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Since a limited number of studies have investigated the different pattern of follicular distribution in the ovaries of PCOS patient, the present study was designed to evaluate the relationship of the follicular distribution pattern (FDP) in the ovaries and MetS as well as insulin resistance index, the sex hormones levels and menstrual status in women with PCOS diagnosis. This prospective study was carried out at Arash Women's Hospital (Tehran, Iran) from September 2023 to June 2024. All PCOS women who were referred for any gynecological examination were screened. The ultrasound images of polycystic ovarian morphology ovaries were further classified as having a peripheral cystic pattern (PCP) if the follicles were arranged at the periphery of the ovary, or a general cystic pattern (GCP) if the follicles were dispersed heterogeneously throughout the ovarian stroma. The association between the ultrasound follicular distribution patterns and the reproductive items (menstrual status, sex hormones levels and Ferriman-Gallwey score), as well as the metabolic features (insulin resistance index and the MetS rate) were evaluated. Of the 108 PCOS patients evaluated during the study, 51 patients were classified in the PCP ovaries group and 57 patients in the GCP ovaries group. There was no statistically significant difference in terms of women' age, body mass index, waist circumstance, and the Ferriman-Gallwey score between groups. The frequency of cases with oligo menorrhea in the PCP group was significantly higher than the GCP group (P = 0.006). However, no significant relationship was found between FDP and the baseline serum hormonal levels, total testosterone, and insulin resistance index as well as MetS rate and any components of MetS. No association was identified between the FDP and the rate of MetS, as well as other sex hormones, glucose, and lipids profiles in patients with PCOS; however, the PCP ovaries was linked to menstrual irregularities., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Tarbiat Modares university (code: IR.MODARES.REC. 1402.079). All procedures were in accordance with the ethical standards of the Regional Research Committee and with the Declaration of Helsinki 1964 and its later amendments. After explaining the study’s purposes, informed written consent and verbal assent were obtained from all participants. They were informed that their participation was voluntary, confidential and anonymous, and that they had the right to withdraw from the research at any time., (© 2025. The Author(s).)

Objective: To study the value of current definitions for follicle number per ovary and ovarian volume in the diagnosis of polycystic ovary syndrome (PCOS)., Design: Cross-sectional study., Subjects: Women diagnosed with PCOS after standardized screening were eligible for inclusion in the PCOS group. Women without PCOS who underwent the same screening, had regular menstrual cycles, normal hormonal values, and no other endocrine pathology were eligible for inclusion., Exposure: Not applicable., Main Outcome Measure(s): Follicle number per ovary and ovarian volume in women with PCOS, stratified by age. Linear regression models to investigate the influence of body mass index (BMI) on follicle number per ovary and ovarian volume. Differences in follicle number per ovary and ovarian volume between the PCOS phenotypes and the additional value of ovarian volume compared with follicle number per ovary., Result(s): A total of 2,492 women (16-50 years) with PCOS and 152 women without PCOS were included. Most women with PCOS up to age of 35 exhibit a follicle number per ovary ≥20 (87.8%-100%) (using an ultrasound transducer ≥8 MHz) or ≥12 (95.1%-98.6%) (using a transducer <8 MHz), followed by a decline in follicle number per ovary >35 years. Median ovarian volume was below the 10 mL cutoff in every age group, for both ultrasound transducers. Follicle number per ovary and ovarian volume were higher in women with PCOS compared with women without PCOS in every age category. In our cohort, 13/2,297 women with PCOS (0.6%) would not have received the diagnosis if ovarian volume was not considered a marker for polycystic ovarian morphology. For both ultrasound transducers, women with phenotype A (ovulatory dysfunction + hyperandrogenism + polycystic ovarian morphology) exhibited the highest follicle number per ovary and ovarian volume, followed by phenotype D (ovulatory dysfunction + polycystic ovarian morphology), then phenotype C (hyperandrogenism + polycystic ovarian morphology), and then phenotype B (ovulatory dysfunction + hyperandrogenism). No clinically significant correlation between BMI and follicle number