Pregnancy following diagnosis of premature ovarian insufficiency: a systematic review.

The aim of this review is to report the occurrence of pregnancies in women with premature ovarian insufficiency (POI), naturally or with different treatments (hormonal replacement therapy, IVF, in-vitro maturation and stem cell therapy). This study involved an exhaustive search of the electronic databases MEDLINE, PubMed and Embase covering the period January 2000 to January 2018. A combination of Medical Subject Heading and text words was used to generate a subset of citations, including studies involving POI ('premature menopause' or 'premature ovarian failure' or 'POI' or 'hypergonadotrophic amenorrhoea'). This subset of citations was then combined with 'AND' to the Medical Subject Heading term 'pregnancy'. Fifteen studies were included in this review. Two randomized controlled trials, two observational studies, and 11 interventional studies reporting cases of pregnancy in women with POI were included. This review reports pregnancy rates across studies ranging from 2.2% to 14.2%. Mean age in patients who achieved a pregnancy was 30 years, highlighting that oocyte quality in these patients is likely unaffected. No treatment has thus far shown its superiority in improving fertility in women with POI. Recent advances in options such as in-vitro maturation and stem-cell therapy, however, are likely to be the future of treatment and may generate new hope for these patients.

The role of AMH in anovulation associated with PCOS: a hypothesis.

Polycystic ovary syndrome (PCOS) is the most common cause of infertility due to anovulation. Despite its prevalence, the precise cause of the anovulation is yet to be clearly defined. There is an increased number of pre-antral and antral follicles in the polycystic ovary, many of which individually produce increased amounts of anti-Müllerian hormone (AMH) compared with those in the normal ovary. In this article, it is hypothesized that the high AMH concentrations present in women with PCOS play an integral role in causing anovulation due to its inhibitory influence on the actions of follicle-stimulating hormone, which normally promotes follicular development from the small antral to the ovulatory stage.

The role of seminal plasma for improved outcomes during in vitro fertilization treatment: review of the literature and meta-analysis.

BACKGROUND: There is a growing body of evidence surrounding the role played by seminal plasma in human implantation. Seminal fluid contains several proteins that interact with cervical and uterine epithelial cells inducing active immune tolerance. We sought to answer the study question: Does exposure to seminal plasma improve pregnancy outcomes in women undergoing IVF? METHODS: Randomized controlled trials (RCTs) were searched for via MEDLINE, EMBASE, the Cochrane Library, National Research Register, ISI conference proceedings, ISRCTN register and Meta-register, from 1966 to December 2013. Search terms included: 'seminal plasma', 'seminal fluid', 'sexual intercourse', 'IVF', 'ICSI', 'ART', 'pregnancy rate', 'implantation', 'embryo transfer' and 'live birth'. This analysis included all RCTs comparing the outcome of IVF treatments in patients exposed to seminal plasma near the time of oocyte pickup (OPU) or embryo transfer (ET) with that of placebo controls or controls with no exposure to seminal plasma. The main intervention was exposure to seminal plasma around the time of OPU or embryo transfer during an IVF cycle. The main outcomes were clinical pregnancy and live birth/ongoing pregnancy rates. Data were collected by two independent authors and statistically pooled via meta-analysis following intention to treat and per protocol principles using RevMan (v5.2.10). I(2) statistic, forest plots and chi-squared heterogeneity tests were used. RESULTS: In total 2204 patients were included in seven RCTs. Meta-analysis revealed a statistically significant improvement in clinical pregnancy rate (RR 1.23, 95% CI 1.06-1.42, P = 0.006) by intention to treat. Per protocol analysis also revealed a statistically significant improvement in clinical pregnancy rate (RR 1.24, 95% CI 1.07-1.43, P = 0.003). There was no statistically significant improvement seen for the outcome of ongoing pregnancy/live birth rate, but the available data were very limited. The methodology and quality of the studies were variable. CONCLUSIONS: There are significantly improved outcomes when women are exposed to seminal plasma around the time of ovum pick-up or embryo transfer, with statistical significance for clinical pregnancy but not for ongoing pregnancy/live birth rates being achieved. This meta-analysis is limited by the small number of studies of variable methodology. Further research is required to determine the effect on live birth rate; however, this meta-analysis indicates a significantly improved clinical pregnancy rate and a potential method for improving IVF outcomes.