The Impact of the Biological Variability or Assay Performance on AMH Measurements: A Prospective Cohort Study With AMH Tested on Three Analytical Assay-Platforms

This study examined longitudinal, age-related and intra-individual variation in Anti-Müllerian Hormone (AMH) in regular menstruating women and correlated the hormonal levels to the antral follicle count (AFC). The impact of variations on an algorithm for calculation of follitropin-dose for ovarian stimulation were also tested. The study was carried out at a fertility clinic of a tertiary university hospital and had a prospective trial design. Twenty-six healthy women not receiving infertility treatment aged 22 to 50 years participated. Blood sampling for hormonal analysis was done every fifth day throughout three consecutive menstrual cycles, AFC was determined with 3-dimentional ultrasound and AMH measured by different assays from Beckman Coulter, Roche and Ansh Labs. Outcome measures were maximum and minimum difference in absolute and relative terms for each study subject during the test-period, coefficient of variation (Cv) for AMH for each cycle and cycle-day and correlation between AMH and AFC. The impact from variable AMH levels on an algorithm calculating follitrophin-delta dose in ovarian stimulation was explored. A significant longitudinal age-independent variation in AMH-levels and coefficient of variation in cycles and cycle days was found. A strong correlation between AMH-levels and AFC was confirmed and a case of significant divergence between assays was seen. Variations in AMH had a significant impact on an algorithm calculated dosage of gonadotrophins in ovarian stimulation. The finding of a substantial longitudinal variation in AMH question one recording being sufficient in quantifying gonadotrophins for ovarian stimulation, decision making and prognostication related to infertility treatment and counseling. Occasionally, commercial assays may fail to recognize specific AMH cleavage-products

Three-dimensional ultrasound studies of normal and abnormal ovaries

The aims of this work were: 1) to estimate the number of follicles, ovarian volume and power Doppler vascular indices and their changes with age using three-dimensional (3D) transvaginal grey-scale and power Doppler ultrasound in asymptomatic women of fertile age either with natural menstrual cycles or using combined oral contraceptives, and 2) to determine whether tumour vascularity, assessed by 3D power Doppler ultrasound, can help discriminate between benign and malignant ovarian tumours. A group of 303 gynaecologically asymptomatic women, aged 20–39 years with normal menstrual cycles (NMC) and another group of 213 women aged 20–39 years using combined oral contraceptives (COC) were examined using two-dimensional (2D) and 3D transvaginal ultrasound once between cycle day 4 and 8. Ovarian volume and the number of antral follicles were found to decrease with age, while no unequivocal changes in vascular indices were seen in women with NMC. In women using COC the number of antral follicles also decreased with age. The ovarian volume and the number of follicles were determined for different age groups, and these results can be used as reference data. A group of women with ovarian tumours (n=106) was examined using 2D and 3D transvaginal ultrasound. Tumour vascularization was assessed using 3D power Doppler ultrasound in the whole tumour and in a 5-cm3 spherical sample in the most vascularized part of the tumour. A logistic regression model with only grey-scale ultrasound variables (size of the largest solid component, wall irregularity, mean diameter of the lesion) was created to predict malignancy. The flow index in the 5-cm3 sample and the branching of vessels in the whole tumour provided additional information to the grey-scale model, but the diagnostic performance was only slightly improved

Prevalence of endometriosis and adenomyosis at transvaginal ultrasound examination in symptomatic women

