Anti-Mullerian hormone and Insulin-like growth factor-1 are predictive markers for ovarian reserve

Background: Ovarian reserve is defined as the existent quantitative and qualitative supply of follicles which are found in the ovaries that can potentially develop into mature follicles which in effect determines a woman’s reproductive potential. Many tests of ovarian reserve are employed including clinical, endocrine static, endocrine dynamic and  ultrasonographic markers. Aims of study: To determine the age-related changes in AMH and IGF-1 levels that occurs in Iraqi women as markers of ovarian reserve and to determine the specificity and sensitivity of IGF-1 and FSH for ovarian reserve. Subjects, material and methods: One hindered cases were collected dividing into two groups; first group includes fifty cases of child bearing age, healthy, fertile females with regular menstrual cycle while second group includes fifty cases of postmenopausal aging group, healthy with normal fertility history. Serum levels of Follicle stimulating hormone, Luteinizing hormone, Prolactin, Anti Müllerian Hormone and Insulin like Growth Factor-1 were estimated for all cases. Results: The overall mean age of the respondents was 45.06 ± 16.68 years old with significant statistical difference between the mean age of pre and post-menopausal women. Results of Anti Müllerian Hormone showing a significant statistical difference between means of Anti Müllerian Hormone hormone for pre-menopausal women (2.89± 2.07 ng/ml) and post-menopausal women (0.0± 0.0 ng/ml). Measuring of Insulin like Growth Factor-1 showing significant statistical difference between pre-menopausal women (211.04± 63.81 ng/ml) and post-menopausal groups' women (120.70± 39.69 ng/ml). Similarly results of Follicle stimulating hormone reveal significant differences between means of Follicle stimulating hormone for pre-menopausal women (6.03± 1.53 ml U/ ml) and post-menopausal women (56.06± 17.07 ml U/ ml). There was no significant association between AMH and IGF1 hormones and IGF1 hormone has been failed to detect ovarian reserve and still the AMH is the gold standard test. Conclusion: Significant changes occur in Anti Müllerian Hormone, I Insulin like Growth Factor-1  and Follicle stimulating hormone with progression of the age and Anti Müllerian Hormone still the stander ovarian reserve test in compare with Insulin like Growth Factor-1 and Follicle stimulating hormone. Key words: Ovarian reserve, AMH, IGF-1

Type 1 and type 2 diabetes after gestational diabetes : a 23 year cohort study

Aims/hypothesis The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. Methods We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984-1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, >= 4.8 mmol/l; 1 h, >= 10.0 mmol/l; and 2 h, >= 8.7 mmol/l. Two follow-up questionnaires were sent (in 1995-1996 and 2012-2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7-28.8) years. Results Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). Conclusions/interpretation All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.Peer reviewe

Interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler ultrasonography of embryos at 7 to 10 weeks and 6 days of gestation

OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = -1.1. For the FI, the ICC was 0.9 and mean difference = -0.5. The VFI presented ICC = 0.9 and mean difference = -1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Doppler ultrasonography at the first trimester of gestation demonstrated a high reproducibility.OBJETIVO: Avaliar a reprodutibilidade interobservador dos índices de vascularização do Doppler de amplitude tridimensional (Doppler de amplitude 3D) no primeiro trimestre de gestação. MATERIAIS E MÉTODOS: Realizou-se estudo de reprodutibilidade com 32 gestantes normais entre 7 e 10 semanas e 6 dias. Para o cálculo do volume tridimensional dos embriões utilizou-se o método VOCAL (Virtual Organ Computer-aided AnaLysis) com ângulo de rotação de 12°. Em seguida obtiveram-se, automaticamente, os três índices vasculares do Doppler de amplitude 3D: índice de vascularização (VI), índice de fluxo (FI) e índice de vascularização e fluxo (VFI). Para o cálculo da variabilidade interobservador, um examinador realizou uma segunda medida dos 32 embriões e um segundo examinador realizou uma terceira medida dos mesmos volumes, ambos desconhecendo os resultados do outro. Utilizaram-se, para análise estatística, o coeficiente de correlação intraclasse (CCI) e gráficos de Bland-Altman. RESULTADOS: Observou-se boa reprodutibilidade interobservador dos três índices vasculares. O VI apresentou CCI = 0,9 e média da diferença = -1,1; o FI apresentou CCI = 0,9 e média da diferença = -0,5; e o VFI apresentou CCI = 0,9 e média da diferença = -1,1. CONCLUSÃO: Os índices vasculares do Doppler de amplitude 3D do embrião no primeiro trimestre de gestação foram altamente reprodutíveis, em especial o FI.Universidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaUNIFESP, Depto. de ObstetríciaSciEL

IgG4 subclass glutamic acid decarboxylase antibodies (GADA) are associated with a reduced risk of developing type 1 diabetes as well as increased C-peptide levels in GADA positive gestational diabetes.

