The rate of oocytes with granular cytoplasm is higher in women with endometrioma in ICSI cycles.

The purpose of this study was to investigate the impact of endometrioma on oocyte morphology and fertility outcome in intracytoplasmic sperm injection (ICSI)cycles. The study material was obtained from 114 ICSI cycles of infertile women aged between 20 and 38 years with ovarian endometriomas and unexplained infertility. In total, 644 mature oocytes were included in the analysis. The rates of specific oocyte morphological abnormalities were similar between the two groups however the central granulation rate was significantly higher in the group with endometrioma (p < .05). Fertilisation rate were not significantly different between the groups (p ≥ .05) however the numbers of metaphase 2 (MII) oocytes and embryos were lower in the endometrioma group (p ≤ .05). Endometrioma was associated with a higher rate of oocytes with granular cytoplasm, despite the fertilisation rate the numbers of the MII oocytes and embryo were affected.IMPACT STATEMENTWhat is already known on this subject? The association between endometrioma and infertility is a well-known condition, but the possible mechanisms of the effects of endometrioma on women's fertility is still debated and controversial. There is limited data on the effect of endometrioma on oocyte morphology. Low oocyte quality and lower fertilisation rates might be the main cause of adverse pregnancy outcomes during in vitro fertilisation/intracytoplasmic sperm injection cycles.What do the results of this study add? Endometrioma was associated with a higher rate of oocytes with granular cytoplasm, and lower metaphase 2 oocytes and embryos.What are the implications of these findings for clinical practice and/or further research? Future studies using further oocyte quality assessment methods and prospective observational studies including live-birth rate should be designed to better understand how endometrioma affects fertility outcomes.

Predictive value of serum and follicular fluid chemerin concentrations during assisted reproductive cycles in women with polycystic ovary syndrome.

AIMS: To evaluate the effect of serum and follicular fluid (ff) Chemerin levels on Assisted Reproductive Technology (ART) outcomes in lean patients with PCOS. MATERIALS AND METHODS: The study included 76 infertile reproductive aged women, between 21-35 years who underwent intracytoplasmic sperm injection (ICSI) procedure. Serum and ff Chemerin levels were evaluated. Fertilization and clinical pregnancy rate were compared between the groups. RESULTS: Serum (13.32 ng/ml versus 29.82 ng/ml) and ff chemerin (35.90 ng/ml versus 87.60 ng/ml) levels were significantly higher in lean PCOS patients compared to controls (p < .01). Serum (24.5 ng/ml versus 18.4 ng/ml) and ff chemerin (71.7 ng/ml versus 52.8 ng/ml) levels were higher in subjects without clinical pregnancy compared to the subjects with clinical pregnancy (p < .05). A cutoff value of 36.2 ng/ml in the ff chemerin level was found to estimate clinical pregnancy with 83% sensitivity and 52% specificity (Area under the curve 0.66; 95% confidence interval, 0.53-0.79). A cutoff value of 12.7 ng/ml in the serum chemerin level was found to estimate clinical pregnancy with 91% sensitivity and 49% specificity (Area under the curve 0.65; 95% confidence interval, 0.52-0.78). Clinical pregnancy rates were significantly higher in group with lower serum chemerin levels (80.0% versus 30.4%, p < .001). High serum chemerin levels are associated with failure of assisted reproduction [OR:0.1(95% CI, 0.03-0.4, p < .001)]. CONCLUSIONS: PCOS is associated with higher serum and ff chemerin levels and high serum chemerin level is a risk factor for failed ART cycle.

