DOCSLIB.ORG

Fertility with Early Reduction of Ovarian Reserve: the Last Straw That Breaks the Camel’S Back Sabahat Rasool1* and Duru Shah2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fertility with Early Reduction of Ovarian Reserve: the Last Straw That Breaks the Camel’S Back Sabahat Rasool1* and Duru Shah2 Rasool and Shah Fertility Research and Practice (2017) 3:15 DOI 10.1186/s40738-017-0041-1 REVIEW Open Access Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back Sabahat Rasool1* and Duru Shah2 Abstract Diminished fertility and poor ovarian response pose a conundrum to the experts in the field of reproductive medicine. There is limited knowledge about the risk factors of diminished ovarian reserve other than the iatrogenic ones. One of the leading causes of infertility in women today is diminished ovarian reserve (DOR). DOR is characterized by a low number of eggs in a woman’s ovaries and/or with poor quality of the remaining eggs, which boils down to impaired development of the existing eggs, even with assisted reproductive techniques. A good number of such women with low ovarian reserve may conceive with their own eggs, if they are given individualized treatment that is tailored for their profile. Such patients should be counseled appropriately for an aggressive approach towards achieving fertility. The sooner the treatment is started, the better the chances of pregnancy. Keywords: Ovarian reserve, Diminished ovarian reserve, Reduced fertility, Poor ovarian response, Poor responders Background Definition Little is known about the risks, and management of di- DOR is defined as a decrease in the number of quality & minished ovarian reserve (DOR), which is affected by quantity of oocytes [5]. It is used to describe women of age, genetics and environmental factors. The one thing reproductive age with regular cycles mostly ovulatory, certain about DOR is that it is irreversible and that these whose response to stimulation or fecundity is reduced women are at risk of poor ovarian response to ovarian compared to women of comparable age. It is distinct stimulation in Assisted Reproductive Technologies from menopause or premature ovarian insufficiency. A (ART) [1, 2]. DOR is a poor prognostic factor in ART, woman’s chronological age is not the only determinant because of a decline in the quantity and quality of oocyte of ovarian reserve. Some studies have demonstrated an [3]. Age is the most well – known contributing factor to association between the cause of DOR and IVF DOR, and probably the most important prognostic fac- outcome. tor in fertility treatment of women with DOR [3].Age-re- Poor ovarian response (POR) implies a subnormal fol- lated abnormal vascularization, oxidative stress, free licular response, which means less number of eggs re- radical imbalance, toxic and genetic changes, all contrib- trieved after ovarian stimulation during IVF [4]. ESHRE ute to the declining oocyte quality, which translates into defined POR using Bologna criteria in order to abnormal fertilization, and disordered embryo implant- standardize the definition, since the variability in the ation [3]. DOR is associated with poor ovarian response definition of POR was striking. According to Bologna to ovarian stimulation, higher cycle cancellation rates criteria, POR is defined as “when at least two of the and lower pregnancy rates during In Vitro Fertilization following three characteristics are present”: (IVF) [4]. 1. Advanced maternal age > 40 yrs. or any other risk factors for poor ovarian response. * Correspondence: [email protected] 2. Previous POR (≤ 3 oocytes with conventional 1Gynaecworld, Kwality House, 1st Floor, Kemps Corner, Mumbai, India stimulation of >149 IU FSH daily), and Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Rasool and Shah Fertility Research and Practice (2017) 3:15 Page 2 of 12 3. An abnormal ovarian reserve test (AFC < 5–7, or affects ovaries depending on the dose, field and age of AMH < 0.5–1.1 ng/ml) the patient [12]. Other causes of DOR include iatrogenic ovarian surgeries, uterine artery ligation, laparoscopic Two episodes of POR after maximal ovarian stimula- salpingectomy, genetic diseases (Turner’s galatosemia, tion are sufficient to label a patient as a poor responder Fragile X, FSH receptor and Inhibin B mutations), [6]. The most important reason for a poor ovarian re- enzyme defects, mumps oophorihis, autoimmunity sponse is DOR. Some subgroups of DOR, based on the (Polyglandular syndrome, lymphocytic oophoritis, Addi- cause of DOR, show better IVF outcome than others. A son’s disease, Hashimoto thyroiditis, celiac disease) and recent retrospective study showed better response to metabolic (Galactosemia)[13]. IVF in DOR caused by surgery for endometrioma com- Idiopathic diminished ovarian reserve involves acceler- pared to idiopathic group [7]. ated oocyte apoptosis. According to Barkers