per ovary or ovarian volume was observed., Conclusion(s): Criteria to define follicle number per ovary should be established per age category, as follicle number per ovary decreases with age. Ovarian volume shows a less clear decline with age and has a lower discriminative power, and therefore could be excluded from the diagnostic criteria. Follicle number per ovary does not need to be stratified by BMI., Competing Interests: Declaration of Interests K.v.d.H. has nothing to disclose. F.B. has nothing to disclose. E.v.S. has nothing to disclose. M.E.L. has nothing to disclose. J.S.E.L. reports grants from Ansh Labs, Ferring, Roche Diagnostics, Merck, outside the submitted work; personal fees from Ferring, Titus Healthcare, Gedeon Richter, Ansh Labs, Roche Diagnostics; honoraria and travel expenses from Ferring and Roche Diagnostics; data safety monitoring board for LOCI Trail UK; an unpaid Board Member and President of the Androgen Excess and PCOS Society; and a member of the American Society for Reproductive Medicine Research Integrity Committee, outside the submitted work. Y.V.L. reports honoraria fees from Ferring and Merck; travel support from Ferring; and funding from Synergy Erasmus Medical Center grant, outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Follicle count, a pivotal metric in the adjunct diagnosis of polycystic ovary syndrome (PCOS), is often underestimated when assessed via transvaginal ultrasonography compared to MRI. Nevertheless, the repeatability of follicle counting using traditional MR images is still compromised by motion artifacts or inadequate spatial resolution. In this prospective study involving 22 PCOS patients, we employed periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) and single-shot fast spin-echo (SSFSE) T2-weighted sequences to suppress motion artifacts in high-resolution ovarian MRI. Additionally, deep learning (DL) reconstruction was utilized to compensate noise in SSFSE imaging. We compared the performance of DL reconstruction SSFSE (SSFSE-DL) images with conventional reconstruction SSFSE (SSFSE-C) and PROPELLER images in follicle detection, employing qualitative indices (blurring artifacts, subjective noise, and conspicuity of follicles) and the repeatability of follicle number per ovary (FNPO) assessment. Despite similar subjective noise between SSFSE-DL and PROPELLER as assessed by one observer, SSFSE-DL images outperformed SSFSE-C and PROPELLER images across all three qualitative indices, resulting in enhanced repeatability in FNPO assessment. These results highlighted the potential of DL reconstruction high-resolution SSFSE imaging as a more dependable method for identifying polycystic ovary, thus facilitating more accurate diagnosis of PCOS in future clinical practices., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: This study aimed to assess the potential impact of primary Sjögren's syndrome (pSS) on fertility and ovarian reserve by evaluating the number of antral ovarian follicles (AFC) through ultrasound and analysing serum levels of anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH), which are currently the most reliable indicators of fertility potential., Method: A total of 52 premenopausal women were recruited from the Maternal, Infantile, and Urological Sciences Department at Umberto I Hospital, Sapienza University of Rome. Among them, 26 had pSS, and 26 served as healthy controls. All participants underwent a gynaecological examination, a transvaginal ultrasound, and serum testing for AMH and FSH levels., Results: The study found that serum AMH levels were significantly lower (p = 0.002) in pSS patients compared to the controls, indicating a potential reduction in ovarian reserve in these patients. However, no statistically significant differences were observed in FSH levels between the two groups., Conclusions: The findings suggest that pSS may have a negative impact on ovarian reserve, as evidenced by lower AMH levels in comparison to age-matched controls. AFC and FSH levels, however, were similar to those of healthy women. These results provide new insights that could be beneficial for this patient population, though further, larger-scale studies are necessary to more comprehensively understand the relationship between pSS and female fertility. Key Points • The study assesses the possible impact of pSS on fertility and ovarian reserve by evaluation of AMH, FSH, and AFC. • Family planning and fertility are important issues for patients with rheumatic disorders and must be considered and discussed with the patient already at the time of diagnosis, and appropriate counselling must be performed., Competing Interests: Declarations. Disclosure: None., (© 2024. The Author(s).)

