Folliculogenesis is a complex process in which there exists a delicate balance between recruitment and atresia of follicles. Transition from primordial to primary follicular stage does not show any change in the mean diameter of the oocyte, although there is an increase in the follicular diameter, indicating that this transition is a slow maturing rather than a growing process.
Evaluation of Microleakage and Microgap of Two Different Internal Implant–Abu...Dr. Anuj S Parihar
Aim: The higher success rate (>90%) of dental implants over 5 years has made this treatment option favorable for dental surgeons as well as for patients. The present in vitro study was conducted to assess microleakage and microgap of two dissimilar internal implant–abutment associations.
Materials and methods: Forty dental implants were divided into two groups: trilobe internal connection fixtures in group I and internal hexagonal geometry fixtures in group II. For the immersion of implant abutment assemblies, sterilized tubes containing 4 mL of Staphylococcus aureus broth culture were incubated at 37°C for 2 weeks. Gram’s stain and biochemical reactions were used for identification of colonies.
Results: The mean log10 colony-forming unit (CFU) in group I was 8.6 and was 9.3 in group II. The disparity among two groups was found to be significant (p < 0.05). The mean microgap in group I was 7.2 μm and was 10.4 μm in group II. The disparity among the two groups was found
to be significant (p < 0.05).
Conclusion: Authors found that microscopic space between implant and abutment may be the site of penetration of bacteria. There was significant higher log10 CFU in dental implant fixtures with an internal hexagonal geometry compared to the dental implant fixtures with a trilobe internal connection.
Evaluation of Microleakage and Microgap of Two Different Internal Implant–Abu...Dr. Anuj S Parihar
Aim: The higher success rate (>90%) of dental implants over 5 years has made this treatment option favorable for dental surgeons as well as for patients. The present in vitro study was conducted to assess microleakage and microgap of two dissimilar internal implant–abutment associations.
Materials and methods: Forty dental implants were divided into two groups: trilobe internal connection fixtures in group I and internal hexagonal geometry fixtures in group II. For the immersion of implant abutment assemblies, sterilized tubes containing 4 mL of Staphylococcus aureus broth culture were incubated at 37°C for 2 weeks. Gram’s stain and biochemical reactions were used for identification of colonies.
Results: The mean log10 colony-forming unit (CFU) in group I was 8.6 and was 9.3 in group II. The disparity among two groups was found to be significant (p < 0.05). The mean microgap in group I was 7.2 μm and was 10.4 μm in group II. The disparity among the two groups was found
to be significant (p < 0.05).
Conclusion: Authors found that microscopic space between implant and abutment may be the site of penetration of bacteria. There was significant higher log10 CFU in dental implant fixtures with an internal hexagonal geometry compared to the dental implant fixtures with a trilobe internal connection.
The recent trends in Life Sciences have been experiencing rapid
transformation in recent years due to development of technology by
considering available ancient techniques. For this change, most
importunately different scientist was discovered scientific
technologies, methods, concepts, and microorganisms. All this
research helped to develop society in all aspects including medicinal
plants research. Different plants are widely known for their medicinal
properties, food properties, industrial important products formation
properties etc., Due to our improved understanding and different
methodology, even our meanings of familiar words, such as antibiotic
and species appear to be shifting. This book is coordinated towards
students, researchers, scientists and starting alumni understudies in
medicinal plants and Botany. However, the book is fully focused on
different plants and their applications in different fields. We would like
to offer our thanks to all authors, parents, teachers, and friends.
The culture of cells in two dimensions does not reproduce the histological characteristics of a tissue for informative or useful study. Growing cells as three-dimensional (3D) models more analogous to their existence in vivo may be more clinically relevant. Discuss the potential of using three dimensional cell cultures for anti-cancer drug screening.
Development of cancer therapeutics is often carried out in 2D cultures prior to testing on animal model. In comparison to 2D cultures, discuss the potential of using 3D in vitro models for drug efficiency testing.
5th Tumor Models Boston July 2017 BrochureDiane McKenna
Tumor Models Boston 2017 will address the preclinical & clinical developments of the most promising therapies including targeted therapies, check-point inhibitors & CAR-T therapies and how these findings can be utilized to bridge the gap between preclinical and clinical studies.
