Due to a lower threshold of detection, picoAMH may be able to predict successful ovarian stimulation among women with DOR using a threshold of 500 pg/mL, with good sensitivity and specificity.

Objective Is polycystic ovary syndrome (PCOS) associated with activating autoantibodies (AAb) to the second extracellular loop (ECL2) of gonadotropin-releasing hormone receptor (GnRHR)? Design and Methods We retrospectively screened sera from 40 PCOS patients and 14 normal controls (NC) with regular menses by ELISA for the presence of GnRHR-ECL2-AAb. We obtained similar data from 40 non-PCOS ovulatory but infertile patients as a control group (OIC) of interest. We analyzed GnRHR-ECL2-AAb activity in purified IgG using a cell-based GnRHR bioassay. Results The mean ELISA value in the PCOS group was markedly higher than the NC (P=0.000036) and the OIC (P=0.0028) groups. IgG from a sample of five PCOS subjects, in contrast to a sample of five OIC subjects, demonstrated a dose-dependent increase in GnRHR-stimulating activity qualitatively similar to the acute action of the natural ligand GnRH and the synthetic agonist leuprolide. The GnRHR antagonist cetrorelix significantly suppressed (P<0.01) the elevated GnRHR activity induced by IgG from seven PCOS patients while the IgG activity levels from seven OIC subjects was unchanged. Five other OIC subjects had relatively high ELISA values at or above the 95% confidence limits. On further study, three had normal or low activity while two had elevated IgG-induced GnRHR activity. One suppressed with cetrorelix while the other did not. The co-presence of PCOS IgG increased the responsiveness to GnRH and shifted the dosage response curve to the left (P<0.01). Conclusions GnRHR-ECL2-AAb are significantly elevated in PCOS compared to normal controls. Their presence raises important etiological, diagnostic and therapeutic implications.

BackgroundAge-adjusted rates of obesity are reported to be 35.8 % among US adult women and 49 % in some race/ethnicity, underserved populations. (1). Underserved populations often have less access to weight-loss intervention options and are at high risk for obesity related problems including anovulation, infertility, pregnancy-related complications and adverse long-term health outcomes. (2). The purpose of this study was to evaluate a home exercise plan using a pedometer on weight loss, ovulation induction and pregnancy rates in our overweight and obese underserved clinic population.MethodsTwenty one overweight (BMI ≥ 25–29.9) and obese I-II (BMI ≥ 30–39.9) 18–42 years old were recruited. Participants received an exercise/nutrition questionnaire at the initiation and completion and called weekly for 4 weeks. Ten participants were randomly assigned to the home exercise program (PedGp). PedGp received a pedometer, daily step-count goal, and were called to increase goal by 50 % weekly. All participants then underwent clomiphene stair-step ovulation induction. All study participants were referred to the University Wellness Clinic for diet and exercise counseling.ResultsThere were high percentages of women with co-morbidities in both groups including fatty liver, low vitamin D, hyperlipidemia, hypothyroidism, prediabetes and diabetes.1. Those completing the 4-week home program increased baseline steps by 21.2 % weekly. Only 3/10 women reached at least one weekly goal of 50 % increase. Although the goal was rarely met, participants who completed study had increased number of daily steps.2. Greater number in PedGp lost weight or stayed the same (5/10 vs. 2/11).3. Greater number in PedGp spontaneously ovulated (4/10 vs. 1/11) or became pregnant (4/10 vs. 3/11). (not statistically significant due to small sample size).ConclusionThere are high percentages of comorbidities in this population. Although the goal was rarely met, participants who completed study had increased number of daily steps. A greater number in PedGp lost weight or stayed the same. A greater number in PedGp spontaneously ovulated or became pregnant (not statistically significant due to small sample size). Importantly, 40 % of women who lost weight became pregnant. This is highly encouraging and suggests that the development of pedometer interventions may prove a cost effective option. Weight loss programs for this population hold promise and efficient hospital or community-based programs may prove beneficial.

Purpose In fresh IVF cycles, embryos reaching the eight-cell stage on day 3 of development are thought to have a higher chance of implantation than those reaching this stage on day 4. To determine whether this difference persists after cryopreservation, we compared pregnancy and implantation rates between frozen embryo transfer (FET) cycles using delayed cleavage-stage embryos (cryopreserved day 4) and normal cleavage-stage embryos (cryopreserved day 3). Methods Participants underwent FET between 2008 and 2012 using embryos cryopreserved on either day 3 (n=76) or day 4 (n=48), depending on the length of time needed to achieve the eight-cell stage. All embryos, regardless of day of cryopreservation, were thawed and transferred on the 4th day of vaginal progesterone following endometrial preparation with oral estradiol. Chi-square and Mann-Whitney U tests were used to compare patient demographics and cycle outcomes. Results More women in the day 4 group had diminished ovarian reserve (44 vs 16 %, p=0.003). Pregnancy outcomes in preceding fresh cycles were not different between the two groups. Pregnancy, implantation, and live birth rates following FET did not differ between the day 3 and day 4 groups. Conclusions This is the first study to address outcomes using day 3 versus day 4 cryopreserved embryos. Despite a higher prevalence of diminished ovarian reserve (DOR) in the day 4 group, delayed cleavage-stage embryos utilized in FET cycles performed as well as embryos growing at the normal rate, suggesting delayed embryo development does not affect embryo implantation as long as endometrial synchrony is maintained.

The objective of this article was to review and synthesize information from the scientific literature pertaining to the preparation of endometrium for cryopreserved embryo transfer. This article is a critical review of selected scientific literature, synthesis, and formulation of opinion. Estrogen and progesterone are necessary and sufficient to induce endometrial receptivity in cryopreserved embryo transfer cycles. A variety of regimens have been described including natural cycles using endogenous ovarian hormones and artificial or programmed cycles with exogenously administered steroid hormones. To achieve optimal synchrony between embryo and endometrium, the timing of progesterone administration needs to be adjusted to the developmental stage of the thawed embryos. There is currently no evidence that any single regimen or adjuvant substance results in superior outcomes in cryopreserved embryo transfer cycles, although timing of progesterone administration does matter. Although no single regimen of endometrial preparation for cryopreserved embryo transfer has been proven superior to the others, the relative convenience and ease of use do vary, depending on the route of administration chosen and any adjuvant added to the cycle.