hypothesis, Yun H, et al. studied the IVF outcome of women maternal endocrine disturbance during in utero life may with diminished ovarian reserve in 99 cycles and re- result in DOR in the female fetus [14]. ported a clinical rate of 11.5% per cycle, cancellation rate of 34.4%. They found that DOR caused by previ- Ovarian reserve estimation ous ovarian surgery had better pregnancy outcome, Ovarian reserve is used to describe a woman’s repro- while that caused by chemotherapy / gonadotoxic ductive potential by means of the quality and quantity of therapy had significantly higher cycle cancellation rate the oocytes her ovaries possess [15]. Ovarian reserve [4]. Studying the trends in DOR assignment in the tests (ORT) aim at identifying women at risk of hypo or Society for Assisted Reproductive Technology (SART) hyper response to ovarian stimulation, detecting repro- Clinic outcomes Reporting System Database and ductive lifespan and approximate menopausal timing evaluating its accuracy for POR prediction, Devine K, and counseling and planning about a family, and indi- et al. reported an increased prevalence of DOR from vidualizing management to optimize ovarian response 19% to 26% from 2004 to 2011 among 181,536 cycles whilst minimizing risks. Nevertheless, it is of utmost studied [8]. The incidence of POR decreased from importance to understand that ORTs should not be used 32% to 30% among cycles clinically assigned as DOR. as a sole criterion to deny ART or other treatments to Basal FSH ≥ 12 v/s clinical management assignment any patients. If ORTs indicate a diminished ovarian re- of DOR had a higher specificity (92.2% v/s 81.6%) serve, it means that pregnancy is less likely but not im- and positive predictive value (38.3% v/s 30.9%) for possible. Though we use a battery of ORTs as a proxy predicting POR. They concluded that despite increas- for oocyte number, testing the oocyte quality or compe- ing DOR prevalence, the ability of clinical DOR to tence using these tests is poor. predict POR in the concurrent cycle worsened. More Ideal ORT needs to be affordable, non-invasive, sensi- accurate markers of POR are needed to minimize tive and specific, with minimal inter and intra cycle vari- patient anxiety, under and over diagnosis of POR. ability, with good sensitivity to detect the decline in Possible explanations for increased DOR prevalence ovarian reserve at a stage where timely interventions include advanced age, more diagnostic modalities and could lead to pregnancy [16]. ORTs should be offered to to explain suboptimal success rates to the patients la- women at risk of DOR, not to the low-risk population. beled such. ORT that are used as of now are biochemical, pro- Causes of DOR [9–11]: vocative and sonographic imaging of ovaries. The tests used for assessing ovarian reserve include basal day −3 Idiopathic follicle stimulating hormone (FSH, introduced in 1998). Chemotherapy Clomiphene citrate challenge test (CCCT, 1989), gonad- Radiotherapy otropins releasing – hormone agonist stimulation test Genetic mutations like FMR (GAST, 1989), Inhibin –B (1997), antral follicle count Smoking (AFC, 1997) and antimullerian hormone (AMH, 2002.) Ovarian surgeries The provocative tests like CCCT and GnRH-agonist Autoimmune stimulation test are literally out of practice now and Mumps FSH, AFC and AMH are being used extensively [17, 18]. Galactosemia Tubal surgery Idiopathic Basal FSH Chemotherapy depletes primordial follicles in a dose This test is based on the negative feedback of FSH- and drug-dependent manner. Risk of toxicity during pituitary secretion by ovarian factors like estradiol chemotherapy increases with age. Similarly, radiation and inhibin B. Normal women have adequate Rasool and Shah Fertility Research and Practice (2017) 3:15 Page 3 of 12 quantities of ovarian hormones in early follicular the sole criterion for denying fertility treatment. On the phase, which maintains the FSH levels with normal contrary, such women should be thoroughly counseled range. However, women with depleting oocyte pool about possible low oocyte yield, high cycle cancellations and diminished ovarian reserve will present with ele- and poor embryo quality. vated basal FSH levels. Though basal FSH levels have AMH assessment is done using Enzyme –linked im- significant inter and intra cycle variability, but when munosorbent assay (ELISA) Gen II, Beckman Coulter combined with basal estradiol, the sensitivity and spe- Inc.; Brea, CA [39]. Newer automated AMH assay plat- cificity of basal FSH to test ovarian reserve is accen- forms are reported to offer better precision and sensitiv- tuated [19]. The specificity for using FSH to predict ity, faster results when compared to standard ELISA poor ovarian response is 45–100% (≤ 4 retrieved assays [40, 41]. Certain factors tend to influence the occytes). However the sensitivity is low 11–86% [19, AMH values.
