Oration delivered by Dr Sujoy Dasgupta at Yuvacon, conference organized by the BOGS (Bengal Obstetric and Gynaecological Society) held on 22-23 April, 2023
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered "Kamini Rao Oration" on "Are we giving much importance to AMH in infertility practice?" in East Zone Yuva FOGSI Conference organized by Imphal Obstetric and Gynaecological Society (IOGS) on 24 December, 2023
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered "Kamini Rao Oration" on "Are we giving much importance to AMH in infertility practice?" in East Zone Yuva FOGSI Conference organized by Imphal Obstetric and Gynaecological Society (IOGS) on 24 December, 2023
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Differences in the endometrial transcript profile during the receptive period between women who were refractory to implantation and those who achieved pregnancy.
By Luis Alberto Velásquez Cumplido
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Dr Sujoy Dasgupta was invited to deliver a lecture on "Male Infertility, Antioxidants and Beyond" on 3 February in Yuvacon 2024 organized by the Bengal Obstetric and Gynaecological Society (BOGS). The session was supported by UNS.
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate FOR the motion "Radical excision of DIE in subferile women with deep infiltrating endometriosis is not recommended" in ENDOGYN 2024, organized by the IAGE (Indian Association of Gynaecological Endoscopists) and the BOGS (Bengal Obstetric and Gynaecological Society) on 10 February 2024.
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in the Ultrasound Workshop of the Annual National Conference of Indian Association of Gynaecological Endoscopists (IAGE) held on 15 March 2024 at the Taj Ganges, Varanasi
Invited lecture by Dr Sujoy Dasgupta on "Azoospermia - Evaluation and Management" in a CME on "Standardising Male Factor Evaluation" organised by Indian Fertility Society (IFS) on 20 January 2024.
Male Infertility-How a Gynaecologist can Manage?Sujoy Dasgupta
Dr Sujoy dasgupta delivered an invited lecture on "Male Infertility-How a Gynaecologist can Manage?" in a CME on "New Frontiers in Infertility" organized by Genome Fertility Centre and Bhagirathi Neotia Woman and Child Care Centre, Kolkata held on 15 December 2023
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Dr Sujoy Dasgupta delivered an invited talk on "Embryo Transfer" in "Ultrasound Workshop" on 8 December 2023 at Milan, 2023, the conference of all the Obstetric and Gynaecological Societies of West Bengal. This conference was organized by Kalyani Obstetric and Gynaecological Society (KOGS).
Rational Investigations and Management of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in the annual conference of WMOGS (West Midnapore Obstetric and Gynaecological Society) held on 16 September, 2023
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
IVF- How it changed the perspective of Male InfertilitySujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk in a CME held on the World IVF Day (25 July, 2023) organized by Burdwan Obst Gynae Society and Corona Remedies.
Male Infertility- How Gynaecologists can manage?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered an invited lecture in a CME organised by JB Pharma with the support from West Midnapore Obst and Gynae Society and Genome Fertility Centre held at Medinipur on 22 July, 2023.
Role of Multivitamins & Antioxidants in Managing Male Infertility Sujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk on "Role of Multivitamins & Antioxidants in Managing Male Infertility " in a CME organized by Agartala Obstetric and Gynaecological Society and ArEx Laboratory held at Agartala on 8 July 2023
Panel discussion moderated by Dr Sujoy Dasgupta and Dr Sudip Basu on "Troubleshooting in Male Subfertility" in the Andrology Workshop organized by Special Interest Group (SIG) Andrology and Indian Fertility Society (IFS) West Bengal Chapter held on 11 June 2023 at Kolkata
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Invited lecture by Dr Sujoy Dasgupta on "Abnormal Semen- What Next" in a CME organized by HBC Life Sciences on "Fertility and Beyond" held on 28 April 2023
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Low AMH-
Is it related to Infertility?
Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons)
MS (OBGY- Gold Medalist)
DNB (New Delhi)
MRCOG (London)
Advanced ART Course for Clinicians (NUHS, Singapore)
M Sc, Sexual and Reproductive Medicine (South Wales, UK)
Consultant: Reproductive Medicine, Genome Fertility Centre, Kolkata
Managing Committee Member, BOGS, 2022-23
Executive Committee Member, ISAR Bengal, 2022-24
Clinical Examiner, MRCOG Part 3 Examination
Winner, Prof Geoffrey Chamberlain Award, RCOG World Congress, London, 2019
4. Terminology
1. Ovarian Reserve- Quantity and quality of
remaining oocytes present in both the ovaries
at a given age
2. Ovarian Responsiveness- Number of oocytes
developed/ retrieved after COH
3. Ovarian Ageing- Decline in quantity and
quality of ovarian activity because of
individualized rhythm of the “biological
clock”
5. Ovarian Reserve Tests
Commonly Used
• Age
• AMH
• AFC
• FSH
Others
• Inhibin B
• Ovarian Volume
• Ovarian blood flow
(Doppler)
• Dynamic Tests
7. Day3 FSH
FSH >15 IU/L
+
Estradiol >75 pg/ml
(>200 pmol/L)
• Cycle dependent
• Inter-cycle variation
• Single abnormal FSH-
not reliable <40 yr of
age
8. Antral Follicle Count (AFC)
• Day 2-4
• TVS- 2-9 mm follicles
• Direct measure of
cohort of follicles
capable of responding to
the stimulation
• Observer and machine
dependent
• 3-D manual and sono-
AVC- ?
• Problematic in presence
of ovarian mass
9. Anti-Műllerian Hormone (AMH)
• Secreted by granulosa cells
• Paracrine control, independent
of HPO endocrine feedback
• Correlates with AFC, FSH,
Inhibin B, E2
• Higher sensitivity and
specificity than conventional
markers
• Declines earlier than FSH
rise
11. Role of AMH in Ovarian Dynamics
• Prevention of unnecessary and excessive
recruitment of primordial follicles
• Restriction of follicular sensitivity to FSH
• Follicular Preservation
• Indirectly helping mono-follicular
development
12. Variability of AMH
La Marca A, Grisendi V, Griesinger G. How Much Does AMH Really Vary in
Normal Women? Int J Endocrinol. 2013;2013:959487.
13. Intra-Class Coefficient (ICC)
Fanchin R, Taieb J, Lozano DH, Ducot B, Frydman, R, Bouyer J. High reproducibility of serum
anti-Mullerian hormone measurements suggests a multistaged follicular secretion and
strengthens its role in the assessment of ovarian follicular status. Hum Reprod 2005; 20(4): 923–7.
15. Reproductive and lifestyle factors
affecting AMH
• Direct association of
low AMH
1. Increasing age
2. Short cycles/
Amenorrhea
3. Family history of POF.
• No correlation with
1. Smoking
2. Sleep
3. Diet
4. BMI
5. Sedentary lifestyle
6. Cell phone or laptop use
Banerjee K, Thind A, Bhatnagar N, Singla B, Agria K, Bajaj P, Jindal A, Arora S,
Goyal P, Mittal B, Malhotra K, Pai H, Malhotra J, Goel P, Jindal N. Effect of
Reproductive and Lifestyle Factors on Anti-Mullerian Hormone Levels in Women of
Indian Origin. J Hum Reprod Sci. 2022 Jul-Sep;15(3):259-271.
16. How “low” is “low”?
• No unanimous consensus
Alipour, F.G., Rasekhjahromi, A., Maalhagh, M., Sobhanian, S., & Hosseinpoor, M.
Comparison of Specificity and Sensitivity of AMH and FSH in Diagnosis of
Premature Ovarian Failure. Disease Markers, 2015;2015:585604.
17. Doroftei B, Mambet C, Zlei M. It's Never over until It's over: How Can Age and
Ovarian Reserve Be Mathematically Bound through the Measurement of Serum AMH-
A Study of 5069 Romanian Women. PLoS One. 2015 Apr 24;10(4):e0125216.
18. Rate of decline in AMH
Age (year) Mean
decline
Median
decline
Standard deviation
decline
<30 0.3
ng/ml/year
0.25
ng/ml/year
0.15
ng/ml/year
31-35 0.2
ng/ml/year
0.2
ng/ml/year
0.15
ng/ml/year
>36 0.1
ng/ml/year
0.1
ng/ml/year
0.1
ng/ml/year
Doroftei B, Mambet C, Zlei M. It's Never over until It's over: How Can Age and
Ovarian Reserve Be Mathematically Bound through the Measurement of Serum AMH-
A Study of 5069 Romanian Women. PLoS One. 2015 Apr 24;10(4):e0125216.
19. Discordance between ovarian
reserve tests
• Approximately 1/5
patients in clinical
practice had discordance
in their AFCs and AMH
levels (Zhang et al., Reprod Bio
Online, 2019)
• Laboratory vs Machine?
• Intermediate prognosis
20. AMH is assay-dependent
Li HWR, Robertson DM, Burns C, Ledger WL. Challenges in Measuring AMH
in the Clinical Setting. Front Endocrinol (Lausanne). 2021 May 24;12:691432.
21. AFC vs AMH
• The faster decline in AMH than in AFC with
age
• The reproducibility for AMH seemed much
better than for AFC.
