Benjamin M. Lannon

High frequency of discordance between antimüllerian hormone and follicle-stimulating hormone levels in serum from estradiol-confirmed days 2 to 4 of the menstrual cycle from 5,354 women in U.S. fertility centers

OBJECTIVE To determine the frequency of clinical discordance between antimüllerian hormone (AMH, ng/mL) and follicle-stimulating hormone (FSH, IU/L) by use of cut points defined by response to controlled ovarian stimulation in the same serum samples drawn on estradiol-confirmed, menstrual cycle days 2 to 4. DESIGN Retrospective analysis. SETTING Fertility centers in 30 U.S. states and a single reference laboratory with uniform testing protocols. PATIENT(S) 5,354 women, 20 to 45 years of age. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Frequency of discordance between serum AMH and FSH values. RESULT(S) Of the 5,354 women tested, 1 in 5 had discordant AMH and FSH values defined as AMH <0.8 (concerning) with FSH <10 (reassuring) or AMH ≥ 0.8 (reassuring) with FSH ≥ 10 (concerning). Of the women with reassuring FSH values (n = 4,469), the concerning AMH values were found in 1 in 5 women in a highly age-dependent fashion, ranging from 1 in 11 women under 35 years of age to 1 in 3 women above 40 years of age. On the other hand, of the women with reassuring AMH values (n = 3,742), 1 in 18 had concerning FSH values, a frequency that did not vary in a statistically significant fashion by age. CONCLUSION(S) Clinical discordance in serum AMH and FSH values was frequent and age dependent using common clinical cut points, a large patient population, one reference laboratory, and uniform testing methodology. This conclusion is generalizable to women undergoing fertility evaluation, although AMH testing has not been standardized among laboratories, and the cut points presented are specific to the laboratory in this study.

Predicting personalized multiple birth risks after in vitro fertilization-double embryo transfer.

OBJECTIVE To report and evaluate the performance and utility of an approach to predicting IVF-double embryo transfer (DET) multiple birth risks that is evidence-based, clinic-specific, and considers each patients clinical profile. DESIGN Retrospective prediction modeling. SETTING An outpatient university-affiliated IVF clinic. PATIENT(S) We used boosted tree methods to analyze 2,413 independent IVF-DET treatment cycles that resulted in live births. The IVF cycles were retrieved from a database that comprised more than 33,000 IVF cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The performance of this prediction model, MBP-BIVF, was validated by an independent data set, to evaluate predictive power, discrimination, dynamic range, and reclassification. RESULT(S) Multiple birth probabilities ranging from 11.8% to 54.8% were predicted by the model and were significantly different from control predictions in more than half of the patients. The prediction model showed an improvement of 146% in predictive power and 16.0% in discrimination over control. The population standard error was 1.8%. CONCLUSION(S) We showed that IVF patients have inherently different risks of multiple birth, even when DET is specified, and this risk can be predicted before ET. The use of clinic-specific prediction models provides an evidence-based and personalized method to counsel patients.

Ethnicity and Amenorrhea

Discussion preceding this chapter has addressed various physiological and pathophysiological states that affect the menstrual cycle. This chapter focuses on the role of race and/or ethnicity on menstrual physiology. Our discussion about the impact of race and ethnicity on amenorrhea focuses on two factors: (1) the physiologic variations in the menstrual cycle among different racial and ethnic groups and (2) variations in cultural attitudes and beliefs about the cessation of menses. While these cultural differences may not always impose specific diagnostic or management dilemmas, awareness may be essential to the goal of providing comprehensive care to our diverse patient population.