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1.
Medicine (Baltimore) ; 100(21): e26075, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032737

RESUMO

ABSTRACT: We aimed to determine clinical factors predicting successful pregnancy by comparing pregnancy failure and success groups after adenomyomectomy. Additionally, we analyzed fertility outcomes after adenomyomectomy.The medical records of 43 patients who had undergone adenomyomectomy and received in vitro fertilization treatment from 2017 to 2020 were retrospectively reviewed. Patients were divided into pregnancy failure (n = 28) and pregnancy success (n = 15) groups. Patients' demographic factors were evaluated and compared between the groups.The age of patients was higher (39.0 [32.0-45.0] vs. 37.0 [33.0-42.0] years, P = .006) whereas the level of anti-Müllerian hormone (anti-Müllerian hormone [AMH]; 0.54 [0.01-8.54] vs. 2.91 [0.34-7.92] ng/mL, P = .002) lower in the pregnancy failure group compared to the pregnancy success group. The operative time was longer (220.0 [68.0-440.0] vs. 175.0 [65.0-305.0] min, P = .048) while the estimated blood loss higher (750 [100-2500] vs. 500 [50-2000] mL, P = .016) in the pregnancy failure group compared to the pregnancy success group. No significant difference was observed in body mass index, symptoms, cancer antigen 125, preoperative uterine volume, or type of adenomyosis. In the multivariate analysis, age and AMH were significant predictive factors for successful pregnancy.Ovarian reserve (age and AMH) and disease severity might be predictive factors for successful pregnancy in patients who have undergone adenomyomectomy. Adenomyomectomy should be considered for women desiring pregnancy and having appropriate ovarian reserve. Our results would be beneficial for patients and clinicians before deciding on adenomyomectomy. Larger prospective studies are required to confirm our findings.


Assuntos
Adenomiose/cirurgia , Hormônio Antimülleriano/sangue , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Feminina/terapia , Adenomiose/sangue , Adenomiose/complicações , Adenomiose/patologia , Adulto , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/etiologia , Miométrio/patologia , Miométrio/cirurgia , Reserva Ovariana , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
2.
Maturitas ; 148: 40-45, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34024350

RESUMO

AIM: Radioactive iodine (RAI) is frequently used as adjuvant therapy in patients with differentiated thyroid cancer (DTC). However, its effect on ovarian reserve has not been fully elucidated, with studies yielding inconsistent results. The aim of this study was to systematically review and meta-analyze the best available evidence regarding the effect of RAI on ovarian reserve in premenopausal women with DTC. METHODS: A comprehensive literature search was conducted in PubMed, Cochrane and Scopus, through to December 6th, 2020. Data were expressed as weighted mean difference (WMD) with a 95% confidence interval (CI). The I2 index was used to assess heterogeneity. RESULTS: Four prospective studies were included in the qualitative and quantitative analysis. Anti-Müllerian hormone (AMH) concentrations decreased at three (WMD -1.66 ng/ml, 95% CI -2.42 to -0.91, p<0.0001; I2 0%), six (WMD -1.58, 95% CI -2.63 to -0.52, p=0.003; I2 54.7%) and 12 months (WMD -1.62 ng/ml, 95% CI -2.02 to -1.22, p<0.0001; I2 15.5%) following a single RAI dose compared with baseline (three studies; n=104). With respect to follicle-stimulating hormone (FSH) concentrations, no difference was observed at six (WMD +3.29 IU/l, 95% CI -1.12 to 7.70, p=0.14; I2 96.8%) and 12 months (WMD +0.13 IU/l, 95% CI -1.06 to 1.32, p=0.83; I2 55.2%) post-RAI compared with baseline (two studies; n=83). No data were available for antral follicle count. CONCLUSIONS: AMH concentrations are decreased at three months and remain low at 6 and 12 months following RAI treatment in women with DTC. No difference in FSH concentrations post-RAI is observed.


Assuntos
Hormônio Antimülleriano/sangue , Infertilidade Feminina/etiologia , Radioisótopos do Iodo/efeitos adversos , Reserva Ovariana/efeitos da radiação , Neoplasias da Glândula Tireoide/radioterapia , Diferenciação Celular , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/patologia , Neoplasias da Glândula Tireoide/sangue
3.
Eur J Endocrinol ; 185(1): 67-75, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-33914702

