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Μικροβίωμα ενδομήτριου
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Endometrial microbiome

A large percentage of women cannot achieve pregnancy through IVF despite the transfer of good quality or chromosomally normal (after performing a preimplantation genetic diagnosis) embryos. Knowing that the quality of embryos is the main factor of implantation, in the case of failed implantations the environment of the intrauterine cavity should also be investigated.

What is the endometrial microbiome?

The endometrial microbiome is defined as the total number of microbes that live and grow in the endometrium. The existence of microbes in the endometrium should not be surprising, since microorganisms are found all over the human body, which collectively are called the microbiome of the human body. The bacteria of the microbiome help the proper functioning of the specific organ.

Although for several years it was a strong belief that the uterus was a sterile, germ-free environment, it has now been proven that this is not the case. Thus, the endometrium is colonized by microorganisms that contribute to its proper functioning and to the protection of the uterus from various infections. In addition, in cases of pregnancy it helps in the successful implantation of the embryo and later on in the formation of the placenta.

 

How does the endometrial microbiome contribute to infertility ?

The endometrium is normally colonized only by lactobacilli, which have a protective role. If the microflora of the endometrium is disturbed from other microorganisms, then various gynecological problems are caused such as endometritis, pelvic inflammatory disease (PID), endometrial cancer, but also infertility leading to failed embryo implantations and subsequent miscarriages. A dysbiotic environment in the endometrium, even if it leads to a successful, implantation cannot create the appropriate conditions for the development of the embryo. The endometrium must be absolutely healthy to achieve pregnancy in cases of assisted reproduction.

 

Endometritis & Infertility

As mentioned above, disorders of the endometrial microbiome can cause endometritis. Endometritis is a chronic inflammation of the uterine cavity.This inflammation causes a decrease in the receptivity of the uterus and reduces the number of fertile days. Also, chronic endometritis affects the intensity of uterine contractions, which makes it impossible for the embryo to implant.

 

Microbiome: How is it collected and tested?

The sample of the endometrial microbiome is collected either with the help of a biopsy in office basis or during a diagnostic hysteroscopy. The sample collection at the physician’s office must take place on a specific day of the cycle. Subsequently, a molecular examination of the microbiome is carried out for both the qualitative and quantitative determination of the microbes that consist the microflora of the endometrium.

 

In which cases should the endometrial microbiome be examined?

The study of the endometrial microbiome is one of the most modern ways of investigating a couple’s infertility. The endometrial microbiome should be examined in the following cases:

  • Presence of unexplained infertility
  • Recurrent UTIs caused by Ureaplasma or Chlamydia
  • Repeated early miscarriages
  • Repeated failures to implant good quality embryos

 

Treatment of endometrial microbiome disorders

If and when the examination of the microbiome endometrium indicates dysbiosis, the administration of antibiotic treatment is necessary. In addition to antibiotic treatment, probiotics can be administered, aiming to to strengthen the microbiome in the case of poor growth.

 

Endometrial microbiome examination provides several answers in cases of investigation of female fertility. The Obstetrician-Gynecologist Melina Stasinou, having extensive experience and expertise in Microsurgery of Female Reproduction and assisted reproduction, is available for any question regarding the microbiome of the endometrium. Dr. Stasinou prioritizes the needs of her patients and applies the most modern and safe protocols for treating female infertility. Contact us and book your appointment.

Any disturbance in the composition of the microbiome ( lack of lactobacillus) can lead to chronic or acute infection of endometrium, called endometritis. This can impair the implantation of embryos and can result in recurrent miscarriages.

 

Endometritis is the chronic inflammation that develops inside the uterus and can cause the following :

  • Decreased uterine receptivity
  • Failed embryo implantations

 

The sample is collected on a specific day of the cycle either through a pipelle biopsy in a private practice, or through a diagnostic hysteroscopy. After collection, the sample is molecularly tested for the quality and quantity of microbes (IGENOMIX SPAIN)

When the following are observed :

  • Presence of unexplained infertility
  • Recurrent UTIs caused by Ureaplasma or Chlamydia
  • Repeated early miscarriages
  • Repeated failures to implant good quality embryos

 

The specialized Obstetrician-Gynecologist will administer antibiotic treatment and personalized probiotic preparations to immediately remove microbes that do not belong to the endometrium and to improve the existing microbiome.

