Objective To investigate the relationship between clinical markers of ovarian reserve and the true ovarian reserve as determined by the ovarian primordial follicle number. Design Prospective ...investigation. Setting Academic medical center. Patient(s) Forty-two healthy women (aged 26–52 years) undergoing oophorectomy for benign gynecologic indications. Intervention(s) Transvaginal ultrasound examination for the determination of the ovarian antral follicle count (AFC) and serum measurements of clinical markers of ovarian reserve. All measurements were obtained within 2 weeks of surgery, irrespective of cycle day. Ovarian primordial follicle count was then determined using a validated fractionator/optical disector method. Main Outcome Measure(s) Univariate and partial correlations between ovarian reserve markers and ovarian primordial follicle count. Result(s) There were significant correlations between the ovarian primordial follicle count and AFC ( r = 0.78), anti-Müllerian hormone (AMH; r = 0.72), FSH ( r = −0.32), inhibin B ( r = 0.40), and chronological age ( r = −0.80). After adjusting for age, significant correlations were identified between the ovarian primordial follicle count and AFC ( r = 0.53) and AMH ( r = 0.48). Conclusion(s) The ovarian AFC and serum levels of AMH correlate with the ovarian primordial follicle number even after adjustment for chronological age.
To determine whether antioxidants improve male fertility, as measured by semen parameters and DNA fragmentation at 3 months and pregnancy resulting in live birth after up to 6 months of treatment, ...among couples with male factor infertility.
Multicenter, double-blind, randomized, placebo-controlled trial with an internal pilot study.
Nine fertility centers in the United States from December 2015 to December 2018.
Men (N = 174) with sperm concentration ≤15 million/mL, motility ≤40%, normal morphology ≤4%, or DNA fragmentation >25%, and female partners who were ovulatory, ≤40 years old, and had documented tubal patency.
Males randomly assigned to receive an antioxidant formulation (n = 85) containing 500 mg of vitamin C, 400 mg of vitamin E, 0.20 mg of selenium, 1,000 mg of l-carnitine, 20 mg of zinc, 1,000 μg of folic acid, 10 mg of lycopene daily, or placebo (n = 86). Treatment lasted for a minimum of 3 months and maximum of 6 months, and couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6.
Primary outcome was live birth; secondary outcomes included pregnancy within 6 months of treatment. For the internal pilot, the primary outcomes were semen parameters and sperm DNA fragmentation index after 3 months of treatment.
In the Males, Antioxidants, and Infertility (MOXI) study, after 3 months of treatment, the change in sperm concentration differed between the antioxidant group (median −4.0 interquartile range−12.0, 5.7 million/mL) and placebo group (+2.4 −9.0, 15.5 million/mL). However, there were no statistically significant differences between the two groups for changes in sperm morphology, motility, or DNA fragmentation. Among the 66 oligospermic men at randomization, sperm concentration did not differ at 3 months between the antioxidant and control groups: 8.5 (4.8, 15.0) million/mL versus 15.0 (6.0, 24.0) million/mL. Of the 75 asthenospermic men, motility did not differ at 3 months: 34% ± 16.3% versus 36.4% ± 15.8%. Among the 44 men with high DNA fragmentation, DNA fragmentation did not differ at 3 months: 29.5% (21.6%, 36.5%) versus 28.0% (20.6%, 36.4%). In the entire cohort, cumulative live birth did not differ at 6 months between the antioxidant and placebo groups: 15% versus 24%.
Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility. Although limited by sample size, this study suggests that antioxidant treatment of the male partner does not improve in vivo pregnancy or live-birth rates.
NCT02421887
El efecto de los antioxidantes en el factor masculino de infertilidad: ensayo clínico aleatorizado de hombres, antioxidantes e Infertilidad
Determinar si los antioxidantes mejoran la fertilidad masculina, según lo medido por los parámetros de semen y fragmentación del ADN a los 3 meses, y embarazo resultante en un nacido vivo después de 6 meses de tratamiento en parejas con infertilidad por factor masculino.
Ensayo multicéntrico, doble ciego, aleatorizado, controlado con placebo con un estudio piloto interno.
Nueve centros de fertilidad en los Estados Unidos desde diciembre del 2005 hasta diciembre del 2018.
Hombres (n= 174) con concentración de esperma ≤ 15 millones/ml, movilidad ≤ 4%, morfología normal ≤ 4%, o fragmentación del ADN > 25% y parejas femeninas las cuales eran ovulatorias, ≤ 40 años y tenían permeabilidad tubárica documentada.
Hombres asignados al azar para recibir una formulación antioxidante (n = 85) que contiene 500 mg de vitamina C, 400 mg de vitamina E, 0.20 mg de selenio, 1.000 mg de L-carnitina, 20mg de zinc, 1.000 ug de ácido fólico, 10 mg de licopeno diario o placebo (n= 86). El tratamiento duró un mínimo de 3 meses y un máximo de 6 meses y las parejas intentaron concebir naturalmente durante los primeros 3 meses y con citrato de clomifeno con inseminación intrauterina de la pareja femenina en los meses 4 a 6.
El primer resultado fue el nacimiento vivo, los segundos resultados incluyeron embarazo dentro de los 6 meses de tratamiento. Para el piloto interno, el primer resultado fueron los parámetros de semen e índice de fragmentación del ADN espermático después de 3 meses de tratamiento.