Poster - Including the matricial tumoral microenvironment in 3D in vitro mode...HCS Pharma
In oncology, 97% of drug candidates fail in clinical trials. This highlights a lack of relevance of preclinical models used upstream. Indeed, human in vitro models don’t consider the Tumoral Extracellular Matrix (TECM). However, more and more studies demonstrate that ECM composition and stiffness are modified in tumors and are linked to cancer initiation, progression, propagation, and drug resistances.
BIOMIMESYS® is a Hyaluronic Acid-based matrix grafted with structural and adhesion molecules, which mimics the ECM/TECM. It is chemically defined and its composition and stiffness can be modified to reproduce the organ-specificity of the ECM, or to mimic a pathological microenvironment in vitro.
We have demonstrated that the exposition of colon cancer cells cultured in BIOMIMESYS® Oncology matrix to an anti-proliferative drug showed a closer in vitro/in vivo correlation in the EC50 curve compared to 2D culture. Cancer cells can be advantageously grown in BIOMIMESYS® for several weeks in multiwell plates and in microfluidic chips for more advanced models. We also observed that modifications in the matrix composition and stiffness modify the cell behavior. Moreover, thanks to collaborations with academic laboratories, we demonstrated that BIOMIMESYS® allows to reproduce in vitro the behavior of cancerous cells in vivo, like mutation effects and metastasis propagation, and could be a relevant alternative to animal models. These results showed that the matricial microenvironment modifies the cell behavior in vitro and should be considered carefully in drug discovery. BIOMIMESYS® hydroscaffold™ is adapted to High Content Screening and represented a powerful tool to better select drug candidate.
GiAN Program report: GIAN (GLOBAL INITIATIVES OF ACADEMIC NETWORK) SHORT-TERM...Saurashtra University
GIAN (GLOBAL INITIATIVES OF ACADEMIC NETWORK)
SHORT-TERM COURSE ON ‘METAGENOMICS &
MICROBIOMES’20-25 FEBRUARY 2017
UGC-CAS DEPARTMENT OF BIOSCIENCES,
SAURASHTRA UNIVERSITY, RAJKOT
The participants
enthusiastically participated in this examination and over all their performance
were very good.
In this GIAN-Short Term Course programme, the spectrum of the participants
included, faculty members, scientists from National Research Institutes, Postdoctoral scientist and Ph. D. students from various parts of the country.
Endometriosis is a painful disorder and can reduce fertility if not treated early. Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining pelvis.Endometriosis can be a challenging condition to manage.
The recent trends in Life Sciences have been experiencing rapid
transformation in recent years due to development of technology by
considering available ancient techniques. For this change, most
importunately different scientist was discovered scientific
technologies, methods, concepts, and microorganisms. All this
research helped to develop society in all aspects including medicinal
plants research. Different plants are widely known for their medicinal
properties, food properties, industrial important products formation
properties etc., Due to our improved understanding and different
methodology, even our meanings of familiar words, such as antibiotic
and species appear to be shifting. This book is coordinated towards
students, researchers, scientists and starting alumni understudies in
medicinal plants and Botany. However, the book is fully focused on
different plants and their applications in different fields. We would like
to offer our thanks to all authors, parents, teachers, and friends.
The culture of cells in two dimensions does not reproduce the histological characteristics of a tissue for informative or useful study. Growing cells as three-dimensional (3D) models more analogous to their existence in vivo may be more clinically relevant. Discuss the potential of using three dimensional cell cultures for anti-cancer drug screening.
Development of cancer therapeutics is often carried out in 2D cultures prior to testing on animal model. In comparison to 2D cultures, discuss the potential of using 3D in vitro models for drug efficiency testing.
5th Tumor Models Boston July 2017 BrochureDiane McKenna
Tumor Models Boston 2017 will address the preclinical & clinical developments of the most promising therapies including targeted therapies, check-point inhibitors & CAR-T therapies and how these findings can be utilized to bridge the gap between preclinical and clinical studies.
Poster - Including the matricial tumoral microenvironment in 3D in vitro mode...HCS Pharma
In oncology, 97% of drug candidates fail in clinical trials. This highlights a lack of relevance of preclinical models used upstream. Indeed, human in vitro models don’t consider the Tumoral Extracellular Matrix (TECM). However, more and more studies demonstrate that ECM composition and stiffness are modified in tumors and are linked to cancer initiation, progression, propagation, and drug resistances.
