Evaluation and Interpretation of AMH in Female Infertility

Anti-Müllerian hormone (AMH) is a glycoprotein that secreted by the granulosa cells of the pre-antral and antral ovarian follicles that have a diameter <8 mm. By inhibiting both initial recruitments of primordial follicles into primary follicles and also the sensitivity of antral follicles to follicle stimulating hormone (FSH) in cyclic recruitment AMH acts as a “follicular gatekeeper”. AMH is recognized as an early marker of the decline in the follicular pool. Although AMH levels are accepted to be stable all through the menstrual cycle, inter- and intracycle variability are detected in the studies with the highly sensitive automated assays. Besides aging, body mass index, obesity, oral contraceptive use, previous ovarian surgery, chemotherapy, BRCA mutations, and ethnicity play a role on the AMH levels. Polycystic ovary syndrome (PCOS) is related with increased AMH level and thus proposed to be used as a diagnostic criterion. However, there is no universally accepted threshold value for AMH that can be used in the diagnosis of PCOS. AMH levels have also been used for designing an ideal treatment protocol in assisted reproduction. AMH measurements can be utilized for the prediction of poor or hyper ovarian response. The value of AMH levels in the prediction of pregnancy outcome remains controversial

Adenomyotic cyst of the uterus associated with pelvic pain: A case report

Adenomyotic cysts of the uterus are extremely rare and this case report is to document an adenomyotic cyst of the uterus associated with pelvic pain. A 27-year old nulliparous patient admitted to the hospital with the complaint of dysmenorrhea, dyspareunia and pain in the right pelvic region for the last 3 months. Transvaginal ultrasonographic examination revealed a 50 × 36 mm intramural cystic lesion on the right region of the corpus uteri. Hysteroscopic examination showed that it did not deteriorate the endometrial cavity. During laparatomy dissection of the uterine wall revealed 5 cm cystic lesion that was excised circumferentially protecting the surrounding myometrial tissue. The definitive pathology report came out as adenomyotic tissue. Imaging techniques are critical in differential diagnosis of adenomyotic cysts and to choose the appropriate intervention. Medical therapy or surgical intervention like excision of the cyst or hysterectomy may be the choices of treatment. J Clin Exp Invest 2014; 5 (1): 100-10

The incidence of metabolic syndrome in adolescents with different phenotypes of PCOS

Objectives: To evaluate the incidence of metabolic syndrome in Turkish adolescents with different phenotypes of polycystic ovary syndrome (PCOS). Material and methods: This cross-sectional study was performed on the Youth Center clinic of a tertiary referral hospital in Turkey. Adolescents with PCOS (n = 144) were classified into four phenotype groups according to the presence of oligo/anovulation (O), hyperandrogenism (H), and polycystic ovarian morphology (P) as follows: Phenotype A (O + H + P), Phenotype B (H + O), Phenotype C (H + P), Phenotype D (O + P). The adolescents gave early follicular phase blood samples for endocrine and metabolic tests. The incidence and the presence of parameters of metabolic syndrome were assessed among the four groups. Results: In total, 54.9% of the adolescents with PCOS were overweight and 25.7% had metabolic syndrome. The incidence of metabolic syndrome in Phenotypes A-D were as follows: 39.5%, 20.5%, 26.5%, and 15.2%, respectively. Although body mass index was higher in the Phenotype A group, insulin resistance was similar in all of the phenotype groups. The most common dyslipidemia was low HDL-C levels and this was present in more than half of the adolescents with PCOS. Both body mass index and total testosterone levels were significantly higher in adolescents with metabolic syndrome in comparison to those without metabolic syndrome. Conclusions: Although low HDL-C levels and insulin resistance are common PCOS findings in adolescents, the metabolic profile seems to be worse in Phenotype A than the other phenotypes. Therefore, screening programs should evaluate patients based on the known risk factors and phenotypes for adolescents with PCOS

Serum and peritoneal fluid levels of ischemia modified albumin in moderate/severe endometriosis