Association between circulating neuregulin 4 levels and metabolic, aterogenic, and AMH profile of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a metabolic disorder associated with obesity and energy metabolic system disturbances in adipose tissue. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism. In the present study, we aimed to evaluate the association between serum NRG4 levels in obese and normal weight PCOS patients. This cross-sectional study was conducted at a tertiary hospital in Turkey from April to August 2017. We included 148 women who were divided into four groups as follows: 40 normal weight and 39 obese PCOS women diagnosed according to the Rotterdam criteria as well as 38 normal weight and 31 obese, age-matched, non-hyperandrogenemic women with a regular menstrual cycle (controls). Levels of serum NRG4, anti-Müllerian hormone (AMH), fasting blood glucose (FBG), insulin, and high-sensitivity C-reactive protein (hs-CRP); lipid and hormone profiles; insulin resistance indices [homeostasis model assessment of insulin resistance (HOMA-IR)];and anthropometric parameters were evaluated. Serum NRG4 levels were elevated in the normal weight PCOS group than in the control group. Moreover, serum NRG4 levels were higher in the obese PCOS group than in the normal weight PCOS and obese control groups (p < .01). Serum NRG4 levels were positively correlated with body mass index (BMI); waist/hip ratio; HOMA-IR; and levels of triglycerides, hs-CRP, FBG, insulin, AMH, and dehydroepiandrosterone sulphate. Multiple regression analyses revealed that serum NRG4 levels were independently associated with BMI. Obesity appears to be the most influential factor for NRG4 secretion in PCOS patients. Management of obesity may be a key factor for resolving PCOS-related metabolic abnormalities and fertility problems. Impact Sstatement What is already known on this subject? PCOS is a dynamic syndrome with different clinical and metabolic features during the reproductive age. PCOS is associated with various metabolic abnormalities, such as insulin resistance (IR), glucose intolerance, dyslipidemia, and obesity (particularly visceral obesity) as well as long-term complications, such as type 2 diabetes and cardiovascular diseases. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism. What do the results of this study add? To the best of our knowledge, this was the first study investigating NRG4 levels in PCOS patients with different BMIs. Obesity appears to be the most influential factor for NRG4 secretion in these patients. Managing obesity may be a key factor for resolving PCOS-related metabolic abnormalities. What are the implications of these findings for clinical practice and/or further research? Further research in PCOS is warranted to ameliorate obesity, and our study can provide basis for future studies investigating NRG4 levels in PCOS patients with different phenotypes as well as studies of gene polymorphisms, AMH, and infertility and can contribute to the elucidation of problems related to the pathophysiology of PCOS.

High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS.

The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.

Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: Which hormone is the main determinant of cycle outcome?

AIM: Is there any relationship between estrogen and progesterone concentrations during assisted reproductive technology (ART)? Which hormone is the main determinant of impaired endometrial receptivity? METHODS: This study was conducted from July to December 2016 at the in vitro Fertilization/Intracytoplasmic Sperm Injection unit at Zeynep Kamil Women and Children's Health Training and Research Hospital. A total of 289 women who underwent ART were prospectively screened and areas under the curve of temporal estrogen (AUCEM) and progesterone measurements (AUCPM) were calculated for each participant. Women were included if they had regular menstrual cycles, normal serum prolactin levels and had not received hormone treatment within three months. ART was indicated in all patients for unexplained infertility. Patients were divided into two groups: with (n = 90) and without (n = 199) embryo implantation. The relationship between the two AUCs and ART success was assessed in terms of embryo implantation and clinical pregnancy. RESULTS: Implantation was successful in 90 (31.1%) women, and a fetal heart rate was detected in 83 (28.7%) cases. There was a significant correlation between AUCEM and AUCPM (r = 0.525, P < 0.001). Multivariate regression analysis showed significant associations between failure of implantation, lack of clinical pregnancy and AUCEM (beta coefficient = 0.311, P < 0.001; beta coefficient = 0.297, P < 0.001, respectively) after adjusting for AUCPM. CONCLUSION: Our data showed that the degree of endometrial estrogen exposure is the main factor functioning as a detrimental effect of ovarian stimulation on endometrial receptivity.

Serum substance P concentrations to predict oocyte maturation index and clinical pregnancy.

AIM: The aim of this study was to assess the predictive value of serum substance P (SP) concentrations on oocyte maturation and clinical pregnancy. METHODS: Ninety-three women with unexplained infertility underwent intracytoplasmic sperm injection (ICSI) cycles. Antagonist protocol was started for each participant and at the day of oocyte pick up, serum samples were obtained from each participant to assess SP concentrations, and these concentrations were utilized to predict mature/total oocyte ratio and clinical pregnancy. RESULTS: SP concentration was a significant predictor for mature/total oocyte ratio > 0.75 and clinical pregnancy. In correlation analyses, maturation index was significantly correlated with FSH (r= -0.226, p = 0.03), estradiol (r = 0.239, p = 0.021), peak estradiol (r = 0.414, p < 0.001), and substance P (r = 0.796, p < 0.001). In multivariate analyses, number of immature (beta coefficient = -0.379, p < 0.001), mature oocyte (beta coefficient = 0.473, p < 0.001), SP concentration (beta coefficient = 0.723, p < 0.001) and maturation index (beta coefficient = -0.387, p = 0.003) were significantly associated with clinical pregnancy. CONCLUSION: SP concentrations at the day of oocyte pick up may be used to predict clinical pregnancy and may be an indirect indicator for cycle outcome in assisted reproductive technology (ART).

