Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. It is not yet possible to accurately predict the onset of menopause, especially early menopause, to give women improved control of their fertility. The decline in ovarian oestrogen production at menopause can cause physical symptoms that may be debilitating, including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. The individual experience of the menopause transition varies widely. Important influential factors include the age at which menopause occurs, personal health and wellbeing, and each woman's environment and culture. Management options range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks. Decisions about therapy for perimenopausal and postmenopausal women depend on symptomatology, health status, immediate and long-term health risks, personal life expectations, and the availability and cost of therapies. More effective and safe therapies for the management of menopausal symptoms need to be developed, particularly for women who have absolute contraindications to hormone therapy. For an illustrated summary of this Primer, visit: http://go.nature.com/BjvJVX.

Objective-Hypothesizing that levels of 25OH-D in body fluids are reflective of vitamin repletion status, we aimed to determine if 25OH-D levels in the follicular fluid (FF) of infertile women undergoing in vitro fertilization (IVF) demonstrate a relationship with IVF cycle parameters and outcome. Design-Prospective Cohort study Setting-Academic tertiary care center Patients-84 infertile women undergoing IVFInterventions-FF from follicles ≥14mm; serum (n=10) and FF levels of 25OH-D Main outcome measures-Clinical pregnancy (CP) (defined as evidence of intrauterine gestation sac on ultrasound) following IVF; IVF cycle parameters.Results-Serum and FF levels of 25OH-D were highly correlated (r=0.94, p<0.001). In a predominantly Caucasian population (66%), significantly lower FF 25OH-D levels were noted in Black versus non-Black patients (p=0.001). Significant inverse correlations were seen between FF 25OH-D levels and BMI (r−0.25, p=0.035). Significantly higher CP and implantation rates were observed across tertiles of FF25OH-D (p=0.029 and p=0.041 respectively); patients achieving CP following IVF (n=26) exhibited significantly higher FF levels of 25OH-D (p=0.005). Multivariable logistic regression analysis confirmed FF 25OH-D levels as an independent predictor to success of an IVF cycle; adjusting for age, BMI, ethnicity and number of embryos transferred (ET) each ng/ml increase in FF 25OH-D increased the likelihood for achieving CP by 6% (p=0.030). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Our findings that women with higher vitamin D level in their serum and FF are significantly more likely to achieve CP following IVF-ET are novel. A potential for benefit of vitamin D supplementation on treatment success in infertile patients undergoing IVF is suggested that merits further investigation. NIH Public Access

Maternal vitD supplementation improved maternal and neonatal vitD status.

No abstract

This article reviews the existing fertility preservation options for females diagnosed with Turner syndrome and provides practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in females, occurring in approximately one in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency (POI) and infertility. Although about 70–80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder may possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, so as to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood as the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, while cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remain investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 and ovarian tissue cryopreservation in prepubertal children affected. However, current efficacy of these approaches is unknown in this cohort.. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of desire for parenting. For those with Turner syndrome related cardiac contraindications to pregnancy, utilization of gestational surrogacy allows the possibility of biological parenting by using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.