Introduction: Prevalence of endometriosis is commonly reported based on surgery findings and varies widely depending on study population and indication for surgery. Symptoms such as dysmenorrhea, pelvic pain, dyspareunia, dysuria, and dyschezia can be associated with endometriosis and adenomyosis. Transvaginal ultrasound examination is proposed to be the first-line diagnostic method, nevertheless there are no published ultrasound-based studies reporting prevalence of endometriosis and adenomyosis in symptomatic women other than those scheduled for surgery. The aim of this study was to determine the prevalence of endometriosis and adenomyosis as assessed by transvaginal ultrasound in women with symptoms suggestive of endometriosis and adenomyosis. Material and methods: This is a retrospective cross-sectional study performed at a tertiary-care center including 373 symptomatic women who were systematically examined with transvaginal ultrasound by an experienced ultrasound examiner. Before ultrasound examination women filled in a questionnaire including self-assessment of the severity of their symptoms (dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, dyschezia) using a visual analog scale. Abnormal findings in the uterus, ovaries, bowel, urinary bladder, uterosacral ligaments, and rectovaginal septum were noted, and their size and location were described. Prevalence of endometriosis, adenomyosis, endometrioma, and deep endometriosis in different anatomical locations was reported. Results: Prevalence of ovarian endometrioma and/or deep endometriosis was 25% and of adenomyosis was 12%. Prevalence of endometrioma was 20% and of deep endometriosis was 9%, for each location being 8% in the bowel, 3% in the uterosacral ligaments, 3% in the rectovaginal septum and 0.5% in the urinary bladder. Conclusions: In symptomatic women examined with transvaginal ultrasound by an experienced ultrasound examiner, ovarian endometrioma and/or deep endometriosis was found in one of four women and adenomyosis in one of nine women. Deep endometriosis was present in one of 11 women. Despite having symptoms, half of the women had no abnormal ultrasound findings

Number of antral follicles, ovarian volume, and vascular indices in asymptomatic women 20 to 39 years old as assessed by 3-dimensional sonography: a prospective cross-sectional study.

Objectives: Our aim was to elicit data representative of normal findings on 3-dimensional (3D) transvaginal gray-scale and power Doppler sonography of ovaries in women of fertile age. Methods: A total of 303 gynecologically asymptomatic white women 20 to 39 years old with spontaneous regular menstrual cycles were examined with transvaginal 3D gray-scale and power Doppler sonography on cycle days 4 to 8. We used a 6- to 12-MHz transducer. The ovarian volume, number and volume of antral follicles of 2 mm or larger, vascularization index, flow index, and vascularization-flow index were calculated using dedicated software. Results are presented separately for women with follicles of 2.0 to 10.0 mm and for those with at least 1 follicle larger than 10.0 mm for 3 age groups: 20 to 29, 30 to 34, and 35 to 39 years. Results: There were 214 women (71%) with follicles of 2.0 to 10.0 mm and 89 (29%) with follicles larger than 10.0 mm. In women with follicles of 2.0 to 10.0 mm, the right ovary was on average 0.8 cm(3) larger and contained on average 1.2 more follicles than the left one. The ovarian volume, number of follicles, and total follicular volume decreased significantly with age in both ovaries (P = .000-.029): for the right ovary ovarian volume, the median (range) decreased from 8.4 (3.7-17.3) cm(3) at 20 to 29 years to 6.5 (2.4-12.7) cm(3) at 35 to 39 years, the number of follicles from 14 (1-32) at 20 to 29 years to 8 (1-21) at 35 to 39 years, and the total follicular volume from 1.08 (0.01-3.10) cm(3) at 20 to 29 years to 0.84 (0.03-2.00) cm(3) at 35 to 39 years. The size of the largest follicle and the vascular indices manifested no clear changes with age in any ovary. In women with follicles larger than 10 mm, the number of follicles decreased with age in both ovaries. Conclusions: We have elicited data representative of normal findings on 3D trans-vaginal sonography of ovaries in gynecologically asymptomatic white women of fertile age. Our gray-scale sonographic results may be used as reference values for general gynecology in populations similar to ours. Vascular indices must be interpreted with caution because of difficulties with standardization

Ovarian size and vascularization as assessed by three-dimensional grayscale and power Doppler ultrasound in asymptomatic women 20-39 years old using combined oral contraceptives

