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Padma Rekha Jirge - One of the best experts on this subject based on the ideXlab platform.
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Role of Ovarian Reserve testing in cancer survivors
The Onco Fertility Journal, 2019Co-Authors: Padma Rekha JirgeAbstract:Improved survival in children and young women affected with malignancies bring forth the impact of gonadotoxic chemotherapy and radiotherapy on future fertility. This review looks at the understanding of mechanisms of damage to Ovarian follicular pool and the evolution of assessment of Ovarian Reserve. The search for articles was done through PubMed. The review summarizes the current evidence on the value of Ovarian Reserve testing in young cancer survivors.
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Poor Ovarian Reserve.
Journal of human reproductive sciences, 2016Co-Authors: Padma Rekha JirgeAbstract:Poor Ovarian Reserve (POR) is an important limiting factor for the success of any treatment modality for infertility. It indicates a reduction in quantity and quality of oocytes in women of reproductive age group. It may be age related as seen in advanced years of reproductive life or may occur in young women due to diverse etiological factors. Evaluating Ovarian Reserve and individualizing the therapeutic strategies are very important for optimizing the success rate. Majority or women with POR need to undergo in vitro fertilization to achieve pregnancy. However, pregnancy rate remains low despite a plethora of interventions and is associated with high pregnancy loss. Early detection and active management are essential to minimize the need for egg donation in these women.
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Ovarian Reserve tests.
Journal of human reproductive sciences, 2011Co-Authors: Padma Rekha JirgeAbstract:Ovarian Reserve plays a crucial role in achieving pregnancy following any treatment in subfertile women. The estimation of Ovarian Reserve is routinely performed through various Ovarian Reserve tests (ORTs) in an effort to predict the response and outcome in couples prior to In Vitro Fertilization and counsel them. Most widely used tests are basal follicle stimulating hormone and anti-Mullerian hormone and antral follicle count. The role of ORTs in our routine practice is discussed in this article. A MEDLINE search was done to identify suitable articles for review.
David H Barad - One of the best experts on this subject based on the ideXlab platform.
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Vitamin D levels are not associated with Ovarian Reserve in a group of infertile women with a high prevalance of diminished Ovarian Reserve.
Fertility and sterility, 2018Co-Authors: Alice J. Shapiro, Norbert Gleicher, David H Barad, Sarah K. Darmon, Vitaly A. KushnirAbstract:Objective To determine whether a relationship exists between vitamin D (25OH-D) levels and Ovarian Reserve parameters (antimullerian hormone [AMH] and FSH levels) in a large cohort of infertile women with a high prevalence of diminished Ovarian Reserve. Design Retrospective cohort study. Setting Academically affiliated private fertility center. Patient(s) A total of 457 infertile women 21–50 years of age who had baseline hormone measurements. Intervention(s) None. Main Outcome Measure(s) Statistical analyses to determine whether a relationship exists between AMH, FSH, and serum 25OH-D levels. Result(s) As defined by 25OH-D Conclusion(s) Vitamin D levels were not associated with Ovarian Reserve in a large group of infertile women with a high prevalence of diminished Ovarian Reserve. Previously reported vitamin D–associated outcomes in infertility patients may, therefore, be mediated by factors other than Ovarian Reserve.
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improvement in diminished Ovarian Reserve after dehydroepiandrosterone supplementation
Reproductive Biomedicine Online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished Ovarian Reserve. Whether DHEA objectively improves Ovarian Reserve is, however, unknown. This study investigated 120 consecutive patients with diminished Ovarian Reserve, supplemented for 30-120 days (mean 73+/-27) with DHEA (25mg three times daily). Anti-Mullerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P=0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P<0.0002). Women reaching IVF experienced a 23.64% clinical pregnancy rate and conceiving women showed significantly improved AMH concentrations compared with those who did not (P=0.001). DHEA supplementation, thus, significantly improved Ovarian Reserve in parallel with longer DHEA use and was more pronounced in younger women.
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Ovarian Reserve determinations suggest new function of fmr1 fragile x gene in regulating Ovarian ageing
Reproductive Biomedicine Online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Abstract With regard to Ovarian Reserve, 26–34 triple CGG repeats on the FMR1 gene denote ‘normal'. This study explores whether two-allele analyses reflects risk towards diminished Ovarian Reserve based on age in consecutive patients (34 oocyte donors and 305 infertility patients), longitudinally and cross-sectionally. Box and whisker plots confirmed the normal range of CGG counts. Patients were then defined as normal with both alleles in range, as heterozygous with one allele outside and as homozygous with both alleles outside of range. Ovarian Reserve was assessed by anti-Mullerian hormone (AMH). Normals at young ages exhibited significantly higher AMH concentrations than either heterozygous or homozygous females ( P =0.009). By approximately age 35, heterozygous women have higher AMH concentrations than normal women, while homozygous women exceed normal women shortly before age 50years. These data support a control function of the FMR1 gene over Ovarian Reserve, thus defining life-long Ovarian Reserve patterns. Heterozygous and homozygous abnormal CGG counts reduce Ovarian Reserve at younger ages and improve Ovarian Reserve at older ages. They, thus, at expense of reduced fertility in the young, pReserve fertility into older age. This function of potential evolutionary importance may explain the preservation of the FMR1 gene despite its, at times, severe neuropsychiatric risks.
