocytes or preimplantation embryo development. The Thy1.2-AMHTg/0 fetal resorption phenotype is nearly identical to that of transgenic LH overexpression models, suggesting that neuroendocrine mechanisms may be involved in the cause of the miscarriage. [ABSTRACT FROM AUTHOR]

Objective: The current study was undertaken to investigate the relationship between antimüllerian hormone (AMH) and polycystic ovarian syndrome (PCOS) phenotypes and to determine whether AMH is associated with pregnancy outcomes in infertile women undergoing their first in vitro fertilization (IVF) treatment.Methods: We performed a retrospective cohort study of 2973 infertile women, including 418 women with PCOS undergoing their first IVF treatment at a private fertility center from January 2014 to March 2018. Women were stratified into three groups using cutoffs defined by the 25th and 75th percentiles of the serum AMH level: 746 women had AMH ≤ 2.25 ng/mL; 1486 women had AMH between 2.25 to 5.71 ng/mL; and 741 women had AMH > 5.71 ng/mL. Endocrine characteristics, PCOS phenotypes, stimulation outcomes, pregnancy outcomes were compared among these groups. When there were any statistical differences (P < 0.05) among the three groups, Bonferroni test was performed as post-hoc tests to determine where the statistical differences existed. To assess the relationships between AMH and pregnancy outcomes in total patients and PCOS patients, logistic regression analysis, adjusted for potential confounding covariates, were performed.Results: Women with high AMH had greater prevalence of hyperandrogenism (HA), polycystic ovarian morphology (PCOM) and amenorrhea than women with low or average AMH. The clinical pregnancy rate were significantly higher in the high-AMH group compared with low- and average-AMH groups (69.9% vs. 58.8% and 64.7% respectively; P < 0.001). The live birth rate was significantly lower in women with AMH ≤ 2.25 ng/mL compared with average- and high-AMH groups (47.6% vs. 55.2 and 59.5% respectively; P < 0.001). However, after controlling for maternal age, oocyte yield, as well as other confounders, AMH was no longer associated with a higher live birth rate (aOR 1.037, 95% CI 0.853-1.261, P = 0.717; aOR 1.099, 95% CI 0.858-1.408, P = 0.455, respectively) and clinical pregnancy rate (aOR 1.064, 95% CI 0.834-1.359, P = 0.617; aOR 1.181, 95% CI 0.875-1.595, P = 0.276, respectively). Moreover, pregnancy outcomes did not differ in PCOS women according to AMH quartiles.Conclusion: Increased AMH levels associated with PCOS severity and greater ovarian stimulation. However, AMH was not associated with clinical pregnancy rate and live birth rate after controlling for other confounders in women undergoing IVF. Thus, AMH should not be used to alter clinical decisions and exclude patients based on a low or even undetectable AMH value. [ABSTRACT FROM AUTHOR]

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Study Objective: To investigate the therapeutic efficacy of catheter-directed ethanol sclerotherapy (CDS) and its effect on ovarian reserve in patients with endometrioma at risk of decreased ovarian reserve.Design: Retrospective study.Setting: Teaching hospital.Patients: We evaluated 18 patients with ovarian endometrioma measuring ≥3 cm and preprocedural serum antimüllerian hormone (AMH) levels of <2 ng/mL.Interventions: An 8.5-F catheter was inserted either transabdominally or transvaginally into the endometrioma. After aspiration, sclerotherapy with 99% ethanol was performed, with a subsequent 20-minute ethanol retention.Measurements and Main Results: Ultrasonography was performed preprocedurally and 6 months after CDS to evaluate any recurrence or changes in cyst size. Furthermore, serum AMH levels, cancer antigen 125 (CA-125) levels, and the visual analog scale scores for dysmenorrhea were obtained to analyze the ovarian reserve and treatment efficacy, preprocedurally and at 6 months after CDS. The mean cyst size on ultrasonography and serum CA-125 levels decreased 6 months after CDS (p <.001 and p = .001, respectively). All patients reported a decreased visual analog scale score for dysmenorrhea (p <.001). However, the difference in serum AMH levels before and after CDS was statistically insignificant (p = .875).Conclusion: CDS was efficacious in reducing pain and serum CA-125 levels in patients with low AMH levels without adversely affecting their ovarian reserve. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oxidative stress in the follicular fluid (FF) is thought to be responsible for the abnormal development of oocytes. In our study patients with polycystic ovarian syndrome (PCOS), endometriosis, and tubal infertility factor (TIF), and healthy women with a male factor of infertility, were prospectively enrolled. From each patient, a sample of individual FF was collected from a dominant follicle. Concentration levels of TAS, 8-IP, 8-OHdG, and AMH were determined. In women with PCOS, we found significantly lower values of oxidative stress markers in the FF. 8-IP and TAS levels were lower in the FF of women with endometriosis. In women with TIF, we also found significantly lower values of all tested markers in the FF, except for 8-OHdG and AMH. We wanted to see whether the biomarker measured in the FF in an individual diagnosis could predict a successfully obtained embryo from this particular follicle. The FF 8-OHdG result in PCOS patients stood out and proved to be a good predictive marker of matured and fertilized oocytes in these patients. Further research is needed to be able to apply the acquired knowledge in improving the outcome of IVF procedures.

Objective: To evaluate the association between sleep quality and ovarian reserve among women of reproductive age., Design: Cross-sectional study., Setting: Not applicable., Patient(s): A total of 1,070 female participants aged 20-40 years enrolled from February 2023 to January 2024., Intervention(s): Not applicable., Main Outcome Measure(s): A 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. The assessment was conducted on ovarian reserve, including total antral follicle count (AFC), antimüllerian hormone (AMH) level, and basal sex hormone level., Result(s): The study sample of 1,070 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, estradiol, testosterone, AFC, and AMH between the two groups. The poor sleep group exhibited significantly lower levels of AMH and AFC. The FSH levels in the poor sleep group were higher. 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 ≥10 mIU/mL; AOR, 1.16; 95% CI, 1.08-1.25; AMH <1.1 ng/mL or AFC <7 or FSH ≥10 mIU/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, 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, 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 body mass index ≤18.4 kg/m 2 subgroups., Conclusion(s): Poor sleep quality is associated with diminished ovarian reserve in women of reproductive age., Competing Interests: Declaration of Interests Y.L. has nothing to disclose. Y.C. has nothing to disclose. Y. Lin has nothing to disclose. S.X. has nothing to disclose. A.R. has nothing to disclose. X.Z. has nothing to disclose. X. Lin has nothing to disclose. X. Li has nothing to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)