Predictive factors for ovarian response in a corifollitropin alfa/GnRH antagonist protocol for controlled ovarian stimulation in IVF/ICSI cycles

Background This secondary analysis aimed to identify predictors of low (<6 oocytes retrieved) and high ovarian response (>18 oocytes retrieved) in IVF patients undergoing controlled ovarian stimulation with corifollitropin alfa in a gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods Statistical model building for high and low ovarian response was based on the 150 μg corifollitropin alfa treatment group of the Pursue trial in infertile women aged 35–42 years (n = 694). Results Multivariable logistic regression models were constructed in a stepwise fashion (P <0.05 for entry). 14.1 % of subjects were high ovarian responders and 23.2 % were low ovarian responders. The regression model for high ovarian response included four independent predictors: higher anti-Müllerian hormone (AMH) and antral follicle count (AFC) increased the risk, and higher follicle-stimulating hormone (FSH) levels and advancing age decreased the risk of high ovarian response. The regression model for low ovarian response also included four independent predictors: advancing age increased the risk, and higher AMH, higher AFC and longer menstrual cycle length decreased the risk of low ovarian response. Conclusions AMH, AFC and age predicted both high and low ovarian responses, FSH predicted high ovarian response, and menstrual cycle length predicted low ovarian response in a corifollitropin alfa/GnRH antagonist protocol

Influence of infertility diagnosis on pregnancy outcome in ART

Abstract Objective: To determine the influence of the infertility diagnosis on gestational age (GA) and birth weight (BW) of children conceived using assisted reproductive technology (ART). Design: Retrospective cohort. Setting: University-affiliated infertility clinic. Patients: Women with a singleton live birth following their first fresh ART cycle with autologous oocytes. Interventions: Patients were stratified into groups based on infertility diagnosis. GA and BW of their infants were compared. Main Outcome Measures: GA and BW of children conceived using ART. Results: 397 women were included. Average GA in the cohort was 38.7±2.3 weeks and average BW was 3301.5±633.8 grams. Maternal age, BMI, and parity were significantly different between groups. After controlling for these factors and stratifying by infertility diagnosis, there was no difference in GA or BW in infants conceived with ART. Conclusions: Contrary to previously reported data, there was no difference in GA or BW in infants conceived with ART when stratified by infertility diagnosis. Our results were not different from the national population; however GA was one week longer in our cohort than in the national ART database. These data suggest a difference exists between our cohort and the ART population at large. We propose that the main difference is our institution’s focus on single embryo transfer

Maternal demographic and clinical variables do not predict intrauterine contraception placement: Evidence for postplacental intrauterine contraception placement

Objective: Determine if specific demographic and clinical variables are associated with intra-uterine contraception (IUC) placement by eight weeks postpartum. Methods: This retrospective cohort study included all patients who delivered at Dartmouth-Hitchcock Medical Center (DHMC) (July-December 2008) who identified IUC as their preferred postpartum contraceptive method. Medical records of patients identified from the birth log were reviewed for preferred contraception, demographics, medical, obstetric, and social histories, as well as payer status. Chi-squared analysis was performed for categorical variables, and Mann-Whitney U test was used for continuous variables. Nonparametric continuous variables were categorized for regression modeling. Results: 224 (34%) patients who delivered identified IUC as their preferred method of postpartum contraception. Of these, 94 (49.7%) women had an IUC placed by 8 weeks postpartum. In univariate analyses comparing those who received an IUC versus those patients who did not, only mean interdelivery interval in months (39.7 vs. 35.5, p=0.027) and mean gravidity (2.3 vs. 2.8, p=0.036) were statistically significant. In multivariate regression modeling, no variables were significantly associated with IUC placement. Conclusions: While statically significant interdelivery interval and gravidity are not likely to be clinically significant. Multivariate modeling failed to identify a model associated with IUC placement suggesting that postpartum IUC placement is not well predicted by patient variables. Lack of identifying factors may support offering postplacental IUC placement to all patients who indicate IUC as their preferred contraceptive method

Anti-Müllerian Hormone concentration levels in maternal plasma during the first, second and third trimester of pregnancy

Follicle-Stimulating Hormone (FSH) drops rapidly in pregnancy but Anti-Mullerian Hormone (AMH) has not been shown to drop until about 12 weeks. Since the follicles that secrete AMH are thought to be FSH independent, AMH levels should slowly decline in the absence of FSH because when the follicles reach FSH dependence, they would die off. A study has presented data that suggests a decline in AMH levels suddenly starts at 12 weeks gestation. The present study agrees with a decline in AMH after the first trimester. There is a sharp decline in AMH at 12-16 weeks gestation indicating that the follicular development is actively suppressed, not passively lost because of a drop in FSH. It appears that pregnancy may be a unique situation in regards to AMH

Anti-Müllerian Hormone concentration levels in maternal plasma during the first, second and third trimester of pregnancy

Follicle-Stimulating Hormone (FSH) drops rapidly in pregnancy but Anti-Mullerian Hormone (AMH) has not been shown to drop until about 12 weeks. Since the follicles that secrete AMH are thought to be FSH independent, AMH levels should slowly decline in the absence of FSH because when the follicles reach FSH dependence, they would die off. A study has presented data that suggests a decline in AMH levels suddenly starts at 12 weeks gestation. The present study agrees with a decline in AMH after the first trimester. There is a sharp decline in AMH at 12-16 weeks gestation indicating that the follicular development is actively suppressed, not passively lost because of a drop in FSH. It appears that pregnancy may be a unique situation in regards to AMH

The influence of fetal sex on patterns of change in anti-Mullerian hormone during pregnancy

Maternal anti-mullerian hormone declines sharply between 13-15 weeks, likely as a result of feto-placental signaling. Fetal AMH levels are known to be widely disparate after the first trimester, with high levels in male and absent levels in female. However, it is unclear as to whether differing fetal AMH levels influence the pattern of change of maternal AMH. Our objective was to examine AMH throughout gestation to determine if the maternal concentration varies according to the gender of the fetus

An open-label clinical trial to investigate the efficacy and safety of corifollitropin alfa combined with hCG in adult men with hypogonadotropic hypogonadism

Subject disposition. (EPS 1138 kb

A logistic model for the prediction of endometriosis

To develop a model using individual and lesion characteristics to help surgeons choose lesions with a high probability of containing histologically-confirmed endometriosis

Nature's lessons in design: nanomachines to scaffold, remodel and shape membrane compartments.

Compartmentalisation of cellular processes is fundamental to regulation of metabolism in Eukaryotic organisms and is primarily provided by membrane-bound organelles. These organelles are dynamic structures whose membrane barriers are continually shaped, remodelled and scaffolded by a rich variety of highly sophisticated protein complexes. Towards the goal of bottom-up assembly of compartmentalised protocells in synthetic biology, we believe it will be important to harness and reconstitute the membrane shaping and sculpting characteristics of natural cells. We review different in vitro membrane models and how biophysical investigations of minimal systems combined with appropriate theoretical modelling have been used to gain new insights into the intricate mechanisms of these membrane nanomachines, paying particular attention to proteins involved in membrane fusion, fission and cytoskeletal scaffolding processes. We argue that minimal machineries need to be developed and optimised for employment in artificial protocell systems rather than the complex environs of a living organism. Thus, well-characterised minimal components might be predictably combined into functional, compartmentalised protocellular materials that can be engineered for wide-ranging applications