Inhibin secretion in women with the polycystic ovary syndrome before and after treatment with progesterone

<p>Abstract</p> <p>Objectives</p> <p>It has been suggested that inhibin secretion is altered in women with the polycystic ovary syndrome (PCOS). However, the contribution of a preceding luteal phase has not been taken into account. The aim of the present study was to investigate whether progesterone in the context of a simulated luteal phase affects basal and FSH-induced inhibin secretion in women with PCOS and elevated LH.</p> <p>Methods</p> <p>Ten women with PCOS and 8 normally cycling women participated in an experimental procedure (Exp) involving the administration of a single injection of recombinant FSH (450 IU sc). In the women with PCOS, the procedure was performed before (Exp 1) and after a 20-day treatment with progesterone (Exp 2), while in the normal women on day 2 of the cycle (Exp 3). Inhibin A and B levels were measured in blood samples taken before and 24 hours after the FSH injection.</p> <p>Results</p> <p>Basal LH levels were significantly higher and inhibin A levels were significantly lower in the PCOS group compared to the control group, while inhibin B levels were comparable in the two groups. In the PCOS group, after treatment with progesterone inhibin A and LH but not inhibin B levels decreased significantly (p < 0.05). After the FSH injection, inhibin A and B levels increased significantly in the women with PCOS (Exp 1 and Exp 2) but not in the control women (Exp 3).</p> <p>Conclusions</p> <p>In women with PCOS, as compared to control women, the dissimilar pattern of inhibin A and inhibin B secretion in response to FSH appears to be independent of a preceding simulated luteal phase. It is possible that compared to normal ovaries, the PCOS ovaries are less sensitive to endogenous LH regarding inhibin A secretion and more sensitive to exogenous FSH stimulation in terms of inhibin A and inhibin B secretion.</p

Prognostic value of follicular fluid 25-OH vitamin D and glucose levels in the IVF outcome

Objectives: The aim of the present study was to measure serum and follicular fluid 25-OH vitamin D and glucose levels in women who underwent IVF-ET treatment and to further investigate whether the circulating 25-OH vitamin D and glucose levels correlate with IVF success. Methods: This prospective observational study included 101 consecutive women who underwent 101 IVF-ICSI ovarian stimulation cycles and were allocated to one of the three groups according to their follicular fluid 25-OH vitamin D concentrations. Group A (n = 31) with less than 20 ng/ml, group B (n = 49) with vitamin levels between 20.1 and 30 ng/ml and group C (n = 21) with more than 30 ng/ml vitamin concentration. Results: Follicular fluid vitamin levels significantly correlated with the quality of embryos in total (r = -0.27, p = 0.027), while the quality of embryos of group C were of lower quality as compared to those of groups A and B (p = 0.009). Follicular fluid glucose levels were lower in women of group C as compared to the respective levels of groups A and B (p = 0.003). Clinical pregnancy rate demonstrated in 14.5% in women of group C and 32.3% and 32.7% in groups A and B, respectively (p = 0.047). Conclusion: The data suggests that excess serum and follicular fluid vitamin levels in combination with decreased follicular fluid glucose levels have a detrimental impact on the IVF outcome

When should patients abandon treatment?

Couples with RIF need counseling regarding when they should abandon IVF cycles and be offered alternative treatment options such as gamete donation or surrogacy. Although there are no epidemiological data on cumulative success rates following various treatments in RIF patients, a rational approach based on current literature is presented. Patients below 40 years of age, after correction of the RIF-related condition may extend the number of subsequent cycles up to nine. Patients aged 40–42 years may benefit from six further cycles, which should be performed in a short period, avoiding a significant delay that has aging-related negative effects on both pregnancy rates and pregnancy outcome. Patients older than 42 years have very low live-birth rates per cycle and should be counseled that less than five cycles should be further offered without delaying entering an oocyte-donation program. © 2020 by Taylor & Francis Group, LLC