RESUMO

Objective: Female childhood cancer survivors (CCS) are at risk of several late effects, such as metabolic syndrome (MetS) and premature ovarian insufficiency (POI). The objective is to study if POI is associated with risk of MetS and increased cardiovascular risk in CSS. Design: A cross-sectional study with a median time since the cancer diagnosis of 25 (12-41) years. Patients and controls were recruited from the South Medical Region of Sweden. Methods: The study included 167 female CCS, median age 34 (19-57) years, diagnosed with childhood cancer at median age 8.4 (0.1-17.9) years together with 164 controls, matched for age, sex, ethnicity, residence, and smoking habits. All subjects were examined with fasting glucose, insulin, HbA1c, and lipid profile. Fat mass was calculated with dual-energy X-ray absorptiometry (DXA), and questionnaires for medication were obtained. Detailed information of cancer treatment was available. Results: POI was present in 13% (22/167) among CCS (hypothalamic/pituitary cause excluded) and in none among controls. MetS was present in 14% (24/167) among all CCS (P = 0.001), in 23% (5/22) of those with POI (P < 0.001), compared with 4% (6/164) among controls. OR for MetS in all CCS compared with controls was 4.4 (95% CI: 1.8, 11.1) (P = 0.002) and among CCS with POI the OR was 7.7 (CI: 2.1, 28.1) (P = 0.002). Conclusion: The prevalence of MetS was higher in females treated for childhood cancer compared with controls, and the presence of POI significantly increased the risk of developing MetS.


Assuntos
Antineoplásicos/uso terapêutico , Sobreviventes de Câncer , Síndrome Metabólica/epidemiologia , Neoplasias/terapia , Insuficiência Ovariana Primária/epidemiologia , Radioterapia/métodos , Absorciometria de Fóton , Tecido Adiposo , Adulto , Hormônio Antimülleriano/sangue , Antineoplásicos Alquilantes/uso terapêutico , Glicemia/metabolismo , Composição Corporal , Estudos de Casos e Controles , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Insuficiência Ovariana Primária/metabolismo , Fatores de Risco , Triglicerídeos/sangue , Adulto Jovem
4.
Medicine (Baltimore) ; 100(17): e25361, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907092

RESUMO

ABSTRACT: We aimed to investigate ovarian reserve status, and explore differences in ovarian reserve between fertile and infertile healthy Chinese women of reproductive age.We recruited 442 fertile women aged 23 to 49 years (mean: 35.22 ±â€Š4.91 years) as subjects, and 196 infertile women aged 23 to 46 years (mean: 32.34 ±â€Š4.34 years) as controls. For all participants, a number of parameters were tested on days 2 to 4 of a spontaneous cycle, including basal serum follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), total testosterone, anti-Müllerian hormone (AMH), ovarian response prediction index (ORPI), and antral follicle count (AFC).There were significant differences in terms of AFC, serum AMH levels, and ORPI among subject subgroups (10.58 ±â€Š5.80; 2.533 ±â€Š2.146 ng/mL; 1.28 ±â€Š1.87; respectively), and among control subgroups (12.44 ±â€Š5.69; 3.189 ±â€Š2.551 ng/mL; 1.88 ±â€Š2.68; respectively) (P < .01 for all). For both subjects and controls, AFC, AMH levels, and ORPI decreased gradually with increasing age, and presented with similar age-related trends; there were positive correlations between AMH and AFC (P < .001), and negative correlations between age and AFC, AMH, ORPI (P < .05 for all). There was a significant difference in age (P < .001), serum E2 (P < .01), and AMH (P < .01) levels between subjects and controls; however, when controlling for confounding factors (age, body mass index, total testosterone, and LH), we found no differences between the 2 groups with regards to the serum levels of AMH, FSH, E2, and AFC (P > .05 for all). Moreover, receiver operating characteristic curve analysis indicated that the significant variables of subjects and controls for evaluating ovarian reserve included age, AMH and ORPI, and ORPI was more valuable than other variables.A diminished ovarian reserve was one of the manifestations caused by female aging. When confounding factors were controlled for, we found no differences in ovarian reserve when compared between fertile and infertile women, and no correlation with infertility.


Assuntos
Envelhecimento/fisiologia , Fertilidade/fisiologia , Infertilidade Feminina/fisiopatologia , Reserva Ovariana/fisiologia , Adulto , Fatores Etários , Hormônio Antimülleriano/sangue , China , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/sangue , Hormônio Luteinizante/sangue , Pessoa de Meia-Idade , Folículo Ovariano/crescimento & desenvolvimento , Curva ROC , Testosterona/sangue , Adulto Jovem
5.
Nat Commun ; 12(1): 2450, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33893301

RESUMO

Infertile men have few treatment options. Here, we demonstrate that the transmembrane receptor activator of NF-kB ligand (RANKL) signaling system is active in mouse and human testis. RANKL is highly expressed in Sertoli cells and signals through RANK, expressed in most germ cells, whereas the RANKL-inhibitor osteoprotegerin (OPG) is expressed in germ and peritubular cells. OPG treatment increases wild-type mouse sperm counts, and mice with global or Sertoli-specific genetic suppression of Rankl have increased male fertility and sperm counts. Moreover, RANKL levels in seminal fluid are high and distinguishes normal from infertile men with higher specificity than total sperm count. In infertile men, one dose of Denosumab decreases RANKL seminal fluid concentration and increases serum Inhibin-B and anti-Müllerian-hormone levels, but semen quality only in a subgroup. This translational study suggests that RANKL is a regulator of male reproductive function, however, predictive biomarkers for treatment-outcome requires further investigation in placebo-controlled studies.