Arvis P, Rongières C, Pirrello O, Lehert P. Reliability of AMH and AFC
measurements and their correlation: a large multicenter study. J Assist
Reprod Genet. 2022 May;39(5):1045-1053.
22. AMH vs AFC-
Evidence from Endometrioma Surgery
Younis JS, Shapso N, Ben-Sira Y, Nelson SM, Izhaki I. Endometrioma surgery-a
systematic review and meta-analysis of the effect on antral follicle count and anti-
Müllerian hormone. Am J Obstet Gynecol. 2022 Jan;226(1):33-51.e7.
23. Zhang Y, Xu Y, Xue Q, Shang J, Yang X, Shan X, Kuai Y, Wang S, Zeng C. Discordance
between antral follicle counts and anti-Müllerian hormone levels in women undergoing in
vitro fertilization. Reprod Biol Endocrinol. 2019 Jul 4;17(1):51.
AFC AMH Cycle cancellation
rate
Clinical pregnancy rate
Group A ≥7 ≥1.1 ng/ml 33.88% 43.32%
Group B ≥7 <1 ng/ml 32.94% 43.86%
Group C <7 ≥1.1 ng/ml 46.61% 23.81%
Group D <7 <1 ng/ml 68.73% 25%
AFC better than AMH for predicting POR
27. Does low AMH mean infertility?
• Prospective, time-to-pregnancy cohort study of
women (N=981) 30–44 years, trying to
conceive for ≤3 months
• Raleigh-Durham area, North Carolina
Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, Baird
DD. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older
Women of Reproductive Age. JAMA. 2017 Oct 10;318(14):1367-1376.
28. AMH is NOT the marker for “natural fertility”
Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, Baird DD.
Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of
Reproductive Age. JAMA. 2017 Oct 10;318(14):1367-1376.
29. 41 yr, undetectable AMH !!!
Fraisse T, Ibecheole V, Streuli I, Bischof P, de Ziegler D. Undetectable serum anti-Müllerian
hormone levels and occurrence of ongoing pregnancy. Fertil Steril. 2008 Mar;89(3):723.e9-11
30. Low AMH ≠ Donor oocyte
• The predictive accuracy of AMH for 1-year
CLBR in GnRH antagonist treatment cycles
was limited and did NOT yield much
additional value on top of age.
• Withholding treatment based on predictors
such as age, AMH, or combination, remains
problematic.
Hamdine O, Eijkemans MJ, Lentjes EW, Torrance HL, Macklon NS, Fauser BC, Broekmans FJ.
Antimüllerian hormone: Prediction of cumulative live birth in gonadotropin-releasing hormone
antagonist treatment for in vitro fertilization. Fertil Steril 2015; 104: 891–8.
31. Predictive power of AMH
• Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P,
Eijkemans MJ, Mol BW, Broekmans FJ; IMPORT study group. Added value of
ovarian reserve testing on patient characteristics in the prediction of ovarian
response and ongoing pregnancy: an individual patient data approach. Hum Reprod
Update. 2013 Jan-Feb;19(1):26-36.
34. Low AMH in younger women
• Retrospective cohort study
• Only patients <38 years old at time oocyte
retrieval
• Patients with AMH values in bottom 10th
%tile were compared to patients in the IQR
(25–75th %tile).
Morin SJ, Patounakis G, Juneau CR, Neal SA, Scott RT, Seli E. Diminished ovarian
reserve and poor response to stimulation in patients <38 years old: a quantitative but
not qualitative reduction in performance. Hum Reprod. 2018 Aug 1;33(8):1489-1498.
35. Morin SJ, Patounakis G, Juneau CR, Neal SA, Scott RT, Seli E. Diminished ovarian
reserve and poor response to stimulation in patients <38 years old: a quantitative but
not qualitative reduction in performance. Hum Reprod. 2018 Aug 1;33(8):1489-1498.
36. Low AMH in older women
• Retrospectively analysed
• Women aged >36 years
• Divided into two groups:
1. AMH high (= > 1.1 ng/ml, H)
2. AMH low (< 1.1 ng/ml, L)
Dai X, Wang Y, Yang H, Gao T, Yu C, Cao F, Xia X, Wu J, Zhou X, Chen L. AMH
has no role in predicting oocyte quality in women with advanced age undergoing
IVF/ICSI cycles. Sci Rep. 2020 Nov 12;10(1):19750.
37. Age rather than AMH affects the quality
of oocytes in older women
Dai X, Wang Y, Yang H, Gao T, Yu C, Cao F, Xia X, Wu J, Zhou X, Chen L. AMH
has no role in predicting oocyte quality in women with advanced age undergoing
IVF/ICSI cycles. Sci Rep. 2020 Nov 12;10(1):19750.
