H. Burks

Can highly sensitive antimüllerian hormone testing predict failed response to ovarian stimulation

OBJECTIVE To determine whether a newer commercially available antimüllerian hormone (AMH) enzyme-linked immunosorbent assay (picoAMH ELISA, AnshLabs) with a lower threshold of detection is predictive of successful ovarian stimulation in a population of women with diminished ovarian reserve (DOR). DESIGN Retrospective case-control study. SETTING University-based IVF program. PATIENT(S) Cases were patients whose first IVF cycle was cancelled for lack of ovarian response (<3 follicles; n = 24). Controls were patients with DOR (early follicular FSH of ≥10 IU/L), whose first cycle resulted in aspiration of at least 3 oocytes (n = 24). INTERVENTION(S) Frozen serum samples collected during routine clinical care between 2008 and 2012 before starting IVF were analyzed for AMH using the picoAMH ELISA. MAIN OUTCOME MEASURE(S) Serum AMH levels in patients who successfully reached oocyte retrieval compared with patients with a failed controlled ovarian hyperstimulation (COH) cycle. Receiver operator curve analysis was used to identify a predictive threshold AMH value. RESULT(S) No demographic differences were found between groups. The successful group had a higher antral follicle count (8.5 vs. 6) and higher AMH levels (847 vs. 406 pg/mL). The AMH level correlated with the antral follicle count (R = 0.61). The AMH level of >500 pg/mL had 83.3% sensitivity and 70.8% specificity to detect patients who proceeded to successful oocyte retrieval. Below AMH levels of 100 pg/mL, no patients achieved oocyte retrieval. CONCLUSION(S) Due to a lower threshold of detection, picoAMH may be able to predict successful ovarian stimulation among women with DOR using a threshold of 500 pg/mL, with good sensitivity and specificity.

Cryopreserved embryo transfer: endometrial preparation and timing.

The objective of this article was to review and synthesize information from the scientific literature pertaining to the preparation of endometrium for cryopreserved embryo transfer. This article is a critical review of selected scientific literature, synthesis, and formulation of opinion. Estrogen and progesterone are necessary and sufficient to induce endometrial receptivity in cryopreserved embryo transfer cycles. A variety of regimens have been described including natural cycles using endogenous ovarian hormones and artificial or programmed cycles with exogenously administered steroid hormones. To achieve optimal synchrony between embryo and endometrium, the timing of progesterone administration needs to be adjusted to the developmental stage of the thawed embryos. There is currently no evidence that any single regimen or adjuvant substance results in superior outcomes in cryopreserved embryo transfer cycles, although timing of progesterone administration does matter. Although no single regimen of endometrial preparation for cryopreserved embryo transfer has been proven superior to the others, the relative convenience and ease of use do vary, depending on the route of administration chosen and any adjuvant added to the cycle.

Diagnostic Criteria and Epidemiology of PCOS

Polycystic ovary syndrome (PCOS) is considered as the most common endocrine disorder amongst reproductive-age women. While characterized by a chronic course, and features that suggest varying combinations of reproductive functional deficits (such as ovulatory dysfunction or polycystic ovarian morphology) and androgen excess (such as acne, and hirsutism), the diagnosis of PCOS is based on well-defined criteria. Ethnicity, lifestyle, and certain underlying secondary disorders can impact on diagnostic accuracy of the disorder. There are currently three major sets of diagnostic criteria for the polycystic ovary syndrome (PCOS), with slight variations between them. The prevalence of PCOS varies depending on the diagnostic criteria utilized as well as the region and ethnicity studied. The prevalence of PCOS is high among women with resistant acne and hirsutism, so patients presenting with these findings should be screened for menstrual irregularities. A timely diagnosis of this chronic disorder allows an opportunity for early detection of a spectrum of morbidities that are commonly encountered in women with PCOS (such as metabolic syndrome, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia and depression), and will allow for timely institution of preventive strategies aimed at minimizing the overall health risk in this population.