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Improvement in diminished Ovarian Reserve after dehydroepiandrosterone supplementation
Reproductive biomedicine online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished Ovarian Reserve. Whether DHEA objectively improves Ovarian Reserve is, however, unknown. This study investigated 120 consecutive patients with diminished Ovarian Reserve, supplemented for 30-120 days (mean 73+/-27) with DHEA (25mg three times daily). Anti-Mullerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P=0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P
Norbert Gleicher - One of the best experts on this subject based on the ideXlab platform.
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Vitamin D levels are not associated with Ovarian Reserve in a group of infertile women with a high prevalance of diminished Ovarian Reserve.
Fertility and sterility, 2018Co-Authors: Alice J. Shapiro, Norbert Gleicher, David H Barad, Sarah K. Darmon, Vitaly A. KushnirAbstract:Objective To determine whether a relationship exists between vitamin D (25OH-D) levels and Ovarian Reserve parameters (antimullerian hormone [AMH] and FSH levels) in a large cohort of infertile women with a high prevalence of diminished Ovarian Reserve. Design Retrospective cohort study. Setting Academically affiliated private fertility center. Patient(s) A total of 457 infertile women 21–50 years of age who had baseline hormone measurements. Intervention(s) None. Main Outcome Measure(s) Statistical analyses to determine whether a relationship exists between AMH, FSH, and serum 25OH-D levels. Result(s) As defined by 25OH-D Conclusion(s) Vitamin D levels were not associated with Ovarian Reserve in a large group of infertile women with a high prevalence of diminished Ovarian Reserve. Previously reported vitamin D–associated outcomes in infertility patients may, therefore, be mediated by factors other than Ovarian Reserve.
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improvement in diminished Ovarian Reserve after dehydroepiandrosterone supplementation
Reproductive Biomedicine Online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished Ovarian Reserve. Whether DHEA objectively improves Ovarian Reserve is, however, unknown. This study investigated 120 consecutive patients with diminished Ovarian Reserve, supplemented for 30-120 days (mean 73+/-27) with DHEA (25mg three times daily). Anti-Mullerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P=0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P<0.0002). Women reaching IVF experienced a 23.64% clinical pregnancy rate and conceiving women showed significantly improved AMH concentrations compared with those who did not (P=0.001). DHEA supplementation, thus, significantly improved Ovarian Reserve in parallel with longer DHEA use and was more pronounced in younger women.
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Ovarian Reserve determinations suggest new function of fmr1 fragile x gene in regulating Ovarian ageing
Reproductive Biomedicine Online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Abstract With regard to Ovarian Reserve, 26–34 triple CGG repeats on the FMR1 gene denote ‘normal'. This study explores whether two-allele analyses reflects risk towards diminished Ovarian Reserve based on age in consecutive patients (34 oocyte donors and 305 infertility patients), longitudinally and cross-sectionally. Box and whisker plots confirmed the normal range of CGG counts. Patients were then defined as normal with both alleles in range, as heterozygous with one allele outside and as homozygous with both alleles outside of range. Ovarian Reserve was assessed by anti-Mullerian hormone (AMH). Normals at young ages exhibited significantly higher AMH concentrations than either heterozygous or homozygous females ( P =0.009). By approximately age 35, heterozygous women have higher AMH concentrations than normal women, while homozygous women exceed normal women shortly before age 50years. These data support a control function of the FMR1 gene over Ovarian Reserve, thus defining life-long Ovarian Reserve patterns. Heterozygous and homozygous abnormal CGG counts reduce Ovarian Reserve at younger ages and improve Ovarian Reserve at older ages. They, thus, at expense of reduced fertility in the young, pReserve fertility into older age. This function of potential evolutionary importance may explain the preservation of the FMR1 gene despite its, at times, severe neuropsychiatric risks.
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Improvement in diminished Ovarian Reserve after dehydroepiandrosterone supplementation
Reproductive biomedicine online, 2010Co-Authors: Norbert Gleicher, Andrea Weghofer, David H BaradAbstract:Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished Ovarian Reserve. Whether DHEA objectively improves Ovarian Reserve is, however, unknown. This study investigated 120 consecutive patients with diminished Ovarian Reserve, supplemented for 30-120 days (mean 73+/-27) with DHEA (25mg three times daily). Anti-Mullerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P=0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P
David B. Seifer - One of the best experts on this subject based on the ideXlab platform.
