Dehydroepiandrosterone Supplementation Improves the Outcomes of in vitro Fertilization Cycles in Older Patients With Diminished Ovarian Reserve
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Background: Dehydroepiandrosterone (DHEA) supplementation has been reported to have beneficial effects on the in vitro fertilization (IVF) outcomes of patients with poor ovarian response or diminished ovarian reserve. The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) stratification is a set of newly established criteria for low prognosis patients. The aim of this study was to examine the potential effects of DHEA supplementation on the IVF outcomes of patients who fulfill the POSEIDON group 4 criteria. Methods: This retrospective cohort study investigated 297 cycles that fulfilled the POSEIDON group 4 criteria and underwent IVF treatment using the gonadotropin-releasing hormone antagonist protocol. The study group contained 159 cycles that received DHEA (30 mg three times per day) daily for 12 weeks before their IVF cycles. The control group included 138 cycles that underwent IVF cycles but did not receive DHEA. The baseline characteristics and cycle parameters as well as the IVF outcomes of both groups were compared. Results: In terms of baseline characteristics, more previous IVF attempts and lower AMH levels were found in the study group than in the control group. Regarding IVF outcomes, patients in the study group had significantly higher follicular oocyte index and higher numbers of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day 3 embryos and top-quality day 3 embryos than those in the control group. Besides, a higher cumulative pregnancy rate and lower cancellation rate were observed in the study group than in the control group although clinical pregnancy rate, live birth rate, and cumulative live birth rate did not differ between the two groups. Whether patients are aged ≤ 40 years or aged > 40, higher numbers of oocytes and embryos were observed in the study group than in the control group. In patients aged > 40, cumulative pregnancy rate was significantly higher in the study group than in the control group. Conclusions: Our data suggest that DHEA supplementation might increase both oocyte and embryo yields, as well as cumulative pregnancy rates, in patients fulfilling the POSEIDON group 4 criteria.Keywords:
Ovarian Reserve
According to Ayurveda Having no Baby is described as Vandhyatva and Infertility in Modern science. In-fertility is a main issue in today’s era. Many couples go for IVF, Surrogacy and many more with very little benefits. Nearly 10-14% of individuals are belonging to the reproductive age group are affected by Infertil-ity. Infertility caused by Diminished Ovarian Reserve (DOR) results from an endocrinological imbalance. The rise in follicle stimulating hormone (FSH), decrease in Anti Mullerian hormone (AMH) and Antral fol-licle count (AFC) etc. for women age more than 35 years can lower pregnancy rates to less than 5 % and increases miscarriage rates to more than 75%. Ayurveda explained wide range of protocols and medicines for the management of Vandhyatva. In Ayurveda its appropriate correlation can be done with Dhatukshaya Vandhya explained in Harita Samhita. Ayurveda states four factors are mentioned Rutu, Kshetra, Ambu, Beeja should be in proper state in order to achieve conception and complete the pregnancy successfully. Aim & Objectives: To evaluate the efficacy of Shamana Aushadhi, Yog Basti, Uttarbasti in the manage-ment of Diminishing Ovarian Reserve (DOR) induced Female Infertility. Materials & Methods: It is the single arm, open labelled case study of the subject of 35 yrs age with pri-mary infertility of Diminishing Ovarian Reserve (DOR) from Ayurveda College who has been treated with Shodhana Chikitsa as Yog Basti, Uttarbasti and Shamana Chikitsa simultaneously. Results & Discussion: There was improvement in hormonal assay with increase in Anti Mullerian hormone (AMH) and Antral follicle count (AFC) followed by conception later on. The Patient delivered with full term normal healthy female baby. Samshodhana and Shamana Aushadha helped to pacify Vata Dosha by Dhatukshaya Vandhya Chikitsa thus restored the fertility. Conclusion: The selected treatment protocol i.e. Samshodhana and Shamana Aushadha is very effective in the management of Diminishing Ovarian Reserve (DOR) induced Female Infertility.
Ovarian Reserve
Antral follicle
Anti-Müllerian hormone
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Summary. Two groups of men were retrospectively selected according to their observed success in in-vitro fertilization. Seminal and post-migration sperm samples from a low fertilization rate group (≤33% cleaved embryos) have been compared to results obtained from a high fertilization rate group (≥ 66%). It was found that a low mean value of the amplitude of lateral sperm head displacement and an increased percentage of abnormal acrosomes were related to in-vitro fertilization failure. None of the individual sperm factors studied was found to determine in-vitro fertilization success with certainty; only when they were considered in combination was it possible to predict the likelihood of successful in-vitro fertilization of human oocytes.
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Women undergoing IVF are routinely subjected to one or more tests of ovarian reserve. The results of these tests are also being extrapolated to women attending infertility clinics and those planning to delay childbearing. This debate examines the predictive power of currently available tests of ovarian reserve and questions the value of subjecting women to ovarian reserve tests. We propose that in the absence of an agreement on (i) a definition of poor ovarian reserve, (ii) the population to be tested and (iii) which interventions are effective in women with poor ovarian reserve, routine ovarian reserve testing is unhelpful.