March 29, 2023

ήπια διέγερση ωοθηκών
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Mild ovarian stimulation

Mild ovarian stimulation (mild IVF) aims to protect egg quality and to enhance the fertilisation and the implantation of the embryo created by reducing the impact of increased doses of stimulation drugs on the health of the woman. Thus, it offers an alternative solution to conventional IVF protocols.

 

Which women are suitable for mild ovarian stimulation?

Women who can undergo the process of mild ovarian stimulation are those who face infertility problems and who have enough follicles according to their age group, so that small doses of stimulation lead to optimal recruitment of eggs, which do not exceed 5-7 eggs per cycle. It is also the appropriate way to treat women who have a limited number of follicles and are of advanced age > 39 years old.

 

Mild ovarian stimulation: What is its main advantage?

Mild ovarian stimulation, as mentioned above, is a form of assisted reproduction protocol. According to mild ovarian stimulation protocols, a smaller dosage of gonadotropins is administered for follicular recruitment compared to conventional protocols. The daily dose is ≤150 IU/day.

Avoiding the manifestation of Ovarian Hyperstimulation Syndrome (OHSS) is the main advantage of mild ovarian stimulation. The Ovarian Hyperstimulation Syndrome occurs when, due to the administration of gonadotropin, the ovaries produce too many eggs, which are non-viable. In case of a severe form, the woman needs hospitalization to treat the syndrome.

 

Are there other benefits to mild ovarian stimulation?

Following the dictates of nature, while the ovary grows one follicle every month, mild ovarian stimulation aims to produce more but not excessive in order not to compromise the quality of eggs.. In addition, its cost is lower and it helps avoiding side effects that can affect a woman’s daily life.The treatment is taken for a short period of time (6-8 days), contrary to the conventional IVF (2-4 weeks).

 

Mild ovarian stimulation and research data

The success rates of mild ovarian stimulation are spectacular. Better egg quality also increases the chances of successful fertilisation, better progression of embryos and also more changes for successful implantation.In contrast, eggs resulting from conventional IVF, although more numerous, are often rejected before implantation and can lead to more frequent 1st trimester miscarriages, as the percentage of abnormal eggs also increases. In addition, by studying the reactions of the eggs of women over 40, it was observed that they respond better to mild stimulation than to conventional IVF.

Nowadays, gynecology has many ways to eliminate factors of infertility. The goal of mild ovarian stimulation is to achieve a pregnancy in a healthy body.

If you face infertility problems, contact an experienced gynecologist, such as Dr. Melina Stasinou. Every woman’s fertility journey is unique. Therefore, proper and individualized guidance from specialized reproductive scientists is of paramount importance.

The Obstetrician-Gynecologist Melina Stasinou has been a Research Associate at Imperial College’s Extracorporeal Unit in London and continues to supervise cases at London’s largest clinic specializing in mild ovarian stimulation (CREATE FERTILITY). What characterizes her is the individualization of treatment and the holistic approach to infertile couples. Contact us for any question or clarification regarding mild ovarian stimulation.

February 22, 2023

Αποτυχημένη εμφύτευση εμβρύου
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Factors of failed embryo implantation

There are numerous factors that can impair the implantation of the embryo after an embryo transfer procedure in IVF.

 

What does “failed embryo implantation” mean?

Repeated embryo implantation failure is determined when transferred embryos fail to implant following several in vitro fertilization treatment cycles. However, there no formal criteria defining the number of IVF cycles or the number of embryos transferred after each attempt.

 

Failed Embryo Implantation: What Factors Affect It?

Successful embryo implantation is characterized as multifactorial.

