Serum anti-Müllerian hormone levels differentiate control from subfertile men but not men with different causes of subfertility

Aim. To determine stimulated serum anti-Müllerian hormone (AMH) levels in men with different causes of subfertility.

Subjects and methods. We prospectively studied 82 subfertile men and 31 controls. The subfertile men underwent a diagnostic procedure to identify the causes of subfertility. Study parameters included testicular volume, levels of follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, inhibin B and AMH, and sperm parameters.

Results. Clinical diagnoses in subfertile men were idiopathic non-obstructive azoospermia (n = 26, 32%), idiopathic non-obstructive dyspermia (n = 17, 21%), varicocele (n = 16, 20%), cryptorchidism (n = 10, 12%) and other diagnoses (n = 13, 16%). Serum AMH levels in subfertile men were 60% lower than in controls [median (interquartile range) 4.6 (3.6) vs. 11.6 (7.7) ng/ml, p < 0.001], with no significant differences among the different groups of subfertile men.

Conclusions. Serum AMH levels differentiate control from subfertile men but not men with different causes of subfertility.     

Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.     

ESHRE task force on ethics and law 15: cross-border reproductive care

This paper analyses the ethical aspects of cross-border reproductive care. Ethical questions are raised by some of the main reasons of cross-border travelling, i.e. law evasion and unequal access to treatment. The phenomenon also generates possible conflicts linked to the responsibility of the professionals. Three points are discussed: the moral obligation of the physician to refer the patient, his/her duty to provide information and counselling and the acceptability of fee-splitting. The recommendations focus on measures to reduce or limit the number of patients that have to travel abroad and on steps to guarantee the safety and quality of the treatment wherever it is provided.     

ThinPrep are superior to conventional smears in the cytological diagnosis of subfertile men by testicular fine-needle aspiration

The aim of this study was the comparison of liquid-based cytology (ThinPrep, TS) to conventional smears (CS) in the investigation of subfertile men with testicular fine-needle aspiration (FNA). Between January and December 2004, testicular FNA biopsies were performed in 30 subfertile men. Both TS and CS were diagnosed according to Meng classification. Features specifically recorded in each smear included sample adequacy, tissue cells preservation, contamination with red blood cells, quality of smear background, ease of cell recognition, and the cytological diagnosis.There was agreement in the cytological diagnosis between TS and CS (P = 0.88) and sample adequacy (P = 0.73). TS was superior to CS regarding cell preservation, presence of red blood cells or tissue artifacts, quality of the smear background, and cell recognition (P < 0.0001). In testicular FNA cytology, TS appear to be superior to CS in respect to cell preservation, absence of red blood cells, background quality, and cell recognition. These advantages, however, are not translated in improved cytological diagnosis.     

Endocrinology: Growth hormone, oestradiol, progesterone and testosterone concentrations in follicular fluid after ovarian stimulation with various regimes for assisted reproduction

Follicular fluid samples and oocytes were obtained from 75 women(87 cycles), who participated in an assisted conception programme.Determinations of the concentration of oestradiol, progesterone,testosterone and growth hormone were performed in all follicularfluid samples. Patients were stimulated with the following regimes:group A (24 cycles, 94 samples), human menopausal gonadotrophin(HMG) (three ampoules/day) and human chorionic gonadotrophin(HCG); group B (23 cycles, 53 samples), HMG/HCG with prednisolone(7.5 mg/day) after cycle programming with oral contraceptives;group C (40 cycles, 60 samples), buserelin with HMG/HCG. Oestradiolconcentrations (mean ± SEM) were significantly higher(P < 0.05) in group A (320.1 ± 27.3 ng/ ml) and thoseof growth hormone in both groups A and C (3.8 ± 0.2 and3.2 ± 0.15 ng/ml, respectively), as compared to the othergroups, whereas progesterone and testosterone concentrationswere similar in all groups. The mean concentrations of oestradiol,progesterone, testosterone and growth hormone were significantlyhigher (P < 0.01) in follicular fluid with oocytes of intermediatematurity than with mature oocytes (382.5 ng/ml, 7847.5 ng/ml,1704.5 ng/dl and 3.7 ng/ml versus 217.8 ng/ml, 5488.4 ng/ml,1313.6 ng/dl and 2.7 ng/ml, respectively). On the other hand,only oestradiol concentrations were significantly higher infollicular fluid of fertilized compared to non-fertilized oocytes.Concentrations of the other hormones analysed, except growthhormone, were similar in follicular fluid from pregnant andnon-pregnant women after assisted reproduction. Growth hormone,on the other hand, was significantly lower (P < 0.05) infollicular fluid from pregnant compared to non-pregnant women(2.8 versus 3.5 ng/ml). It is concluded that intermediate maturityoocytes and oocytes which will be subsequently fertilized arefound in follicles with higher follicular fluid concentrationsof growth hormone and steroids. Moreover, oocytes leading topregnancy after in-vitro fertilization and embryo transfer arederived from follicles with lower growth hormone concentrationsin follicular fluid.     

GnRH antagonists in IVF

The present review summarizes existing knowledge on the use of gonadotropin releasing hormone (GnRH) antagonists based on experience gathered after the completion of phase III comparative trials with GnRH agonists. Available data suggest that prolongation of the follicular phase significantly decreases the probability of pregnancy. Moreover, patients with elevated progesterone at initiation of stimulation have significantly fewer chances of achieving an ongoing pregnancy. Luteal support remains mandatory, while the replacement of human chorionic gonadotrophin by GnRH agonist does not appear to be feasible. Although not conclusive, existing data are not in favour of increasing the starting dose of gonadotrophins, of LH supplementation or of using a flexible antagonist protocol.