Predictive Value and Clinical Impact of Basal Follicle-Stimulating Hormone in Subfertile, Ovulatory Women

Abstract

Available reports suggest that uterine artery embolization (UAE) has advantages over surgery when treating heavy menstrual bleeding caused by uterine fibroids, but some of these studies lack a control group of women treated in other ways-as by hysterectomy. The EMMY trial (comparing EMbolization with hysterectoMY), conducted at 28 Dutch hospitals, compared the efficacy of UAE with that of hysterectomy for treating menorrhagia resulting from uterine fibroids. Women describing increased or prolonged menstrual blood loss that interfered with daily life were included in the trial. A total of 88 patients were randomized to UAE and 89 to hysterectomy, which usually was performed transabdominally. The primary end point was whether, after a prospective 24-month follow-up interval, UAE avoided subsequent hysterectomy in at least 75% of cases. UAE failed bilaterally in 4 patients who later underwent hysterectomy. The rate of unilateral failure was 12%. In all, 23.5% of patients assigned to UAE had undergone hysterectomy 2 years after treatment. The hysterectomies were evenly distributed over time. All but one of them were done for persistent or recurrent menorrhagia. There were no significant group differences in the rate of improvement in either lower abdominal pain or bulk-related symptoms. Pain was less than at baseline in more than three-fourths of both patient groups, and bulk-related symptoms in at least two-thirds of women in each group. Reductions in uterine volume and fibroid volume following UAE were highly significant. Blood hemoglobin levels rose significantly in both groups compared to baseline values.The investigators conclude that UAE is a sound alternative to hysterectomy in women with symptomatic uterine fibroids. Nevertheless, hysterectomy remains the preferred treatment for patients who wish to be certain that bleeding will cease. GYNECOLOGYVolume 62, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Operative laparoscopy is a most important development in gynecological surgery, and also is a technically challenging type of surgery. In general surgery, making available an advanced endoscopic surgeon in the setting of mentor traineeship has improved the results of advanced procedures performed by residents. This study evaluated a mentor traineeship in laparoscopic surgery at a teaching hospital. Starting in 2001, an advanced endoscopic gynecologist has mentored a trainee in laparoscopic surgery. Results were reviewed for the preceding years 1997-2000 and for the training years 2001-2004. The trainee was scheduled to perform surgery 1 day a week and was mentored biweekly in the operating room. The trainee was in each instance the primary surgeon, and the mentor an assistant. ABSTRACTMucosal lichen planus (LP) is a rare variant of LP, itself a common skin disorder. Two-thirds of those affected have an erosive form of LP that causes severe vulvovaginal and, in some cases, oral mucosal symptoms, including burning, pain, and pruritus. The disease affects the vaginal orifice and often, the labia minora. P...

Single nucleotide polymorphisms in the Anti-Müllerian hormone (AMH Ile49Ser) and Anti-Müllerian hormone type II receptor (AMHRII −482 A>G) as genetic markers in assisted reproduction technology

“…A possible explanation regarding higher basal FSH levels found in carriers of the AMH polymorphism may be the accelerated recruitment of primordial follicles leading to an exhaustion of follicles from ovarian reserve. This finding is in accordance with several studies which confirm that basal FSH levels constitute a marker of ovarian reserve, as high basal FSH levels represent the decline of ovarian potential and are associated with a decreased fecundity and vice versa [40,41]. Concerning the lower number of growing follicles that carriers of AMHRII polymorphism with more than two previous IVF attempts had, we suggest that the absence or the reduced number of normal functioning AMHRII hampers the physiological role of AMH, leading again to the exhaustion of follicles.…”

A lower antral follicle count is associated with infertility

“…Few studies, however, have evaluated whether ovarian reserve tests predict spontaneous pregnancy. Earlier studies in subfertile women suggested high FSH, as a marker of low ovarian reserve, was associated with a decline in pregnancy rate in subfertile patients and longer time to spontaneous pregnancy regardless of age [29, 30] More recently, Haadsma et al (2008) addressed this question in an ovulatory, subfertile population, and found an inverted U-shape best described the relationship between pregnancy likelihood and both AFC and FSH. However, excluding those with low FSH and/or high AFC eliminated any significance of ovarian reserve testing for predicting conception.…”

Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States

“…The present study reports results from an 18-month prospective observational study of couples pursuing the full range of cycle-based fertility treatments. The aims of the present study were to describe the use, duration, and success of cycle-based treatments over this period while adjusting for infertility risk factors such as maternal age (16), infertility duration and diagnosis (17–19), and parity (20–22). Such information could be useful in counseling infertile patients as to when they should abandon less intensive treatment for more intensive and potentially more costly therapy.…”