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A new study by French researchers suggest the diagnoses for polycystic ovary syndrome (PCOS) may be outdated.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.

Female fertility and BPA

Mice are often used as a model for human fertility- especially when researchers study the effects of chemicals on fertility.  Bisphenol A (BPA) is a chemical that is leached from epoxy resins and plastics.  Peretz et al. found that antral follicles (follicles that have developed to be ovulated) from adult mouse ovaries exposed to BPA have inhibited growth and lowered levels of progesterone, DHEA, ADSD, E1, testosterone and estradiol.  This indicates BPA interferes with estrogen biosynthesis in the ovary.

A new study presented by Singh et al. at The Endocrine Society’s Annual Conference this year indicates BPA also lowers sperm counts and serum testosterone in male mice.  This study is not yet published.

Sparing fertility in women with borderline ovarian tumors

Two studies came out this week on the safety of treating borderline ovarian tumors (BOTs) with fertility-sparing surgery (Song et al. and Cabenda-Narain et al.).

BOTs are tumors on the surface of the ovary (the ‘epithelium’) that have some characteristics of malignancy, but have been caught early.  Fertility-sparing surgery involves excising the tumor while leaving the ovary intact and in place.

In the case study of four women who were treated with fertility-sparing surgery and then underwent IVF, BOT disease recurrences occurred both prior to and after IVF (Cabenda-Narain et al.).  However, the women were all alive and disease-free at study conclusion.

In Song et al.‘s paper of 298 women undergoing radical or fertility-sparing surgery for borderline ovarian tumors between 1997-2009, the rate of recurrence was much lower (4.9% and 7.7%).  And, 88.2% of patients in the fertility-sparing group who attempted to conceive, were successful.

These studies suggest methods for sparing fertility can be used in cases of women with BOTs who may wish to conceive in the future.   Discuss the options with your patients or your care provider.

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.