Testing and interpreting measures of ovarian reserve: a committee opinion

Penzias, Alan S.; Azziz, Ricardo; Bendikson, Kristin; Falcone, Tommaso; Hansen, Karl R.; Hill, Micah J.; Hurd, William W.; Jindal, Sangita; Kalra, Suprita; Mersereau, Jennifer; Racowsky, Catherine; Rebar, Robert W.; Reindollar, Richard H.; Shannon, Chevis N.; Steiner, Anne Z.; Stovall, Dale W.; Tanrikut, Cigdem; Taylor, Hugh S.; Yauger, Belinda J.

doi:10.1016/j.fertnstert.2020.09.134

Cited by 161 publications

(70 citation statements)

References 52 publications

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“…In 2015, the American College of Obstetricians and Gynecologists recommended that ovarian reserve testing should be performed in all women who underwent ovarian surgery (22). Ovarian reserve testing could allow the individualization of treatment protocols to achieve optimal response while minimizing safety risks (16,22). Therefore, we conducted this prospective cohort study to test the hypothesis that optimal time for recovery of ovarian reserve recovery after the laparoscopic unilateral ovarian nonendometriotic cystectomy occurred 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

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The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

Yan

Wang

et al. 2021

Front. Endocrinol.

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BackgroundLaparoscopic ovarian cystectomy is established as the standard surgical approach for the treatment of benign ovarian cysts. However, previous studies have shown that potential fertility can be directly impaired by laparoscopic ovarian cystectomy, diminished ovarian reserve (DOR), and even premature ovarian failure. Therefore, fertility-preserving interventions are required for benign gynecologic diseases. However, there are still little data on the time period required for recovery of ovarian reserve after the laparoscopic unilateral ovarian cystectomy, which is very important for the individualization of treatment protocols. This study aimed at investigating the time needed for the ovarian reserve to recover after laparoscopic unilateral ovarian non-endometriotic cystectomy.Materials and MethodsSixty-seven patients with unilateral ovarian non-endometriotic cyst from Zhoupu and Punan Hospitals who underwent laparoscopic unilateral ovarian cystectomy were recruited as a postoperative observation group (POG). Also, 69 healthy age-matched women without ovarian cyst who did not undergo surgery were recruited as a referent group (RFG). Ovarian reserve with the serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2) levels, ovarian arterial resistance index (OARI), and antral follicle counts (AFCs) were measured on the third to fifth days of the same menstrual cycle. A postoperative 6-month follow-up of cases was performed.ResultsCompared with RFG, AFC of cyst side in the POG group showed no difference in the first, third, and sixth postoperative month (F = 0.03, F = 0.02, F = 0.55, respectively; p = 0.873, p = 0.878, p = 0.460, respectively). The OARI of cyst side in the POG group revealed no differences in the first, third, and sixth postoperative month (F = 0.73, F = 3.57, F = 1.75, respectively; p = 0.395, p = 0.061, p = 0.701, respectively). In the first month, the postoperative AMH levels significantly declined, reaching 1.88 ng/ml [interquartile range (IQR): 1.61–2.16 ng/ml] in POG and 2.57 ng/ml (IQR: 2.32–2.83 ng/ml) in RFG (F = 13.43, p = 0.000). For the data of AMH levels stratified by age, the same trend was observed between less than 25 and more than 26 years old. At this same time interval, the postoperative rate of decline was significantly lower compared to the preoperative one in POG (32.75%). The same trend was observed between the POG and RFG groups (26.67%).ConclusionsThe optimal time for recovery of ovarian reserve after laparoscopic unilateral ovarian cystectomy is estimated to be 6 months.

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Section: Discussionmentioning

confidence: 99%

“…Anti-Müllerian hormone (AMH) level testing is a useful screening test for assessing ovarian reserve in women at high risk of diminished ovarian reserve (16), especially for young women with cancer (17). According to a previous study, there was no significant decrease in the serum of AMH levels 3 months after endometrioma cystectomy (18).…”

Section: Introductionmentioning

confidence: 99%

The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

Yan

Wang

et al. 2021

Front. Endocrinol.