Background: The aim of this study is to estimate ovarian volume, number and volume of antral follicles, and ovarian power Doppler vascular indices as assessed by three-dimensional (3D) transvaginal grayscale and power Doppler ultrasound in women using combined oral contraceptives (COC). Study Design: Two hundred thirteen gynecologically asymptomatic women 20-39 years old using COC were examined with transvaginal 3D grayscale and power Doppler ultrasound on cycle day 4-8 (first cycle day is first day of withdrawal bleeding). We used a Voluson E8 ultrasound system with a 6-12-MHz transvaginal transducer. Ovarian volume, number and volume of antral follicles >= 2 mm, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the virtual organ computer-aided analysis (VOCAL (TM)) and sonography-based automated volume calculation (SonoAVC (TM)) software. Results are described separately for women with follicles 2.0-10.0 mm and for those with at least one follicle >10.0 mm for two age groups: 20-29 years (n=166) and 30-39 years (n=47). Results are also compared between women on monophasic (n=151) and triphasic (n=59) COC, and between women using COC with older (n=110) and newer (n=100) progestins and different doses of estrogen. Results: One hundred eighty-nine (89%) women had follicles 2.0-10.0 mm, and 24 (11%) had follicle(s) >10.0 mm. The proportion of women with follicle(s)>10.0 mm did not differ between women with different types of COC. In women with follicles 2.0-10.0 mm, the right ovary was larger (mean difference 0.5 cm(3) [95% confidence interval 0.22-0.82]) and contained more follicles (mean difference 1.5 [0.52-2.56]) than the left one in the age group 20-29 years. The same differences between the right and left ovary were seen in women 30-39 years old, but they were not statistically significant. In both ovaries, the number of antral follicles 2.0-10.0 mm [median (range)] was significantly higher in women 20-29 than in those 30-39 years old [11(2-34) vs. 8(1-26), p=.012 for the right ovary; 9 (0-28) vs. 7(1-28), p=.035 for the left ovary]. Ovarian volume tended to be smaller in women 20-29 than in those 30-39 years old, but the differences were not statistically significant. Size of the largest follicle, total follicular volume and vascular indices manifested no clear differences between the age groups. For all 378 ovaries with follicles <= 10 mm, ovarian volume ranged from 1 to 16 cm(3) (median 5), total follicular volume ranged from 0.03 to 2.7 cm(3) (median 0.7), VI ranged from 0.0 % to 13.4% (median 0.97), FI ranged from 0 to 38 (median 25), and VFI ranged from 0.0 to 4.7 (median 0.3). Conclusions: Our results show estimated ranges of 3D grayscale and power Doppler ultrasound measurements in ovaries of women using COC. (C) 2012 Elsevier Inc. All rights reserved

Prevalence of deep endometriosis at transvaginal ultrasound in subfertile women

Förekomst av djup endometrios vid ultraljudsundersökning av infertila kvinno

The appearance of the endometrium at saline contrast sonohysterography in the luteal phase of the menstrual cycle: a prospective observational study.

To describe the ultrasonographic morphology of the endometrium at saline contrast sonohysterography (SCSH) performed in the luteal phase of the menstrual cycle in women 20 - 38 years old with regular menstrual cycles

Transvaginal ultrasound examination of the endometrium in postmenopausal women without vaginal bleeding.

To estimate in gynecologically asymptomatic postmenopausal women with and without hormone replacement therapy (HRT) the prevalence at transvaginal ultrasound examination of 1) endometrial thickness ≥5.0mm, 2) intrauterine focal lesions if endometrial thickness ≥5.0mm, and 3) premalignant and malignant changes in the endometrium if endometrial thickness is ≥5.0mm and intrauterine focal lesions are present

Prevalence of extrauterine pelvic lesions at transvaginal ultrasound examination of asymptomatic women 20-39 years old.

To estimate the prevalence of extrauterine pelvic lesions at transvaginal ultrasound examination of gynecologically asymptomatic women of fertile age and to compare this prevalence between women with spontaneous menstrual cycles, those using combined oral contraceptive pills (COC) or a gestagen intrauterine contraceptive device (IUD)