We evaluated the impact of adenomyosis and ovarian endometriosis on ovarian reserve function through transvaginal three-dimensional ultrasound and anti-mullerian hormone testing. A total of 150 female patients who were admitted to our hospital from January 2023 to May 2024 were selected; 58 cases had adenomyosis (adenomyosis group), 36 had ovarian endometriosis (ovarian endometriosis group), and 56 were healthy (healthy group). There were no statistically significant differences in clinical baseline data among the three groups (all P > 0.05). However, significant overall differences were found in anti-Mullerian hormone levels, antral follicle count, ovarian volume, vascularization index, flow index, and vascularization flow index among the three groups (F values were 90.34, 146.50, 92.61, 63.87, 59.50, 49.36 respectively; all P < 0.001); compared to the healthy group, these indicators were all decreased in the adenomyosis group and ovarian endometriosis group (all P < 0.05). Pearson correlation analysis revealed that serum anti-mullerian hormone levels were positively correlated with antral follicle count, ovarian volume, vascularization index, flow index, and vascularization flow index (r = 0.80, 0.73, 0.50, 0.48, 0.45, respectively; all P < 0.01). These data suggest that adenomyosis and ovarian endometriosis can lead to a decline in ovarian reserve function in women of reproductive age compared to their peers. Also, antral follicle count and ovarian volume are the optimal indicators for evaluating ovarian reserve function in these patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This work has been carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association. This research was approved by the hospital’s ethics committee (Ethics number: [2023] Fujian Medical College Second Affiliated Hospital Ethics Approval Number [253]). Informed consent was obtained from all participants. Consent for publication: Not applicable., (© 2024. The Author(s).)

Objectives: Polycystic ovary syndrome (PCOS) and subclinical hypothyroidism (SCH) are prevalent gynecological conditions. However, the interrelationship between the two remains elusive. This study aims to elucidate the association between these conditions and determine the potential impact of SCH on the physiological and metabolic characteristics of patients with PCOS., Methods: This cross-sectional study enrolled 133 patients with PCOS from our Hospital. Participants were categorized into two groups: those with PCOS + SCH ( n  = 58) and those with PCOS ( n  = 75). Serum hormonal levels, metabolic markers, ovarian volume, and follicle count were compared between the groups., Results: There was a significant difference in BMI between the two groups, with a higher prevalence of obesity in the PCOS + SCH group ( p  = .014). Compared to the PCOS group, patients with PCOS + SCH had significantly higher levels of TSH ( p  < .001), triglycerides ( p  = .025), and HOMA-IR ( p  < .001), while LH levels were significantly lower ( p  = .048). However, multivariate linear regression analysis revealed that TSH, triglycerides, LH, and HOMA-IR were not determinants for the occurrence of SCH in patients with PCOS. Additionally, there was a notable reduction in follicle count in the left ovary for the PCOS + SCH group compared to the PCOS group ( p  = .003), and the overall follicle diameter of the PCOS + SCH group was also smaller ( p  = .010)., Conclusion: SCH may exert effects on the physiological and metabolic profiles of patients with PCOS. Further investigation into the relationship between these disorders is warranted to delineate their clinical implications.

Objectives: Research investigating the association between reproductive health and diet has predominantly focused on the antenatal and prenatal periods, as well as childbirth in women, and semen quality in men. There is a limited amount of research addressing female fertility assessed as ovarian reserve in relation to diet. The main aim of this study was to evaluate the association between dietary patterns and the parameters of ovarian reserve, such as antral follicle count (AFC), anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol (E2) - predictors of reproductive health in women of childbearing age., Material and Methods: Women aged 24-39 years (N = 511) were enrolled from fertility clinic in central Poland. The count of antral follicles was determined using ultrasonography (USG), FSH and E2 levels were measured using a chemilumi- nescence method and for determination of AMH level, an enzyme-linked immunosorbent assay method was employed. Diet was assessed according to food frequency questionnaire and dietary patterns were identified by factor analysis. Women were classified into 3 groups according to scores of each dietary pattern: Western, mixed, prudent., Results: Higher adherence to the prudent dietary pattern in obese women was associated with significantly higher AFC (p = 0.03) and AMH (p = 0.05) as compared to participants with the Western dietary pattern. The results were adjusted for age, BMI, smoking and duration of fertility. Increased consumption of mixed dietary pattern was not statistically significant associated with any of examined ovarian reserve parameters., Conclusions: The prudent dietary pattern is positively associated with ovarian reserve in a cohort of women seeking fertility care. Continued research in this area will provide nutritional guidance for clinicians and their patients and provide novel insight on potential modifiable lifestyle factors which can be associated with ovarian reserve. Int J Occup Med Environ Health. 