  • Hormonal changes: some unforeseen hormonal changes in the woman’s body can prevent the implantation of the embryo and consequently the achievement of pregnancy (thyroid disease, hyperprolactinemia, progesterone insufficiency)
  • Congenital or acquired anatomical anomalies: In general, congenital anatomical anomalies of the uterus are already known. Thus, health professionals take preventive measures in advance. However, there are also cases of acquired anatomical anomalies such as fibroids and polyps that interfere with the implantation of the embryo.
  • Endometrial thickness: The endometrium may exhibit reduced acceptability if it does not have the appropriate thickness or if there have been previous medical interventions that have affected its acceptability.
  • Endometrial infections: Bacterial or viral infections of the endometrium may contribute to the failure of the embryo to implant.
  • Disorders of the immune system that can reject the embryo.
  • Disorders of blood coagulation which impair blood circulation at the time of implantation.
  • Chromosomal abnormalities of the couple: The chromosomal abnormalities of the couple may or may not be known. Also, the embryo to be implanted may also display some of them, either transferred by the parents or by its own. Chromosomal abnormalities occur after fertilization and cannot be predicted. An increased chance of chromosomal abnormalities exists when the mother is older than 37 years.

 

What should I do if I have many failed IVFs?

Unfortunately, the IVF procedure also involves some chances of failure. However, if you have undergone several IVFs without success, you should refer to an experienced obstetrician-gynecologist with further expertise in recurrent implantation failures.

Each failed implantation should be thoroughly investigated and it must be determined which of the above-mentioned factors are responsible for its failure. Determining the factors that make implantation difficult is the A’s and Z’s for your next IVF attempt.

Also, the couple must be informed by the obstetrician-gynecologist about the factors that inhibit the achievement of pregnancy. Then, the appropriate IVF plan should be designed to achieve pregnancy using other available methods to enhance the implantation chances of the embryo.

Failed embryo implantation occurs frequently. Therefore, every woman who experiences “failure” should not be disappointed. The chances of achieving a pregnancy are definitely more than the chances of failure.

The Obstetrician-Gynecologist Dr. Melina Stasinou has extensive experience in assisted reproduction methods and has specialized and worked in specialized clinics that apply the most modern methods. Beyond her vast experience, what distinguishes her is her empathy and her goal to help women experience motherhood. Do not hesitate to contact the physician for any question you may have about assisted reproduction.

  • Hormonal changes (thyroid disease)
  • Congenital or acquired anatomical abnormalities
  • Chromosomal abnormalities of the intent parents
  • Immune system disorders
  • Blood coagulation disorders (increased thrombotic risk factor)
  • Acute or chronic infections of the endometrium
  • Thin endometrium
  • Advanced female age

 

No, because after every failed implantation, the obstetrician-gynecologist thoroughly examines the factors that could contribute to the failure of the implantation.

 

  • Study and determination of the factors that contributed to the failure.
  • Design of an individualized plan for ovarian stimulation and embryo implantation
  • Clear and effective communication with the couple is one of the most important steps!
December 14, 2022

Εξωσωματική γονιμοποίηση
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IVF

Modern medicine has managed to eliminate the barrier of infertility with a number of modern methods. In vitro fertilization is a technique of assisted reproduction and has brought smiles to couples who were facing the problem of infertility.

 

 

What is IVF?

In vitro fertilization, as its name suggests, is a method of assisted reproduction in which fertilization takes place outside the woman’s body. More specifically, the egg is fertilized with sperm in a laboratory by highly experienced scientists.

 

What factors lead to IVF?

When a couple has been trying to conceive naturally for over 12-18 months without success, then they should start investigating the possible underlying factors that could impair conception. In cases where the woman is older than 35 years, then the investigation should start earlier, within 6 months. In view of this, the couple must visit a gynecologist specialized in assisted reproduction techniques. Based on the couple’s medical history and the cause of infertility, the attending physician will suggest the appropriate method of assisted reproduction.

 

Infertility factors

Either the man or the woman can be responsible for the difficulty in normal conception. More specifically, causes of female infertility are:

  • Poor egg quality
  • Endocrinological problems
  • Endometriosis
  • Chronic or acute infections of gynaecological system
  • Hormonal problems
  • Early menopause
  • Anatomical problems
  • Unexplained infertility
  • Age

On the other hand, there are also some factors that contribute to male infertility. More specifically:

  • Chronic infections
  • Presence of varicocele
  • Obstruction or absence of the seminal ducts
  • Low motility or low sperm count

 

What are the steps of IVF?

