New standard for PCOS diagnosis

PCOS may be over-diagnosed by new, more sensitive ultrasounds.

A new study by French researchers suggest the diagnoses for polycystic ovary syndrome (PCOS) may be outdated.  The old criterion: more than 12 follicles per ovary, detected with ultrasound, may no longer be valid given new tools.  In their study of 240 women, Dewailly et al. found that a serum anti-Mullerian hormone (AMH) level of more than 5 ng/ml is much more predictive of polycystic ovary morphology than even a follicle number of greater than 19.

This new tool  is less expensive to perform and would be available to a greater variety of women seeking diagnosis for infertility or mentrual disorders.

Predicting pregnancy in IVF

Can pregnancy after an IVF cycle be predicted?

A new study by Ben-Haroush et al. concludes that the volume of a woman’s ovary and the
number of small follicles growing at the time of IVF treatment are significant predictors of whether the woman will become pregnant.  Women in this study with 10 or more small antral follicles (2-5 mm diameter) and an ovarian volume of greater than 1400 mm^3 had a significantly higher rate of pregnancy (58.3%) compared to women who did not (30.1%; p=0.049).

The next step will be determining whether follicle development and ovarian volume affect pregnancy likelihood, or are simply products of an already healthy environment for pregnancy.

For knee scrapes and ovulation? Hydrogen peroxide in the ovary

Shkolnik et al.‘s article caught my eye today, because of this earlier post on male factor infertility and oxidative stress.  In sperm, oxidative stress causes DNA damage and cell death.  But in ovarian follicles, reactive oxygen species (ROS)- arbiters of oxidative stress- are actually absolutely required for proper functioning.  Shkolnik et al. showed that when mouse ovaries were injected with the antioxidants BHA or NAC, LH-induced cumulus expansion was prevented (this event is essential to ovulation), LH could no longer stimulate progesterone production in these ovaries and the rate of ovulation was significantly decreased.  The addition of hydrogen peroxide (which is a ROS and is produced by normal human cells while they are active) restores the cumulus expansion event.  Who knew that stingy stuff mom brought out when you scraped your knee could be so important for fertility?

Shkolnik et al. suggest that ROS- like hydrogen peroxide, superoxide, and hydroxyl radical- which are produced in normally functioning cells but have nearly always been considered “toxic,” are not only not toxic but are important and essential for proper ovarian function.

Cytokines in ovarian follicular fluid- why are they important?

Certain cytokine profiles in follicular fluid are associated with successful assisted reproductive technology (ART) outcomes (interleukins (IL)-1, IL-1a, IL-1b, IL-12/23 (p40) and vascular endothelial growth factor (VEGF)) while others are associated with poor ART outcomes (historically, IL-12, IL-15).  What are cytokines and why are they present in follicular fluid?

Cytokines are proteins which are produced and secreted into the follicular fluid by the immune system after an immune response is activated.  Follicular fluid was previously presumed to be sterile, but Pelzer et al. show that microorganisms are present in the follicular fluids of women undergoing IVF who are fertile (male factor infertility) and infertile (due to endometriosis, PCOS, genital tract infections or currently unexplainable reasons “idiopathic”).  These bacteria and yeast could be responsible for activating the immune response which results in the presence of beneficial or detrimental cytokines in the follicular fluid.

There is no adverse outcome for having bacteria/yeast in follicular fluid.  According to the study, the fertilization rates and clinical pregnancy rates after IVF are actually significantly higher in fertile and infertile women who have the same bacteria and yeast in their vagina and follicular fluid compared to fertile and infertile women who have the flora in their follicular fluid only.  That is, when bacteria colonize the follicular fluid only, there may well be an adverse ART outcome.

Pelzer et al. found that all 16 cytokines were detectable in follicular fluid, most probably in response to bacterial colonization.  IL-6, IL-8, IL-12, IL-18, IL-10 and VEGF were associated with endometriosis, PCOS, genital tract infection or idiopathic infertility.  Women with idiopathic infertility had significantly higher levels of IL-18 in their follicular fluid compared to all other women in the study.  IL-18 may be an important candidate for further research into the causes of unexplained infertility.

more about cytokines