Clinical analyses of successful and previously failed intracytoplasmic sperm injection cycle parameters in patients with poor ovarian reserve.

OBJECTIVE: To determine some major characteristic differences between two consecutive successful and unsuccessful intracytoplasmic sperm injection (ICSI) cycles in poor responders. MATERIALS AND METHODS: Sixty women with poor ovarian response as determined using the Bologna criteria underwent ICSI cycles following an unsuccessful trial. Some parameters of both cycles including age, body mass index (BMI), serum follicle-stimulating hormone (FSH) and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, antagonist starting day, duration of antagonist administration, endometrial thickness at trigger day, number of total and fertilized oocytes, embryo transfer day, number of embryo cells, and fertilization rate were compared in the same patients to identify predictors of cycles with clinical pregnancy. RESULTS: The mean age, BMI, serum FSH, estradiol concentrations, and antral follicle count were 35.9 years (range, 30-42 years), 25.9 kg/m2 (range, 18.4-33.5 kg/m2), 10.9 IU/mL (range, 7-13 IU/mL), 52.9 pg/mL (range, 11.6-75 pg/mL), and 4.7 (range, 2-10), respectively. A comparison of cycle characteristics showed a significantly higher total number of mature and fertilized oocytes in successful cycles. The fertilization rate was also significantly higher in cycles with clinical pregnancy. Early initiation of antagonist was shown to result in favorable outcomes. A comparison of embryo characteristics showed that transfer of higher-stage embryos and embryos with higher numbers of cells had a significant impact on cycle outcomes. CONCLUSION: Our comparison of parameters of failed and successful ICSI cycles in poor responders revealed significantly earlier antagonist initiation, higher total number of mature and fertilized oocytes, fertilization rate, and significantly higher stage of embryo development and cell numbers at transfer in cycles that resulted in clinical pregnancy.

Acute fetal heart rate tracing changes secondary to cigarette smoking in third trimester pregnancies.

OBJECTIVE: In this study, we aimed to assess the acute alterations on some features of fetal heart rate (FHR) tracings in third trimester pregnancies. METHODS: Data of FHR tracing records were obtained from 79 otherwise healthy pregnant women aged between 18 and 41. Among 79 women, 39 were nonsmokers while the remaining were chronic smokers (six or more cigarettes per day, with an average of 10 cigarettes per day). The baseline of tracings, the number of accelerations and decelerations of FHR, as well as the FHR mean, standard deviation, short-term variability of FHR were all calculated for each participant. The results of smokers and nonsmokers, then the results of smokers before and after smoking were compared. RESULTS: Comparison of some demographic and FHR tracing characteristics between smoker and nonsmoker groups indicated significantly decreased variability in smoker group. All FHR tracing characteristics were compared before and, immediately after cigarette smoking and revealed significantly higher mean baseline, lower variability and acceleration after smoking a cigarette. CONCLUSION: Even in a short time period, smoking is associated with some changes in FHR monitorization characteristics, detailed analyses of these changes may clarify the pathophysiology of smoking associated perinatal outcome.

Area under curve of temporal estradiol measurements for prediction of the detrimental effect of estrogen exposure on implantation.

OBJECTIVE: To assess whether the area under the curve of temporal estradiol measurements (AUCEM) during cycles of assisted reproductive technology (ART) can be used to predict failure of implantation and clinical pregnancy. METHODS: In a prospective study, women aged 24-39years undergoing ART at a center in Turkey were enrolled between January and December 2014. Eligible patients had a regular menstrual cycle, normal levels of serum prolactin, and no hormone treatment within the past 3months. The area under the curve of the time course of estradiol measurements was calculated for each participant, and assessed for its ability to predict successful implantation. RESULTS: Among 282 participants, 109 (38.6%) women had successful implantation. There was a significant difference between the two groups of women in AUCEM, estradiol per day (AUCEM divided by duration of stimulation), and endometrial thickness on the day of human chorionic gonadotropin administration (P<0.05 for all). CONCLUSION: The area under the curve of estradiol measurements during ART cycles might be useful for predicting failure of implantation and clinical pregnancy.