Assuntos
Fertilidade/fisiologia , Ligante RANK/metabolismo , Análise do Sêmen/métodos , Células de Sertoli/metabolismo , Espermatozoides/metabolismo , Animais , Hormônio Antimülleriano/sangue , Hormônio Antimülleriano/metabolismo , Denosumab/farmacologia , Fertilidade/efeitos dos fármacos , Humanos , Inibinas/antagonistas & inibidores , Inibinas/sangue , Inibinas/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Osteoprotegerina/farmacologia , Ligante RANK/antagonistas & inibidores , Ligante RANK/genética , Sêmen/efeitos dos fármacos , Sêmen/metabolismo , Células de Sertoli/efeitos dos fármacos , Contagem de Espermatozoides , Espermatozoides/citologia , Espermatozoides/efeitos dos fármacos
6.
BMC Pregnancy Childbirth ; 21(1): 186, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673814

RESUMO

BACKGROUND: The age-specific definition of low anti-müllerian hormone (AMH) is lacking. This study aims to define an age-specific reference for low AMH and to evaluate the associated outcome in women undergoing IVF treatment. METHODS: A retrospective study was performed in women receiving IVF treatment at the Shenzhen maternity and child healthcare hospital between September 2016 and September 2018. We excluded cases without AMH concentration. Polynomial least-squares regression was used to estimate the age-specific reference ranges for AMH after log-transformed. The age-specific 10th centile was defined as the threshold of low AMH concentration. RESULTS: A total of 909 patients were analyzed in this study. The age-specific reference ranges for AMH were established using linear regression model and resulted in an age-specific equation for mean: mean of LnAMH = (- 0.085 × age) + 3.722 (ng/ml, in unit). Women with AMH level higher than 10th centile had favorable outcomes in ovarian stimulation compared to those with low AMH level. In patients younger than 35 years, the rates of clinical pregnancy per transfer and ongoing pregnancy per transfer in the subgroup with AMH level higher than 10th centile were significantly higher than that in the subgroup of low AMH level, 57% versus 31.3% p = 0.003 and 51.9% versus 21.9% p = 0.001, respectively. CONCLUSION: Women with AMH lower than age-specific 10th centile had significantly unfavorable outcomes after IVF treatment. The age-specific 10th centile of AMH concentration may be useful to predict the outcome of IVF treatment.


Assuntos
Hormônio Antimülleriano , Adulto , Fatores Etários , Hormônio Antimülleriano/análise , Hormônio Antimülleriano/sangue , China/epidemiologia , Feminino , Fertilização In Vitro/métodos , Humanos , Nascido Vivo/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Indução da Ovulação/métodos , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 100(7): e24362, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607770

RESUMO

ABSTRACT: This study investigates the effect of 2 laparoscopic methods on ovarian reserve in patients of reproductive age with endometriomas.This was a retrospective study performed at a tertiary medical center from Jan 1st to Dec 31st, 2016. Laparoscopic cystectomy (group 1, 46 patients) and laparoscopic ovarian drainage and ablation with bipolar coagulation at low power (group 2, 30 patients) were performed to treat endometriomas larger than 3 cm. Anti-Müllerian hormone was used to assess ovarian reserve before and after surgery.There were no statistically significant differences in patients' baseline clinical characteristics, endometriotic stage, operative time, and follow-up time between the groups. The mean serum anti-Müllerian hormone concentration decreased significantly from 4.25 ng/ml to 3.40 ng/ml in group 1 compared with 4.47 ng/ml to 3.95 ng/ml in group 2 (P  = .04). Pregnancy rates were 71.05% in group 1 and 73.08% in group 2, with a mean follow-up of 30.40 months and 32.35 months (P  > .99), respectively. Although there was no statistical significance, the recurrence rate in group 1 was lower than that in group 2 (4.35% vs 16.67%, respectively; P = .11). The mean diameter of recurrent cysts was 1.75 cm in group 1 and 1.54 cm in group 2 (P = .13).Appropriate laparoscopic electrocautery of the endometrioma wall with a bipolar instrument may be a valid alternative to traditional laparoscopic cystectomy, with less effects on ovarian reserve.


Assuntos
Cistos/cirurgia , Técnicas de Ablação Endometrial/métodos , Endometriose/cirurgia , Laparoscopia/métodos , Reserva Ovariana , Adulto , Hormônio Antimülleriano/sangue , Cistos/patologia , Endometriose/patologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos
8.
BMC Surg ; 21(1): 49, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478468

RESUMO

BACKGROUND: To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors. METHODS: A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined. RESULTS: Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210). CONCLUSION: The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.