IVF consists of several steps. These steps must be followed precisely aiming to achieve conception. More specifically:

Step 1: Stimulation

Tailored protocol of stimulated drugs is prescribed to the woman, which are called fertility drugs. These drugs trigger the ovaries to produce more than one egg each month.

Step 2: Egg retrieval

Eggs are then retrieved from within the woman’s body in a minor procedure called egg retrieval. With a fine needle inserted into the vagina, the gynecologist retrieves the eggs from the woman’s ovaries under mild anesthesia.

Step 3: Fertilization

The sperm is combined with the mature eggs retrieved in a controlled chamber. Usually, a few hours later fertilization takes place.

Step 4: Embryo culture

After successful fertilization, the zygote ( embryo) divides into multiple cells and becomes an embryo. Specialist staff check if the embryos are developing properly for a few days.

Step 5: Embryo transfer

The physician inserts the embryo into the woman’s uterus through a thin catheter. If the embryo implants in the uterine area, then a successful pregnancy will be confirmed by a blood test a few days later.

 

Methods and Techniques of IVF

Depending on the circumstances, the obstetrician-gynecologist will recommend the most suitable treatment to the couple.

  • Classic IVF: Classic IVF is applied in cases where the sperm is good, the number of eggs is high and it is the woman’s first IVF attempt.
  • Intracytoplasmic sperm injection (ICSI): Intracytoplasmic sperm injection is chosen in cases where we have limited number of eggs, the sperm is abnormal or there are previous failed attempts of classical in vitro fertilization.

 

In vitro fertilization: Success factors

The success rate of IVF depends on many factors. More specifically, the age of the woman plays a decisive role. The younger a woman is, the more likely the method is to succeed. In addition, the quality of the eggs and sperm used for fertilization plays a significant role.

The Obstetrician – Gynecologist Melina Stasinou, having extensive experience in assisted reproduction protocols and operations, will prepare a holistic personalized  plan for a successful IVF journey.

Do not hesitate to contact the physician for any question or clarification regarding IVF.

  • When the couple has been trying to conceive naturally for more than 18 months.
  • When there is a sperm problem
  • When there is female pathology that prevents normal conception ( tubal factor)
  • When genetic material has been cryopreserved in the past

 

  • Poor egg quality
  • Endometriosis
  • Early menopause
  • Advanced age of the woman
  • Hormonal problems
  • Chronic pelvic inflammations
  • Anatomical problems
  • Endocrine problems
  • Fallopian tube obstruction

 

  • Chronic infections
  • Varicocele
  • Low sperm motility
  • Low sperm count
  • Obstruction or absence of seminal ducts

 

At first, the patient receives fertility drugs for ovarian stimulatio so that more eggs can develop than the normal number (1-2) of the female cycle. The eggs are then retrieved through oocyte retrieval procedure. Fertilisation happens after the collection of the eggs by leaving sperm and eggs alone in a controlled chamber for fertilization to take place (best sperm to penetrate through the egg wall). After fertilization, the division of the embryo begins and it is monitored for a few days by specialized personnel. Finally, it is transferred through a special catheter to the mother's uterus.

  • In vitro fertilization (IVF)
  • Intracytoplasmic sperm injection (ICSI)

  • Woman's age
  • Sperm quality
  • the ovarian reserve
  • Underlying pathology (endometriosis, PCOS, inflammations)

 

November 23, 2022

Δότρια ωαρίων
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Egg donor

Primary infertility is the inability for a couple to achieve a pregnancy after 12-18 months of trying to conceive. Female problems can contribute to 30% of primary infertility and can impair or limit the possibility to reach the desired goal of conception, even through multiple IVF attempts. In cases where the woman is responsible of primary infertility, another woman can “donate” her eggs and become an egg donor.

Egg donation is a legal procedure that has enabled many mothers to experience the blessing of motherhood.

 

Which women turn to egg donation?

There are women who realize that it would be extremely difficult or even impossible to conceive with their own eggs. There are various reasons for this. The most important are:

  • Absence of ovaries
  • Women underwent chemotherapy or radiotherapy
  • Women with early menopause or in perimenopause
  • Women who have a low ovarian reserve or have had repeated failed IVF attempts using their own gametes
  • Women with chromosomal abnormalities
  • Women with rare genetic diseases who do not want to pass on the gene to their child
  • Women over 44 who have difficulty conceiving regardless of the cause of infertility.