38. Low AMH- Young vs Older
• 296 infertile patients with AMH measured
• Younger group, aged 25-38 years
• Older group, aged 39-42 years
• AMH levels of <1.0ng/mL and ≥1.0ng/mL
were compared.
• Young women with low AMH- good
prognosis if blastocyst can be developed
Miyagi M, Mekaru K, Nakamura R, Oishi S, Akamine K, Heshiki C, Aoki Y. Live birth
outcomes from IVF treatments in younger patients with low AMH. JBRAAssist
Reprod. 2021 Jul 21;25(3):417-421.
39. AMH is a predictor of live birth among
older, but not younger, women
Miyagi M, Mekaru K, Nakamura R, Oishi S, Akamine K, Heshiki C, Aoki Y. Live birth
outcomes from IVF treatments in younger patients with low AMH. JBRAAssist
Reprod. 2021 Jul 21;25(3):417-421.
42. • A young woman with a poor response >>>
older woman with a poor response
Poor Responders ≠ Same
Oudendijk JF, Yarde F, Eijkemans MJ, Broekmans FJ, Broer SL. The poor responder in IVF: is the prognosis
always poor?: a systematic review. Hum Reprod Update. 2012 Jan-Feb;18(1):1-11. doi:
10.1093/humupd/dmr037. Epub 2011 Oct 10. PMID: 21987525.
50. Stimulation regimes for POR
High dose Gn No benefits >300 IU FSH
GnRH Agonist protocols
Long protocol Oversuppression
Short protocol (Flare-up) Theoretically less suppression
Microdose flare up protocol Cost-friendly
Ultra-short protocol Not much benefit
Cessation/ Stop protocol No additional advantage
GnRH Antagonist protocols
Flexible vs fixed protocol Most widely used
GnRH Agonist-antagonist protocol Not much benefit
Natural cycle Not recommended
Modified natural cycle Not recommended
Mild stimulation protocol
CC/ letrozole + Gn + Antag No additional benefit
Luteal phase stimulation No additional benefit
Dual stimulation Needs further studies
51. Does low AMH mean increased
risk of pregnancy loss?
52. Serum AMH- a marker of RPL?
• RPL patients demonstrated AMH levels
significantly lower than the normal population,
both in women aged ≤35 years (p<0.004), and
those aged >35 years (p>0.03).
Catherine D. McCormack, Shalem Y. Leemaqz, Denise L. Furness, Gustaaf A.
Dekker & Claire T. Roberts (2019) Anti-Müllerian hormone levels in recurrent
embryonic miscarriage patients are frequently abnormal, and may affect
pregnancy outcomes, Journal of Obstetrics and Gynaecology, 39:5, 623-627
53. Low AMH does NOT increase risk of
pregnancy loss after IVF-ICSI
• Retrospective cohort
study on 1383 women
undergoing their first
IVF/ICSI cycle in
Finland
Peuranpää P, Hautamäki H, Halttunen-Nieminen M, Hydén-Granskog C, Tiitinen
A. Low anti-Müllerian hormone level is not a risk factor for early pregnancy loss
in IVF/ICSI treatment. Hum Reprod. 2020 Mar 27;35(3):504-515.
54. Low AMH was associated with embryo
aneuploidy ONLY ≥35 years age
• Retrospective study of 422 IVF cycles of 394 unexplained
RPL patients undergoing PGT-A,
• Divided on AMH levels
1. Group 1: low AMH <1.50 ng/ml
2. Group 2: normal AMH 1.50– < 5.60 ng/ml
3. Group 3: high AMH ≥ 5.60 ng/ml
• Aneuploidy was significantly higher in the low AMH group
compared with that in the normal AMH group (P1vs2 = 0.002)
and high AMH group (P1vs3 = 0.015).
• After age stratification, embryonic aneuploidy rate was still
significantly different among AMH groups with a similar trend
in women ≥35 years old (P1vs2 = 0.025, P1vs3 = 0.035), but not
in young subjects
Jiang X, Yan J, Sheng Y, Sun M, Cui L, Chen ZJ. Low anti-Müllerian hormone
concentration is associated with increased risk of embryonic aneuploidy in women
of advanced age. Reprod Biomed Online. 2018 Aug;37(2):178-183.
56. AMH- earlier predictor of POF
AMH Day3 FSH
Sensitivity 80% 29%
Specificity 79% 79%
PPV 17% 17%
NPV 99% 87%
Diagnostic
accuracy
79% 72%
Alipour, F.G., Rasekhjahromi, A., Maalhagh, M., Sobhanian, S., & Hosseinpoor, M.