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Background: Fertility rates have started declining in India in the last few decades. The total fertility rate, which was 3.5 in 93-94 declined to 2.5 in 2005-6. Researchers attribute this fertility transition to concomitant socio-economic development. Decreasing ovarian reserve is an important contributor for age related infertility. Objectives: The objective of this study was to assess the association of ovarian reserve with socio-economic status (SES) with the available clinical ovarian reserve markers in reproductive age women. Materials and Methods: A total of 160 married women in the age group of 20-35 years, belonging to all three socio-economic strata were assessed for ovarian reserve using the clinical ovarian reserve parameters Antimullerian hormone (AMH), Antral follicle count (AFC) and follicular stimulating hormone (FSH). Analysis of variance was used to see the association of ovarian reserve with SES. Results: Both the ovarian parameters AMH and AFC have shown a significant association with SES (P = 0.000 for AMH and P = 0.023 for AFC). The association between FSH and SES was not significant (P = 0.147). Conclusions: Higher SES in this study was seen to be associated with better ovarian reserve as assessed by the available clinical ovarian reserve markers.
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Anti-Müllerian hormone
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Objective: Subfertility is commonly observed in patients with rheumatoid arthritis (RA). Although the causes are not well established, the alteration of the ovarian reserve is thought to contribute to the lower chances of pregnancy. This cross-sectional study aimed to evaluate the ovarian reserve in patients with RA. Materials and methods: Two parameters associated with ovarian reserves such as the antral follicle count (AFC) and the anti-müllerian hormone (AMH) were assessed in 38 patients with RA. We also analyzed the correlation of these parameters with the medication used to treat this pathology and with the illness severity. Results: The AMH levels in women with RA were comparable to those found on healthy individuals although the RA patients were more likely to have a low AFC. Ovarian reserve and RA were neither influenced by parameters of disease activity nor by the use of medication. Conclusion: The ovarian reserve in women with RA was similar to that found in healthy individuals.
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Human scalp hair follicles of both sexes actively metabolized dehydroepiandrosterone-4-14C or dehydroepiandrosterone-15-3H in vitro. The principal metabolites were 7α-hydroxy-dehydroepiandrosterone, 7-keto-dehydroepiandrosterone, 5-androstene-3β,17β-diol, 4-androstene-3, 17-dione and 5α-androstane-3,17-dione. Testosterone or 5α-dihydrotestosterone were not detectable. Dehydroepiandrosterone-l,2-3H-sulphate was not converted to free dehydroepiandrosterone, but sulphoconjugation of the free steroid occurred to a limited extent. The metabolic activity of the follicular bulbs was several times higher than that of the sheaths. No sex differences were detected in the quality or quantity of the major metabolites isolated. Hair follicles obtained from balding men, however, exhibited severe metabolic deviations from the control pattern of metabolism seen in non-balding individuals.
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ABSTRACT The dynamic parameters of dehydroepiandrosterone and dehydroepiandrosterone sulphate metabolism have been determined following a single injection of [4- 14 C] dehydroepiandrosterone and [7α- 3 H] dehydroepiandrosterone sulphate into normal female subjects. The urinary secretion and production rates, the ϱ DDS and ϱ DSD conversion factors, the metabolic clearance rates, blood production rates and distribution volumes were calculated. Although the comparison between urinary and blood parameters of steroid dynamics suggested certain limitations of the methods used, they were found suitable for gaining information on dehydroepiandrosterone and dehydroepiandrosterone sulphate metabolism. A poor extra-adrenal conversion of dehydroepiandrosterone to the sulphate, small dehydroepiandrosterone sulphate and large dehydroepiandrosterone distribution volumes or clearance patterns, and a possible correlation between the blood parameters of dehydroepiandrosterone sulphate and anthropomorphology of normal female subjects were found.
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The effects of different fertilization modes and levels on the growth and production of maize are studied.On the fertilization ratio(N∶P=1∶1) the 1000-grain weight increases on all levels of fertilization compared with the non-fertilization and increases to the maximum on the middle fertilization level,while it decreases on both the low fertilization and high fertilization levels;while on the fertilization ratio(N∶P=0.5∶1) the production increases with higher fertilization levels and the 1000-grain weight gets to the maximum on the low fertilization level.The diameter,shoot height and number of the leaves increase in the similar pattern on different fertilization modes.The fertilization has significant effects on them compared with the non-fertilization.The three indicators have little changes on the middle and higher levels.The two different fertilization modes have significant difference in the low fertilization level.It can be concluded that in low ratio of N and P the production increases with the fertilization level and the N is the limitting factor.While in the high ratio of N and P the production increases at first and decreases,the P becomes the limiting factor.To get high production the fertilization levels should be on the middle level on two different fertilization modes from the economic prospect.The study is to provide theoretical guidance for the proper fertilization of the maize in Three Gorges Region.
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