The Effect of Age and AMH Level on ART Outcomes in Patients With Reduced Ovarian Reserve: A Retrospective Cross-Sectional Study.

Background: Despite many advances, patients with a poor ovarian response to stimulation are one of the most important and challenging factors of infertility. Chronological and ovarian ages are two effective factors responsible for poor response to assisted reproduction treatment. The purpose of this study was to determine the effect of age and AMH level on the in vitro fertilization (IVF) outcomes in participants with a reduced ovarian reserve. Methods: In this retrospective cross-sectional study, 210 participants with anti-Mullerian hormone (AMH) < 1.1 ng/ml were included. The effect of age and AMH on pregnancy outcomes including dominant follicle count, serum estradiol level on the day of trigger administration, number of metaphase II (MII) oocytes, number of embryos, biochemical pregnancy, clinical pregnancy, abortion and live birth rate were evaluated. Results: The number of dominant follicle (p < 0.001), MII oocyte (p < 0.001), grade A (p < 0.001) and B (p < 0.001) embryos, serum estradiol level (p < 0.001), gonadotropin level ( p< 0.001), AMH (p = 0.001), biochemical pregnancy (p = 0.007), clinical (p = 0.01) pregnancy, and live birth rate (p = 0.003) were higher in participants younger than 35 years old. In univariable logistic regression, the chance of retrieving more than 3 oocytes in individuals over 35 years old was 97.1% lower than in individuals younger than 35 years old (p < 0.001). Conclusion: It has been concluded that the higher clinical pregnancy and live birth rate in participants younger than 35 years can be due to the higher AMH level in this group. Under the same conditions of AMH and other variables, age can affect the number of retrieved oocytes.

Evaluation of Choroidal Thickness during Pregnancy and Postpartum: A Longitudinal Study.

Purpose: To assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy and postpartum. Methods: The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy nonpregnant women. Choroidal thickness was measured manually with EDI-OCT at seven locations: The fovea, 500, 1000, and 1500 µm temporal (T) from the fovea and 500, 1000, and 1500 µm nasal (N) from the fovea. Measurements were obtained at each pregnancy trimester and 6 weeks postpartum and in the follicular phase of the menstrual cycle for the control group. Results: The mean subfoveal choroidal thickness was 410.2 ± 82.4 µm, 434.8 ± 79.6 µm, 433.5 ± 80.3 µm, and 395.0 ± 71.1 µm in the first, second, and third trimesters and 6 weeks postpartum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and postpartum in the choroidal thickness (P < 0.001). Choroidal thickness increased from the first trimester to the second and third trimester, after which it decreased at postpartum. Choroidal thickness was greater in the pregnant group during pregnancy and postpartum compared to the control group (P < 0.001). Conclusions: This study indicated significant change in choroidal thickness at seven locations measured with EDI-OCT throughout pregnancy and 6 weeks after delivery. We showed that 6 weeks after delivery, choroidal thickness remains significantly higher than nonpregnant subjects.

The relationship between thyroid function and ovarian reserve: a prospective cross-sectional study.

BACKGROUND: Thyroid dysfunction can affect fertility and miscarriage risk by affecting the process of follicular growth, embryo development, implantation, and placental formation. It has been suggested that thyroid disorders are associated with ovarian reserve by affecting the follicular process. The aim of the present study was to investigate the relationship between thyroid hormone levels and ovarian reserve. METHODS: Three hundred fourteen women with infertility due to various etiologies were enrolled in this study (172 individuals with Anti-Mullerian hormone (AMH) level ≥ 1.1 ng/ml and 142 individuals with AMH < 1.1 ng/ml). Serum levels of follicle-stimulating hormone (FSH), estradiol (E2) on day 2-4 of menstrual cycles, AMH, Thyroid-stimulating hormone (TSH), and thyroxine (free T4) were evaluated. RESULTS: In participants with age over 35 years, median TSH level in women with AMH < 1.1 ng/ml was significantly higher than those with AMH ≥1.1 ng/ml (P-value =0.037). There was no significant difference in body mass index (BMI) in patients with age older than 35 years and younger than 35 years sub-groups based on AMH level (P-value = 0.102, and P-value = 0.909 respectively). With one unit increase in TSH level, the odds of having AMH < 1.1 ng/ml increases by 1.25 times or by 25% (P-value =0.017). Receiver operator characteristic (ROC) curve analysis showed a TSH cut-off point of 1.465 mIU/L in participants over 35 years in identifying decreased AMH level. CONCLUSION: Our study supports the relationship between TSH level and ovarian reserve so that with an increase in TSH from a certain level is associated with a decrease in ovarian function.

The association between the levels of anti-Müllerian hormone (AMH) and dietary intake in Iranian women.

PURPOSE: This paper aimed to assess the association between AMH with dietary intake of adult women referred to the infertility clinic of Al-Zahra Hospital in Rasht, Iran. METHODS: This cross-sectional study was performed on 234 adult women referred to the infertility clinic of Al-Zahra Hospital, Rasht, Iran. The participants were categorized into two groups based on their AMH levels. Participants' data on lifestyle and anthropometry as well as blood samples were collected. Dietary intakes were assessed by a validated food frequency questionnaire (FFQ). RESULTS: Serum AMH concentration was negatively associated with the intake of fast foods (P = 0.002) and saturated fats (P = 0.040). These associations remained significant after adjustments for age, rural or urban location, and education. Additional adjustments for body mass index (BMI) and physical activity did not change the results. The results remained significant after further adjustments for menstrual age, menstrual pattern, and oral contraceptive pills. CONCLUSION: Fast foods and saturated fats were significantly associated with lower AMH concentrations and modifying the amount of these dietary components may be an important strategy for increasing the reservation of ovaries in women. Future longitudinal studies are warranted to confirm these findings and to identify the underlying mechanisms.

Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil - A randomized clinical trial.

OBJECTIVE: Anesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. MATERIAL AND METHODS: This randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 µg/kg), fentanyl (F; 1.5 µg/kg) or remifentanil (R; 1.5 µg/kg) groups. RESULTS: Three hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. CONCLUSIONS: The results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. REGISTRATION NUMBER: IRCT201410258677N4.

Association between GSTM1 gene polymorphism in Iranian patients with endometriosis.

Endometriosis is defined as a condition in which tissue histologically similar to the endometrium is found outside the uterine cavity. It develops mostly in women of reproductive age. Endometriosis shows a drastically elevated frequency in industrial areas. GSTM1 gene encodes a major detoxification phase enzyme that helps detoxify various xenobiotics. Deficiency in GSTM1 activity is caused by homozygous deletion of GSTM1 and leads to various biological consequences. There are significant interethnic differences in GSTM1 allele frequencies. In this study, the relationship between GSTM1 genotypes and endometriosis in an Iranian population was investigated. The study included 120 patients and 200 healthy volunteers. Genomic DNA was prepared from peripheral blood leukocytes. Genotypes and allele frequencies were determined in patients and healthy controls using polymerase chain reaction (PCR). The GSTM1 null genotype was significantly associated with the increased risk of endometriosis (OR=3.75, 95% confidence interval (CI)=2.42-6.45, P<0.0001). The prevalence of GSTM1-null genotype in the patient group was 72.5%, compared to 40% in the control group. The proportion of GSTM1A/B genotype was higher in controls as compared to cases (20% vs. 2.5%). This study suggests that GSTM1 null genotype is associated with higher risk of endometriosis; these observations, however, requiring further confirmation in a larger multi-ethnic study.