Assuntos
Adesivo Tecidual de Fibrina , Laparoscopia , Neoplasias Ovarianas , Suturas , Adolescente , Adulto , Hormônio Antimülleriano/sangue , Cistos/sangue , Cistos/cirurgia , Endometriose/cirurgia , Estudos de Viabilidade , Feminino , Adesivo Tecidual de Fibrina/administração & dosagem , Humanos , Cirurgia Endoscópica por Orifício Natural , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Técnicas de Sutura , Vagina/cirurgia , Adulto Jovem
9.
Maturitas ; 143: 216-222, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308632

RESUMO

OBJECTIVES: To examine if age-specific anti-Müllerian hormone (AMH) levels are associated with cancer risk; and to investigate if age-related AMH trajectories differ between women who develop cancer and women who do not. More specifically, we examined associations with breast cancer, cancers in other tissues expressing AMH receptor AMHR2, and cancers in non-AMHR2-expressing tissues. STUDY DESIGN: We included longitudinal data from 3025 women in the prospective Doetinchem Cohort Study. Cox proportional hazards models were used to assess the association of baseline age-specific AMH tertiles with cancer. We applied linear mixed models to compare age-related AMH trajectories between women who were diagnosed with cancer and women who were not. MAIN OUTCOME MEASURES: Cancer (n = 385; 139 breast cancers, 112 cancers in other AMHR2-expressing tissues, 134 cancers in non-AMHR2-expressing tissues). RESULTS: Overall, baseline age-specific AMH levels were not associated with cancer risk, although in women ≤ 40 years an increased risk was suggested for breast cancer (HRT2:T1 = 2.06, 95%CI = 0.95-4.48; HRT3:T1 = 2.03, 95%CI = 0.91-4.50). Analysis of age-related AMH trajectories suggested that AMH levels were higher at younger ages and declined faster in women who were diagnosed with cancer compared with women who were not, but our results did not provide evidence for actual differences in trajectories. CONCLUSIONS: Our results did not provide evidence for an association between age-specific AMH levels and age-related trajectories and risk of cancer. However, effect estimates for breast cancer were in line with risk-increasing effects found in previous studies.


Assuntos
Hormônio Antimülleriano/sangue , Neoplasias/epidemiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/metabolismo , Países Baixos/epidemiologia , Estudos Prospectivos , Receptores de Peptídeos/metabolismo , Receptores de Fatores de Crescimento Transformadores beta/metabolismo
10.
Sci Rep ; 10(1): 22291, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33339878

RESUMO

This study aimed to assess whether basal hormonal levels can predict the levels of progesterone (P4) on the day of oocyte retrieval (OR) and examine the impact of P4 levels on the day of OR on the outcome of assisted reproduction. One hundred sixty-four patients that were enrolled in the assisted reproduction procedure were classified according to their P4 levels on the OR day (< 2 ng/ml vs. ≥ 2 ng/ml). Patients who had P4 levels < 2 ng/ml had significantly higher follicle stimulating hormone (FSH) levels and significantly lower anti-Mullerian hormone (AMH) levels. More than half of patients with P4 levels < 2 ng/ml on the OR day got pregnant and delivered healthy infants. There was a significant correlation between lower FSH values and higher P4 values at OR and between higher AMH values and higher P4 values on the day of OR. Regression analysis showed that high FSH levels are the most important factor that can reliably imply lower P4 levels on OR day. Our study confirmed that lower basal FSH levels can predict the levels of P4 on the OR day. Moreover, lower levels of P4 on the day of OR are associated with a positive outcome in assisted reproduction.


Assuntos
Hormônio Antimülleriano/sangue , Hormônio Foliculoestimulante/sangue , Recuperação de Oócitos/métodos , Oócitos/crescimento & desenvolvimento , Progesterona/sangue , Adulto , Estradiol/sangue , Feminino , Fertilização In Vitro , Humanos , Recuperação de Oócitos/efeitos adversos , Oócitos/metabolismo , Folículo Ovariano/crescimento & desenvolvimento , Folículo Ovariano/metabolismo , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez
11.
Front Endocrinol (Lausanne) ; 11: 595448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343511

