Angela C. Thyer

A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to menopause

BACKGROUND The primary determinant of reproductive age in women is the number of ovarian non-growing (primordial, intermediate and primary) follicles (NGFs). To better characterize the decline in NGF number associated with aging, we have employed modern stereology techniques to determine NGF number in women from birth to menopause. METHODS Normal human ovaries were collected from 122 women (aged 0-51 years) undergoing elective oophorectomy, organ donation or autopsy. After gross pathologic examination, systematic random sampling was utilized to obtain tissue for analysis by the fractionator/optical disector method. Models to describe the resulting decay curve were constructed and evaluated. RESULTS NGF decay was best described by a simple power function: log (y) = ax(b) + c, where a, b and c are constants and y = NGF count at age x (R(2) = 0.84, Sums of Squares Error = 28.18 on 119 degrees of freedom). This model implies that follicles decay faster with increasing age. CONCLUSIONS Unlike previous models of ovarian follicle depletion, our model predicts no sudden change in decay rate, but rather a constantly increasing rate. The model not only agrees well with observed ages of menopause in women, but also is more biologically plausible than previous models. Although the model represents a significant improvement compared with earlier attempts, a considerable percentage of the variation in NGF number between women cannot be explained by age alone.

Fecundability trends among sperm donors as a measure of donor performance

OBJECTIVE To examine fecundability trends among sperm donors. DESIGN Retrospective analysis. SETTING University-based sperm bank and donor insemination program. PATIENT(S) Sperm donors and recipients. INTERVENTION(S) A group of recipients underwent IUI with cryopreserved donor sperm. Fecundability was calculated for 20 sperm donors over 800 insemination cycles. MAIN OUTCOME MEASURE(S) Average fecundability per donor was compared for the first 40 cycles of a donors use and for those donors within a group of more fertile recipients. Sperm parameters, recipient ages, and number of unique recipients for each donor were analyzed. RESULT(S) Average donor fecundability is constant; however, individual donors demonstrated differences among their fecundabilities (overall mean, 0.09; range, 0.01-0.26). These differences persisted for donors among a group of more fertile recipients (overall mean, 0.12; range, 0.02-0.35). A donors fecundability at 15 cycles is predictive of his future performance. CONCLUSION(S) Differences in fecundability exist among sperm donors which cannot be discerned through routine semen parameters. Sperm donor fecundability should be analyzed periodically, and directors of sperm banks should consider discontinuing use of a donor whose outcome is substandard.

An Improved Method for the Production of Slides from Oversized Samples of Glycol Methacrylate-Embedded Tissues: Application for Optical Disector Based Stereology

Abstract An improvement in embedment and sectioning methodology of large tissue samples in glycol methacrylate resin is presented. The method improves efficiency by allowing relatively large tissue slabs, or multiple sets of smaller tissue samples to be embedded in large 2 × 3 inch blocks. The method described has general applicability for many histological procedures where large tissue sections are required. In the example presented here, the method also provides for relatively thick tissue sections to be generated (20–70 μm), thereby meeting the requirements of the optical dissector method for use with modern stereology procedures. The methods impact on increased efficiency for application of these stereological methods is discussed. (The J Histotechnol 26:49, 2003) Submitted: July 18, 2002; Accepted with revisions January 14, 2003

Curbside consultations in the era of social media connectivity and the creation of the Society for Reproductive Endocrinology and Infertility Forum

Social media, as defined by Wikipedia, the social encyclopedia, is a computer-mediated tool that allows people to create, share, or exchange information, career interests, ideas, and pictures/videos in virtual communities and networks. A Google search for the term yields 1.2 billion hits and you are hard pressed to get through your morning coffee without being asked to give or receive information through one of the many outlets that fall under this umbrella. Given its meteoric rise, it was only a matter of time before electronic connectivitys impact on the medical field was felt. A Pubmed search for ‘‘social media’’ as the keyword in 2007 would have yielded zero search results, although ‘‘social networks’’ were noted to have ‘‘considerable opportunity to advance the public health’’ (1). The first four results for ‘‘social media’’ were listed the ensuing year in 2008 followed by an exponential rise culminating in nearly 4,000 results in the medical literature as of January 2016. Not only is it being studied in terms of patient and physician interaction, it has also become a ‘‘hallway forum’’ for the old curbside consultation. There is little doubt that the way the world electronically communicates is changing, and the medical field is no exception. This evolution in medical communication brings along with it some significant concerns. Many question the validity or trustworthiness of information dispersed on social media given the lack of requirements or disclosure of user qualifications. Most platforms require only an internet connection, circumventing the traditional gatekeepers previously in place in the media. A second concern is the existence of disparities in social media, less having to do with access in modern society, and more having to do with the desire to learn the new skills required to function in this quickly evolving environment— the so called ‘‘digital divide.’’ These issues take a backseat to privacy which is of paramount concern when discussing social media in the medical community. In the era of big datamining, electronicfingerprints are constantly being captured, processed, and analyzed. Indeed, electronic tracking via third party applications allow data miningwithout user consent or knowledge. Socialmedia integration in the work environment can lead to conflicts with employees and employers as popular platforms, such as Facebook, Twitter, Instagram, and others, are used to fulfill professional roles when they are better suited for social communication. These concerns over both patient and personal confidentiality, reputation, and risk management need to be acknowledged and squarely addressed. In a study of 57 general surgery residency programs in 2014, 32% of residents had publically identifiable Facebook profiles that contained unprofessional content ranging from binge drinking and sexually suggestive photographs to clear violations of the Health Insurance Portability and Accountability Act (HIPAA) in 26% of cases (2). In response to this growth and in an attempt to establish guidelines for its membership, the American Congress of Obstetricians and Gynecologists issued Committee Opinion 622 in February 2015, which addressed the use of

Insulin and Glucose Responses to Metformin Correlate With Ovarian in Clomiphene-Resistant Women With Polycystic Ovary Syndrome

uated by non paired t-test. Results: Mean (6SE) serum concentration of leptin in azoospermic men was 7.6 6 0.8 mg/L, which was significantly higher (p 5 0.008) compared to the level of leptin in fertile men (5.0 6 0.5 mg/L). Serum leptin concentration in the oligozoospermic patients was 7.1 6 1.6 mg/L. Serum concentrations of LH and FSH were not correlated with leptin levels in the three groups. No significant differences were observed in testosterone and prolactin concentrations between the groups. Conclusions: Serum leptin concentration is significantly elevated in azoospermic men compared to normal-fertile men. Whether this new phenomenon is evidence of a direct effect of leptin on the testis or a result of the hypergonadotropic profile is yet to be determined.