Severe endometriosis: low value of AMH did not affect oocyte quality and pregnancy outcome in IVF patients.

OBJECTIVE: The aim of this pilot study was to determine whether the low anti-müllerian hormone (AMH) serum level, due to severe endometriosis, was associated with diminished oocyte yield, poor oocyte/embryo quality and reduced in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) clinical outcomes in young patients (<37 years old). PATIENTS AND METHODS: A total of 50 IVF cycles of patients younger than 37 with severe endometriosis were retrospectively analyzed in a single center between November 2016 and July 2018. The clinical outcome was then compared to a control group of 84 patients with no story of endometriosis and normal AMH value. AMH value was evaluated within three months before the stimulation. In these two groups, number and maturation of retrieved oocytes, embryo quality, and pregnancy outcomes were evaluated and compared using Student's t-test and Fisher's test. RESULTS: The number of oocytes retrieved per cycle and the percentage of mature oocytes (MII) were significantly lower (p < 0.001) in IVF patients with severe endometriosis and AMH value ≤ 1.1 ng/ml (Group A; 3.8±2.6 retrieved oocytes, 70% MII) compared to patients without endometriosis and AMH levels > 1.1 ng/ml (Group B; 6.9±4.6 retrieved oocytes, 83% MII). On the other hand, embryo morphology, implantation rate (31% vs. 33%; p = 0.833) and pregnancy rate (50% vs. 49%; p = 1) were comparable in the two groups. CONCLUSIONS: This study shows that younger patients with an impairment of the ovarian reserve due to severe endometriosis, displayed a diminished oocyte yield but not a reduction in embryo quality and pregnancy outcomes. These results suggest that serum AMH levels should not be adopted as a criterion for discouraging these patients from undergoing IVF/ICSI treatments.

Humoral and cellular immunological factors as possible markers of clinical relapse in HLA-typed Graves' patients followed with time.

Humoral and cellular immune factors were studied in 33 newly diagnosed Graves' patients at diagnosis and in 12 of these patients at regular intervals thereafter. All the patients were treated with carbimazole for 15 months (initially 60 mg and then 20 mg supplemented with L-Thyroxine). The incidence of relapse after treatment was 42%. Thyrotropin receptor antibodies (TRAb), T-cell subsets, K and NK cells and mononuclear cells expressing surface antigen markers of different activation were evaluated respectively by the use of a radioimmunoassay and a panel of monoclonal antibodies. Patients in the follow-up study were HLA-A, B, C and D typed. TRAb levels (91%) and levels of 4F2-positive cells (73%) and class II-positive lymphocytes (69.6%) were significantly increased in newly diagnosed Graves' patients in comparison with normal controls, whereas CD8 cells were significantly decreased. There was a significant inverse correlation between the increase in 4F2-positive cells and TRAb values. In the follow-up study both humoral and cellular immunological parameters showed a wide variation in levels, but TRAb, 4F2 and L243 values declined on average with respect to diagnosis. After 15 months some patients still showed abnormal values of activated T cells and TRAb values. All patients who relapsed (42%) after medical treatment showed a significant increase of 4F2-positive cells, and some of TRAb, some time before the appearance of clinical symptoms. Finally, no correlation was found between HLA type and relapse of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative immunological differences between newly diagnosed Graves' disease patients and relapsed patients.

Class 2-positive T cells, T-cell and mononuclear cell subsets, thyrotropin receptor antibodies (TRAb) and immune complexes were evaluated in 34 newly diagnosed Graves' patients and in 13 relapsed patients before a cycle of specific medical treatment. Class II-positive T lymphocytes were detected by monoclonal antibodies against different epitopes of class II antigens, whereas 4F2-positive cells were detected by 4F2 monoclonal antibody. 4F2-positive cells were statistically increased in newly diagnosed Graves' patients compared to relapsed patients (p less than 0.05). An increased percentage of class II activated T cells, detected by monoclonal antibodies L243, was found in newly diagnosed patients in comparison with relapsed subjects (p less than 0.025). Newly diagnosed Graves' patients showed a significant decrease in the ratio suppressor/cytotoxic T cells in comparison with normal control subjects but not with relapsed patients. Ninety-one % of newly diagnosed Graves' patients showed a high TRAb value, whereas only 69% of relapsed patients showed increased values (p less than 0.025). No difference was observed in the immune complex positivity between newly diagnosed Graves' patients and relapsed subjects. In conclusion, both humoral and cellular immune differences were found in relapsed patients vs newly diagnosed Graves' patients. The immunological abnormalities are quantitatively more pronounced in the latter group.