En el estudio Masculinos, Antioxidantes e Infertilidad (MOXI), después de 3 meses de tratamiento, el cambio en la concentración de esperma difirió entre el grupo antioxidante (mediana -4,0 rango intercuartil -12.0- 5,7 millones / mL) y el grupo placebo (+2,4 9,0- 15,5 millones / ml). Sin embargo, no hubo diferencias estadísticamente significativas entre los dos grupos para los cambios de morfología, motilidad o fragmentación del ADN espermático. Entre los 66 hombres oligospérmicos aleatorizados, la concentración de esperma no difirió a los 3 meses entre los grupos antioxidante y control: 8,5 (4,8- 15,0) millones / ml versus 15,0 (6,0- 24,0) millones / ml. De los 75 hombres astenospérmicos, la motilidad no difirió a los 3 meses: 34% ± 16,3% versus 36,4% ± 15,8%. Entre los 44 hombres con alta fragmentación del ADN, la fragmentación del ADN no difirió a los 3 meses: 29,5% (21,6% - 36,5%) versus 28,0% (20,6% - 36,4%). En toda la cohorte, la tasa acumulada de nacido vivo no difirió a los 6 meses entre los grupos de antioxidantes y placebo: 15% versus 24%.
Los antioxidantes no mejoran los parámetros de semen o integridad del ADN entre los hombres con infertilidad por factor masculino. Aunque limitado por el tamaño muestral, este estudio sugiere que el tratamiento de la pareja masculina con antioxidantes no mejora las tasas de embarazo o nacido vivo.
Fertility treatment strategies are evolving, with a more rapid transition to assisted reproductive technology (ART) treatments after unsuccessful non-ART treatments. This trend increases the ...potential importance of adjuvant treatments in non-ART cycles, such as steroid hormone supplementation. It has been established that success rates of ART treatments are increased with the use of luteal support with progesterone. In the setting of non-ART cycles, however, the evidence is less clear, and clinical practices vary widely between providers and clinics. In this review, we aimed to provide an overview of the current evidence for the use of steroid hormone supplementation, including progesterone for luteal support, estrogens, androgens, and mineralocorticoids, in the setting of non-ART treatments for ovulatory women.
Obesity is common in women with polycystic ovary syndrome. polycystic ovary syndrome and obesity are associated with reduced fertility. The effect of metabolic syndrome on the success of infertility ...treatment and pregnancy outcomes in women with polycystic ovary syndrome undergoing ovulation induction has not been investigated.
The objectives of this study were to determine the associations of metabolic syndrome on the rate of live birth after ovulation induction and pregnancy complications in obese women with polycystic ovary syndrome and determine whether there is a difference in outcomes concerning specific medications used for ovulation induction.
This prospective cohort analysis used data collected from participants in the Pregnancy in Polycystic Ovary Syndrome II clinical trial conducted by the Reproductive Medicine Network. In the Pregnancy in Polycystic Ovary Syndrome II trial, 750 women with polycystic ovary syndrome and infertility were randomized to either clomiphene citrate or letrozole for ovulation induction for 1 to 5 cycles or until pregnancy occurred. Cox regression and modified Poisson regression, chi-square test, and Student t test or Wilcoxon test were used in this study. Outcomes of interest were rates of live birth and clinical pregnancy and pregnancy complications. Having metabolic syndrome was defined by the presence of at least 3 of 5 cardiometabolic risk factors (waist circumference of >88 cm, low high-density lipoprotein cholesterol of <50 mg/dL, triglycerides of ≥150 mg/dL, systolic blood pressure of ≥130 or diastolic blood pressure of ≥85 mm Hg, and fasting glucose of >100 mg/dL). In addition, we used a continuous metabolic syndrome z score. Body mass index categories were defined as normal (body mass index of <25 kg/m2), high (25 to 35 kg/m2), and very high (>35 kg/m2).
As illustrated in the Table, early pregnancy losses showed no difference by metabolic syndrome. Fewer women achieved a clinical pregnancy (20.5% vs 29.7%; P=.007) or had a live birth (16.5% vs 27%; P=.001) in the presence of metabolic syndrome. Early pregnancy losses showed no difference by metabolic syndrome status. However, at least 1 pregnancy complication occurred more often with metabolic syndrome: 61.9% (26 of 42 cases) with metabolic syndrome vs 44.4% (59 of 133 cases) (P=.05) without metabolic syndrome. Gestational diabetes mellitus (35.7% vs 18.2%; P=.02) and macrosomia (21.4% vs 8.3%; P=.02) were more common in the presence of metabolic syndrome. After adjustment for other potential confounders, the rate ratio for live births for a 1-unit change in the metabolic syndrome z score was 0.89 (95% confidence interval, 0.79–1.00; P=.04) for those whose body mass index was 25 to 35 kg/m2. For the very high body mass index subgroup (>35 kg/m2), the independent effects of metabolic syndrome from obesity were harder to discern. The rate of live birth was higher with the use of letrozole, although metabolic syndrome had a different detrimental effect concerning the medication given. The overall incidence of pregnancy complications was high (approximately 49%) in the Pregnancy in Polycystic Ovary Syndrome II trial and the 2 medications. Letrozole was associated with more obstetrical complications in the presence of metabolic syndrome, and clomiphene was associated with a lower rate of live birth rate when metabolic syndrome was present.
Metabolic syndrome is a risk factor that lowers the rate of live birth after ovulation for women with polycystic ovary syndrome, independent of obesity, and it is particularly associated with a lower rate of live birth for women using clomiphene compared with women using letrozole. In addition, metabolic syndrome is a risk factor for pregnancy complications for women with obesity using letrozole. Furthermore, having metabolic syndrome is a risk factor for gestational diabetes mellitus and macrosomia.
To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program ...(NSQIP) database reporting of comorbidity index variables in patients with facial fractures.
The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics.
In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable.
4 Laryngoscope, 2023.
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