2024;37(4):411-20., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Study Question: Is there a possible association between prenatal phthalate exposure and late effects in teenage daughters with respect to reproductive hormone levels, uterine volume, and number of ovarian follicles?, Summary Answer: Our study showed subtle associations between phthalate metabolite concentrations in maternal serum from pregnancy or cord blood and LH and insulin-like growth factor 1 (IGF-1) levels as well as uterine volume in their daughters 16 years later., What Is Known Already: Endocrine-disrupting environmental chemicals may adversely affect human reproductive health, and many societies have experienced a trend toward earlier puberty and an increasing prevalence of infertility in young couples. The scientific evidence of adverse effects of foetal exposure to a large range of chemicals, including phthalates, on male reproductive health is growing, but very few studies have explored effects on female reproduction., Study Design, Size, Duration: This follow-up study included 317 teenage daughters who were part of the Copenhagen Mother-Child Cohort, a population-based longitudinal birth cohort of 1210 females born between 1997 and 2002., Participants/materials, Setting, Methods: A total of 317 female participants (median age 16 years) were examined for weight, height, and menstrual pattern. A serum sample was analysed for concentrations of reproductive hormones, and trans-abdominal 3D ultrasonography was performed to obtain the number of ovarian follicles, ovarian and uterine size. Prenatal maternal serum samples were available for 115 females, and cord blood samples were available for 118 females. These were analysed for concentrations of 32 phthalate metabolites. Weighted quantile sum regression was used for modelling associations of combined prenatal phthalate exposure with the reproductive outcomes in post-menarcheal females., Main Results and the Role of Chance: In bivariate correlation analyses, negative significant associations were found between several prenatal phthalate metabolite concentrations and serum hormone concentrations (testosterone, 17-OH-progesterone, and IGF-1) as well as number of ovarian follicles in puberty. Positive significant correlations were found between prenatal phthalate exposure and FSH and sex hormone-binding globulin concentrations. Combined analyses of phthalate exposure (weighted quantile sums) showed significant negative associations with IGF-1 concentration and uterine volume as well as a significant positive association with LH concentration., Limitations, Reasons for Caution: Phthalate metabolites were measured in serum from single prenatal maternal blood samples and cord blood samples. Potential concomitant exposure to other endocrine-disrupting environmental chemicals before or after birth was not controlled for. The study population size was limited., Wider Implications of the Findings: Our results support the need for further research into possible adverse effects of environmental chemicals during foetal development of the female reproductive system., Study Funding/competing Interest(s): The work was supported by The Center on Endocrine Disruptors (CeHoS) under The Danish Environmental Protection Agency and The Ministry of Environment and Food (grant number: MST-621-00 065). No conflicts of interest are declared., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Research Question: What is the relationship between antral follicle count (AFC) and chronological age, and what are the expected values for AFC?, Design: This was a retrospective cohort study at a specialist gynaecological ultrasound centre in London, UK. Women presenting to a gynaecology diagnostic unit for investigation of symptoms or routine check-up, and undergoing transvaginal ultrasound (TVUS) examinations, between 1 January 2017 and 22 September 2022 were included in this study., Results: In total, 8821 TVUS records from 7573 patients were analysed. The relationship between AFC and age was estimated to develop an AFC nomogram independent of the stage in the menstrual cycle. AFC corresponding to the 10 th , 25 th , 50 th , 75 th and 90 th centiles for each patient and age group were calculated. Both nomogram and condition-specific populations displayed a Gaussian relationship between AFC and age. For the nomogram population (scans n = 4256, patients n = 3821), a peak median AFC of 30 was observed between 21-23 years of age. The AFC distribution of the group with previous ovarian cystectomy (scans n = 534, patients n = 443) was found to be significantly different compared with the nomogram population (P < 0.0001). However, the same did not hold true for those on hormonal contraception (scans n = 566, patients n = 534) (P = 0.43)., Conclusions: An AFC nomogram reporting median and interquartile values for AFC by chronological age across the reproductive years was developed. This is a useful tool for providing counselling for those undergoing ovarian reserve assessments, and can be taken any time in the menstrual cycle, including in women on hormonal contraceptives or who have undergone previous ovarian cystectomy., (Copyright © 2024. Published by Elsevier Ltd.)

