Objective: To analyze the hormonal, ultrasonographic, and color Doppler parameters in a population- based follow- up study of female childhood cancer survivors with regular menstrual cycle and normal early follicular ...Objective: To analyze the hormonal, ultrasonographic, and color Doppler parameters in a population- based follow- up study of female childhood cancer survivors with regular menstrual cycle and normal early follicular FSH values. Design: Controlled, prospective clinical study. Setting: University hospital. Patient(s): Twenty- eight female patients affected by a malignant tumor during childhood and 14 age- matched healthy controls. Intervention(s): Hormonal, ultrasonographic, and color Doppler analyses. Main Outcome Measure(s): In the midluteal phase of the cycle, the patients underwent hormonal assay of gonadotropins, E2, and P; ultrasonographic evaluation of the uterine and ovarian volume, the endometrial thickness, and of the corpus luteum characteristics; color Doppler analysis of uterine, intraovarian, and periluteal arteries. Result(s): A greater uterine volume and a better utero- ovarian vascularization was observed in controls in comparison with cancer survivors. In patients who suffered from childhood malignancies the P values were lower than in controls. On the basis of circulating P (> or < 20 nmol/L)values, we divided the former group in ovulatory and nonovulatory patients. We observed that even if there were no differences between ovulatory cancer survivors and controls, the nonovulatory group showed a reduced uterine volume associated with elevated resistance at the level of uterine and intraovarian arteries. Among these two groups the time elapsed between the diagnosis of cancer and menarche was shorter in nonovulatory than in ovulatory women, and was directly correlated with both uterine volume (r = 0.660) and ovarian volume (r = 0.597). Conclusion(s): Ultrasonographic and Doppler analyses may noninvasively study the subtle utero- ovarian modifica- tion after anticancer therapies.展开更多
To evaluate the effects of treatment with FSH on seminal parameters and spontaneous pregnancy in male infertility. Design: Prospective, controlled, randomized clinical study. Setting: Infertility center at a universit...To evaluate the effects of treatment with FSH on seminal parameters and spontaneous pregnancy in male infertility. Design: Prospective, controlled, randomized clinical study. Setting: Infertility center at a university hospital. Patient(s): One hundred twelve men affected by idiopathic oligozoospermia. Intervention(s): Patients were randomized into two groups: 62 subjects were treated with 100 IU of recombinant human FSH on alternate days for 3 months, and 50 patients did not receive any treatment. Semen analysis was performed in all subjects at the end of this period of treatment and after the following 3 months. Subjects who had not reached spontaneous pregnancy underwent assisted reproductive techniques. Main Outcome Measure(s): Seminal parameters, testicular cytologic analysis, FSH, LH, T, and inhibin B concentrations. Result(s): The treatment group considered as a whole did not show modifications in sperm parameters. However, a subgroup of these (30, 48.4% ) had a significant increase of sperm count (responder group). In the period including 3 months after the withdrawal of FSH therapy, we observed a significantly higher spontaneous pregnancy rate in the responder group (5 of 30 [16.7% ]) with respect to nonresponder and nontreated groups (1 of 32 [3.1% ] and 2 of 50 [4.0% ], respectively). Furthermore, the improvement of seminal parameters in the responder group allowed these patients to undergo less frequent IVF- ET/intracytoplasmic sperm injection. Conclusion(s): Results from this controlled, randomized clinical trial show that FSH therapy does not improve sperm concentration or pregnancy rate when infertile male patients are chosen solely by the clinical criteria of idiopathic oligospermia and normal FSH concentration. Subgroup analysis, however, does indicate that patients without maturation arrest in addition to the clinical scenario do benefit from medical therapy.展开更多
Objective: To determine the predictive value of antimü llerian hormone (AMH) as a marker for ovarian reserve and to compare its value with the markers currently being used. Design: Prospective analysis. Setting: ...Objective: To determine the predictive value of antimü llerian hormone (AMH) as a marker for ovarian reserve and to compare its value with the markers currently being used. Design: Prospective analysis. Setting: In vitro fertilization (IVF) clinic of a tertiary medical center. Patient(s): Fifty women undergoing assisted reproduction cycles. Intervention(s): None. Main Outcome Measure(s): Comparison of day- 3 serum AMH levels among women with less than five retrieved oocytes and five or more oocytes. Antral follicle count, mature oocyte count, age, basal follicle- stimulating hormone (FSH), estradiol (E2), maximum serum E2 levels, and pregnancy success were also compared. Result(s): The mean serum AMH levels of patients with more than five retrieved oocytes were found to be higher (0.67 ± 0.41 vs. 0.15 ± 0.11 pg/mL). Mature oocyte counts, antral follicle counts, and maximum E2 levels were found to be statistically significantly different in the two groups despite similar ages and levels of basal FSH and E2. Although the receiver operator characteristics analysis revealed that the most sensitive and specific indicator of ovarian reserve is the level of AMH, it does not indicate pregnancy success as well when 0.25 pg/mL is taken as a cut- off value. Conclusion(s): These data demonstrate an association between early follicular serum AMH and ovarian response, but no association with pregnancy success.展开更多