RESUMO

Objectives: To retrospectively analyze the correlation between anti-Müllerian hormone (AMH) and the number of oocytes obtained by controlled ovarian hyperstimulation (COH) in women of different ages and explore the factors affecting in vitro fertilization and embryo transfer (IVF-ET) in clinical pregnancy of infertile women to provide evidence for infertile women to choose assisted reproduction strategies. Methods: Infertile women who received IVF-ET or intracytoplasmic sperm injection and embryo transfer (ICSI-ET) treatment in the reproductive center of XX hospital between October 2018 and September 2019 were included. Patient data on medical records, age, body mass index (BMI), years of infertility, basic follicle-stimulating hormone (FSH), basic luteinizing hormone (LH), basic estradiol (E2), anti-Müllerian hormone level (AMH), antral follicle count (AFC), gonadotropins (Gn) medication days, Gn dosage, endometrial thickness on transplantation day, the number of retrieved oocytes, the number of mature oocytes obtained, the number of embryos transferred, clinical pregnancy status, etc., were collected. Results: A total of 314 patients were enrolled in this study, with an average age of 31.0 ± 4.5 years. The infertility period ranged from 0-21 years. The AMH level showed a downward trend with increasing age. Overall, the AMH level of women of all ages was positively correlated with the number of retrieved oocytes (r = 0.335, p < 0.001). The AMH level of women between 22 and 28 years old was positively correlated with the number of retrieved oocytes (r = 0.164, p < 0.061) but it was not statistically significant. Similarly, the AMH level of women aged 29-35 and 36-43 was positively correlated with the number of retrieved oocytes (r = 0.356, p < 0.001; r = 0.461, p < 0.001). The average age of the pregnant group (30.6 ± 4.4 years) was lower than that of the non-pregnant group (32.2 ± 4.6 years) (p < 0.001). The number of oocytes obtained (9.8 ± 4.5) and the number of embryos transferred (1.9 ± 0.4) in the pregnant group was significantly higher than that in the non-pregnant group (9.2 ± 4.5; 1.7 ± 0.5); the difference was statistically significant. The multivariate logistic regression model showed that age (OR = 0.574 95% CI: 0.350-0.940), AMH (OR = 1.430 95% CI: 1.130-1.820) and the number of oocytes obtained (OR = 1.360 95% CI: 1.030-1.790) were factors affecting clinical pregnancy. Conclusion: We found that the level of AMH in infertile women decreased with age and the number of oocytes obtained in infertile women was positively correlated with AMH. Moreover, the number of oocytes and embryo transferred in the pregnant group was significantly higher than those in the non-pregnant group. Furthermore, age, AMH and the number of oocytes affected the clinical pregnancy.


Assuntos
Hormônio Antimülleriano/sangue , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Oócitos/fisiologia , Indução da Ovulação/métodos , Adulto , Feminino , Humanos , Infertilidade Feminina/sangue , Recuperação de Oócitos , Oócitos/citologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
13.
PLoS One ; 15(10): e0239779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044971

RESUMO

BACKGROUND: The conditions of diminished ovarian reserve and primary ovarian insufficiency, characterized by poor fertility outcomes, currently comprise a major challenge in reproductive medicine, particularly in vitro fertilization. Currently in the IVF industry, blastocyst developmental success rate per treatment is routinely overlooked when a live birth results from treatment. Limited data are available on this significant and actionable variable of blastocyst development optimization, which contributes to improvement of treatment success Women with elevated basal FSH concentration are reported to still achieve reasonable pregnancy rates, although only a few studies report correlations with blastocysts development. Diagnostic values of AMH/basal FSH concentrations can be useful for determining the optimal stimulation protocol as well as identification of individuals who will not benefit from IVF due to poor prognosis. The objective of this study is to identify actionable clinical and culture characteristics of IVF treatment that influence blastocyst developmental rate, with the goal of acquiring optimal success. METHODS AND FINDINGS: A retrospective observational study was performed, based on 106 women undergoing IVF, regardless of prognosis, over a six-month period from January 1, 2015 to June 31, 2015. Rate of high-quality blastocyst production, which can be used for embryo transfer or vitrification, per normally fertilized oocyte, was evaluated. Treatment was determined successful when outcome was ≥ 40% high-quality blastocysts. The data were initially evaluated with the Evtree algorithm, a statistical computational analysis which is inspired by natural Darwinian evolution incorporating concepts such as mutation and natural selection (see Supplementary Material). The analysis processes all variables simultaneously against the outcome, aiming to maximize discrimination of each variable to then create a "branch" of the tree which can be used as a decision in treatment. The final model results in only those variables which are significant to outcomes. Generalized linear model (GLM) employing logistic regression and survival analysis with R software was used and the final fitting of the model was determined through the use of random forest and evolutionary tree algorithms. Individuals presenting with an [AMH] of >3.15 ng/ml and a good prognosis had a lower success per treatment (n = 11, 0% success) when total gonadotropin doses were greater than 3325 IU. Individuals that presented with an [AMH] of <1.78 ng/ml and a poor prognosis exhibited a greater success per treatment (n = 11, 80% success). AMH emerged as a superior indicator of blastocyst development compared to basal FSH. The accuracy of the prediction model, our statistical analysis using decision tree, evtree methodology is 86.5% in correctly predicting outcome based on the significant variables. The likelihood that the outcome with be incorrect of the model, or the error rate is 13.5%. CONCLUSIONS: [AMH] is a superior indicator of ovarian stimulation response and an actionable variable for stimulation dose management for optimizing blastocyst development in culture. Women whose [AMH] is ≥3.2 mg/ml, having a good prognosis, and developing >12 mature follicles result in <40% blastocysts when gonadotropin doses exceed 3325 IU per treatment. IVF treatments for poor responders that present with infertility due to diminished ovarian reserve, if managed appropriately, can produce more usable blastocyst per IVF treatment, thus increasing rate of blastocyst developmental success and ultimately increasing live birth rates. Future studies are needed to investigate the intra-follicular and the intra-cellular mechanisms that lead to the inverse relationship of blastocysts development and total gonadotropin doses in good responders in contrast to poor responders.