Ovum pick-up (OPU) by transvaginal ultrasound guided follicle aspiration in mares is a common assisted reproductive technique used for oocyte recovery and in vitro production of horse embryos. There has been relatively little research into the factors influencing oocyte recovery in OPU from live mares. The objective of this study was to compare oocyte recovery and morphology of ultrasound-guided follicle puncture and aspiration in live mares and in postmortem excised ovaries, in order to validate an experimental model for research purposes of the efficiency of OPU in mares. Data from OPU performed in 12 mares from a commercial program (follicle numbers, oocyte recovery and oocyte morphology) were compared to that obtained from ultrasound-guided follicle puncture of 13 postmortem excised ovaries from slaughtered mares processed within 2 h of slaughter. In both groups, the OPU was performed by the same operator using the same equipment and OPU technique. The recovered oocytes per aspirated follicle was higher (P < 0.05) in the postmortem group (105/166, 63.2 %) than in live mares (138/261, 52.9 %). There was more (P < 0.05) expanded cumulus oocyte complexes in the postmortem than in the live mares (18 % vs. 2.9 %). Several oocytes (5 oocytes from 81 aspirated follicles) were found in the leaked fluid which overflowed during follicle flushing of postmortem ovaries. In conclusion, the higher recovery rate obtained in the excised ovaries and the finding of oocytes in the leaked fluid during OPU, suggests that there is still room for improvement in the in vivo OPU technique. Utilizing postmortem excised ovaries could offer an alternative for further research into factors affecting oocyte recovery and oocyte leakage during OPU procedures., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Knowledge on hormonal regulation of reproductive cycles in viperid snakes is still incipient, especially when it comes to females and tropical species. There is an urgent need to understand the reproduction of venomous snakes to improve assisted reproduction techniques and optimize the maintenance of these animals in captivity. With this in mind, we monitored Northern pit viper females year-round throughout different seasons via serum levels of progesterone (P 4 ) and estradiol (E 2 ) in conjunction with ultrasound examinations. Ovarian follicles were classified according to their size and stage of vitellogenesis in F-I and F-II (non-vitellogenic phase) or in F-III and F-IV (vitellogenic phase). During autumn and winter, five adult males were rotated among these females for reproductive pairing, which resulted in 17 copulations and 2 pregnancies in the first year and 12 copulations and 5 pregnancies in the second year. Then, we assessed changes in P4 and E2 levels according to seasons, predominant ovarian structures and the presence of embryos or eggs in the oviduct. Our findings showed high levels of E 2 when a greater number of vitellogenic follicles were detected, indicating a possible influence of E 2 on vitellogenesis and higher levels of P 4 whenever eggs and embryos were visualized in the oviduct, implying its role in maintaining pregnancy. Descriptive analysis of the vipers' ovarian cycles revealed a greater number of vitellogenic follicles during winter, probably as a result of increases in E 2 ; whereas pregnancies occurred predominantly in spring, under the influence of P4. The use of ultrasound images, as a minimally invasive methodology, associated with serum steroid levels has proven to be an efficient approach in the reproductive monitoring of Northern pit vipers in vivo. In addition, these data suggest that female pit vipers under human care display a seasonal reproductive cycle, despite earlier studies involving captive males of the species indicating a lack of seasonality in sperm production and quality., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate whether trigger and oocyte collection at a smaller follicle size decreases the risk of premature ovulation while maintaining the reproductive potential of oocytes in women with a severely diminished ovarian reserve undergoing modified natural-cycle in-vitro fertilization., Methods: This was a retrospective cohort study including women who had at least one unsuccessful cycle (due to no response) of conventional ovarian stimulation with a high dosage of gonadotropins and subsequently underwent a modified natural cycle with a solitary growing follicle (i.e. only one follicle > 10 mm at the time of trigger). The association between follicle size at trigger and various cycle outcomes was tested using regression analyses., Results: A total of 160 ovarian stimulation cycles from 110 patients were included in the analysis. Oocyte pick-up (OPU) was performed in 153 cycles and 7 cycles were canceled due to premature ovulation. Patients who received their trigger at smaller follicle sizes (≤ 15 mm) had significantly lower rates of premature ovulation and thus higher rates of OPU (98.9% vs 90.8%; odds ratio, 9.56 (95% CI, 1.58-182.9); P = 0.039) compared with those who received their trigger at larger follicle sizes (> 15 mm). On multivariable analysis, smaller follicle sizes at trigger (> 10 to 13 mm, > 13 to 15 mm, > 15 mm to 17 mm) were not associated significantly with a lower rate of cumulus-oocyte complex (COC) retrieval, metaphase-II (MII) oocytes or blastulation when compared to the > 17-mm group. On sensitivity analysis including only the first cycle of each couple, the maturity rate among those with COC retrieval was highest in follicle sizes > 15 to 17 mm (92.3%) and > 13 to 15 mm (91.7%), followed by > 10 to 13 mm (85.7%) and lowest in the > 17-mm group (58.8%). During the study period, five euploid blastocysts developed from 48 fertilized MII oocytes with follicle sizes of 12 mm (n = 3), 14 mm (n = 1) and 16 mm (n = 1) at trigger. Of those, four were transferred and resulted in two live births, both of which developed from follicles with a size at trigger of 12 mm., Conclusions: The ideal follicle size for triggering oocyte maturation may be smaller in women with a severely diminished ovarian reserve managed on a modified natural cycle when compared to conventional cut-offs. The risk of OPU cancellation was significantly higher in women triggered at follicle size > 15 mm and the yield of mature oocytes was not adversely affected in women triggered at follicle size > 13 to 15 mm compared with > 15 to 17 mm. Waiting for follicles to reach sizes > 17mm may be detrimental to achieving optimal outcome. © 2024 International Society of Ultrasound in Obstetrics and Gynecology., (© 2024 International Society of Ultrasound in Obstetrics and Gynecology.)

