High serum AMH inhibits pathological growth of the low biomass endometrial microbiome.

OBJECTIVE: Although host microbiome play a role in both hormonal status and fertility, this issue has not yet been clarified. Since the endometrium is a sterile tissue, it is accepted that microbiota does not grow under normal conditions. The aim of the study was to reveal the characteristics of endometrial microbiota according to serum AMH levels in women with implantation failure. PATIENTS AND METHODS: Forty-five women aged 20-30 years with two or more implantation failures were included in the study. They were divided into 3 groups according to their serum AMH values: Group 1 -AMH <1.3 ng/ml; Group 2 - AMH between 1.3-2.6 ng/ml; Group 3 - AMH >2.6 ng/ml. Twenty-two healthy fertile women who were the same age as the infertile group and applied for cervical smear screening were accepted as the control group. Following the embryo transfer, the tip of the catheter was inserted into the transport medium under sterile conditions. Sowing was carried out by touching the tips of the catheter to the blood agar medium. After the evaluation of the petri dishes at the end of 48 hours of incubation, colonies were stained with Gram stain. Microorganisms in the colonies were identified with the Vitek-2 device according to their gram-staining characteristics and their antibiograms were made. RESULTS: A negative correlation was detected between low AMH values and the microbiome detection rates in endometrial cultures. In patients with low serum AMH levels, the chance of endometrial microbiota growth was higher in the endometrial culture medium. The most common bacteria were found to be MSSA, MRKNS and lactobacillus. Clinical pregnancy rates were found to be significantly higher in the group with high AMH levels. As AMH levels increased, positive flora detection rates decreased, while clinical pregnancy rates increased. CONCLUSIONS: Low serum AMH level increases the rate of positive endometrial microbiome in culture and decreases clinical pregnancy rates.

Serum 25-hydroxyvitamin D correlates with endometrial HOXA10 mRNA expression.

OBJECTIVE: Endocrine Society classified patients with serum 25-hydroxyvitamin D [25(OH)D] levels below 20 ng/ml as deficiency, 20-30 ng/ml as insufficiency, and >30 ng/ml as replete. This study was planned to investigate the relationship between serum vitamin D level and homeobox 10 mRNA expression in women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: Thirty women with PCOS who failed the first IVF/ICSI attempt and were decided to have endometrial injury before second attempt were included in the study. Before the endometrial injury, the serum vitamin D levels of the women were measured, and they were divided into three equal groups as proposed by the Endocrine Society. Group 1 consisted of vitamin D deficient women (<20 ng/mL), Group 2 consisted of vitamin D insufficient women (20-30 ng/mL), and Group 3 consisted of vitamin D replete women (>30 ng/mL). Women in each group were injured with a Pipelle cannula during mid-luteal phase. Endometrial samples collected during injury were analyzed for HOXA10 mRNA expression by RT-PCR and correlated with serum vitamin D level. RESULTS: When analyzing the results according to different vitamin D thresholds, as proposed by the Endocrine Society, HOXA10 mRNA expression was comparable between vitamin D deficient and vitamin D insufficient women. The HOXA10 mRNA expression of vitamin D replete women(Group 3) was found to be higher than both vitamin D deficient (Group 1) and vitamin D insufficient women (Group 2). HOXA10 mRNA expression of the women in Group 3 was 3.3-fold higher than Group 1 and 2.6-fold higher than Group 2. HOXA10 mRNA expression was correlated to the levels of vitamin D in the Group 3 (r=0.655, p=0.02). There was no significant correlation between serum vitamin D levels and endometrial HOXA10 mRNA expression of women in both Group 1 (r=0.343, p=0.06) and Group 2 (r=0.456, p=0.08). CONCLUSIONS: Endometrium of women with PCOS with sufficient serum vitamin D levels express significantly higher HOXA10 mRNA than patients with low serum vitamin D levels.

Relationship between serum vitamin D levels semen parameters and sperm DNA damage in men with unexplained infertility.

OBJECTIVE: The aim of the study was to investigate the relationship between serum level of vitamin D, semen analysis parameters and sperm DNA damage in men with unexplained subfertility. PATIENTS AND METHODS: Fifty-eight men diagnosed with unexplained infertility and 50 age and BMI matched fertile men were included in the study. A participant whose semen parameter is normal but pregnancy is not achieved was accepted as unexplained male infertility. Blood samples were taken from all participants following three-day abstinence for measurement of vitamin D. Sperm DNA damage was assessed by Aniline Blue staining of the collected samples. RESULTS: Compared with the fertile men, male patients with unexplained infertility had significantly lower vit D levels (27.00 ng/mL (12.63-39.30) vs. 23.66 ng/mL (7.50-55.00), p<0.004). While the number of patients with vitamin D levels lower than 20 ng/mL was 26 (44.8%) in the infertile group, it was recorded as 5 (10.0%) in the fertile group (p<0.001). DNA damage was found in 31.50% (9.0-71.0) of the infertile men and 26.00% (11.0-54.0) of the fertile men. DNA damage was found to be significantly higher in the unexplained infertile group (p<0.002). In men with unexplained male infertility, serum vit D levels were positively correlated with total sperm count (r = 0.527, p<0.001), total motility (r = 0.527, p<0.001) and sperm morphology (r = 0.416, p = 0.001). There was a negative and significant correlation between vit D levels and sperm DNA damage (r = -0.605, p<0.001). In the logistic regression analysis, serum vit D > 20 ng/mL led to an improvement in fertility outcome. CONCLUSIONS: Men with unexplained infertility exhibit decreased serum vit D levels and increased sperm DNA damage.

