Catherine Lefebvre

Anti-Müllerian hormone follow-up in young women treated by chemotherapy for lymphoma: preliminary results

Susceptibility of the ovarian reserve to chemotherapy is highly variable from one patient to another and poorly documented. To better characterize the evolution of follicular depletion in patients treated for lymphoma, serum anti-Müllerian hormone (AMH) assay was used. A total of 30 young women (mean age 24years) were prospectively recruited before initiation of chemotherapy for lymphoma. They were assigned either to an adriamycin, bleomycin, vinblastine and dacarbazine protocol (ABVD group) or to a protocol that included cyclophosphamide (non-ABVD group). AMH assays were performed before and during chemotherapy, and then every 3months after the end of treatment for a period of 1year. In all patients, AMH concentrations fell drastically just after the start of chemotherapy and were close to the detection limit at the end of the treatment. In the ABVD group, AMH concentrations increased from the third month after the end of chemotherapy and returned to pretreatment values 12months after the end of chemotherapy. Conversely, no significant change was observed in the non-ABVD group throughout the follow-up period. In conclusion, longitudinal analysis of AMH during chemotherapy highlights differences between protocols that could contribute to an understanding of ovarian toxicity and, ultimately, be useful in fertility preservation counselling.

Increased anti-Müllerian hormone and decreased FSH levels in follicular fluid obtained in women with polycystic ovaries at the time of follicle puncture for in vitro fertilization

OBJECTIVE To confirm the increased levels of anti-Müllerian hormone (AMH) in preovulatory follicles from patients with polycystic ovary syndrome (PCOS) and to study the role of other hormones involved in folliculogenesis in this increased secretion. DESIGN Prospective study. SETTING University hospital in France. PATIENT(S) Twenty-two patients with PCOS and 20 controls undergoing IVF. INTERVENTION On the day of oocyte retrieval, follicular fluid (FF) from one small follicle (8-13 mm) (SF) and one large follicle (16-23 mm) (LF) was collected in each patient. MAIN OUTCOME MEASURE(S) Per-follicle AMH, FSH, estradiol, androstenedione, hCG, and progesterone levels, and pregnancy rate. RESULT(S) In FF from both SF and LF of PCOS patients, AMH level was significantly increased, and FSH level was significantly decreased when compared with controls. Both hormone levels were negatively and significantly related in controls but not in PCOS. The AMH levels from SF and LF were significantly lower in patients who began a pregnancy. CONCLUSION(S) Our findings suggest that the granulosa cells from polycystic ovaries continue to produce elevated levels of AMH, possibly because of impaired access of FSH to follicles. Such an excess in FF AMH may have harmful consequences on oocyte quality and final maturation through unknown mechanisms.

First intention IVF protocol for polycystic ovaries: does oral contraceptive pill pretreatment influence COH outcome?

BackgroundMorphological aspect of polycystic ovaries (PCO) is a very common finding in an IVF center population: this includes PCOS patients identified in 18–25% of the couples presenting with infertility and so called “sonographic PCO only” the prevalence of which has been estimated as high as 33% in asymptomatic patients. Finding the optimal first intention IVF protocol for polycystic ovaries patients is still challenging in order to improve the controlled ovarian hyperstimulation (COH) outcome while avoiding ovarian hyperstimulation syndrome (OHSS). It has been suggested that women with PCO would benefit from a longer period of pituitary down-regulation. The purpose of this study was to compare an extended duration of OCP pretreatment with a classic GnRH agonist protocol.MethodsA single center prospective non-randomized study was performed from January 2009 to December 2010 in the Lille University Hospital including 113 women diagnosed with PCO(S) according to the Rotterdam ultrasonographic criteria and undergoing their first IVF attempt. Comprehensive hormonal and ultra-sonographic assessments were collected during COH in these patients. LH and androgen suppression and dynamics of follicular growth were compared between the two protocols as well as the COH outcome in terms of oocyte/embryo number and quality, implantation and pregnancy rates.ResultsNo significant difference was observed between the two groups concerning dynamics of follicular growth and hormonal values. Clinical and ongoing pregnancy rates were significantly lower in the OCP group despite same oocyte and embryo quality. Nevertheless, the cumulative pregnancy rate did not differ between the two groups. The incidence of OHSS was not statistically significant.ConclusionsExtended duration of OCP pretreatment, as a first intention IVF protocol for PCO patients, does not improve the pattern of follicular growth nor the oocyte and embryo quality.

Serum inhibin B during controlled ovarian hyperstimulation: an additional criterion for deciding whether to proceed with egg retrieval

OBJECTIVE To determine the predictive value of the inhibin B increment during controlled ovarian hyperstimulation (COH) for differentiating between poor and normal responders and for deciding whether to continue or stop an IVF attempt. DESIGN Prospective study. SETTING Assisted reproduction unit at a university hospital. PATIENT(S) A total of 110 women undergoing IVF for idiopathic, tubal, and/or male infertility. INTERVENTION(S) Blood samples were collected on days 6 and 8 of COH. Inhibin B and E(2) assays were performed. MAIN OUTCOMES MEASURE(S) The degree of inhibin B increment was defined as Delta IB = day-8 value minus day-6 value. We analyzed the correlation of day-6 and day-8 inhibin B values and Delta IB with the number of oocytes retrieved. The predictive value of each parameter was determined by using the receiving operator characteristics curve analysis. RESULT(S) The Delta IB correlated best with the number of oocytes retrieved (r = 0.5) and with the number of embryos obtained (r = 0.26), independently of age. From the receiving operator characteristics curve analysis, a Delta IB cutoff value of 300 pg/mL discriminated poor (few than four oocytes retrieved, n = 16) from normal (more than four oocytes retrieved, n = 94) responders, with a sensitivity of 70% and a specificity of 94%. CONCLUSION(S) The degree of inhibin B increment during COH provides additional information for predicting ovarian response to COH. An increment >300 pg/mL is required to rule out the eventuality of a poor ovarian response.

Influence of Dementia on Antithrombotic Therapy Prescribed before Stroke in Patients with Atrial Fibrillation

Background and purpose: Oral anticoagulation (OAC) decreases the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF), but remains underused in practice. The aim of this study was to test the hypothesis that prestroke dementia influenced the nonprescription of OAC before stroke. Methods: This is an ancillary study of Stroke in Atrial Fibrillation Ensemble II, an observational study conducted in patients with a previously known NVAF, consecutively admitted for an acute stroke to French and Italian centers. Prestroke dementia was evaluated by the clinical physician and validated by an Informant Questionnaire for Cognitive Decline in the Elderly score of ≧104 in patients with a reliable informant. Results: Of 204 patients, 24 patients met criteria for prestroke dementia according to GP’s opinion. The only variables independently associated with OAC before stroke were follow-up by a cardiologist (adjusted OR: 3.33; 95% CI: 1.47–7.53) and a younger age of patients (adjusted OR: 0.94; 95% CI: 0.89–0.99). Variables independently associated with any antithrombotic drug therapy before stroke were follow-up by a general practitioner (adjusted OR: 2.78; 95% CI: 1.09–7.11), and by a cardiologist (adjusted OR: 3.15; 95% CI: 1.48–6.69). Conclusion: In daily practice, the under-prescription of OAC in patients with NVAF mainly depends on co-morbidity and on characteristics of the physician, not on prestroke dementia.