BIOMIMESYS® is a Hyaluronic Acid-based matrix grafted with structural and adhesion molecules, which mimics the ECM/TECM. It is chemically defined and its composition and stiffness can be modified to reproduce the organ-specificity of the ECM, or to mimic a pathological microenvironment in vitro.
We have demonstrated that the exposition of colon cancer cells cultured in BIOMIMESYS® Oncology matrix to an anti-proliferative drug showed a closer in vitro/in vivo correlation in the EC50 curve compared to 2D culture. Cancer cells can be advantageously grown in BIOMIMESYS® for several weeks in multiwell plates and in microfluidic chips for more advanced models. We also observed that modifications in the matrix composition and stiffness modify the cell behavior. Moreover, thanks to collaborations with academic laboratories, we demonstrated that BIOMIMESYS® allows to reproduce in vitro the behavior of cancerous cells in vivo, like mutation effects and metastasis propagation, and could be a relevant alternative to animal models. These results showed that the matricial microenvironment modifies the cell behavior in vitro and should be considered carefully in drug discovery. BIOMIMESYS® hydroscaffold™ is adapted to High Content Screening and represented a powerful tool to better select drug candidate.
GiAN Program report: GIAN (GLOBAL INITIATIVES OF ACADEMIC NETWORK) SHORT-TERM...Saurashtra University
GIAN (GLOBAL INITIATIVES OF ACADEMIC NETWORK)
SHORT-TERM COURSE ON ‘METAGENOMICS &
MICROBIOMES’20-25 FEBRUARY 2017
UGC-CAS DEPARTMENT OF BIOSCIENCES,
SAURASHTRA UNIVERSITY, RAJKOT
The participants
enthusiastically participated in this examination and over all their performance
were very good.
In this GIAN-Short Term Course programme, the spectrum of the participants
included, faculty members, scientists from National Research Institutes, Postdoctoral scientist and Ph. D. students from various parts of the country.
Endometriosis is a painful disorder and can reduce fertility if not treated early. Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining pelvis.Endometriosis can be a challenging condition to manage.
Fertility enhancing surgeries are usually advised to young women with suspected minimal to moderate disease of tubes, ovaries or uterus.
https://www.femelife.com/ivf-fertility-care/fertility-enhancing-surgeries/
PCOS- An insight into polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age
Melatonin, a pineal hormone that regulates circadian rhythms, has also been shown to exhibit unique oxygen scavenging abilities. Melatonin supplementation in IVF may lead to better pregnancy rates. Hence role for melatonin in gamete biology is under research.
PGD combines advances in Molecular genetics and in assisted reproductive technology and is conducted before the embryo is placed inside the womb of the woman.Pre implantation genetic diagnosis was introduced to prevent the inheritance of sex linked diseases
A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Embryogenesis is the process by which the embryo forms and develops. In mammals, the term refers chiefly to early stages of prenatal development from conception to 8 weeks of pregnancy .Later it is referred to as fetogenesis
Sperm is the male reproductive cell and its main sperm function is to reach the ovum and fuse with it to deliver two sub-cellular structures called embryoOn average, each time a man ejaculates he releases nearly 100 million sperm but it takes only one to make a baby .To meet the waiting egg, semen must travel from the vagina to the fallopian tubes, a tough journey that few sperm survive.
An oocyte is a female gametocyte or germ cell involved in reproduction.It is an immature ovum or an egg
An oocyte is produced in the ovary during female gametogenesis.The female germ cells produce a primordial germ cell pgc which undergoes mitosis to form an oogonium
During oogenesis the oogonium becomes a primary oocyte
Oogenesis consists of several sub processes – oocytogenesis, ootidogenesis and the maturation to form an ovum
Folliculogenesis is a separate sub process and supports all three oogenetic sub process
Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 17/12/2017 Antral follicle size in the downregulated cycle and its relation to in vitro fertilization outcome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800930/ 2/7
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of days of gonadotropin required, basal estradiol and folliclestimulating
hormone (FSH) level, zooming of follicles, and quality of oocytes.