Load more

Recommended publications
  • The Relationship Between H19 and Parameters of Ovarian Reserve Xi Xia1,2, Martina S
    Xia et al. Reproductive Biology and Endocrinology (2020) 18:46 https://doi.org/10.1186/s12958-020-00578-z RESEARCH Open Access The relationship between H19 and parameters of ovarian reserve Xi Xia1,2, Martina S. Burn2, Yong Chen3,2, Cengiz Karakaya4 and Amanda Kallen2* Abstract Context: The H19 long noncoding RNA (lncRNA) belongs to a highly conserved, imprinted gene cluster involved in embryonic development and growth control. We previously described a novel mechanism whereby the Anti- mullerian hormone (Amh) appears to be regulated by H19. However, the relationship between circulating H19 and markers of ovarian reserve including AMH not been investigated. Objective: To determine whether H19 expression is altered in women with decreased ovarian reserve. Design: Experimental study. Setting: Yale School of Medicine (New Haven, USA) and Gazi University School of Medicine (Ankara, Turkey). Patients or other participants: A total of 141 women undergoing infertility evaluation and treatment. Intervention: Collection of discarded blood samples and cumulus cells at the time of baseline infertility evaluation and transvaginal oocyte retrieval, respectively. Main outcome measure: Serum and cumulus cell H19 expression. Results: Women with diminished ovarian reserve (as determined by AMH) had significantly lower serum H19 expression levels as compared to controls (p < 0.01). Serum H19 was moderately positively correlated with serum AMH. H19 expression was increased 3.7-fold in cumulus cells of IVF patients who demonstrated a high response to gonadotropins, compared to low responders (p < 0.05). Conclusion: In this study, we show that downregulation of H19 in serum and cumulus cells is closely associated with decreased ovarian reserve, as measured by decreased AMH levels and reduced oocyte yield at oocyte retrieval.
    [Show full text]
  • Diagnostic Evaluation of the Infertile Female: a Committee Opinion
    Diagnostic evaluation of the infertile female: a committee opinion Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7). (Fertil SterilÒ 2015;103:e44–50. Ó2015 by American Society for Reproductive Medicine.) Key Words: Infertility, oocyte, ovarian reserve, unexplained, conception Use your smartphone to scan this QR code Earn online CME credit related to this document at www.asrm.org/elearn and connect to the discussion forum for Discuss: You can discuss this article with its authors and with other ASRM members at http:// this article now.* fertstertforum.com/asrmpraccom-diagnostic-evaluation-infertile-female/ * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. diagnostic evaluation for infer- of the male partner are described in a Pregnancy history (gravidity, parity, tility is indicated for women separate document (5). Women who pregnancy outcome, and associated A who fail to achieve a successful are planning to attempt pregnancy via complications) pregnancy after 12 months or more of insemination with sperm from a known Previous methods of contraception regular unprotected intercourse (1).