文摘Objective: To analyze the hormonal, ultrasonographic, and color Doppler parameters in a population- based follow- up study of female childhood cancer survivors with regular menstrual cycle and normal early follicular FSH values. Design: Controlled, prospective clinical study. Setting: University hospital. Patient(s): Twenty- eight female patients affected by a malignant tumor during childhood and 14 age- matched healthy controls. Intervention(s): Hormonal, ultrasonographic, and color Doppler analyses. Main Outcome Measure(s): In the midluteal phase of the cycle, the patients underwent hormonal assay of gonadotropins, E2, and P; ultrasonographic evaluation of the uterine and ovarian volume, the endometrial thickness, and of the corpus luteum characteristics; color Doppler analysis of uterine, intraovarian, and periluteal arteries. Result(s): A greater uterine volume and a better utero- ovarian vascularization was observed in controls in comparison with cancer survivors. In patients who suffered from childhood malignancies the P values were lower than in controls. On the basis of circulating P (> or < 20 nmol/L)values, we divided the former group in ovulatory and nonovulatory patients. We observed that even if there were no differences between ovulatory cancer survivors and controls, the nonovulatory group showed a reduced uterine volume associated with elevated resistance at the level of uterine and intraovarian arteries. Among these two groups the time elapsed between the diagnosis of cancer and menarche was shorter in nonovulatory than in ovulatory women, and was directly correlated with both uterine volume (r = 0.660) and ovarian volume (r = 0.597). Conclusion(s): Ultrasonographic and Doppler analyses may noninvasively study the subtle utero- ovarian modifica- tion after anticancer therapies.
文摘To evaluate the effects of treatment with FSH on seminal parameters and spontaneous pregnancy in male infertility. Design: Prospective, controlled, randomized clinical study. Setting: Infertility center at a university hospital. Patient(s): One hundred twelve men affected by idiopathic oligozoospermia. Intervention(s): Patients were randomized into two groups: 62 subjects were treated with 100 IU of recombinant human FSH on alternate days for 3 months, and 50 patients did not receive any treatment. Semen analysis was performed in all subjects at the end of this period of treatment and after the following 3 months. Subjects who had not reached spontaneous pregnancy underwent assisted reproductive techniques. Main Outcome Measure(s): Seminal parameters, testicular cytologic analysis, FSH, LH, T, and inhibin B concentrations. Result(s): The treatment group considered as a whole did not show modifications in sperm parameters. However, a subgroup of these (30, 48.4% ) had a significant increase of sperm count (responder group). In the period including 3 months after the withdrawal of FSH therapy, we observed a significantly higher spontaneous pregnancy rate in the responder group (5 of 30 [16.7% ]) with respect to nonresponder and nontreated groups (1 of 32 [3.1% ] and 2 of 50 [4.0% ], respectively). Furthermore, the improvement of seminal parameters in the responder group allowed these patients to undergo less frequent IVF- ET/intracytoplasmic sperm injection. Conclusion(s): Results from this controlled, randomized clinical trial show that FSH therapy does not improve sperm concentration or pregnancy rate when infertile male patients are chosen solely by the clinical criteria of idiopathic oligospermia and normal FSH concentration. Subgroup analysis, however, does indicate that patients without maturation arrest in addition to the clinical scenario do benefit from medical therapy.
文摘Objective: To determine the predictive value of antimü llerian hormone (AMH) as a marker for ovarian reserve and to compare its value with the markers currently being used. Design: Prospective analysis. Setting: In vitro fertilization (IVF) clinic of a tertiary medical center. Patient(s): Fifty women undergoing assisted reproduction cycles. Intervention(s): None. Main Outcome Measure(s): Comparison of day- 3 serum AMH levels among women with less than five retrieved oocytes and five or more oocytes. Antral follicle count, mature oocyte count, age, basal follicle- stimulating hormone (FSH), estradiol (E2), maximum serum E2 levels, and pregnancy success were also compared. Result(s): The mean serum AMH levels of patients with more than five retrieved oocytes were found to be higher (0.67 ± 0.41 vs. 0.15 ± 0.11 pg/mL). Mature oocyte counts, antral follicle counts, and maximum E2 levels were found to be statistically significantly different in the two groups despite similar ages and levels of basal FSH and E2. Although the receiver operator characteristics analysis revealed that the most sensitive and specific indicator of ovarian reserve is the level of AMH, it does not indicate pregnancy success as well when 0.25 pg/mL is taken as a cut- off value. Conclusion(s): These data demonstrate an association between early follicular serum AMH and ovarian response, but no association with pregnancy success.