The relationship between estradiol-progesterone alterations after ovulation trigger and treatment success in intrauterine insemination cycles.

OBJECTIVE: To assess the relationship between the estrogen-progesterone alterations before and after ovulation trigger and treatment success in intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: Two hundred fifty-one women with infertility underwent ovulation induction followed by IUI. For all subjects, estradiol and progesterone concentrations were evaluated on the trigger and IUI day. The results were analyzed to assess the relationship between hormone levels and positive pregnancy test. RESULTS: There were 34 women with a positive pregnancy test following controlled ovarian stimulation and IUI cycle. Estradiol and progesterone levels on the trigger day and the day of IUI were compared within groups with and without positive pregnancy tests. The comparison revealed significantly increased levels of progesterone after trigger in both groups; however, although there were estradiol level drops in both groups, the drop in the group with negative pregnancy tests was statistically significant. CONCLUSION: Significant drops in estradiol concentrations after ovulation trigger are associated with IUI cycle treatment failure.

Non-invasive prediction of implantation window in controlled hyperstimulation cycles: Can the time from the menstrual day at embryo transfer to expected menstrual cycle give a clue?

OBJECTIVE: The aim of this study was to assess whether the time from the menstrual day at embryo transfer to expected menstrual cycle (TETEMC) is associated with the implantation in women with regular cycles or not. MATERIALS AND METHODS: Forty women with successful implantation and forty women without implantation with regular cycles were randomly selected from prospectively collected database of assisted reproductive technology clinic of Zeynep Kamil Women And Children's Health Training and Research Hospital. TETEMC was calculated for each case to assess relationship with the successful implantation. RESULTS: Comparison of groups revealed significant differences with regard to TETEMC and the menstrual period (p<0.05). In ROC analyses both the TETEMC (AUC=0.824, p<0.001) and the menstrual period (AUC=0.797, p<0.001) were significant predictors for clinical pregnancy. Cut off value for the menstrual period was found to be 27.5 days with 82.6% sensitivity and 65% specificity. Cut off value for TETEMC was 11.5 days with 75% sensitivity and 63.2% specificity. CONCLUSION: Longer menstrual cycle and the TETEMC seem to be associated with the implantation failure.

Assessment of the relationship of basal serum anti-mullerian hormone levels with oocyte quality and pregnancy outcomes in patients undergoing ICSI.

BACKGROUND: Anti-Mullerian hormone (AMH) is constantly secreted during menstrual cycles and may offer several advantages over traditional biomarkers of ovarian reserve. OBJECTIVE: To assess the relationship of anti-Mullerian hormone (AMH) values, which are used to evaluate ovary reserves, with oocyte and embryo quality and with ART outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: This cross sectional study was performed using 50 women undergoing ICSI in IVF center of Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey. All patients received the long protocol. Follicle-stimulating hormone, luteinizing hormone, estradiol, and AMH levels were measured and antral follicle counts were obtained on the 3(rd) day of menstruation. A cut-off value based on the number of oocytes was determined for AMH, and women were evaluated after being divided into two groups as bad responders and good responders, according to their AMH levels. RESULTS: Twelve (27.3%) women were in bad responders group and 32 (72.7%) women were in good responders group. AMH measurements were statistically significantly different between the two groups (p<0.01). Based on this significance, the researchers used ROC analysis to estimate a cut-off point for AMH. The researchers detected the good responders with an AMH level 1.90 or above, with 87.50% sensitivity, 66.67% specificity, 87.50% positive prediction, and 66.67% negative prediction (AUC=0.777, p<0.01). CONCLUSION: Basal AMH levels can be used as an indicator to determine the ovarian response in women undergoing ICSI. AMH can be used to predict the number of mature oocytes that can be collected during treatment and the number of oocytes that can be fertilized. However, AMH is not a valuable tool to evaluate oocyte quality, the development of high-quality embryos, or pregnancy conception.

The assesment of follicular fluid presepsin levels in poor ovarian responder womenandits relationship with the reproductive outcomes.

