Charles Chapron

AMH concentration is not related to effective time to pregnancy in women who conceive naturally

This study determined whether anti-Müllerian hormone (AMH) concentration influences the time necessary to conceive a live-born child--effective time to pregnancy (eTTP)--in a population of women who conceived naturally. This is an observational study of 87 women with a planned spontaneous pregnancy resulting in a live birth. eTTP was assessed retrospectively by a questionnaire and AMH was measured in a frozen serum sample from first trimester of pregnancy. eTTP was correlated with age (r=-0.24, P=0.02), but not with AMH (r=-0.10) or body mass index (r=0.05). With logistic regressions, the only variable that affected the probability of pregnancy within 3 or 6 months was age, irrespective of whether an AMH concentration limit of 1.0 ng/ml or 2.0 ng/ml was chosen. In conclusion, this study suggests that there is no relationship between AMH concentration and eTTP and therefore speaks against determining AMH in women who are not infertile for the purpose of predicting their chances of pregnancy. The findings are concordant with previous reports describing AMH as a quantitative but not a qualitative marker of ovarian reserve and therefore does not reflect a womans ability to become pregnant. Anti-Müllerian hormone (AMH) is secreted by small growing ovarian follicles and reflects a womans ovarian reserve - the number of primordial follicles at a given time. AMH concentrations has been extensively studied in infertile women but there are only scarce data on AMH in non-infertile women. Our objective was to determine whether AMH concentrations influence the time necessary to conceive a live-born child - also called effective time to pregnancy (eTTP) - in a population of women who conceived naturally. We conducted an observational study between 2007 and 2009 in which we assessed eTTP retrospectively in 87 women who had delivered a live-born child and measured AMH in a frozen blood sample collected during the first trimester of pregnancy. The results of our study show, as expected, a decrease of AMH concentrations as age increases but no relationship between AMH and eTTP. In conclusion, our study results suggest AMH concentrations do not influence the time necessary to conceive a live-born child spontaneously and therefore speak against determining AMH in women who are not infertile for the purpose of predicting their chances of pregnancy. Our findings are concordant with previous reports describing AMH as a quantitative but not a qualitative marker of ovarian function that does therefore not reflect a womans ability to become pregnant.

Article originalNeurotrophines et douleur : étude d’expression et de corrélation dans l’endométrioseNeurotrophins and pain in endometriosis

OBJECTIVESnTo evaluate the expression of five members of the neurotrophins family in ovarian endometriotic cyst (endometrioma) (OMA), compared to eutopic endometrium (EE) and to examine the correlation between the levels of induction and the pain intensity.nnnPATIENTS AND METHODSnTwelve Caucasian women in luteal phase, operated for painful stage IV endometriosis were assigned to 2 groups according to a total Visual Analog Scale (tVAS) score above 15 or below 10. tVAS takes into account all VAS scores for dysmenorrhea, deep dyspareunia, non cyclic chronic pelvic pain, gastrointestinal and lower urinary symptoms. Samples of OMA and EE were processed by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) for NGF, BDNF, NT-3, NT-4/5 and NTRK2 mRNA expression. Expression levels in OMA were compared to those in EE on one hand and between two groups of 6 mild painful and 6 highly painful patients on the other.nnnRESULTSnAll neurotrophins were significantly higher expressed in OMA than in EE, in particular NGF and BDNF (induction ratios: 20.6 and 9.7, respectively). In contrast, no correlation was observed between induction ratios and pain intensity.nnnCONCLUSION AND DISCUSSIONnThis is the first study reporting an over-expression of all neurotrophins in endometriosis, as only NGF was previously documented. It confirms the central role of this family in the genesis and modulation of pain in endometriosis. Anti-neurotrophin selective therapy might be a promising way of analgesia in the future.

Endométriose et infertilité

L’endometriose est une maladie gynecologique frequente dont la prevalence dans la population generale est estimee entre 6 et 10% (1). Elle atteint des femmes en âge de procreer. De nombreuses etudes ont montre que l’endometriose etait responsable d’infertilite mais les facteurs causant l’infertilite en cas d’endometriose restent mal etablis. Ceci est du pour une part a la grande diversite de l’endometriose et au fait que sa physiopathologie reste mal elucidee.

I065 ENDOMETRIOSIS: CAUSES OF PAIN

Endometriosis is a disease characterized by the growth of endometrial glands and stroma in aeras outside the uterus. There are three types of endometriotic lesions: superficial lesions (peritoneal lesions and/or ovarian), endometriotic cysts (endometriomas), and deeply infiltrating lesions (DIE). DIE is a specific entity defined histologically as lesions that penetrate the muscularis of the organs (bladder, Intestine, ureter, . . . ). Endometriosis is an enigmatic disease and various theories have been proposed to explain the pathogenesis. If endometriosis is a pathology that leads to numerous symptoms, the two main symptoms are infertility and pelvic pain. The relationship between pain symptoms and endometriosis is unclear because painful symptoms are numerous (dysmenorrhea, deep dyspareunia, non cyclic chronic pelvic pain, pain at ovulation, gastrointestinal and/or urinary symptoms during menstruation) in women with this pathology and also because asymptomatic form of endometriosis is frequent. Pathogenesis of pain in endometriosis include several mechanims: inflammation, adhesions, fibrosis, deep nodule with nerves involvement. In this lecture we will perform a precise semiological analysis of pelvic pain symptoms characteristics to increase the diagnosis and therapeutic management of endometriosis related to pelvic pain.