Dietary fish oil restores ovarian function in subfertile rats, which is thought to be associated with decreased transcription of follicle-stimulating hormone (FSH) β-subunit. We have previously demonstrated a reduction in early follicular serum FSH levels in normal weight but not obese women after treatment with omega-3 polyunsaturated fatty acids (PUFA). Herein, we report the effect of supplementation with omega-3 PUFA on urinary reproductive hormones across the whole menstrual cycle. This interventional study included 17 eumenorrheic women, aged 24-41 years. One month of daily morning urine was collected before and after 1 month of omega-3 PUFA supplementation with 4 g of eicosapentaenoic acid and docosahexaenoic acid daily. Measurements included urinary FSH, luteinizing hormone (LH) and estrogen and progesterone metabolites, plasma fatty acid composition, and markers of endoplasmic reticulum stress. Compliance with dietary supplementation was verified by significantly reduced ratios of omega-6 to omega-3 PUFA for all subjects after treatment ( P < .01). After 1 month of omega-3 PUFA supplementation, urinary FSH was significantly decreased in normal weight, but not obese women, in both follicular and luteal phases (−28.4% and −12.6%, respectively, both P = .04). No significant changes were seen in LH or sex steroids for either weight group. The selective and specific decrease in FSH suggests that omega-3 PUFA supplementation merits further investigation in normal weight women with decreased fertility and/or diminished ovarian reserve.
OBJECTIVE: Fatty acids (FA) have been shown to be important for several reproductive processes, including steroidogenesis, endometriosis, and fecundability, though associations between specific FA and ovulatory function are uncertain. Thus, we investigated the relationship between plasma phospholipid FA status and ovulation among women with proven fecundity.DESIGN: This was a secondary analysis of the EAGeR trial which evaluated the effect of preconception-initiated low dose aspirin on reproductive outcomes. 1228 participants ages 18-40 with 1-2 prior pregnancy losses, no history of infertility, and self-reported regular cycles of 21-42 days were attempting to conceive.MATERIALS AND METHODS: Plasma phospholipid FAs were measured at baseline. Daily urine samples were collected during the first two cycles of follow-up, with an absence of a rise in urinary luteal pregnanediol glucuronide determining anovulation status. A repeated-measures logbinomial regression model estimated the Risk Ratio (RR) and 95% confidence intervals (CI) of anovulation per cycle, adjusted for age, race, smoking, body mass index, physical activity, income, parity, treatment arm, and total cholesterol.RESULTS: Monounsaturated fatty acids (MUFA) were associated with an increased risk of anovulation (RR [95% CI]: 1.10 [1.00, 1.22] per unit increase in % of total FA), whereas polyunsaturated fatty acids (PUFA, 0.95 [0.89, 1.02]), saturated fatty acids (SFA, 1.02 [0.94, 1.10]), and trans fatty acids (1.30 [0.90, 1.91]) were not associated with anovulation. Omega-3 FAs also were not associated with anovulation (0.96, [0.84, 1.09]).CONCLUSIONS: Although MUFAs were suggestive of an increased risk of anovulation, PUFAs, SFAs, trans fatty acids, and omega 3s were not associated with the risk of anovulation among women with proven fecundity. These data suggest that the potential role of FAs on fecundability does not likely work through ovulatory function but through other mechanisms.
The menopause transition is a gradual physiologic process characterized by an intricate interplay between hypothalamic-pituitary axis dysfunction and ovarian follicle failure. Clinically, symptoms are variable and can range from minimal to severe. The hallmark symptom of the perimenopause and postmenopause is the hot flash; however, systemically low estrogen has widespread effects in the aging woman, including important changes in the cardiovascular, musculoskeletal, genitourinary, and central nervous systems. The diagnosis of menopause is a clinical one. Although there is no single laboratory marker that can predict the final menstrual period, an elevated follicle stimulating hormone is the classic marker of a menopausal state. Newer evidence suggests that antimullerian hormone may be more predictive of the final menstrual period; however, more studies are needed. An understanding of the physiology and symptomatology of the menopausal transition is crucial for educating women about their health risks later in life. This review contains 2 figures and 30 references Key Words: hot flashes, menopause, perimenopause, postmenopause, race/ethnicity in menopause, stages of transition in menopause, stress/psychological complications, women’s health
Patients undergoing assisted reproduction are advised to abstain from intercourse to prevent the possibility of multiple pregnancy. If patients do not follow this advice, multiple dizygotic pregnancy or even a heterotopic pregnancy can result. We report the case of a 28-year-old nulliparous female with unexplained infertility who underwent freeze-all vaginal oocyte retrieval. Twenty-one days later she presented with vaginal bleeding (similar to menstruation) and right lower-quadrant pain. The results of ultrasound scanning and a laboratory work-up were consistent with an ectopic pregnancy. She underwent laparoscopic right salpingectomy for a tubal ectopic pregnancy. We recommend sexual abstinence during assisted reproduction to lower the risk of multiple pregnancy and especially of heterotopic pregnancy.
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