This study aimed to compare the inter-software and inter-observer reliability and agreement for the assessment of follicular and luteal morphometry and echotexture parameters in beef crossbreed females (3/8 Bos taurus indicus and 5/8 Bos taurus taurus). B-mode and color Doppler ultrasonographic ovarian images were obtained at specific time points of estradiol-progesterone-based protocols for timed artificial insemination (TAI). Sonograms were analyzed by two observers using a licensed (IASP1) and an open access (IASP2) software package. A total of 292 snap-shot sonograms were analyzed for morphometric parameters and 504 for echotexture parameters. inter-software reliability was judged moderate to excellent (ICC or CCC=0.73-0.98), whereas inter-observer reliability for morphometric parameters was deemed good to excellent (ICC or CCC=0.82-0.98). A small percentage (up to 10.95 %) of measured parameters fell outside the limits of inter-software and inter-observer agreement. For echotexture parameters, inter-software reliability varied widely (ICC or CCC=0.16-0.95) based on the size of regions of interest (ROI), while inter-observer reliability ranged from moderate to excellent (ICC or CCC= 0.71-0.97). The highest inter-software reliability for pixel value and heterogeneity value was observed for the corpus luteum (ICCs=0.81-0.95; P>0.05), followed by the peripheral follicular antrum (ICCs=0.75-0.78; P<0.05). However, lower reliability was determined for the follicular wall (ICCs=0.08-0.33; P<0.0001) and perifollicular stroma (ICCs=0.16-0.46; P<0.05). In conclusion, both software packages showed high reproducibility for morphometric measurements, while echotexture measurements were more challenging to replicate based on ROI sizes. Caution is advised when selecting ROI sizes for echotexture measurements in bovine ovaries., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The objective was to establish whether aspects of ovarian morphology correlate with reproductive and metabolic features during the first postmenarcheal year using data from the Ovarian Morphology in Girls (OMG!) cohort study. The feasibility of transabdominal ultrasonography to assess ovarian features was also determined., Methods: Healthy adolescent females enrolled in a prospective cohort study. Study visits occurred at 6-10, 11-13, 17-19, and 23-25 months postmenarche and entailed a physical exam, transabdominal ultrasound, and fasting blood draw. Participants maintained menstrual diaries throughout the study. The present analysis reflects participants who completed the study visit at 6-10 months postmenarche. Associations between ovarian morphology or average cycle length with reproductive and metabolic features were assessed by Spearman correlations and linear regression., Results: Forty participants enrolled in the OMG!, Study: Thirty-one participants initiated study procedures at 6-10 months postmenarche, and data were available for analysis for 29 participants. Image quality was judged as partially visible or excellent in 90% of the left and 78% of the right ovaries assessed, with all images collected having sufficient image quality to provide measurements of at least 1 ovarian marker. The follicle number per ovary and ovarian volume were positively associated with anti-Müllerian hormone levels and negatively associated with fasting insulin. The average cycle length was only associated negatively with triglycerides., Conclusion: Transabdominal ultrasonography in the early postmenarcheal period provides sufficient resolution to enable estimations of antral follicle count and ovarian size. Ovarian features in early gynecological life may correspond with measures of reproductive and metabolic function., Competing Interests: Conflicts of Interest HVB has received funding from the Canadian Institutes of Health Research (FRN 146182), a grant from the Cornell University Office of Academic Integration, and a CMRIF Pilot Award from Cornell University. MEL has received R-01 and R-21 funding from the National Institutes of Health, a grant from the Cornell University Office of Academic Integration, a CMRIF Pilot Award from Cornell University, and payment or honoraria from the Society of Obstetrics and Gynecology of Canada; serves in a leadership role in the Androgen Excess and PCOS Society; and has received equipment, materials, gifts, or other services from the PCOS Awareness Association. TSB has received R-21 