STATISTICAL ANALYSIS USED:
Data were analyzed using the Graphpad software with a microsoft excel spread
sheet. A Pvalue < 0.05 (Fisher exact test) was taken to be significant.
Multinomial regression tests were used as appropriate.
RESULTS:
A significant number of follicles were in the 36 mm group whereas the
population below 35 years constituted the majority. There was no significant
difference in basal estradiol and FSH levels among the three groups.
Accelerated growth of follicles (zooming) was significantly associated with
bigger antral follicles (P < 0.001) whereas poor quality oocytes were
significantly higher in Group 1.
CONCLUSION:
The significant number of poor quality of oocytes produced by such follicles
whereas zooming of follicles among the bigger antral follicle group suggest
their accelerated development potential and hence the dose of gonadotropin
should be adjusted accordingly, indicating evidence of intrinsic abnormality of
folliculogenesis in very small follicles.
Keywords: Antral follicle size, folliculogenesis, quality of oocytes, zooming
INTRODUCTION
There has been a continuous effort to provide an optimum environment for a
successful controlled ovarian hyperstimulation (COH) programme. Various
fields have been explored for this and during recent years there is increased
interest in understanding the mechanism that regulates follicular growth during
early gonadotropinindependent stages of development. Theoretically, every
primordial follicle has the potential to mature and ovulate, but this seldom
happens.[1] Folliculogenesis is a complex process in which there exists a
delicate balance between recruitment and atresia of follicles. Transition from
primordial to primary follicular stage does not show any change in the mean
diameter of the oocyte, although there is an increase in the follicular diameter,
indicating that this transition is a slow maturing rather than a growing process.
[2] Although early folliculogenesis is independent of folliclestimulating
hormone (FSH) due to lack of receptors, FSH is required to protect these
follicles from atresia. More so, by a direct or indirect action, pituitary
hormones such as prolactin, TSH, and growth hormone act synergistically with
luteinizing hormone (LH) and FSH to enhance the entry of nongrowing
3. 17/12/2017 Antral follicle size in the downregulated cycle and its relation to in vitro fertilization outcome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800930/ 3/7
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follicles into the growth phase.[3] Hence, early folliculogenesis depends on
various autocrine and paracrine mechanisms, which is difficult to interpret
accurately. However, the size of the antral follicle does reflect the internal
milieu and can predict dynamics of follicular growth. Studies have shown that
during the later luteal phase the largest healthy follicles are between 2 and 5
mm in diameter.[4] Keeping this in view, we have made an effort to relate the
antral follicular size on day 3 of the downregulated cycle to in vitro fertilization
(IVF) outcome.
MATERIALS AND METHODS
Two hundred and twentyeight patients undergoing the long protocol
programme for IVF/intracytoplasmic sperm injection at the Institute of
Reproductive Medicine and Women's Health, Madras Medical Mission, are
included, wherein eight cycles were cancelled due to poor response. The
indications for IVF were unexplained infertility, tubal factor, endometriosis,
poor ovarian reserve, and male factor infertility. All the patients were
downregulated using Lupride (250 μg 1 mg, depending on the basal LH) from
day 21 of the previous cycle and were given an oral contraceptive pill for
withdrawal bleed. Patients having persistent clear cysts were not included
whereas those with endometriotic cysts were included in the study. After 1012
days of gonadotropinreleasing hormone agonist administration, the day 3
follicular size was measured. The size of all antral follicles was measured and
the patient was allocated into a group according to the mean follicular size.
Based on the size, the patients were divided into three groups: Group I (03
mm), Group II (36 mm), and Group III (69 mm). Follicles larger than 9 mm
were not included in the study group. All the patients were scanned using
sonoline G 50 2D transvaginal probe of 7.5 MHz (siemens, germany) by a
single observer to avoid observer bias. Various parameters like age and
gynecological disorders like polycystic ovarian syndrome (PCOS) and
endometriosis were correlated with the antral follicle size. Outcome measures
taken into account were amount and number of days of gonadotropin required,
basal estradiol and FSH level, zooming of follicles, and quality of oocytes.
Zooming of follicles was defined as rapid growth in follicular size to reach 14
mm or more on day 6 of gonadotropin therapy or those follicles which were
ready by day 8 of gonadotropin therapy. Various morphological criteria were
used to define quality of oocytes at par with international standards.