 

Egg donor: How to choose the perfect candidate

The prospective egg donor must meet certain conditions. In particular, she should be between 18 and 35 years old. The donor can be older only in cases where the donor is related to the recipient. In addition, she must have a normal medical history and her clinical tests, as prescribed by law, must be within normal limits. Sometimes psychometric tests are also carried out, which aim to check the mental health of the egg donor.

 

Procedure

In the first stage, the egg donor undergoes a controlled ovarian stimulation protocol. For this stage injectable hormones (FSH and LH) will be used , as in the IVF process.

As soon as the tests show that enough follicles have been produced, the egg retrieval is performed. The eggs can be cryopreserved for future use if no couple has been identified or on the day of the egg collection, the husband gives a sample of his sperm, which together with the donor’s eggs is placed in a special tube, in which the incubation will take place. Within twenty-four hours, the number of eggs that have been fertilized will be known and after 3-5 days the embryo is transferred to the recipient. After ten days of the embryo transfer procedure, the recipient is tested to determine whether or not pregnancy has been achieved.

The Obstetrician – Gynecologist Melina Stasinou, having great experience and expertise in Microsurgery of Female Reproduction, is at your disposal for any question you may have regarding egg donation. Respecting each woman and her needs, she will properly advise you on the method that suits you, after the personalized diagnosis of your problem.

Do not hesitate to contact the physician for any question or clarification regarding egg donation.

ΕΘΝΙΚΗ ΑΡΧΗ ΥΠΟΒΟΗΘΟΥΜΕΝΗΣ ΑΝΑΠΑΡΑΓΩΓΗΣ:

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Νόμος 4958 | 07/2022
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    November 17, 2022

    ωορρηξία
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    All you need to know about ovulation

    What is ovulation?

    A woman’s menstrual cycle is a set of complex processes regulated by endocrine factors that ensure the possibility of reproduction.

    Ovulation is a very important event of the menstrual cycle which triggers a sequence of events leading to final implantation of the embryo. Ovulation is the process by which the ovary releases an egg, which is received by the fallopian tube to initiate the union with the sperm. The fertilization occurs inside the ampulla of the fallopian tube and leads to the creation of a zygote, a fertilized egg. At the blastocyst stage of development, the embryo can be implanted to the endometrium leading to a pregnancy. If it is not implanted, then it is eliminated through menstruation.

    When does it happen?

    The day of ovulation is not fixed, and it varies between the female population according to the length on the menstrual cycle. In general, ovulation occurs about 13-15 days before the beginning of the next menstrual cycle. However, the time of ovulation can vary every month and if the cycle is not regular or longer than 35 days then there is an increased possibility to be anovulatory cycle. In short, ovulation reveals the fertile period of a woman that usually lasts for 12 to 24 hours. Finally, it should be noted that there is a case of two or three ovulations in a cycle, while there is the possibility of releasing multiple eggs during ovulation.

    How does ovulation work?

    The first stage of ovulation begins with the release of a hormone from the body, the follicle-stimulating hormone (FSH). The release of this hormone serves to mature the egg in the ovary until it is released from it. The egg is then released from the follicle and received by the fallopian tube. The egg has a margin of about 12-24 hours to be fertilized by the sperm in the fallopian tube. In case of fertilization, it is directed to the uterus during the next 5-6 days for implantation, marking the beginning of pregnancy.

     

    What are the most common symptoms of ovulation?

    1.   Mild abdominal pain

    2.   Mild vaginal edema

    3.   Changes in vaginal secretions and increased mucus

    4.   Mild differences in body temperature

    5.   Changes in the cervix

    6.   Increased libido

     

    Can ovulation be predicted and in what ways?

    Ovulation can be predicted by various methods in the efforts to conceive naturally:

    First, monitoring the duration of the cycle and the frequency of menstruation is necessary:

    1.   Through observation of the changes in your body, including temperature and cervical mucus.

    2.   Through follicular monitoring and hormonal blood tests in a fertility clinic (estradiol, luteinizing hormone, and progesterone)

    3.   Through ovulation testing. These are urine tests, which you can easily get from a pharmacy, and which are considered quite reliable and trustworthy.

