Pubertal and reproductive stages of woman's life are
characterized by sex steroids' predominant action. Osteoporosis
and osteopenia can develop in patients with estrogen
deficiency (amenorrhoea). DXA scans are used to evaluate
bone mineral density (BMD) using T-score. Retrospectively,
we examine 234 patients with amenorrhoea. The mean age
was 31,80,7 years, the mean duration of amenorrhoea was
6,41,2 years. The highest rate of osteoporosis was determined
in patients younger then 30 years with gonadal dysgenesia
in 31,7% and in patients with hypogonadotrophic
amenorrhoea in 17,9%. Unaltered mineral bone density and
osteopenia were more common in patients older then 30 years
with premature ovarian failure in 17,2 % (n=16) (p
Aim. To assess the possibility of using androstenedione levels in blood serum and follicular fluid to predict ovarian response in assisted reproductive technology programs and to conduct a comparative analysis of the results obtained by 2 methods chemiluminescent immunoassay (CLIA) and high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS).
Materials and methods. A prospective study included 55 couples who received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer program therapy. The patients were divided into 3 groups depending on the ovarian response to stimulation: 1st (13 oocytes, n=4), 2nd (49 oocytes, n=27), 3rd (over 10 oocytes, n=24). Androstenedione levels were measured in blood serum obtained on the day of transvaginal ovarian puncture and in follicular fluid samples with CLIA and HPLC-MS/ MS methods at the laboratories of Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology.
Results. On the day of transvaginal ovarian puncture, the serum androstenedione levels, which were measured by HPLC-MS/MS, were increasing with an increase of the number of oocytes obtained. The CLIA method revealed a difference in the androstenedione levels between the groups with the number of oocytes obtained of less than 3 and more than 10. Moreover, the androstenedione levels measured by CLIA were significantly different between the patient groups (p0.05).
Comparison of serum androstenedione levels measured by CLIA and HPLC-MS/MS, showed high correlations between the values [=0.73 (p0.001)], which makes it possible to use both methods equally, given the existing equipment of the clinical base.
Conclusion. Prediction of ovarian response to stimulation is an important step in assisted reproductive technology programs. Measuring androstenedione concentration in blood serum on the day of transvaginal ovarian puncture with highly specific methods (CLIA and HPLC-MS/MS) can be used to predict the degree of ovarian response along with the traditional assessment of the ovarian reserve based on determining anti-Mullerian hormone levels in the early follicular phase of the menstrual cycle.
The review presents data on metabolites in the follicular fluid (FF) from the perspective of reproductive medicine and their use in order to predict outcomes of assisted reproductive technology (ART) programs. It considers various components of this biological medium (hormones, lipids, melatonin, etc.) with an assessment of their predictive value in prognosis of the effectiveness of in vitro fertilization (IVF) programs. The data on experimental directions in this field and the prospects for their use in clinical practice are presented. The article emphasizes that the growing clinical need and the unsolved problem of increasing the effectiveness of ART programs determine the need for further studies of the FF composition.
Materials and methods. The review includes data related to this topic from foreign and Russian articles found in PubMed which were published in recent years.
Results. Given the established fact of a direct effect of FF composition on growth and maturation of oocytes, and further, on the fertilization process, various FF metabolites are actively investigated as non-invasive markers of quality of oocytes/embryos. The article provides data on the experimental directions in this field and the prospects for their use in clinical practice. However, clinical studies of a relation between various FF metabolites levels and outcomes of IVF programs are contradictory.
Conclusion. Owing large economic cost for treatment of infertility with IVF, there is need for expansion and intensification of studies to identify and use reliable predictors in prognosis of ART programs outcomes.
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