Assuntos
Hormônio Antimülleriano/sangue , Blastocisto/metabolismo , Blastocisto/fisiologia , Desenvolvimento Embrionário/fisiologia , Hormônio Foliculoestimulante/sangue , Adulto , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/métodos , Humanos , Infertilidade/sangue , Infertilidade/terapia , Nascido Vivo , Masculino , Folículo Ovariano/metabolismo , Reserva Ovariana/fisiologia , Ovário/metabolismo , Ovário/fisiologia , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 99(31): e21538, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756205

RESUMO

BACKGROUND: With the increase in the incidence of premature ovarian insufficiency (POI) over the years, the ovarian function has become one of the integral aspects of research in reproductive medicine today. POI seriously affects the physical and mental health of women, especially reproductive health. Studies show both complementary and alternative therapies to be effective in treating POIs. However, consistency in conclusions is still far-fetched. In light of this, we will carry out a study to evaluate the effectiveness and safety of complementary and alternative therapies for POIs. We therefore develop a study protocol for a proposed network meta-analysis (NMA) and systematic review on POI. METHODS: The following electronic bibliographic database will be searched: VIP database, Wanfang database, Chinese National Knowledge Infrastructure (CNKI), The Cochrane Library, PubMed, EMBASE and Web of Science from inception till 31 December 2019. A search at the World Health Organization (WHO) International Clinical Trials Registry Platform will also be done. Subsequently, the searched data will undergo independent screening, retrieving, and risk of bias assessment by 2 reviewers. Analysis will be performed on included studies using the NMA technique. Next, the primary outcomes will be compared using ADDIS 1.16.5 and Stata 15.0. RESULTS: The safety and effectiveness of alternative and complementary therapies used in the treatment of POI will be compared and evaluated. CONCLUSION: This work will provide high-quality evidence for clinicians in the field to build on for best practices in effective interventions (complementary and alternative therapies) for POI. ETHICS AND DISSEMINATION: This NMA is a secondary research which based on some previously published data. Therefore, the ethical approval was not necessary. PROSPERO REGISTRATION NUMBER: CRD42020163873.


Assuntos
Terapias Complementares/métodos , Insuficiência Ovariana Primária/terapia , Adulto , Hormônio Antimülleriano/sangue , Terapias Complementares/efeitos adversos , Estrogênios/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Metanálise em Rede , Projetos de Pesquisa , Adulto Jovem
15.
Medicine (Baltimore) ; 99(30): e20601, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791661

RESUMO

INTRODUCTION: The women with hydrosalpinx have lower pregnancy rates in assisted reproductive technology, and only laparoscopic salpingectomy and tubal occlusion has proven to be effective to improve the outcome of in vitro fertilization. The main objective of the present meta-analysis was to assess and compare the ovarian reserve after salpingectomy or proximal tubal occlusion (PTO) in the published literature. MATERIAL AND METHODS: We considered all published cohort (retrospective and prospective) and cross-sectional studies as well as randomized controlled trials that investigated changes in serum anti-Müllerian hormone (AMH), follicle-stimulating hormone levels or antral follicle count (AFC) following salpingectomy or PTO. Two investigators (SW, QZ) independently screened the full text of all identified articles to assess relevance to our meta-analysis. RESULTS: In total, 648 patients were included in 5 studies. In the analysis of comparative studies. In the analysis of comparative studies, the follicle-stimulating hormone of salpingectomy had no significant difference with that of PTO (WMD 0.46IU/L, 95% CI[-0.14,1.05]). The AMH and AFC of salpingectomy were significantly higher than that of PTO (AFC: WMD -0.80IU/L, 95% CI [-1.46, -0.14]; AMH: WMD -1.01IU/L, 95% CI [-1.28, -0.74]). CONCLUSIONS: Salpingectomy did more harm to ovarian reserve than PTO in the short-term. However, the long-term effects on ovarian reserve remains uncertain.


Assuntos
Doenças das Tubas Uterinas/cirurgia , Reserva Ovariana , Salpingectomia/efeitos adversos , Esterilização Tubária/efeitos adversos , Hormônio Antimülleriano/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos
16.
Hum Reprod ; 35(7): 1630-1636, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32544225