    [Show full text]
  • Maximizing the Ovarian Reserve in Mice by Evading LINE-1 Genotoxicity
    ARTICLE https://doi.org/10.1038/s41467-019-14055-8 OPEN Maximizing the ovarian reserve in mice by evading LINE-1 genotoxicity Marla E. Tharp1,2,Safia Malki1 & Alex Bortvin 1* Female reproductive success critically depends on the size and quality of a finite ovarian reserve. Paradoxically, mammals eliminate up to 80% of the initial oocyte pool through the enigmatic process of fetal oocyte attrition (FOA). Here, we interrogate the striking correlation 1234567890():,; of FOA with retrotransposon LINE-1 (L1) expression in mice to understand how L1 activity influences FOA and its biological relevance. We report that L1 activity triggers FOA through DNA damage-driven apoptosis and the complement system of immunity. We demonstrate this by combined inhibition of L1 reverse transcriptase activity and the Chk2-dependent DNA damage checkpoint to prevent FOA. Remarkably, reverse transcriptase inhibitor AZT-treated Chk2 mutant oocytes that evade FOA initially accumulate, but subsequently resolve, L1-instigated genotoxic threats independent of piRNAs and differentiate, resulting in an increased functional ovarian reserve. We conclude that FOA serves as quality control for oocyte genome integrity, and is not obligatory for oogenesis nor fertility. 1 Department of Embryology, Carnegie Institution for Science, Baltimore, MD 21218, USA. 2 Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA. *email: [email protected] NATURE COMMUNICATIONS | (2020) 11:330 | https://doi.org/10.1038/s41467-019-14055-8 | www.nature.com/naturecommunications 1 ARTICLE NATURE COMMUNICATIONS | https://doi.org/10.1038/s41467-019-14055-8 ogenesis programs across metazoans reflect diverse suggested the involvement of an additional mechanism(s) in Oreproductive strategies observed in nature.
    [Show full text]
  • Endometriosis, Ovarian Reserve and Live Birth Rate Following in Vitro
    THIEME 218 Original Article Endometriosis, Ovarian Reserve and Live Birth Rate Following In Vitro Fertilization/ Intracytoplasmic Sperm Injection Endometriose, reserva ovariana e taxa de nascidos vivos após FIV/ICSI Marcela Alencar Coelho Neto1 Wellington de Paula Martins1 Caroline Mantovani da Luz1 Bruna Talita Gazeto Melo Jianini1 Rui Alberto Ferriani1 Paula Andrea Navarro1 1 Department of Obstetrics and Gynecology, Faculdade de Medicina Address for correspondence Paula Andrea Navarro, MD, PhD, de Ribeirão Preto, Universidade de São Paulo – USP, Ribeirão Preto, Departmento de Ginecologia e Obstetrícia, Faculdade de Medicina de SP, Brasil Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Centro de Reprodução Humana, Universidade de São Paulo, Avenida Rev Bras Ginecol Obstet 2016;38:218–224. Bandeirantes, 3.900, 8o andar, Ribeirão Preto, caixa postal: 14048- 900, Ribeirão Preto, SP, Brazil (e-mail: [email protected]). Abstract Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count (AFC). Methods This retrospective cohort study evaluated all women who underwent IVF/ ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometri- osis, and each group was divided again into a group that had AFC 6 (poor ovarian reserve) and another that had AFC 7 (normal ovarian reserve).
    [Show full text]
  • Unexplained Infertility
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, University of Helsinki, Finland UNEXPLAINED INFERTILITY Studies on aetiology, treatment options and obstetric outcome RITA ISAKSSON ACADEMIC DISSERTATION To be presented by permission of the Medical Faculty of the University of Helsinki for public criticism in the Auditorium of the Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Haartmaninkatu 2, Helsinki, on October 18th, 2002, at 12 noon. Helsinki 2002 1 Supervised by Docent Aila Tiitinen, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Docent Bruno Cacciatore, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Reviewed by Docent Anne-Maria Suikkari, M.D., Ph.D. The Family Federation of Finland, Infertility Clinic, Helsinki Docent Aydin Tekay, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital Offi cial opponent Docent Hannu Martikainen, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital ISBN 952-91-5071-7 (print) ISBN 952-10-0712-5 (PDF) Yliopistopaino Helsinki 2002 2 To my family 3 CONTENTS LIST OF ORIGINAL PUBLICATIONS ....................................................................7 ABBREVIATIONS .................................................................................................