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Ovarian Reserve testing: a user's guide.
American journal of obstetrics and gynecology, 2017Co-Authors: Reshef Tal, David B. SeiferAbstract:Ovarian Reserve is a complex clinical phenomenon influenced by age, genetics, and environmental variables. Although it is challenging to predict the rate of an individual's Ovarian Reserve decline, clinicians are often asked for advice about fertility potential and/or recommendations regarding the pursuit of fertility treatment options. The purpose of this review is to summarize the state-of-the-art of Ovarian Reserve testing, providing a guide for the obstetrician/gynecologist generalist and reproductive endocrinologist. The ideal Ovarian Reserve test should be convenient, be reproducible, display little if any intracycle and intercycle variability, and demonstrate high specificity to minimize the risk of wrongly diagnosing women as having diminished Ovarian Reserve and accurately identify those at greatest risk of developing Ovarian hyperstimulation prior to fertility treatment. Evaluation of Ovarian Reserve can help to identify patients who will have poor response or hyperresponse to Ovarian stimulation for assisted reproductive technology. Ovarian Reserve testing should allow individualization of treatment protocols to achieve optimal response while minimizing safety risks. Ovarian Reserve testing may inform patients regarding their reproductive lifespan and menopausal timing as well as aid in the counselling and selection of treatment for female cancer patients of reproductive age who receive gonadotoxic therapy. In addition, it may aid in establishing the diagnosis of polycystic ovary syndrome and provide insight into its severity. While there is currently no perfect Ovarian Reserve test, both antral follicular count and antimullerian hormone have good predictive value and are superior to day-3 follicle-stimulating hormone. The convenience of untimed sampling, age-specific values, availability of an automated platform, and potential standardization of antimullerian hormone assay make this test the preferred biomarker for the evaluation of Ovarian Reserve in women.
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Knowledge of Ovarian Reserve and reproductive choices
Journal of assisted reproduction and genetics, 2015Co-Authors: Erum Azhar, David B. Seifer, Katherine Melzer, Ahmed I. Ahmed, Jeremy Weedon, Howard MinkoffAbstract:Objective To determine the factors that influence the reproductive choices of health care professionals, and to assess whether knowledge of Ovarian Reserve would modify those choices.
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Potential Mechanisms for Racial and Ethnic Differences in Antimüllerian Hormone and Ovarian Reserve
International journal of endocrinology, 2013Co-Authors: Reshef Tal, David B. SeiferAbstract:Accumulating evidence suggests that reproductive potential and function may be different across racial and ethnic groups. Racial differences have been demonstrated in pubertal timing, infertility, outcomes after assisted reproductive technology (ART) treatment, and reproductive aging. Recently, racial differences have also been described in serum antimullerian hormone (AMH), a sensitive biomarker of Ovarian Reserve, supporting the notion that Ovarian Reserve differs between racial/ethnic groups. The existence of such racial/ethnic differences in Ovarian Reserve, as reflected by AMH, may have important clinical implications for reproductive endocrinologists. However, the mechanisms which may underlie such racial differences in Ovarian Reserve are unclear. Various genetic factors and environmental factors such as obesity, smoking, and vitamin D deficiency which have been shown to correlate with serum AMH levels and also display significant racial/ethnic variations are discussed in this review. Improving our understanding of racial differences in Ovarian Reserve and their underlying causes may be essential for infertility treatment in minority women and lead to better reproductive planning, improved treatment outcomes, and timely interventions which may prolong reproductive lifespan in these women.
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Inhibin-B: the physiologic basis of the clomiphene citrate challenge test for Ovarian Reserve screening.
Fertility and sterility, 1998Co-Authors: Glen E. Hofmann, Douglas R. Danforth, David B. SeiferAbstract:Abstract Objective: To determine inhibin-B concentrations during Ovarian Reserve screening in women with normal and diminished Ovarian Reserve as determined by the clomiphene citrate challenge test. Design: Retrospective. Setting: Tertiary fertility center. Patient(s): Women undergoing Ovarian Reserve screening for a routine fertility evaluation. Intervention(s): Clomiphene citrate challenge test. Main Outcome Measure(s): Inhibin-B concentrations on menstrual days 3 and 10. Result(s): Nineteen patients with normal Ovarian Reserve and 15 with diminished Ovarian Reserve had serum inhibin-B concentrations determined during Ovarian Reserve screening. For all patients, day 10 inhibin-B concentrations were higher than day 3. Women with normal Ovarian Reserve had higher inhibin-B concentrations on both days 3 and 10 than women with diminished Ovarian Reserve. Inhibin-B concentrations demonstrated a negative correlation with FSH levels on both cycle days 3 and 10 and a positive correlation with E 2 on cycle day 10. Conclusion(s): Women with diminished Ovarian Reserve during Ovarian Reserve screening had reduced granulosa cell inhibin-B production compared with women with normal Ovarian Reserve. The lower inhibin-B concentrations may be responsible for the elevated FSH concentrations and may be indicative of the aging follicular apparatus.