    4.   Finally, if you want to be sure and need a scientific and thorough opinion, it would be good to have an ovulation ultrasound with your gynecologist.

     

    Can ovulation be induced artificially?

    The answer is yes. It is possible for the ovulation process to be induced by administrating fertility drugs which promote maturation of the egg on the proper time of follicular growth.

    Are there any diseases that can disrupt ovulation?

    In case a woman suffers from certain diseases or syndromes, there is the possibility of infertility or difficulty in conceiving, even during ovulation. The most common diseases include:

    •    Endometriosis

    •    Tubal obstruction

    •    Polycystic ovarian syndrome

    •    Hypothalamic dysfunction

    •    Hyperprolactinaemia

    •    Premature Menopause (Primary Ovarian Failure)

    In case you are having difficulty conceiving, the specialist and experienced obstetrician – gynecologist, Dr. Melina Stasinou, shall be by your side to advise you, but also to suggest the solutions that suit your problem.

    June 28, 2022

    προεμμηνορρυσιακό σύνδρομο
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    The Premenstrual Syndrome in women of reproductive age

    What is the Premenstrual Syndrome (PMS) and when does it occur?

     

    The Premenstrual Syndrome (PMS) is defined as the set of symptoms -emotional and physical- that occur in a woman a few days or up to two weeks before menstruation.

    It is estimated that 80% of women of childbearing age experience one or more of the premenstrual symptoms. Most women do not suffer from symptoms that can affect their quality of life, as they disappear after the onset of menstruation. However, for a group of women, the symptoms can significantly disrupt their routine. In the case of severe emotional symptoms, we are dealing with the condition described as Premenstrual Dysphoric Disorder (PMDD).

     

    Premenstrual Syndrome Symptoms

    As mentioned above, the symptoms are classified as physical and emotional. The following symptoms effect women physically:

    •          Bloating

    •          Breast tenderness

    •          Headache

    •          Aches and joint pain

    •          Edema of hands and feet

    •          Acne

    •          Fatigue

    •          Craving for carbs and sugar

    •          Nausea

    •          Weight gain

    •          Tachycardia

    •          Abdominal pain

     

    On the other hand, emotional symptoms include the following:

    •          Irritability

    •          Anxiety

    •          Lack of concentration

    •          Depression

    •          Mood swings

    •          Insomnia or drowsiness

    •          Changes in sexual drive

    •          Low libido

     

    It is worth mentioning that there are conditions ehich imitate the Premenstrual Syndrome symptoms. Diagnosis of these conditions is difficult before menstruation, as their existence is confused with the symptoms of PMS. However, these are situations that continue throughout the menstrual cycle, in contrast to PMS.

     

    Causes and underlying factors

     

    The exact causes of the Premenstrual Syndrome are not known. Certainly, changes in hormonal levels during the cycle affect the onset of symptoms and there are clearly variations in their manifestation in the female population. It has been observed that low levels of progesterone, in combination with elevated estrogen levels are responsible for the mood swings during the days leading up to menstruation.

    Factors that can worsen the symptoms include increased caffeine and alcohol consumption, smoking, increased stress levels, family history and co-existing depression. Nutrition also plays an important role, especially when there is a reduced intake of vitamins and other elements, such as magnesium and vitamin E.

     

    Natural ways of relief and prevention

    Wellness and a healthy lifestyle that combines exercise and a balanced diet can alleviate the onset of PMS. Low glycemic index foods such as whole grain carbohydrates, fiber rich foods, vitamin B6 and magnesium can help reduce severe symptoms.

    For more information about the Premenstrual Syndrome and the treatment of the symptoms that severely affect your daily life, consult the obstetrician-gynecologist Dr. Melina Stasinou.

    June 28, 2022

    αντιμυλλέριος ορμόνη
    BLOG
    Anti-Müllerian Hormone

    What is the anti-müllerian hormone?

