Serum Anti-Mullerian Hormone (AMH) Levels Among Different PCOS Phenotypes and Its Correlation with Clinical, Endocrine, and Metabolic Markers of PCOS.

Anti-Mullerian hormone (AMH) is one of the direct indicators of follicular pool but no standard cutoff has been defined for diagnosis of polycystic ovary syndrome (PCOS). The present study evaluated the serum AMH levels among different PCOS phenotypes and correlated the AMH levels with clinical, hormonal, and metabolic parameters among Indian PCOS women. Mean serum AMH was 12.39 ± 5.3ng/mL in PCOS cohort and 3.83 ± 1.5 ng/mL in non-PCOS cohort (P < 0.01). Out of 608 PCOS women, 273 (44.9%) women belonged to phenotype A, 230 (37.8%) women were phenotype D. Phenotypes C and B were 12.17% and 5.10% respectively. Among those with the highest AMH group (AMH>20ng/ml; 8.05%), majority belonged to phenotype A. Menstrual cycle length, serum testosterone, fasting total cholesterol levels, and follicle number per ovary had positive correlation with serum anti-Mullerian levels (P < 0.05). AMH cutoff for the diagnosis of PCOS was calculated as ≥ 6.06 ng/mL on ROC analysis with sensitivity and specificity of 91.45% and 90.71% respectively. The study shows high serum AMH levels in PCOS are associated with worse clinical, endocrinological, and metabolic parameters. These levels may be used to counsel patients regarding treatment response, help in individualized management and prediction of reproductive and long-term metabolic outcomes.

Myoinositol versus metformin pretreatment in GnRH-antagonist cycle for women with PCOS undergoing IVF: a double-blinded randomized controlled study.

OBJECTIVE: To study the effects of myoinositol (Myo) in comparison to metformin (Met), in reducing the risk of OHSS and improving ART outcome in PCOS women undergoing IVF. DESIGN: Double-blinded randomized controlled trial (CTRI/2018/05/014196). SETTING: ART Clinic, AIIMS, New Delhi patients: 102 infertile PCOS women undergoing IVF cycles were enrolled after evaluating for eligibility and allotted as 50 in group 1 (Myo) and 52 in group 2 (Met) after randomization. INTERVENTIONS: Recruited patients received Myo 2 g twice daily (group 1) and Met 850 mg twice daily (group 2). Pre- and post-treatment clinical (menstrual pattern, BMI), hormonal profile (LH, FSH, testosterone, prolactin [PRL], and AMH), biochemical parameters (HOMA IR, fasting glucose, and insulin), ovarian with antral follicle count (AFC) and side effect profile were assessed. After 3 months of therapy, patients were recruited for IVF cycle by antagonist protocol was involving controlled ovarian stimulation, cycle monitoring, oocyte recovery, insemination of oocytes and follow up with fertilization, cleavage, transfer of good grade cleavage embryos, or blastocysts pregnancy outcomes and OHSS incidence and medications was continued until the day of OPU. MAIN OUTCOME MEASURES: Primary outcome was OHSS and clinical pregnancy rate including spontaneous, IVF, and cumulative pregnancy rate including FET. Secondary outcome was ART outcomes and the change in biochemistry and hormonal profile between groups and inter group after medications at 12 weeks. RESULTS: Incidence of OHSS (Myo 5 (10.0) (n = 50), Met 10 (20.0) (n = 50) p .07) was not statistically different between groups. Clinical pregnancy rate (Myo 18 (36.0) (n = 50), Met 9 (18.0) (n = 50) p .04) cumulative pregnancy rate including FET (Myo 16 (43.2) (n = 37) vs. Met 10) 22.7) (n = 44) p .05) and spontaneous conception (prior to IVF) Myo 13 (26.0) (n = 50), Met 6 (12.0) (n = 50) p .07) was significantly high in Myo group. No between group difference in ovarian stimulation outcomes including duration and dosage of gonadotropins, E2, P4 levels, number of follicles >14 mm on day of trigger. Number of oocytes retrieved and grade of maturity were similar between groups. Fertilization, cleavage and number of good grade embryos were significantly higher in Myo group. However, implantation rate and number of embryos for freezing were similar between groups. Myo had improvement in fasting insulin, HOMA, Sr.AMH, and SHBG suggesting decreased insulin resistance. CONCLUSIONS: Myo is equally beneficial as Met in reducing the risk of OHSS and has better ART outcome in PCOS women undergoing antagonist cycles.

Development of a Questionnaire to Assess the Psychosocial Effects of COVID-19 on Peripartum Women.

Objective The social and behavioral changes brought about by the coronavirus disease 2019 (COVID-19) pandemic have led to adverse consequences on the psychosocial functioning of peripartum women. Therefore, we developed and validated a tool to assess the psychosocial effect of the pandemic among these women. Methods The questionnaire was developed using a scientifically accepted systematic methodology comprising literature search, focus-group discussion (FGD), expert evaluation, pretesting, and validation. Results The final questionnaire consists of 38 questions, and it has a Cronbach's α value of 0.90 and a Kaiser-Meyer-Olkin (KMO) value of 0.773. Conclusion The questionnaire has good reliability and face, content, and construct validity. It can be used to assess the psychosocial functioning of peripartum women in low middle-income countries and help perinatal mental health specialists to devise strategies to cope with the psychological impact of COVID-19-like pandemics on peripartum women.

Incidental diagnosis of sad fetus syndrome in triplets.

An unusual presentation of gestational trophoblastic disease is twin molar pregnancy, rarest in triplets with differentials being partial/complete mole, placental mesenchymal dysplasia (PMD), placental cysts or chorioangioma each with different complications. Counselling to continue pregnancy depends on diagnosis. A 37-year-old G2P1L1, donor oocyte In vitro fertlisation (IVF) twin pregnancy was referred at 24 weeks with cystic areas in placenta. Probability of twin partial mole or PMD was assessed. The scan of fetuses showed normal growth, no structural anomalies. Biochemical markers showed high maternal beta human chorionic gonadotropin (ß-hCG). Amniocentesis of molar fetus revealed normal karyotype. Likely diagnosis made as twin partial mole. The patient delivered by caesarean section at 28+2 weeks due to preterm labour. Twins, a male and a female baby, were delivered with three placentas, two normal and the third with molar changes and no fetal parts. Diagnosis was revised as triplet with partial mole, which was confirmed on histopathology. Serial monitoring of ß-hCG became undetectable by eighth week. The male baby died on day 4. The mother and the female baby were discharged.