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Preimplantation Genetic Testing of Aneuploidies (PGT-A)
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Daniela N. Bakalova, Darren K. Griffin, Maria E. Póo, Alan R. Thornhill
Couples undergoing IVF treatment are often faced with a multitude of financial and emotional burdens. The impact of age is most apparent in female patients, as ovarian reserve begins to diminish over the age of 35 and, with it, aneuploidy in eggs (and subsequently embryos). By selectively transferring euploid embryos identified using PGT-A, the time to pregnancy can be significantly reduced. A recent retrospective cohort study involving women of AMA showed that clinical pregnancy leading to a live birth was achieved in a shorter time in the PGT-A group as compared to a control (104.8 days vs. 140.6 days) [79]. This is further supported in an RCT performed by Rubio and colleagues, where time to pregnancy was nominally reduced in patients undergoing PGT-A treatment [61]. Prioritization of normal embryos for transfer may lead to a couple conceiving a healthy baby in a shorter time; this may be especially advantageous for AMA patients. It is also notable that a shorter time to pregnancy is associated with a reduced number of cycles and transfers, which may reduce the costs and emotional burden of ART treatment.
The Use of Ovarian Markers
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Neena Malhotra, Siladitya Bhattacharya
Ovarian reserve is a term used to describe a woman's reproductive potential and is a reflection of her pool of primordial follicles or, more specifically, the number and quality of oocytes in her ovaries (1). Each woman is born with approximately 2 million primordial follicles, but this number drops to 400,000 around menarche as a consequence of follicular atresia (2). Follicle numbers fall further with age, and the rate of decline is faster when women are in their mid-30s. This decline in fertility potential is specific for an individual woman and is influenced by race as well as genetic and environmental factors.
Fertility preservation in pediatric and adolescent girls
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
While it is impossible to know exactly how many oocytes are remaining in an individual female at a specific point in time, there are serum and ultrasound markers that can give a general sense of overall ovarian reserve. The ovaries are fairly quiescent until puberty, at which time they fall under the control of the hypothalamic-pituitary-ovarian axis (Figure 26.2), with follicle-stimulating hormone (FSH) secreted at the beginning of each cycle to begin recruitment of a dominant follicle. A cohort of oocytes is recruited every month, but generally only one reaches final maturity and is ovulated, while the rest undergo apoptosis. Once the dominant follicle begins to develop, surrounding granulosa cells secrete estradiol into the circulation, which provides negative feedback to the hypothalamus and pituitary, with a resultant decrease in serum FSH levels (Figure 26.2). As such, serum FSH and estradiol levels must be checked early in the follicular phase (preferably on cycle day 2, 3, or 4) to assess ovarian reserve, with higher FSH levels indicating worse ovarian reserve. Ideal ovarian function is reflected by FSH <10 IU/mL, with FSH rising above 40 IU/mL in menopause. It is important to draw an estradiol with FSH levels, as negative feedback from increased estradiol levels can drive down the FSH level and provide false reassurance. An elevated estradiol level on cycle day 2, 3, or 4 can also reflect declining ovarian function.
Clinical efficacy of ultrasound-guided interventional therapy in patients with benign ovarian cysts: a meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2023
Yukun Lu, Zuoxi He, Yuedong He
Ovarian function is a critical indicator for assessing female sex hormone secretion and ovulation ability, and reduced ovarian function can affect female fertility (Iwase et al.2010). At present, LH, FSH, E2 and other sex hormones are commonly used to assess ovarian reserve in clinical practice (Laven and Fauser 2006). In the present meta-analysis, E2 levels were significantly higher in patients after ultrasound intervention than in the control group, while LH and FSH levels were significantly lower. Previous studies have reported that surgical treatment of benign ovarian cysts results in damage to follicles and granulosa cells in the ovary, which affects the level of benign ovarian cysts (Ergun et al.2015). The reason why ultrasound-guided interventional therapy has less impact on the body is that it causes less damage to ovarian follicles and granulosa cells than conventional surgery (Xu et al.2019).
Is low anti-Mullerian hormone (AMH) level a risk factor of miscarriage in women <37 years old undergoing in vitro fertilization (IVF)?
Published in Human Fertility, 2022
Anne-Sophie Cornille, Clémence Sapet, Arnaud Reignier, Florence Leperlier, Paul Barrière, Pascal Caillet, Thomas Fréour, Tiphaine Lefebvre
Anti-Mullerian hormone (AMH) and antral follicle count (AFC) are currently considered the two best ovarian reserve markers (Dewailly et al., 2014). Ovarian reserve decreases physiologically with age. The decline in serum AMH levels accelerates beyond 35–37 years and becomes undetectable 3–5 years before the onset of menopause (Kelsey et al., 2011). However, in some women this is accelerated, with a lower ovarian reserve than expected at their age. Except for some specific cases such as women with Turner syndrome or a history of gonadotoxic treatment, the aetiologies of this phenomenon called ‘diminished ovarian reserve’ (DOR) are poorly understood (Greene et al., 2014). Although this concept is commonly accepted, and schemes such as the Bologna criteria and the Poseidon criteria to define women with lower prognosis are proposed (Abu-Musa et al., 2020), there is no consensus definition in the literature (Cohen et al., 2015). This entity differs from premature ovarian failure (POF), which has been well defined by the European Society of Human Reproduction and Embryology (European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI et al., 2016). Patients with DOR are generally identified by low AMH and/or low AFC by infertility specialists. Low serum AMH level and/or low AFC are associated with a poor quantitative ovarian response to controlled ovarian hyperstimulation (COH), a greater risk of cycle cancellation, a lower number of collected oocytes, and a reduced number of embryos available for transfer and freezing (Tal et al., 2015).
Controlled ovarian stimulation outcomes of fertility preservation procedures in newly diagnosed breast cancer patients: a retrospective study from a single-tertiary-IVF centre
Published in Journal of Obstetrics and Gynaecology, 2022
Gulnaz Sahin, Ege Nazan Tavmergen Goker, Erhan Gokmen, Levent Yeniay, Ferruh Acet, Osman Zekioglu, Erol Tavmergen
The majority of young women with BC require adjuvant chemotherapy (CT) (Kasum et al. 2014) which includes gonadotoxic agents. Decreased ovarian reserve secondary to such treatments is well defined. Reduction of ovarian reserve depends on many factors, such as the age of the patient, the type and cumulative dose of CT agents (Meirow and Nugent 2001; Sonmezer and Oktay 2006; Bedoschi et al. 2016). Alkylating agents are the most gonadotoxic drugs and can damage resting ovarian primordial follicles (Meirow and Nugent 2001; Sonmezer and Oktay 2006; Rodriguez-Wallberg and Oktay 2010). The mechanisms of the gonadotoxic effects of different CT agents have been discussed in detail (Bedoschi et al. 2016; Spears et al. 2019). Ageing is an important risk factor; however, younger women may also face infertility due to reduction of their ovarian reserve secondary to gonadotoxic treatments (Dunn and Fox 2009). Fertility after cancer treatments is one of the major challenges for young women. Due to the risk of infertility and premature ovarian failure, many guidelines encourage health care providers to discuss options for fertility preservation (FP) before the initiation of gonadotoxic treatments (Loren et al. 2013; Peccatori et al. 2013; Ethics Committee of the ASRM 2018; Dolmans et al. 2019).