    The anti-müllerian hormone (AMH) is a glycoprotein that belongs to the family of the transforming growth factors TGF–β, which are involved in the differentiation and follicular development. In women, AMH is produced by the granulosa cells of the small follicles (<6 mm). Hormone production decreases as the follicles increase in size and is not detected in follicles larger than 8 mm. It is detected at high levels in the reproductive age and starts to decrease at the age of 35. In women, before adolescence and after menopause, it cannot be detected. The anti-müllerian hormone can  be used to assess the ovarian reserve.

    Clinical utility of AMH

    Infertility marker: The anti-müllerian hormone acts as a hormonal marker by assessing the ovarian reserve. According to the levels of AMH, the physician will choose the best stimulation protocol by adjusting the ovarian stimulation according to its level, avoiding over response and reducing the chances of developing ovarian hyperstimulation syndrome.

    Ovulation Assessment Index: AMH can detect ovarian dysfunction. It is a useful indicator for the monitoring of polycystic ovary syndrome (PCOS), as well as the premature ovarian failure. Decreased hormone levels can predict ovarian aging and the IVF success rates.

    Ovarian Failure Index: It concerns young women. In this case, AMH can detect damage to the ovaries and the reduction of ovarian reserve.

    Tumor marker: Ovarian cancer increases the levels of the anti-müllerian hormone, so AMH is used as a tumor marker. Decreased hormone levels indicate a positive response to treatment, while elevated levels indicate a chance of cancer recurrence.

     

    AMH LEVELS AND RATES FOR SUCCESSFUL IVF

    Women with high levels of AMH have a better response to ovarian stimulation and more eggs collected during oocyte retrieval, which makes IVF more successful.

    The levels of AMH do not give information about the quality of the eggs, especially when the woman is young and less than 35 years old, however the AMH levels are consistent with the number of eggs retrieved.

    Research on the use of AMH as a prognostic factor for the outcome of IVF has shown:

    ·        High rates of AMH are associated with lower rates of cancellation of ovarian stimulation cycles, with more eggs being retrieved, higher pregnancy rates and an increased possibility of freezing additional embryos for future use.

     

    ·        Low AMH levels are not a prognostic factor for the outcome of IVF for women <35 years old

     

    ·        Infertile couples with low AMH levels should not be excluded from trying to conceive through in vitro fertilization process as pregnancies can occur even with low AMH, always depending on the female age.

    For more information about the anti-müllerian hormone (AMH) and what information it provides in your case, contact the Obstetrician-Gynecologist, Dr. Melina Stasinou.

    June 27, 2022

    stress και υπογονιμότητα
    BLOG
    Stress and Infertility

    Infertility can significantly impact on a couple’s life. It can affect the relationship of partners, their sex life, but also their relationships with the social environment. Research conducted on women with infertility, cancer, heart disease and AIDS showed that women with infertility problems had the same levels of stress as women with other conditions.

     

    How does stress affect fertility?

    Stress can cause changes in a woman’s hormones, resulting in delayed menstruation or secondary amenorrhea. During amenorrhea, the ovaries stop producing eggs and subsequently ovulation doesn’t occur leading to inability to conceive naturally. This fact proves that stress affects the reproductive system and consequently female fertility. Women with depression are more likely to be diagnosed with infertility. Stress can also delay pregnancy and reduce the success rate of IVF.

     

    The prevailing theory focuses on the fact that, during intense stress, the hypothalamic-pituitary-adrenal axis is activated and cortisol levels increase, which in turn suppresses the normal production of reproductive hormones in both men and women. It also activates a strong inflammatory reaction of the tissues as the body’s priority is to cope with the demanding period of stress.

     

    Is the connection between stress and infertility scientifically confirmed?

    It is difficult to determine whether stress alone can cause infertility or not. Research conducted at Ohio State University has tracked the progress of women seeking to conceive. Saliva samples were regularly collected from these women to measure α-amylase levels. This enzyme is an indicator of stress as it is secreted by the salivary glands in response to stress. The results of the study showed that women with elevated α-amylase levels were less likely to conceive.

     

    In addition, a BMJ Open analysis that took place in couples who were undergoing infertility treatments comes to confirm the above research. The results of the analysis showed that those who attended stress reduction programs were twice as likely to have a positive treatment outcome and achieve pregnancy. The research also pointed out the positive effect of these programs mainly on women compared to men.

