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Infertility
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Amanda Jefferys, Valentine Akande
Knowing the detrimental effect endometriomas and their management can have on ovarian reserve, there would appear to be an increasing place for fertility preservation (egg or embryo freezing) in women with endometriosis. With recent improvements in the performance of cryopreserved oocytes (67), this is now an option available to women regardless of relationship status. In women with mild endometriosis, where the ovaries are unaffected, this conversation may not be necessary. However, in women with more severe endometriosis and known endometrioma, particularly if bilateral, a conversation regarding ovarian reserve and future fertility should be conducted. This should be ideally at an early stage, given that success with egg freezing is greater in women who freeze eggs under the age of 35, and ideally prior to first endometriosis surgery. An assessment of ovarian reserve as part of the pre-operative workup may be helpful. NICE guidance (68) suggests this is best achieved with either an antral follicle count (AFC) or AMH. Given the impact an endometrioma may have on AFC, an AMH level is preferable. Whether a woman wishes to proceed with fertility preservation is likely to depend on her age, current ovarian reserve, the severity of endometriosis and likelihood of requiring further surgery, relationship status and availability of funding.
I am ready to build a prediction model
Published in Thomas A. Gerds, Michael W. Kattan, Medical Risk Prediction, 2021
Thomas A. Gerds, Michael W. Kattan
In the in vitro fertilization study, the effect of the number of antral follicles (considered as a continuous variable) on the risk of ovarian hyperstimulation syndrome could be modified by smoking status. Here we also adjust for age. Table 4.7 shows the predicted risks for six selected covariate patterns.
The Ovaries and the Adnexa
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kuhan Rajah, Dimitrios Mavrelos
As discussed earlier, at the beginning of the menstrual cycle, the ovaries contain a wealth of antral follicles seen on transvaginal ultrasound as simple sac-like pockets that contain anechoic fluid between 2 and 10 mm arranged at the periphery of the ovary. Quantification of these follicles is a direct assessment of a woman's ovarian reserve as the number of antral follicles that emerge will reflect the number of primordial follicles available to start the journey of maturation approximately 180 days earlier [9]. The subpopulation of antral follicles that best correlates with ovarian reserve includes those between 4 and 6 mm [10]. Counting smaller ones is likely to include atretic follicles and therefore be an overestimate. However, to avoid the time-consuming process of measuring each follicle individually, by convention, all follicles measuring 2–10 mm are included in antral follicle counts (AFCs) [11].
Diagnostic value of anti-Müllerian hormone combined with androgen-levels in Chinese patients with polycystic ovary syndrome
Published in Gynecological Endocrinology, 2023
Lingling Jiang, Xiangyan Ruan, Yanqiu Li, Muqing Gu, Jiaojiao Cheng, Yuejiao Wang, Yu Yang, Che Xu, Zhikun Wang, Lili Liu, Alfred O. Mueck
Age, height, body mass, body mass index (BMI), waist circumference, hip circumference, systolic blood pressure, and diastolic blood pressure were collected. Blood samples were collected on the second to third day of the menstrual cycle, and in amenorrheic cases, blood was drawn when no follicles ≥10 mm in diameter were seen on ultrasound, and blood was collected from the brachial vein between 8:00 to 10:00 am after 12 h of fasting. The antral follicle count was determined using transvaginal ultrasound. In amenorrheic cases, we measure progesterone and human chorionic gonadotropin to exclude possible ovulation or pregnancy. Serum anti-müllerian hormone was determined by the Elecsys AMH Plus immunoassay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland). The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), progesterone (P), thyroid stimulating hormone (TSH), cortisol (F) were determined by ADVIA Centaur XP automatic chemiluminescence immunoassay produced by Siemens Company in Germany. Total testosterone (T), free testosterone (FT) (calculated), sex hormone binding globulin (SHBG) (calculated on website http://www.issam.ch/freetesto.htm), bioavailable testosterone (BIOT) (calculated),17-hydroxyprogesterone (17-OHP), and dehydroepiandrosterone sulfate (DHEAS), androstenedione (A2), were determined by liquid chromatography-mass spectrometry tandem method (LC-MS/MS), which were performed using an AB Sciex 5500 mass spectrometer coupled with a Shimadzu Nexera X2 high-performance liquid chromatography (HPLC) system[22].
Which is more predictive ovarian sensitivity marker if there is discordance between serum anti-Müllerian hormone levels and antral follicle count? A retrospective analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Kiper Aslan, Isil Kasapoglu, Cihan Cakir, Meltem Koc, Murat Deniz Celenk, Baris Ata, Berrin Avci, Gurkan Uncu
Female age, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation (Ferraretti et al. 2011). Antral follicle count is the total count of 2–9 mm follicles in both ovaries measured by transvaginal ultrasound and reflects ovarian reserve (Chang et al. 1998; Broekmans et al. 2010). It is widely known that AFC has a good predictive value for IVF cycle outcomes like; ovarian response, number of retrieved oocytes (Chang et al. 1998; Hsu et al. 2011; Tsakos et al. 2014). Similar to AFC, AMH also has a good predictive value for ovarian response. AMH is produced by granulosa cells from pre-antral and antral follicles and inhibits follicular burn-out (Weenen et al. 2004). As it reflects the ovarian follicular pool, a decreasing number of follicles reduces serum AMH. Anti-Müllerian hormone and AFC are both positively correlated with ovarian reserve, and they are expected to be concordant with each other. Nevertheless, some women present with discordant AMH and AFC results, e.g. low AMH with a normal AFC or vice versa. Such discordance presents a challenge in predicting ovarian response and chances of success with an ART cycle. Limited evidence is available with regard to individual accuracy of AMH and AFC in predicting ovarian response in the presence of discordant results.
Are all antral follicles the same? Size of antral follicles as a key predictor for response to controlled ovarian stimulation
Published in Journal of Obstetrics and Gynaecology, 2022
Isil Kasapoglu, Adnan Orhan, Kiper Aslan, Esra Sen, Aysenur Kaya, Berrin Avcı, Gurkan Uncu
Most of the studies in the literature have evaluated the value of total AFC for predicting response to COS with limited data on the predictive value of the size of antral follicles before COS. Pöhl et al. (2000) suggested that patients with antral follicles between 5 and 10 mm had significantly higher pregnancy rates and ovarian response compared to those with AFS <5 mm or >10 mm. On the other hand, Hernández et al. (2016) suggested that larger or smaller size follicles contribute to the mature oocytes. Sanverdi et al. (2018) showed that increased antral follicle diameter variance is a predictor for poor ovarian response in patients with normal ovarian reserve. Lai et al. (2013) reported that the number of oocytes retrieved after COS was significantly higher and that IVF outcome was better in patients with baseline AFS of 6–7 mm than those with AFS of 2–6 mm or 8–10 mm. In the present study, we found that a high ratio of small-size antral follicles (2–5 mm) before COS is a predictive factor for higher ovarian response. Our findings are also in agreement with previous studies showing that neither basal FSH nor AFC can significantly predict ovarian response (Eppsteiner et al. 2014; Rombauts et al. 2015). We did not, however, evaluate the variance in AFS and fertility outcome of patients, or the response to COS for different stimulation protocols (analogue protocols), which were the main limitations of our study.