Comparison of Specificity and Sensitivity of AMH and FSH in Diagnosis of
Premature Ovarian Failure. Disease Markers, 2015;2015:585604.
57. AMH is highly predictive for timing of menopause
Broer SL, Eijkemans MJ, Scheffer GJ, van Rooij IA, de Vet A, Themmen AP, Laven JS, de
Jong FH, Te Velde ER, Fauser BC, Broekmans FJ. Anti-mullerian hormone predicts
menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab.
2011 Aug;96(8):2532-9
60. See the overall scenario
• Age
• Duration of trying for pregnancy
• Previous treatment received
• Tubal factor
• Male factor
• Other pathologies- endometriosis, fibroid,
hydrosalpinx etc
• What the couple wants
61. Low AMH and ………..
Tube block in HSG
• IVF rather than
laparoscopy
Tube, semen normal
• Unexplained
subfertility
(ASRM, 2020)
Male factor
• Not to do repeated IUI
cycles
63. Endometriosis- the biggest confusion
• In endometriosis, with
and without a history of
ovarian surgery, ovarian
reserve markers were
worse (lower AMH and
higher FSH) compared to
women with male factors
Romanski PA, Brady PC, Farland LV, Thomas AM, Hornstein MD. The effect of
endometriosis on the antimüllerian hormone level in the infertile population. J
Assist Reprod Genet. 2019 Jun;36(6):1179-1184.
64. Endometrioma-related reduction in
ovarian reserve (ERROR)
Kasapoglu I, Ata B, Uyaniklar O, Seyhan A, Orhan A, Yildiz Oguz S, Uncu G.
Endometrioma-related reduction in ovarian reserve (ERROR): a prospective longitudinal
study. Fertil Steril. 2018 Jul 1;110(1):122-127.
65. Endometriosis- surgery or not
Yılmaz Hanege B, Güler Çekıç S, Ata B. Endometrioma and ovarian reserve: effects of
endometriomata per se and its surgical treatment on the ovarian reserve. Facts Views
Vis Obgyn. 2019 Jun;11(2):151-157.
67. • In women identified as poor responders
undergoing ART, pre-treatment with DHEA or
testosterone may be associated with improved
live birth rates.
• The overall quality of the evidence is moderate.
• There is insufficient evidence to draw any
conclusions about the safety of either androgen.
• Definitive conclusions regarding the clinical role
of either androgen awaits evidence from further
well-designed studies.
Role of DHEA
Nagels HE, Rishworth JR, Siristatidis CS, Kroon B. Androgens
(dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction.
Cochrane Database Syst Rev. 2015 Nov 26;(11):CD009749
70. Unanswered questions?
• ICSI for all ?
• Ideal day of transfer-
D3/D5?
• PGT for all?
• Oocyte pooling and
embryo banking?
• In vitro activation of
oocytes (IVA)
• Mitochondrial transfer
• Intraovarian PRP
71. Social egg freezing-
race against time?
• Often perceived (and
promoted) as a form
of insurance
• Success rates will be
limited in women
who are already in
their mid–late 30s
• Significant costs
• Low fecundity rate
72. Donor oocyte
• Repeated IVF failure
• High FSH and low AMH
( how high is high and how low is low)
• Counselling
73. Conclusion
• AMH predicts ovarian response
• AMH can help in decision making
• AMH cannot predict egg quality, pregnancy, live birth
• Low AMH ≠ Egg donation
• Low AMH ≠ IVF
• See the overall scenario
• Can offer adjuvant (DHEA) but do NOT delay active
treatment
• Best stimulation protocol?
• Unconventional protocols in IVF need further studies
• Overall prognosis may be guarded for low AMH + age
>35
The ICC is the ratio of the interindividual variability over the total variability. Hence the higher the ICC, the lower the intraindividual variability. Both studies concluded that 89% of the variation in AMH was due to between-subject variation, while only 11% of variability was secondary to individual fluctuation in AMH levels (Figure 4).
| Poseidon criteria of low prognosis patients in ART. Four distinct groups of low prognosis patients can be established based on quantitative and qualitative
parameters, namely: 1. The age of the patient and the expected embryo aneuploidy rate; 2. Ovarian biomarkers (antral follicle count [AFC] and/or anti-Müllerian
hormone [AMH]), and 3. The ovarian response of the patient in terms of oocyte quantity provided a previous cycle of stimulation was carried out. Art drawing by Chloé
Xilinas, EXCEMED, Rome, Italy. Adapted from Esteves et al