ObjectiveOvarian reserve evaluation has been the focus of substantial clinical research for several years. This study aimed to examine the associations between markers of ovarian reserve and ovarian response.MethodsThis prospective study included 132 infertile women aged 24-48 years undergoing routine exploration during unstimulated cycles prior to the start of assisted reproductive technology (ART) treatments at our center from July 2015 to January 2017. Descriptive parameters and patient characteristics were reported as mean (SD) or median (range) values depending on the data distribution pattern. Student’s t-test was performed for continuous variables; the Wilcoxon and Pearson’s test were used for data not following a normal distribution; and Fisher’s test was used for categorical variables. p<0.05 was considered statistically significant.ResultsAt the time of the study, the patients had a mean age of 35.7±3.84 years. On day 3 of the cycle, the mean anti-Müllerian hormone (AMH) serum level was 2.84±1.57 ng/mL and the patients had 14.68±4.2 antral follicles (AFC). A significant correlation was observed between AMH and age (r=-0.34 p<.01), follicle stimulating hormone (FSH) serum levels (r=-0.32, p<.01), AFC (r=0.81, p<.00001), total dose of medication during ovarian stimulation (r=-0.28, p<.0003), and ongoing pregnancy rate (p<.05). Age was significantly correlated with FSH (r=0.46, p<.01), AFC (r=-0.34, p<.00001), total dose of medication during ovarian stimulation (r=0.43, p<.0003), and ongoing pregnancy rate (p<.04).ConclusionSerum AMH and age are independent predictors of ovarian reserve and ovarian stimulation outcome in infertile women. Age and serum AMH level may be used to advise subfertile couples of their pregnancy prospects.
Objective: This study aimed to evaluate the effects of three different luteal phase support protocols with estrogen on the pregnancy rates and luteal phase hormone profiles of patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to evaluate which ovarian reserve markers correlated with pregnancy rates. Methods: This retrospective observational study was carried out at a private tertiary reproductive medicine teaching and research center. The study enrolled 104 patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist protocol for controlled ovarian hyperstimulation (COH). The women were divided into three groups based on the route of administration of estrogen (E2) for luteal phase support: oral (Primogyna); transdermal patches (Estradott); or transdermal gel (Oestrogel Pump). The administration of estrogen provided the equivalent to 4 mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. Blood samples were drawn on the day of hCG administration and on the day of beta hCG testing to measure E2 and P levels. Clinical pregnancy rate (PR) was the main endpoint. Results: The patients included in the three groups were comparable. No significant differences were found in implantation rates, clinical PR, miscarriage rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG measurement. Concerning ovarian reserve markers, significant correlations between testing positive for clinical pregnancy and AMH (r = 0.66 , p <0.0001) and E2 levels on beta hCG measurement day (r = 0.77; p <.0001) were observed. Conclusions: No significant differences were seen in the pregnancy rates of patients submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal patches, or transdermal gel E2 during the luteal phase. A correlation was found between clinical pregnancy rate and AMH and E2 levels on beta hCG testing day.
Objective: To evaluate the effects of three different estrogen used for endometrium preparation on pregnancy rate, as well as hormone profile on day 5 frozen embryo transfer (FET) cycles. Methods: Retrospective, observational study. Setting: A tertiary teaching and research private reproductive medicine center. Patients: Ninety patients who were undergoing endometrium preparation for day five frozen embryo transfer cycle (FET). Intervention(s): The women were divided in three groups according to the administration route of estrogen (E2): oral (Primogyna), transdermal patches (Estradot), or transdermal gel (Oestrogel Pump). These administration routines of estrogen are equivalent to 6mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. We drew blood samples on starting P day, as well as on beta hCG day for E2 and P measurements. Main Outcome Measure(s): Clinical pregnancy rates (PR). Results: Patient features in the three groups were comparable. There were no significant differences concerning implantation rate, clinical PR, miscarriage rate, multiple-pregnancy rate, or E2 and P levels on starting P day and on beta hCG day. Conclusions: In FET cycles with oral (Primogyna) or transdermal patches (Estradot), or transdermal gel (Oestrogel Pump), there was no significant difference on pregnancy rates.
Objective: The aim of the present study was to investigate and to compare the relations of anti-Mullerian with the prognostic parameters and the outcome of assisted reproductive treatment. Methods: Prospective longitudinal study. A total of one hundred and twelve infertile women. Inclusion criteria: i) both ovaries present, ii) no current or past diseases affecting ovaries or gonadotropin or sex steroid secretion, clearance, or excretion, iii) no current hormone therapy, iv) adequate visualization of ovaries at transvaginal ultrasound scans, and v) total number of small antral follicles (3-12 mm in diameter) between 1 and 32 follicles. On cycle day 3, woman underwent blood sampling for serum FSH and AMH measurement and a transvaginal ovarian ultrasound scan for follicle measurement. Ongoing pregnancy was evaluated as biochemical pregnancy and observation of gestational sac(s). Results: Mean age of 36.13 ± 4.65 years old, BMI 21.59 ± 2.78 kg/m2, and length of infertility of 2.88 ± 2.36 years. Their ovaries had an average of 13.74 ± 6.0 antral follicles and AMH was 2.49 ± 1.98 ng / mL. A significant relationship of AMH with age (r = -0.37 P <.01) , with FSH (r = -0.22, P <.01) , with AFC (r = 0.74, P <.00001), with smoking (P <.009), with SOP (P <.00001), with the total dose of the drug during stimulation ovarian (r = -0.36, P <.0004), with abortion (P <.05) and with the ongoing pregnancy (P <.05). Conclusion: AMH is a marker of quantitative and qualitative aspects of the ovarian reserve.
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