Monitoring COS and HRT cycles

The aim of monitoring the COS during an IVF/ICSI cycle is the retrieval of an adequate number of oocytes and timing the triggering for final oocyte maturation. Ultrasound scanning of the number and size of follicles is the main monitoring method, while measurement of serum estradiol levels together with ultrasonography does not seem to add any benefits. In HRT cycles, the endometrium is prepared for frozen-thawed embryo transfer with the administration of estradiol and progesterone. During the administration of estradiol, the endometrial thickness is assessed by transvaginal ultrasound. This measurement determines the onset of progesterone treatment and finally the time of frozen-thawed embryo transfer. © 2018 Elsevier Inc

Investigation of the effect of age smoking in the function of woman's reproductive axis

Introduction: The age of the women is a known significant factor that diminishes the ovarian reserves which are depleted completely at menopause. Although, pituitary sensitivity to GnRH is reduced with aging after menopause, data in premenopausal women are scanty. Smoking has been shown to reduce ovarian reserves in subfertile women. However, the effect smoking may have on the ovarian reserves of normal, fertile women has not been appriopriately studied as yet. Furthermore, whether smoking affects the pituitary sensitivity to GnRH in normal, fertile women has not been studied so far. Aim of the study: The aim of the present study was the investigation of the effects of age and smoking on ovarian reserves and the pituitary function in healthy, fertile, normally cycling women. Materials and methods: One hundred and fiftytwo healthy, fertile, normally cyckling women, with history of delivery of at least one neonate, were included in the present study. In all women, an indwelling catheter was introduced on day 3 of their spontaneous cycle and blood samples were obtained. In all women a sinlge injection of GnRH, at the dose of 10 μg was given. Blood samples in relation to the injection of GnRH (time 0) were taken at -15, 0 and 30 min. in all blood samples (serum), FSH and LH were measured. The LH response to GnRH was calculated as the net increase of LH levels at 30 min (ΔLH) above the basal levels (mean value of LH values at -15 and 0 min). in all blood samples taken at time 0 the levels of estradiol (E2), progesterone, inhibin B and antimullerian hormone (AMH) were measured. For the statistical analysis of the data, t-test, Pearson’s correlation and linear regression analysis were performed. Results: In all women, the age had a positive correlation with the basal levels of FSH and LH and a negative correlation with the levels of inhibin B and ΑΜΗ. The LH response to GnRH (ΔLH) (in vivo bioassay of GnSAF bioactivity) was significantly higher in smokers as compared to non-smokers. In terms of FSH, LH, estradiol, progesterone and AMH there were no differences between smokers and non-smokers, whether the comparisons were performed for women 37 years. It was found that only in women 37 ετών δεν υπήρχαν διαφορές μεταξύ των καπνιστριών και των μη-καπνιστριών στα επίπεδα των FSH, LH, οιστραδιόλης, προγεστερόνης και AMH. Στις γυναίκες ηλικίας < 37 ετών μόνο, βρέθηκε οι καπνίστριες να έχουν υψηλότερες τιμές ΔLH και χαμηλότερες τιμές ινχιμπίνης B, σε σύγκριση με τις μη-καπνίστριες. Συμπεράσματα: Η ηλικία σχετίζεται με σημαντική μείωση των ωοθηκικών εφεδρειών σε φυσιολογικές γόνιμες γυναίκες. Το κάπνισμα φαίνεται να έχει αρνητική επίδραση στην παραγωγή μη στεροειδών ωοθηκικών παραγόντων (ινχιμπίνης B και GnSAF) σε νεότερες γυναίκες (ηλικίας < 37 ετών), ενώ δεν επηρεάζει σημαντικά τη συνολική δεξαμενή πρωτογενών ωοθυλακίων (τιμή της ΑΜΗ στην κυκλοφορία) και τη στεροειδογένεση

Ovarian stimulation protocols

Ovarian stimulation for in vitro fertilization treatment of infertility, aiming to the production of many oocytes to increase the possibility of pregnancy, may be performed with conventional and novel protocols. The conventional protocols include the gonadotrophin-releasing hormone (GnRH) agonist and GnRH antagonist protocols, which have similar efficacy in terms of live birth rate, but the antagonists are safer with lower risk of ovarian hyperstimulation syndrome. Generally, the types of gonadotropins have shown rather comparable results. The novel protocols, the random-start and the double stimulation protocols, have been developed to facilitate fertility preservation for oncological patients and to increase the oocyte yield in poor responders. © 2023 Elsevier Inc. All rights reserved