Background: Recently, the role of oxidative stress in progression of endometriosis has been reported. Ischemia-modified albumin (IMA) is a marker of protein oxidation and very limited number of studies has evaluated the role of IMA in endometriosis. This study was designed to evaluate the serum and peritoneal fluid IMA levels in moderate/severe endometriosis as a marker for oxidative stress.Methods: This study was designed as a prospective controlled clinical trial. The study group consisted of 35 cases who underwent laparoscopy and with a diagnosis of moderate/severe endometriosis. The control group (n=35) was cases without endometriosis that underwent laparoscopy for tubal sterilization. The serum and peritoneal fluid IMA levels were measured spectrophotometrically by colorimetric method with complex of albumin non-binding cobalt and dithioerthreitol.Results: Although the median serum IMA levels in study and control groups were similar (p=0.553), the levels of peritoneal fluid IMA were significantly higher in study group (p=0.044). In endometriosis cases with dysmenorrhea peritoneal fluid IMA levels were much higher than cases without dysmenorrhea (p=0.018).Conclusions: The increased levels of IMA in peritoneal fluid of endometriosis support the possible role of oxidative stress in endometriosis. With this study, peritoneal fluid IMA levels are initially documented in endometriosis cases

The value of LH supplementation in young women with diminished ovarian reserve treated with GnRH Antagonist Protocol for ovarian hyperstimulation in ICSI-cycles

Objectives: To compare the success of two controlled ovarian hyperstimulation protocols; rFSH + hp-hMG with only rFSH in the GnRH antagonist protocol in diminished ovarian reserve under 35 years of age. Material and methods: Data from January 2015 to June 2019 were abstracted from the hospital records of IVF Clinic. The women younger than 35 years of age who were diagnosed as diminished ovarian reserve and underwent standard GnRH antagonist protocol were included. Patients in Group-1 underwent controlled ovarian stimulation with rFSH alone and Group-2 with rFSH in combination with hp-hMG. Patients in both groups were divided into three subgroups according to their antral follicle count at Day 3:  < 4 (a), 4–6 (b), and 7–10 (c). Demographic features and IVF outcomes of the patients were extracted. Results: Total number of retrieved oocytes, was higher in Group-1 than Group-2 (6.5 ± 2.1 vs 5.5 ± 2.3, respectively, p <  0.001). However, there were no significant differences between the two groups in terms of clinical pregnancy rate, implantation rate, miscarriage rate and live birth rate. Although the main study outcome parameters did not show significant difference between Group-1a and Group-2a, the number of mature oocytes (5 ± 2.8 vs 1.8 ± 1.2, respectively, p = 0.006) was higher in Group-1a. Conclusions: We observed no beneficial effect of LH supplementation during IVF for the treatment of women under 35 years old with diminished ovarian reserve in the first treatment cycle when compared with rFSH only in the antagonist protocols

A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls

STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of ≥70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P < 0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P < 0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users ≥70 kg was <20% and <8% were obese. WIDER IMPLICATIONS OF THE FINDINGS Findings of the study can inform policy makers and clinicians about choice of implant, but also about TCu380A IUD in relation to implants. STUDY FUNDING/COMPETING INTEREST(S) UNDP/UNFPA/WHO/UNICEF/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization (WHO). This report contains the views of an international expert group and does not necessarily represent the decisions or the stated policy of the WHO. TRIAL REGISTRATION ISRCTN33378571 registered on 22 March 2004. The first participant was enrolled on 12 May 200

The Complete Evacuation Rate of Two Different Single Dose Misoprostol Regimens for Termination of Missed Abortion

OBJECTIVE: To compare the complete evacuation rate of two different single dose misoprostol regimens in termination of missed abortion within 24 hours. STUDY DESIGN: Hundred and one women with a diagnosis of missed abortion were randomized into two groups. Women in Group I received four tablets of misoprostol (800 mg) vaginally. In Group II, two tablets of misoprostol were administered vaginally simultaneously with two tablets taken orally. Women were evaluated by transvaginal sonography after the initiation of vaginal bleeding (primary visit) or in cases with no bleeding within 24 hours after the administration. In cases that had not completed the abortion at the primary visit, a surgical evacuation was performed. Mean expulsion time, clinical outcomes, side-effects, complications and any additional interventions required were analyzed in two groups. RESULTS: There was no statistically significant difference between the two groups in terms of age, number of previous pregnancies, the complete evacuation rate at the primary visit or mean expulsion time. The complete evacuation rate within 24 hours was 18% in Group I and 14% in Group II (p=0.38). The overall complete evacuation rate was 16% (n=16). There was a statistically significant difference between the groups for mean hemoglobin values before and after treatment (0.64 vs 0.62 respectively, p<0.05). CONCLUSION: With a single dose misoprostol regimen regardless of the route of administration, overall complete evacuation rate was low at the first follow-up visit