RESUMO

STUDY QUESTION: Will a delay in initiating IVF treatment affect pregnancy outcomes in infertile women with diminished ovarian reserve? SUMMARY ANSWER: A delay in IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation. WHAT IS KNOWN ALREADY: In clinical practice, treatment delays can occur due to medical, logistical or financial reasons. Over a period of years, a gradual decline in ovarian reserve occurs which can result in declining outcomes in response to IVF treatment over time. There is disagreement among reproductive endocrinologists about whether delaying IVF treatment for a few months can negatively affect patient outcomes. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study of infertile patients in an academic hospital setting with diminished ovarian reserve who started an IVF cycle within 180 days of their initial consultation and underwent an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: Diminished ovarian reserve was defined as an anti-Müllerian hormone (AMH) <1.1 ng/ml. In total, 1790 patients met inclusion criteria (1115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1-90 days after presentation (immediate) or 91-180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH <0.5 and for patients >40 years old with an AMH <1.1 ng/ml (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred. MAIN RESULTS AND THE ROLE OF CHANCE: The mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%; delayed: 25.6%; OR 1.08, 95% CI 0.85-1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH <0.5 ng/ml (immediate: 18.8%; delayed: 19.1%; OR 0.99, 95% CI 0.65-1.51) and in patients >40 years old with an AMH <1.1 ng/ml (immediate: 12.3%; delayed: 14.7%; OR 1.21, 95% CI 0.77-1.91). LIMITATIONS, REASONS FOR CAUTION: There is the potential for selection bias with regard to the patients who started their IVF cycle within 90 days compared to 91-180 days after initial consultation. In addition, we did not include patients who were seen for initial evaluation but did not progress to IVF treatment with oocyte retrieval; therefore, our results should only be applied to patients with diminished ovarian reserve who complete an IVF cycle. Finally, since we excluded patients who started their IVF cycle greater than 180 days from their first visit, it is not known how such a delay in treatment affects pregnancy outcomes in IVF cycles. WIDER IMPLICATIONS OF THE FINDINGS: A delay in initiating IVF treatment in patients with diminished ovarian reserve up to 180 days from the initial visit does not affect pregnancy outcomes. This observation remains true for patients who are in the high-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistic or financial reasons, treatment outcomes will not be affected. STUDY FUNDING/COMPETING INTEREST(S): No financial support, funding or services were obtained for this study. The authors do not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER: Not applicable.


Assuntos
Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Nascido Vivo , Doenças Ovarianas/terapia , Reserva Ovariana , Tempo para o Tratamento , Adulto , Hormônio Antimülleriano/sangue , Coeficiente de Natalidade , Transferência Embrionária/métodos , Feminino , Humanos , Infertilidade Feminina/sangue , Recuperação de Oócitos/métodos , Doenças Ovarianas/sangue , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
17.
PLoS One ; 15(6): e0235140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574203

RESUMO

BACKGROUND: Due to improved treatment, there is an increasing focus on the reproductive potential of survivors of childhood cancer. Cytotoxic chemotherapy accelerates the decline in the number of primordial follicles within the mammalian ovary at all ages, but effects on the developmental potential of remaining oocytes following prepubertal cancer treatment are unclear. OBJECTIVES: To investigate whether cyclophosphamide (CY) exposure in the prepubertal period in female mice influences ovarian function and the functional competence of oocytes in adulthood. METHODS: This study used Swiss albino mice as the experimental model. Female mice were treated with 200 mg/kg CY on either postnatal day 14 (CY14), 21 (CY21) or 28 (CY28) i.e at a prepubertal and 2 young postpubertal ages. At 14 weeks of life, ovarian function, functional competence of oocytes, and embryo quality were assessed. RESULTS: The number of primordial follicles decreased significantly in CY14 and CY21 groups compared to control (p < 0.01). The number of oocytes from superovulated was 8.5 ± 1.4, 24.1 ± 2.9 and 26.8 ± 2.1 in CY14, CY21 and CY28 respectively which was significantly lower than control (50.2 ± 3.2; p < 0.001). In vitro culture of CY14 embryos demonstrated only 55.4% blastocyst formation (p < 0.0001) and reduced ability of inner cell mass (ICM) to proliferate in vitro (p < 0.05) at 120 and 216 h post insemination respectively. On the other hand, ICM proliferation was unaltered in 2 young postpubertal ages. CONCLUSION: Our results indicate long-term effects on the developmental competence of oocytes exposed to CY in early but not adult life. These data provide a mechanism whereby long-term fertility can be impaired after chemotherapy exposure, despite the continuing presence of follicles within the ovary, and support the need for fertility preservation in prepubertal girls before alkylating agent exposure.