RESULTS
Of 220 patients, 176 (80%) were less than 35 years of age and constituted the
majority in all three groups, whereas 178 (80.6%) had primary subfertility.
Male factor infertility accounted for 26% of the cases [Table 1]. 51.3% of the
patients had 36 mm follicles, whereas only 18% had follicles less than 3 mm.
4. 17/12/2017 Antral follicle size in the downregulated cycle and its relation to in vitro fertilization outcome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800930/ 4/7
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Very small follicles as well as larger antral follicles were found in younger age
groups, which signify that follicle size does not change with age [Table 2].
Majority of PCOS patients had larger antral follicles (P < 0.001) whereas in
patients with endometriosis, follicle size was not significantly correlated with
any group (P = 0.06) [Figure 1]. There was no significant difference in basal
estradiol and FSH levels among the three groups [Table 3]. Also, there was no
difference in the amount of gonadotropin used, as this study was double
blinded, and there was a difference in the median days of gonadotropin therapy
(Group 1, P = 0.02). Accelerated growth of follicles (zooming) was
significantly associated with bigger antral follicles (P < 0.005) [Table 4]. Poor
quality oocytes were significantly high in Group 1.
Table 1
Clinical profile of patients
Table 2
Antral follicle size in relation to age
Table 3
Relationship of basal FSH and estradiol to antral
follicle size
Table 4
Zooming of follicles in relation to antral follicle
size n = 220
Figure 1
PCOS vs endometriosis – antral follicle size Note:
In polycystic ovary syndrome, antral follicles
more than 6 mm are abundant whereas in
endometriosis, a majority are 36 mm in size
DISCUSSION
Small antral follicles measuring 26 mm have a higher correlation with age.
[5,6] However, smaller antral follicles constituted the majority of patients
irrespective of age, which probably represents the endocrine reserve in the
subfertile group.[5] In contrast, in PCOS patients, there is a cohort of
heterogeneous follicles and the bigger antral follicles actually represent the
endocrine reserve. Perhaps, the smaller follicles represent the proportion that
has undergone premature arrest and hence is associated with follicular arrest in
PCOS.[7] However, the developmental potential of oocytes derived from
5. 17/12/2017 Antral follicle size in the downregulated cycle and its relation to in vitro fertilization outcome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800930/ 5/7
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women with PCOS is normal and typically leads to a normal cumulative
conception rate.[8,9] Pohl et al., in their series of 113 patients, found that
patients with a higher number of follicles between 5 and 10 mm showed a
significantly higher pregnancy rate.[10]
Zooming of follicles was significantly higher (P < 0.001) in Group III patients
who had bigger antral follicles. There is emerging evidence for an intrinsic
abnormality of folliculogenesis in PCOS that affects the very earliest,
gonadotropinindependent stages of follicle development.[11] Although the
cause of these early abnormalities are not yet clear, it could be attributed to
abnormal serum concentration of FSH, which is suppressed below the
threshold level during early follicular phase. Aberrant dynamics of follicle
development during early stages leading to disproportionately more granulosa
cells per oocyte in transitional and primary follicles may be the cause of such
accelerated development.[11] Some authors have also proved that the granulosa
cells cultured from follicles derived from anovulatory women with PCOS are
hyperresponsive to FSH in terms of estradiol production.[12,13] It is clearly
indicated in our study that zooming of follicles is significant high (P < 0.001)
among Group III patients who had bigger antral follicles.
A significant number of poor quality oocytes (P = 0.002) among Group I could
be attributed to defective early folliculogenesis [Table 5]. Oocyte quality is
determined by the follicular environment rather than by age factors.[14] As the
very small antral follicles are not gonadotropin dependent and the number of
granulosa cells are less, the response to COH is poor in such follicles and the
mean duration of therapy is significantly high in this group.
Table 5
Oocyte quality in relation to antral follicle size
Certainly, patients with follicles <3 mm or >6 mm in the downregulated cycle
need more vigilant followup and survey. The quality of oocytes is influenced
by the internal environment of the follicle, which is reflected in its size. In an
era where the COH programme is being optimized in all respects, perhaps our
study will add a parameter to predict IVF outcome. But, conclusions could be
drawn only after following a larger series of patients.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
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