A considerable proportion of all women undergoing IVFrespond poorly to gonadotropin stimulation. These women are reported to be associated with increased cancellation rates and lower pregnancy rates. It has been hypothesized that poor response to ovarian stimulation is a first sign of ovarian ageing or premature ovarian failure, which might be related to altered inflammatory response in the body. We aimed to compare follicular fluid presepsin levels between poor- and normo-responder patients to ovarian stimulation, to assess its relationship with reproductive outcomes. This study included infertility patients who underwent ovulation induction with either long GnRH agonist or GnRH antagonist protocols and who subsequently underwent IVF/ICSI. Included patients were assigned to two groups according to the Bologna criteria for poor ovarian response. Group 1 and 2 consisted of normo- and poor-responder patients, respectively.The 2 groups were compared in terms of FF presepsin levels. Also, any relationship between the FF presepsin levels and fertility outcomes was assessed within the groups. The groups were compared by using student's t-test, Mann-Whitney U test and X(2) test, where appropriate. Pregnancy rates were not significantly different between the groups (22.6% and 17.6%; P=0.650, respectively). FF presepsin levels were higher in Group 1, however, the difference was not statistically significant (298.0±797.4 and 149.2±422.3; P=0.190, respectively). FF presepsin levels did not significantly differ between pregnancy positive and the pregnancy negative patients in both Group 1 (243.6±531.1 and 314.3±866.5; P=0.055, respectively) and Group 2 (112.2±79.8 and 157.1±464.3; P=0.394, respectively). Consequently, FF presepsin seems not to be a reliable marker in predicting pregnancy in both normo-responder and poor-responder infertility groups.

Mammographic breast density changes after 1 year of tibolone use.

UNLABELLED: Hormone replacement therapy (HRT) is widely used with a large variety of regimens and medications. For each of these regimens the goal is the same but there is always a fear about side effects, especially on breast. Mammographic screening is a standard tool for all women receiving hormone replacement therapy. Breast density is very important, because it interferes with the sensitivity of the evaluation and it is also a predictor of malignity. OBJECTIVE: We planned a study to investigate the effects of tibolone on mammographic breast density. DESIGN AND METHODS: We studied 70 postmenopausal women who started tibolone therapy (2.5 mg per day) after initial mammography and blood samples taken for biochemical examinations. None of the women used any hormone replacement therapy before. Eleven of them either discontinued the therapy or lost contact. After 1 year, we evaluated 59 women by mammographic status, using Wolfe classification. Mammographies were analyzed by two independent radiologists. RESULTS: Mammographies of 59 women were compared with the initial ones. While in the low density patterns, there was a slight increase (15%; P < 0.05); in the higher density groups, there was a decrease of 25% as observed by one radiologist, and 16% according to the other (P < 0.05). None of the women had a diffuse, high density pattern. There was no statistically significant inter-observer variation between two radiologists (P < 0.05). CONCLUSIONS: Wolfe classification allows easy interpretation of mammographic evaluation and the results are reproducible. Tibolone, as a tissue-specific steroid, does not have an estrogenic effect on breast cells. We found that it might limit, even reverse breast density increase, especially in postmenopausal women with high breast density.

Comparison of long GnRH agonist versus GnRH antagonist protocol in poor responders.

OBJECTIVE: To compare long GnRH agonist with GnRH antagonist protocol in poor responders. MATERIALS AND METHODS: Medical charts of 531 poor responder women undergoing in-vitro fertilization (IVF) cycle at Zeynep Kamil Maternity and Children's Hospital, IVF Center were retrospectively analysed. Those who received at least 300 IU/daily gonadotropin and had ≤3 oocytes retrieved were enrolled in the study. Poor responders were categorized into two groups as those who received long GnRH agonist or GnRH antagonist regimen. RESULTS: Treatment duration and total gonadotropin dosage were significantly higher in women undergoing the long GnRH agonist regimen compared with the GnRH antagonist regimen (p<0.001 for both). Although the number of total and mature oocytes retrieved was similar between the groups, good quality embryos were found to be higher in the GnRH antagonist regimen. The day of embryo transfer and number of transferred embryos were similar in the groups. No statistically significant differences were detected in pregnancy (10.5% vs 14.1%), clinical pregnancy (7.7% vs 10.6%) and early pregnancy loss rates (27.2% vs 35%) between the groups. CONCLUSION: GnRH antagonist regimen may be preferable to long GnRH regimen as it could decrease the cost and treatment duration in poor responders.

Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome.