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“…In current practice, physicians adjust OS parameters by assessing ovarian reserve, including an antral follicular count (AFC), a measure of serum anti-müllerian hormone (AMH) level and baseline (day-3) serum follicle-stimulating hormone level before starting OS (4). Although all of these tests provide information to anticipate response to OS, the AMH level is the most widely used in routine practice (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…However, in practice, the predictive value of these two parameters may have limitations and the ovarian response may not correspond to the expected response. Therefore, the ability of these two ovarian markers to reflect oocyte quality and competence is still debated and controversial (4,12,13).…”

Section: Introductionmentioning

confidence: 99%

Impact of Ovarian Yield—Number of Total and Mature Oocytes Per Antral Follicular Count—On Live Birth Occurrence After IVF Treatment

et al. 2021

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To assess the relation between oocytes yield including total retrieved oocytes (O)c and total mature oocytes (MII) relative to the antral follicular count (AFC) (3–9 mm in diameter) and relative to anti-müllerian hormone (AMH) ng/mL level: Oc/AFC, MII/AFC, Oc/AMH, and MII/AMH, respectively, and ART outcomes. We included retrospectively 264 IVF cycles after the first embryo transfer (ET) and after the cumulative ET (CET). The implantation rate (IR) and the live birth rate (LBR) after first ET were 31 ± 39% and 32.6%, respectively, and after CET 35 ± 38% and 45.1%, respectively. There was a significantly higher average of Oc/AFC and MII/AFC when live birth (LB) occurred after the first ET (0.82 ± 0.4 vs. 0.71 ± 0.35 and 0.57 ± 0.4 vs. 0.68 ± 0.3, respectively, P < 0.05). We reported a significantly higher average of MII/AFC when LB occurred after CET (0.66 ± 0.3 vs. 0.56 ± 0.30, P = 0.02) in comparison to the group where no LB was obtained. Increased Oc/AFC and MII/AFC ratios were associated with the occurrence of LB and increased IR after first ET (P < 0.05). Increased MII/AFC ratio was associated with the occurrence of LB and IR after CET (P = 0.02 and P = 0.04, respectively). After age-adjusted multivariate analyses, all these trends were confirmed (P < 0.05) except for the effect of MII/AFC ratio on IR after CET. In conclusion, Oc/AMH and MII/AMH ratios have no effect on the occurrence of LBR or on IR after first ET or CET at either age grouping. Ratios Oc/AFC and MII/AFC seem promising indicators to assess ovarian response.

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“…However, it is unclear whether these new cells can function as oocytes (Wood & Rajkovic 2013). Gametogenesis begins during fetal development in females, and by mid-gestation, the number of oocytes reaches a maximum number of approximately 6-7 million (Allen 2010). After reaching this peak, there is a stage of pronounced oocyte atresia that decreases the oocyte number to approximately 2 million at birth.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of ovarian aging

2021

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Ovarian aging in women correlates with the progressive loss of both the number and quality of oocytes. When these processes occur early or are accelerated, their clinical correlates are diminished ovarian reserve and/or premature ovarian insufficiency. Both these conditions have important consequences for the reproductive and general health of women, including infertility. Although there are many contributing factors, the molecular mechanisms underlying many of the processes associated with ovarian aging have not been fully elucidated. In this review, we highlight some of the most critical factors that impact oocyte quantity and quality with advancing age. We discuss chromosomal factors including cohesion deterioration and mis-segregation, errors in meiotic recombination, and decreased stringency of the spindle assembly checkpoint. DNA damage, telomere changes, reactive oxygen species and mitochondrial dysfunction as they relate to ovarian aging, and well-known gene mutations associated with primary ovarian insufficiency and diminished ovarian reserve are also discussed. Additionally, studies investigating recently acknowledged cytoplasmic factors associated with ovarian aging including protein metabolic dysregulation and microenvironmental alterations in the ovary are presented. We use both mouse and human studies to support the roles these factors play in physiologic and expedited ovarian aging, and we propose directions for future studies. A better understanding of the molecular basis of ovarian aging will ultimately lead to diagnostic and therapeutic advancements that would provide women with information to make earlier choices about their reproductive health.

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Testing and interpreting measures of ovarian reserve: a committee opinion

Cited by 161 publications

References 52 publications

The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

Impact of Ovarian Yield—Number of Total and Mature Oocytes Per Antral Follicular Count—On Live Birth Occurrence After IVF Treatment

Mechanisms of ovarian aging

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