    [Show full text]
  • Age and Fertility: a Guide for Patients
    Age and Fertility A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications Committee. No portion herein may be reproduced in any form without written permission. This booklet is in no way intended to replace, dictate or fully define evaluation and treatment by a qualified physician. It is intended solely as an aid for patients seeking general information on issues in reproductive medicine. Copyright © 2012 by the American Society for Reproductive Medicine AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Age and Fertility A Guide for Patients Revised 2012 A glossary of italicized words is located at the end of this booklet. INTRODUCTION Fertility changes with age. Both males and females become fertile in their teens following puberty. For girls, the beginning of their reproductive years is marked by the onset of ovulation and menstruation. It is commonly understood that after menopause women are no longer able to become pregnant. Generally, reproductive potential decreases as women get older, and fertility can be expected to end 5 to 10 years before menopause. In today’s society, age-related infertility is becoming more common because, for a variety of reasons, many women wait until their 30s to begin their families. Even though women today are healthier and taking better care of themselves than ever before, improved health in later life does not offset the natural age-related decline in fertility. It is important to understand that fertility declines as a woman ages due to the normal age- related decrease in the number of eggs that remain in her ovaries.
    [Show full text]
  • Endometrioma Is a Responsible Factor for Reduced Ovarian Reserve
    Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2): 98-104 Endometrioma is a Responsible Factor for Reduced Ovarian Reserve MOSAMMAT RASHIDA BEGUM1, MARIYA EHSAN2, NAZIA EHSAN3, FARHANA SHARMIN4, FARZANA KHAN5, AURIN IFTEKAR AMIN6 Abstract: Objective (s): The aim of the study was to assess ovarian reserve (OR) of patients with endometrioma and to explore the differences of ovarian reserve in age matched group of infertile patients without endometrioma. Materials and methods: This prospective analytic study was done in Infertility Care and Research Center, between January 2013 and December 2015 to assess the ovarian reserve of patients with endometrioma. During this period 105 patients of endometriosis with endometrioma were selected for study. Selection criteria were: no history of previous surgery, <36 years of age, no history of endocrine problems, no history of recent medical treatment for this condition within 6 months and no history of irregular menstruation. For ovarian reserve testing we assessed serum FSH, E2 and AMH. Patient of same age group who had no emdometrioma, no history of any surgery, no menstrual irregularity, endocrine disorder or any other medical diseases were taken as control to compare the ovarian reserve between these two groups. For control group also we did the same tests. Data was analyzed by SPSS package. One-way ANOVA test was done for test of significance. A p-value of <0.05 was considered as significant. Results: There was no difference in characteristics of patients of both groups regarding age, type of infertility and duration of infertility. Size of the endometriotic cysts were variable and average diameter of cyst was 6.2 ±2.32 cm.