Assuntos
Blastocisto/efeitos dos fármacos , Ciclofosfamida/farmacologia , Desenvolvimento Embrionário/efeitos dos fármacos , Reserva Ovariana/efeitos dos fármacos , Maturidade Sexual/fisiologia , Animais , Hormônio Antimülleriano/sangue , Antineoplásicos Alquilantes/farmacologia , Blastocisto/citologia , Blastocisto/fisiologia , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Proliferação de Células/efeitos dos fármacos , Ciclofosfamida/administração & dosagem , Embrião de Mamíferos/efeitos dos fármacos , Embrião de Mamíferos/embriologia , Desenvolvimento Embrionário/fisiologia , Feminino , Fertilidade/efeitos dos fármacos , Fertilidade/fisiologia , Camundongos , Oócitos/efeitos dos fármacos , Oócitos/fisiologia , Tamanho do Órgão/efeitos dos fármacos , Reserva Ovariana/fisiologia , Ovário/anatomia & histologia , Ovário/citologia , Ovário/efeitos dos fármacos , Fatores de Tempo
18.
BMC Womens Health ; 20(1): 134, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32586307

RESUMO

BACKGROUND: To investigate the age-dependent changes in circulating anti-Müllerian hormone (AMH) levels in healthy Arabic-speaking Lebanese women, and to correlate changes in serum AMH levels with serum FSH and LH values, and LH/FSH ratio. METHODS: Cross-sectional study, involving 1190 healthy females, age 17-54 years, with regular menses and both ovaries. Serum AMH levels (ng/ml) were measured by ELISA. RESULTS: There was an inverse proportion of AMH and subject's age, which declined from median 6.71 (2.91) ng/ml in young subjects, to 0.68 (0.45) ng/ml in subjects older than 50 years. Average yearly decrease in median AMH levels was 0.27 ng/ml/year through age 35, but then diminished to 0.12 ng/ml/year afterwards. Receiver operating characteristic curve analysis demonstrated high sensitivity and specificity of age as determinant of AMH levels. In contrast to AMH, FSH levels increased progressively from 5.89 (0.11-62.10) ng/ml in young subjects, to 38.43 (3.99-88.30) ng/ml in subjects older than 50 years. On the other hand, age-dependent changes in LH/FSH ratio paralleled those of AMH. Linear regression modeling testing the independent effect of AMH on FSH and LH, adjusted for age, showed that AMH was significant predictor of FSH and LH/FSH ratio, but not LH. This did not contribute significantly to baseline LH and FSH prediction. CONCLUSIONS: Circulating AMH levels are inversely related to age as also shown elsewhere, and are predictors of LH/FSH ratio and FSH but not LH levels in eumenorrheic females.


Assuntos
Hormônio Antimülleriano/sangue , Hormônio Foliculoestimulante/sangue , Hormônio Luteinizante/sangue , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Líbano , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Adulto Jovem
19.
Maturitas ; 137: 11-17, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498931

RESUMO

Mutation of BRCA genes significantly increases the lifetime risk of breast, ovarian, fallopian tube and primary peritoneal cancers. In addition to the increased risk of these multiple malignancies, the recent literature suggests that mutations in BRCA genes may lead to decreased reproductive potential. In this systematic review, we focus on the effect of BRCA gene mutation on reproductive potential. The main outcomes included the rate of nulliparity, ovarian reserve, ovarian response, and the age at natural menopause. A total of 23 observational studies were included for quality analysis. The certainty of evidence was low to moderate: the main limitations were imprecision and statistically significant heterogeneity. Meta-analysis suggested that the rate of nulliparity, serum anti-müllerian hormone levels, antral follicle counts and ovarian response were not significantly affected in BRCA gene mutation carriers (P > 0.05). BRCA gene mutation carriers tended to have a lower number of primordial follicles (P = 0.0002) and lower age at natural menopause than non-carriers. In conclusion, there is no compelling evidence indicating that the rate of nulliparity, serum AMH, antral follicle counts and ovarian response are affected in BRCA mutation carriers.


Assuntos
Genes BRCA1 , Genes BRCA2 , Fenômenos Reprodutivos Fisiológicos/genética , Hormônio Antimülleriano/sangue , Feminino , Humanos , Menopausa/genética , Mutação , Folículo Ovariano , Reserva Ovariana/genética , Paridade/genética
20.
Medicine (Baltimore) ; 99(23): e20523, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502004

RESUMO

Some muscular dystrophies may have a negative impact on fertility. A decreased ovarian reserve is 1 of the factors assumed to be involved in fertility impairment. AMH (anti-Müllerian hormone) is currently considered the best measure of ovarian reserve.A total of 21 females with myotonic dystrophy type 1 (MD1), 25 females with myotonic dystrophy type 2 (MD2), 12 females with facioscapulohumeral muscular dystrophy (FSHD), 12 female carriers of Duchenne muscular dystrophy mutations (cDMD) and 86 age-matched healthy controls of reproductive age (range 18 - 44 years) were included in this case control study. An enzymatically amplified 2-site immunoassay was used to measure serum AMH level.The MD1 group shows a significant decrease of AMH values (median 0.7 ng/mL; range 0 - 4.9 ng/mL) compared with age-matched healthy controls (P < .01). AMH levels were similar between patients and controls in terms of females with MD2 (P = .98), FSHD (P = .55) and cDMD (P = .60).This study suggests decreased ovarian reserve in women with MD1, but not in MD2, FSHD and cDMD.


Assuntos
Hormônio Antimülleriano/sangue , Distrofias Musculares/sangue , Reserva Ovariana , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
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