Some women with gestational diabetes (GDM) present with autoantibodies associated with type 1 diabetes. These are usually directed against glutamic acid decarboxylase (GADA) and suggested to predict development of type 1 diabetes. The primary aim of this study was to investigate if GADA IgG subclasses at onset of GDM could assist in predicting postpartum development. Of 1225 women diagnosed with first-time GDM only 51 were GADA-positive. Total GADA was determined using ELISA. GADA subclasses were determined with radioimmunoassay. Approximately 25% of GADA-positive women developed type 1 diabetes postpartum. Titers of total GADA were higher in women that developed type 1 diabetes (142.1 vs 74.2u/mL; p=0.04) and they also had lower titers of GADA IgG4 (index=0.01 vs 0.04; p=0.03). In conclusion we found that that women with high titers of total GADA but low titers of GADA IgG4 were more prone to develop type 1 diabetes postpartum

Three-dimensional follicular assessment: a review of technique and indications

Follicular maturity assessment and tracking are employed to ascertain mature oocytes’ presence and assess the response to ovarian stimulation. This step is crucial to ensure successful outcomes during assisted reproductive techniques. Currently, two-dimensional (2-D) transvaginal ultrasound is performed to monitor follicle growth and determine the optimal time for administration of human chorionic gonadotropin (hCG) hormone. However, the accurate follicle size, count, and multi-follicle maturity assessment require significant expertise and negligible inter-observer variations to maintain the reliability and validity of the measurements. 2-D ultrasound allows only an approximation of the actual follicular volume; therefore, it cannot be used to define standards for follicular maturity assessment. With the improvement of ultrasonography imaging technologies and the supporting software, it is now possible to acquire three-dimensional data sets and perform precise estimation of absolute dimensions, volumes, and mean dimensions of even complex structured follicles. This paper aimed to provide an in-depth review of the use of 3D ultrasound (3D-US) in reproductive medicine and combines an overview of the technique of performing a 3D-US for a fast, valid, objective, and reliable follicular assessment

Combined analysis of endometrial thickness and pattern in predicting outcome of in vitro fertilization and embryo transfer: a retrospective cohort study

<p>Abstract</p> <p>Objective</p> <p>To evaluate the combined effect of endometrial thickness and pattern on clinical outcome in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET).</p> <p>Methods</p> <p>Cycles of IVF/ICSI-ET conducted between January 2003 and December 2008 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded on the day of hCG administration. In the combined analysis, endometrial thickness groups (group 1: equal or <7 mm; group 2: 7-14 mm; group 3: >14 mm) were subdivided into two endometrial patterns (pattern A: triple-line; pattern B: no-triple line). Clinical pregnancy rate (CPR) and early miscarriage rate in different groups were analyzed.</p> <p>Results</p> <p>A total of 2896 cycles were reviewed. Clinical pregnancy rate (CPR) was 24.4% in group1-A. There were no second trimester pregnancies in group 1-B. Miscarriage rate in group 2-A was significantly lower compared to group 2-B (P < 0.01), although CPR did not show any significant differences between the groups. A no-triple line endometrial pattern with moderate endometrial thickness (7-14 mm) had a detrimental effect on pregnancy outcome, but not the occurrence of pregnancy. In group 3, there was no difference in CPR and miscarriage rates between the two patterns; adequate endometrial thickness (>14 mm) seemed to mitigate the detrimental impact (high miscarriage rate) of pattern B.</p> <p>Conclusion</p> <p>Combined analysis of endometrial thickness and pattern on the day of hCG administration was a better predictor of the outcome of IVF/ICSI-ET and may be more helpful for patient counseling than the separate analyses.</p

Autoantibodies in Diabetes Mellitus

Based on American Diabetes Association (ADA), diabetes can be classified into the following general categories: type 1 diabetes (T1D), type 2 diabetes (T2D), gestational diabetes mellitus (GDM) and specific types of diabetes due to other cause. Obesity is by far the main underlying factor causing T2D and its pathological potential lies in obesity-associated insulin resistance, activation of innate immunity and chronic low-grade inflammation. When tissue inflammation induced, tissue destruction occurs, 'self' antigens, which are generally not accessible to T cells, can be released from the affected tissues and promote autoimmune activation. The 4 major autoantibodies are islet-cell cytoplasmic autoantibodies (ICA), glutamid acid decarboxylase antibody (GADA), islet antigen-2 antibody (IA-2A) and insulin autoantibodies (IAA). In addition, ZnT8A has recently been found to predict T1D. ZnT8 is contained in the islets of Langerhans, with the highest expression is in β cells of the pancreas. ZnT8A measurements simultaneously with GADA, IA-2A and IAA achieve rates of 98% detection for onset level of autoimmune diabetes. Presence of antibodies in T2D also shows the potential serious complications compared with T2D without antibodies. The combination of GADA, IA-2A and ZnT8A can be suggested as the most powerful and cost-effective diagnostic approach in patients with T1D.Keywords: autoantibody, autoimmune, diabetes mellitus, ICA, GADA, IA-2A, IAA, ZnT8