Cord blood and maternal serum preptin and irisin concentrations are regulated independently in GDM.

OBJECTIVE: The aim of this study is to examine the maternal serum and cord blood irisin and preptin levels in gestational diabetes mellitus (GDM) and correlate their levels with demographic and biochemical parameters. PATIENTS AND METHODS: A total of 21 pregnant women with GDM and 21 BMI and age-matched pregnant women without GDM were included in the study. They underwent 50 g glucose challenge test (GCT) between 24-28th gestational weeks. Women with a GCT result higher than 140 mg/dl received 100 g oral glucose tolerance test (OGTT). Detection of one of the following criteria after OGTT was accepted as GDM: fasting plasma glucose level 92 mg/dL; 1-h plasma glucose level 180 mg/dL; and 2-h plasma glucose 153 mg/dL. Correlation between metabolic parameters and cord blood and maternal serum preptin and irisin levels in GDM and non-GDM subjects were analyzed. RESULTS: Maternal serum preptin values of GDM subjects were similar to the serum preptin values of non-GDM control subjects (123.12±34.3 pg/mL vs. 112.02±12.0 pg/mL, p<0.23). Cord blood preptin levels of GDM (64.3±1.09 pg/mL vs. 123.12±34.3 pg/mL, p<0.03) and non-GDM subjects (59.2±021 pg/mL vs. 112.02±12.0 pg/mL, p<0.02) were significantly lower than the maternal serum preptin values. Serum preptin levels of GDM group were positively correlated with HOMA-IR (r=0.33, p<0.04), but not with other parameters. Maternal serum irisin levels in the GDM group were lower than the non-GDM control group (5.32±0.44 µg/mL vs. 7.74±4.52 µg/mL, p<0.01). Cord blood irisin concentrations were found similar in women with GDM and non-GDM subjects (4.91±3.12 µg/mL vs. 5.01±2.14 µg/mL, p<0.14). Cord blood irisin levels of GDM subjects were similar to maternal serum irisin levels (4.91±3.12 µg/mL vs. 5.32±0.44 µg/mL, p<0.57). We found positive correlation between irisin concentration and fasting insulin, HOMA-IR, and BMI in women with GDM. In subgroup analysis of 6 patients using insulin treatment, serum and cord blood irisin and preptin levels were similar to those that did not use insulin. CONCLUSIONS: Maternal serum and cord blood preptin and irisin concentrations are regulated independently in women with GDM.

AFC vs. AMH: prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation.

OBJECTIVE: To assess the clinical value of antral follicle count (AFC) and anti-Mullerian hormone (AMH) for the prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation for IVF using GnRH antagonist treatment. PATIENTS AND METHODS: Fifty patients with endometrioma who underwent their first IVF/ICSI cycle with GnRH antagonist treatment were included in the study. The average AMH values were recorded as 1.5-2 ng/mL. Fifty infertile women are not suffering from endometrioma were selected from those with male factor infertility as control. They were matched according to both serum AMH levels and age. Serum samples have been collected before the IVF treatment for determining AMH levels in both groups of subjects. Likewise, each group of subject underwent ultrasound scan for AFC on day 3. Total number of oocytes retrieved during OPU, the number of transferred embryo, implantation and clinical pregnancy rates, live birth and abortion rates, total dose of rhFSH were noted in both groups of subjects. RESULTS: Day 3 AFC was significantly higher in the control group compared to women with endometrioma. Both the number of retrieved oocytes during oocyte pick-up, MII oocytes and 2 PN embryo were significantly lower in the endometrioma. Likewise, the fertilization, implantation, clinical pregnancy and live birth rates of endometrioma group were significantly lower than those in the control group. The total rFSH dose was higher in the endometrioma group than those in control. The percentage of abortion in the endometrioma group was found to higher compared to those with controls. CONCLUSIONS: AFC is more sensitive than the AMH in detecting ovarian response in women with ovarian endometrioma. The individualization of GnRH antagonist protocols in subjects having endometrioma might be improved by using an AFC-tailored approach instead of AMH.