    [Show full text]
  • Prevalence and Clinical Associations with Premature Ovarian Insufficiency, Early Menopause, and Low Ovarian Reserve in Systemic Sclerosis
    Clinical Rheumatology https://doi.org/10.1007/s10067-020-05522-5 ORIGINAL ARTICLE Prevalence and clinical associations with premature ovarian insufficiency, early menopause, and low ovarian reserve in systemic sclerosis Arporn Jutiviboonsuk1 & Lingling Salang2 & Nuntasiri Eamudomkarn2 & Ajanee Mahakkanukrauh1 & Siraphop Suwannaroj1 & Chingching Foocharoen1 Received: 9 October 2020 /Revised: 5 November 2020 /Accepted: 23 November 2020 # International League of Associations for Rheumatology (ILAR) 2020 Abstract The low prevalence of pregnancy in women with systemic sclerosis (SSc) is due to multi-factorial causes, including premature ovarian insufficiency (POI). The study aimed to determine the prevalence of POI, early menopausal status, and any clinical associations of these among Thai female SSc patients. An analytical cross-sectional study was conducted among female SSc patients between 18 and 45 years of age. The eligible patients underwent blood testing for follicle stimulating hormone and anti- mullerian hormone levels, gynecologic examination, and transvaginal ultrasound for antral follicle count. We excluded patients having surgical amenorrhea, previous radiation, and history of hormonal contraception < 12 weeks and pregnancy. A total of 31 patients were included. The majority (67.7%) had diffuse cutaneous systemic sclerosis. Three patients were POI with a preva- lence of 9.7%. The factors associated with POI were a high cumulative dose of cyclophosphamide (CYC) (p =0.02)andthelong duration of CYC used (p = 0.02). After excluding POI, early menopause was detected in 10 patients with a prevalence of 35.7%. The factors associated with early menopause were long disease duration (p = 0.02), high cumulative dose of CYC (p =0.03),and high cumulative dose of prednisolone (p = 0.02).
    [Show full text]
  • Yamamoto Capstone Page 1 of 117 Comparing
    Yamamoto Capstone Comparing the Effects of TCM Therapy Durations on Pregnancy Outcome of Infertile Advanced Maternal Aged Women A Capstone Project Submitted in partial fulfillment of the requirements for the Doctor of Acupuncture and Oriental Medicine Degree By Kumiko Yamamoto L.Ac., Dipl. OM. Yo San University Los Angeles, California April 2013 Page 1 of 117 2 . Approval Signature Page This Capstone Project has been reviewed and approved by: Lawrence J. Ryan, PhD., Capstone Advisor June 10, 2013 Daoshing Ni, PhD., L.Ac. Specialty Chair June 10, 2013 Andrea Murchison, DAOM, L.Ac. June 10, 2013 Yamamoto Capstone ABSTRACT Fertility declines with age, and age is one of the most important factors that affect female fertility. There is an increasing population of advanced maternal aged (AMA) women with infertility, however, their treatment options are often limited, and prognoses are poor. Traditional Chinese Medicine (TCM) has been utilized as a complementary and alternative medicine modality for treating infertility. The goal of this study was to investigate the effects of TCM treatment durations (less than 3 months vs. more than 3 months) on the pregnancy outcome (yes or no) of AMA women with infertility. A retrospective chart review of more than 500 charts using purposive, convenience sampling was engaged, and 67 eligible charts were reviewed. The results revealed that there was no significant difference between the two TCM treatment durations. From the findings of the current study, it is reasonable to state that AMA patients are likely to respond to TCM therapy within the first 3 months of treatments. Although not statistically significant, this trend from the current study implies that the 3-month period may be considered as an appropriate treatment cycle for TCM therapy when treating AMA patients with infertility.
    [Show full text]
  • Ovarian Reserve (Predicting Fertility Potential in Women)
    Contact: (214) 827-8777 ________________________________________________________________________________________________ Ovarian Reserve (Predicting Fertility Potential in Women) Ovarian reserve is a woman’s fertility potential. With age, the ability to get pregnant reduces due to a decrease in the number and quality of eggs, and the presence of chromosomal abnormalities in the eggs. Generally, a woman can begin to face difficulty in conceiving by the age of 36 years or older; however, this age can vary among individuals. An individual’s ovarian reserve and ability to conceive can be evaluated through several tests. Ovarian reserve is commonly assessed by measuring the levels of different hormones in the blood. • Follicle stimulating hormone (FSH): FSH levels in the blood are measured at the beginning of the menstrual cycle (day 1 to 5, usually on day 3). The level of this hormone show how the ovaries and the pituitary gland are working together. Generally, FSH levels are low at the beginning of menstruation and then rises to initiate the growth of a follicle and maturing of an egg. • Estradiol hormone: Estradiol levels in the blood are also measured at the start of the menstrual cycle (day 1 to 5, usually on day 3). Similar to FSH, the level of estradiol hormones also shows how the ovaries and the pituitary gland are working. High FSH and/estradiol levels generally indicate a lower chance of conceiving by ovulation induction or IVF. • Antimullerian hormone (AMH): AMH is excreted by follicles and indicates the number of eggs available at the time of the blood test. The test for AMH can be performed anytime during the cycle.