Glen E. Hofmann - One of the best experts on this subject based on the ideXlab platform.
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Inhibin-B: the physiologic basis of the clomiphene citrate challenge test for Ovarian Reserve screening.
Fertility and sterility, 1998Co-Authors: Glen E. Hofmann, Douglas R. Danforth, David B. SeiferAbstract:Abstract Objective: To determine inhibin-B concentrations during Ovarian Reserve screening in women with normal and diminished Ovarian Reserve as determined by the clomiphene citrate challenge test. Design: Retrospective. Setting: Tertiary fertility center. Patient(s): Women undergoing Ovarian Reserve screening for a routine fertility evaluation. Intervention(s): Clomiphene citrate challenge test. Main Outcome Measure(s): Inhibin-B concentrations on menstrual days 3 and 10. Result(s): Nineteen patients with normal Ovarian Reserve and 15 with diminished Ovarian Reserve had serum inhibin-B concentrations determined during Ovarian Reserve screening. For all patients, day 10 inhibin-B concentrations were higher than day 3. Women with normal Ovarian Reserve had higher inhibin-B concentrations on both days 3 and 10 than women with diminished Ovarian Reserve. Inhibin-B concentrations demonstrated a negative correlation with FSH levels on both cycle days 3 and 10 and a positive correlation with E 2 on cycle day 10. Conclusion(s): Women with diminished Ovarian Reserve during Ovarian Reserve screening had reduced granulosa cell inhibin-B production compared with women with normal Ovarian Reserve. The lower inhibin-B concentrations may be responsible for the elevated FSH concentrations and may be indicative of the aging follicular apparatus.
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The effect of intrauterine diethylstilbestrol exposure on Ovarian Reserve screening
American journal of obstetrics and gynecology, 1997Co-Authors: Manjeeri Sangvai, Jennifer Thie, Glen E. HofmannAbstract:Abstract Objective: Our goal was to evaluate the effect of intrauterine diethylstilbestrol exposure on Ovarian Reserve. Study design: Four hundred two women underwent Ovarian Reserve screening. Twenty had intrauterine diethylstilbestrol exposure, and 382 women did not have exposure. The groups were compared regarding age, the incidence of diminished Ovarian Reserve, and cycle length. Nine women with and 204 women without diethylstilbestrol exposure underwent comparison of the total human menopausal gonadotropin dose, the day of human chorionic gonadotropin administration, the peak estradiol level, and the number of mature follicles. Results: The diethylstilbestrol-exposed women were similar in age (37 ± 3.4 years) to the non-diethylstilbestrol-exposed women (35 ± 4.4 years, p > 0.05). Three of 20 exposed women (15.8%) and 57 of 382 nonexposed women (15.3%) had diminished Ovarian Reserve ( p = 0.41). When the exposed women were compared with the nonexposed subjects, the amounts of human menopausal gonadotropin (30 ± 10 vs 33.7 ± 10.6 ampules) required to achieve peak estradiol levels (633 ± 323 vs 817 ± 518 pg/ml) with comparable numbers of follicles (5.7 ± 2.7 vs 5.4 ± 2.8) on the day of human chorionic gonadotropin administration were similar ( p > 0.05). Conclusions: The diethylstilbestrol-exposed and nonexposed women had a similar incidence of diminished Ovarian Reserve and a similar follicular response to gonadotropins.
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Prognostic assessment of Ovarian Reserve
Fertility and sterility, 1995Co-Authors: Richard T. Scott, Glen E. HofmannAbstract:Objective To review the literature regarding dimished Ovarian Reserve, the screening techniques that are currently available, and their appropriate application in clinical practice. Data Resources Directed Medline searches. Results Ovarian Reserve screening identifies women with greatly diminished chances of achieving pregnancy. The screening techniques include the clomiphene citrate challenge test, basal day 3 FSH measurements, and the GnRH agonist stimulation test. All have been evaluated in assisted reproduction programs and the predictive values of an abnormal test for failing to conceive is very high. When abnormal, these tests allow physicians to counsel patients that their prognosis for conception is poor. Although the presence of a normal result does indicate better long-term chances for conception, an age-related decline in fecundity remains and patient age should still be considered when counseling patients with normal screening results. Clinicians are urged to validate the threshold values with the assay system used in their own laboratory before the application of these tests. Conclusion The literature consistently demonstrates the value of diminished Ovarian Reserve screening.