BACKGROUND: Estradiol (E2) is required for follicular development and play an important role in embryo implantation. OBJECTIVE: The aim of this study was to assess the impact of serum E2 levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation (COH). MATERIALS AND METHODS: A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E2 levels on the day of hCG administration. RESULTS: The mean number of the retrieved oocytes was (NRO) 10.6±6.7, mean fertilization rate was 55.7±24.8, and implantation rate was 9.0±19.2. Of 203 patients, 43 (21%) patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E2 levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women ≤36 years old, the IVF-ICSI outcomes were better in patients with serum E2 levels >4000 pg/ml. CONCLUSION: In spite of the lack of high quality evidence to support a positive association between serum E2 levels and IVF-ICSI outcomes, this study shows that high E2 levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E2 levels >4000 pg/ml.

Clinical, endocrine, and metabolic effects of acarbose, a alpha-glucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome.

OBJECTIVE: To determine the clinical, endocrine, and metabolic effects of acarbose use in overweight and nonoverweight patients with polycystic ovarian syndrome (PCOS). DESIGN: Prospective analysis. SETTING: Gynecology and infertility clinic of a tertiary care medical center. PATIENT(S): Seventy-four patients with PCOS and 30 healthy women. INTERVENTION(S): Acarbose use. MAIN OUTCOME MEASURE(S): Clinical findings of hyperandrogenism, body mass indices, LH, FSH, DHEAS, total T, PRL, basal insulin, fasting glucose/insulin levels, and lipid profiles. RESULT(S): Acarbose treatment improved LH/FSH levels, decreased total T, DHEAS, basal insulin, low-density lipoprotein, very low-density lipoprotein, and triglyceride levels, and increased high-density lipoprotein levels in patients with PCOS. Basal insulin and fasting glucose/insulin levels reacted more significantly in overweight patients undergoing acarbose treatment. CONCLUSION(S): Acarbose has been found to improve insulin levels and thus glucose/insulin ratios more effectively in overweight patients compared with nonoverweight patients with PCOS. This drug seems to be an effective drug to be used in overweight as well as nonoverweight patients with PCOS.

Comparison of two forms of continuous combined hormone replacement therapy with respect to metabolic effects.

OBJECTIVE: To compare the metabolic effects of two frequently used continuous hormone replacement therapies. MATERIALS AND METHODS: Two hundred and forty-six menopausal women, aged between 41 and 57 years were enrolled in the present study. They were randomized to receive either estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA) or 1 mg 17 estradiol + 0.5 mg norethindrone acetate (E2/NETA). Women in group I (n = 139) and group II (n = 107) were followed up for 1 year and compared with respect to total cholesterol, triglycerides, HDL, LDL, VLDL, weight gain during this period. RESULTS: The basal and 12th month weight of the patients of two groups were not statistically different (P = 0.57 and P = 0.17, respectively, in the groups I and II). No changes were detected in the levels of triglycerides, HDL and VLDL, while total cholesterol (P = 0.01) and LDL (P = 0.003) levels significantly decreased in the CEE/MPA group. In group 2, total cholesterol and triglyceride levels showed no significant change, however, levels of HDL cholesterol (P = 0.001) increased and LDL (P = 0.001) and VLDL cholesterol (P = 0.006) decreased significantly. CONCLUSION: Administration of E2/NETA regimen has better results on lipid profile when compared to CEE/MPA regimen. No weight gain is recorded in E2/NETA group.

Early follicular antimüllerian hormone as an indicator of ovarian reserve.

OBJECTIVE: To determine the predictive value of antimüllerian hormone (AMH) as a marker for ovarian reserve and to compare its value with the markers currently being used. DESIGN: Prospective analysis. SETTING: In vitro fertilization (IVF) clinic of a tertiary medical center. PATIENT(S): Fifty women undergoing assisted reproduction cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Comparison of day-3 serum AMH levels among women with less than five retrieved oocytes and five or more oocytes. Antral follicle count, mature oocyte count, age, basal follicle-stimulating hormone (FSH), estradiol (E2), maximum serum E2 levels, and pregnancy success were also compared. RESULT(S): The mean serum AMH levels of patients with more than five retrieved oocytes were found to be higher (0.67 +/- 0.41 vs. 0.15 +/- 0.11 pg/mL). Mature oocyte counts, antral follicle counts, and maximum E2 levels were found to be statistically significantly different in the two groups despite similar ages and levels of basal FSH and E2. Although the receiver operator characteristics analysis revealed that the most sensitive and specific indicator of ovarian reserve is the level of AMH, it does not indicate pregnancy success as well when 0.25 pg/mL is taken as a cut-off value. CONCLUSION(S): These data demonstrate an association between early follicular serum AMH and ovarian response, but no association with pregnancy success.