     

    The American Infertility Company Society of Reproductive Medicine in a statement explicitly declares that although infertility is a very stressful process there is no evidence that stress can change the outcome of an IVF attempt.

     

    In 2019 a study was published clarifying that healthy creative stress (eustress), equivalent to focus on work or championship stress, can help women during conception, as opposed to high levels of non-targeted stress, which may lead to delayed conception. (Daily perceived stress and time to pregnancy: prospective cohort study of women trying to conceive Psychoneuroendocrinology 110; Dec 2019, 104446)

     

     

    THE EFFECTS OF STRESS ON THE LIFE OF INFERTILE COUPLES:

    Despite the conflicting studies, it is widely accepted that stress can lead to the adoption of a lifestyle that doesn’t enhance the conception:

    • Sleep disorders
    • Eating disorders, as it is difficult to follow a healthy diet
    • Excessive exercise or complete avoidance
    • Increasing habits such as smoking and alcohol consumption
    • Increased caffeine consumption
    • Low libido

     

    If you feel that stress wears you down in your attempt to conceive, then it is important – in combination with the proper therapeutic psychological support – to know your options. The Obstetrician-Gynecologist, after the necessary examinations, will suggest you a personalized strategy for achieving pregnancy. Dr. Melina Stasinou, specializing in assisted reproduction, has led many couples to the desired result of childbearing.

    June 27, 2022

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    Polycystic Ovarian Syndrome and Infertility

     

    What is the polycystic ovarian syndrome?

    The Polycystic Ovarian Syndrome or PCOS is the most common hormonal disorder in women in reproductive age. It is a complex disease with no identifiable etiology. The syndrome is associated with a variety of characteristics related to reproduction, metabolism, skin and mental health.

     

    What are its causes?

    The causes of the disease are not yet clear. Hereditary, genetic and environmental factors appear to contribute to the onset of the syndrome.

     

    When does the polycystic ovarian syndrome appear?

    The condition usually appears in adolescence with menstrual disorders, large ovaries with excessive number of follicles and acne. It is noteworthy that in almost 50% of women the syndrome is not diagnosed and as a result the estimation of the time in which PCOS appears in a woman’s life differs.

     

    What are the symptoms of PCOS?

    The symptoms of PCOS are:

    ·        Acne

    ·        Hair growth (due to high levels of androgens)

    ·        Hair loss (due to high levels of androgens)

    ·        Menstrual disorders (secondary amenorrhea, hypermenorrhea)

    ·        Excessive number of follicles on ultrasound

    ·        Increased body mass index or metabolic syndrome

    ·        Anovulation

     

    How is the diagnosis established?

    It is important that the differential diagnosis includes other diseases with similar symptoms. The Rotterdam 2003 criteria and the four female phenotypes based on them have been used in clinical practice in the recent years. More specifically, 2 of the 3 should apply:

    ·        Oligomenorrhea or amenorrhea

    ·        Hyperandrogenism confirmed by phenotype or hormonal tests

    ·        Appearance of polycystic ovaries on ultrasound

     

     

    Can polycystic ovarian syndrome lead to infertility?

    The anovulation due to irregularity of the menstrual cycles is the main cause of infertility. The specialized obstetrician-gynecologist will suggest you some medication or lifestyle changes to achieve the desired body weight and enhance the regularity of ovulation. It should be noted that the chances of having children are the same as the chances of women of the same age without polycystic ovarian syndrome.

     

    PCOS and lifestyle

    To treat PCOS the following are recommended:

    ·        Healthy diet

    ·        Normal body weight

    ·        Physical exercise

    ·        Stop smoking

    Identifying the factors that can influence or worsen the hormonal imbalance in women with PCOS is the first step moving forward.

    Dr. Melina Stasinou has worked as the managing director of the Ultrasound Department at Create Fertility, one of the largest IVF clinics. In addition, she is an Assistant Professor at Weill Cornell Medicine on in vitro fertilization and gynecological endocrinology. She collaborates with Hygeia IVf Embryogenesis and specializes in Assisted Human Reproduction.

    You may consult the specialized Obstetrician – Gynecologist Dr. Melina Stasinou for an individualized diagnosis and treatment of the polycystic ovarian syndrome.

    April 5, 2022

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