    [Show full text]
  • Crosstalk Between PTEN/PI3K/Akt Signalling and DNA Damage in the Oocyte: Implications for Primordial Follicle Activation, Oocyte Quality and Ageing
    cells Review Crosstalk between PTEN/PI3K/Akt Signalling and DNA Damage in the Oocyte: Implications for Primordial Follicle Activation, Oocyte Quality and Ageing Mila Maidarti 1,2,3, Richard A. Anderson 1 and Evelyn E. Telfer 2,* 1 MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; [email protected] (M.M.); [email protected] (R.A.A.) 2 Institute of Cell Biology, University of Edinburgh, Edinburgh EH9 3FF, UK 3 Obstetrics and Gynaecology Department, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia * Correspondence: [email protected]; Tel.: +44-(0)131-650-5393 Received: 31 October 2019; Accepted: 13 January 2020; Published: 14 January 2020 Abstract: The preservation of genome integrity in the mammalian female germline from primordial follicle arrest to activation of growth to oocyte maturation is fundamental to ensure reproductive success. As oocytes are formed before birth and may remain dormant for many years, it is essential that defence mechanisms are monitored and well maintained. The phosphatase and tensin homolog of chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB, Akt) is a major signalling pathway governing primordial follicle recruitment and growth. This pathway also contributes to cell growth, survival and metabolism, and to the maintenance of genomic integrity. Accelerated primordial follicle activation through this pathway may result in a compromised DNA damage response (DDR). Additionally, the distinct DDR mechanisms in oocytes may become less efficient with ageing. This review considers DNA damage surveillance mechanisms and their links to the PTEN/PI3K/Akt signalling pathway, impacting on the DDR during growth activation of primordial follicles, and in ovarian ageing.
    [Show full text]
  • Ovarian Reserve Assessment in Women with Different Stages of Pelvic Endometriosis
    PRACE ORYGINALNE Ginekol Pol. 2014, 85, 446-450 ginekologia Ovarian reserve assessment in women with different stages of pelvic endometriosis Ocena rezerwy jajnikowej u kobiet z endometriozą miednicy mniejszej Ewa Posadzka, Robert Jach, Kazimierz Pityński, Agnieszka Nocuń Department of Gynecological Oncology, Jagiellonian University, Cracow,Poland Abstract Introduction: Endometriosis is defined as the appearance of ectopic endometrial cells outside the uterine cavity. Ectopic cells demonstrate functional similarity to eutopic cells, but structural and molecular differences are signifi­ cant and manifest themselves in gene expression of the metalloproteinase genes, integrin or the Bcl-2 gene. Pelvic pain remains to be the main symptom of the disease. Endometriosis may cause dysfunction of the reproductive system and lead to infertility. Pathogenesis o f infertility in endometriosis is based on its influence on the hormonal, biochemical and immunological changes in the eutopic endometrium, as well as structural damages of the ovaries and the fallopian tubes. Objectives: The aim of the study was to assess the ovarian reserve in patients with endometriosis. Material and methods: A total of 39 patients (aged 22-34 years) with different stages of endometrial changes were recruited for the study. The number of antral follicles was rated by vaginal ultrasonography and the level of FSH was measured between days 1-3 of the menstrual cycle. The stage of the disease was established after lapa­ roscopy with the rASRM scale. Results:No statistically significant correlation between the number of follicles(AFC), the level of FSH and the stage of endometriosis was found. Conclusions: Evaluation o f the number o f antral follicles and measurements of the FSH level do not allow to pre­ dict the ovarian reserve in women with endometriosis.
    [Show full text]