funding from the National Institutes of Health. RB has received R-21 and K-23 funding from the National Institutes of Health. AM and MG have no disclosures., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To determine the minimum follicular volume on the day of trigger that will correspond to a mature oocyte at egg retrieval by individualized follicular puncture and to calculate the mean follicular growth from ovulation induction to egg retrieval using SonoAVCfollicle., Design: A prospective observational study of 53 women undergoing in vitro fertilization, in which it was possible to identify unequivocally one or more follicles at trigger and egg retrieval using three-dimensional ultrasound., Setting: University-affiliated private in vitro fertilization center., Patients: The final sample included 206 follicles from 14 oocyte donors and 39 patients., Interventions: A three-dimensional ultrasound with SonoAVCfollicle was performed at trigger and egg retrieval. The same operator selected follicles that were identified easily on both scans and verified that they were apt to be aspirated individually. Follicles were punctured individually, recording the real aspirated volume and the maturity stage of the oocyte., Main Outcome Measures: The primary outcome was the relationship between follicular volume on the day of the trigger and the oocyte maturity stage. The secondary outcome was the rate of follicular growth from the day of trigger to the day of oocyte retrieval, as measured using SonoAVCfollicle., Results: On the day of trigger 206, follicles were selected. Of these, 5 could not be identified on the day of oocyte retrieval, probably because of follicular rupture (mean volume: 4 cm 3 , range: 2-7 cm 3 ), and in 48, an oocyte was not obtained. The relationship between follicular volume and oocyte maturity was studied in 153 follicles: 125 (82%) contained mature and 28 (18%) contained immature oocytes. Receiver operating characteristic curves showed an area under the curve value of 0.73 (95% confidence interval: 0.65-0.80). A follicular volume of >0.56 cm 3 is the cutoff point, with the highest Youden index having a sensitivity of 85% and a specificity of 64% to predict oocyte maturity. The mean follicular growth from trigger to egg retrieval was 26%-50% in 53% of cases., Conclusion: A follicular volume of >0.56 cm 3 at trigger is the cutoff point with the optimal balance between sensitivity and specificity for oocyte maturity. Follicles of >2-3 cm 3 may undergo spontaneous rupture before egg retrieval. Given these findings, we propose new volume-based criteria for trigger: 70% of follicles of >0.6 cm 3 and dominant follicles between 2 and 3 cm 3 . These findings need validation by randomized controlled trials., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Study Question: Do antral follicle dynamics change in women with obesity and regular ovulatory cycles after a 6-month hypocaloric dietary intervention?, Summary Answer: After a 6-month hypocaloric dietary intervention, women with obesity and regular ovulatory cycles displayed evidence of improved antral follicle dynamics defined by the emergence of more dominant follicles, larger ovulatory follicle diameter at selection, and increased luteal progesterone concentrations compared to pre-intervention., What Is Known Already: Precise events in antral folliculogenesis must occur in order for natural and regular monthly ovulation. In healthy women of reproductive age, antral follicles are recruited for growth in a wave-like fashion, wherein a subset of follicles are selected for preferential growth, and typically, one dominant follicle culminates in ovulation. Women with obesity and regular ovulatory cycles display evidence of suppressed antral follicle development, as evidenced by fewer recruitment events, fewer selectable and dominant follicles, smaller diameter of the ovulatory follicle at selection, and a higher prevalence of luteal phase defects. While improvements in gonadotropin and ovarian steroid hormone concentrations after weight loss have been documented in eumenorrheic women with obesity, the precise impact of weight loss on antral follicle dynamics has not been evaluated., Study Design, Size, Duration: A pre-post pilot study of 12 women who participated in a 6-month hypocaloric dietary intervention., Participants/materials, Setting, Methods: Twelve women with obesity (total body fat ≥35%) underwent transvaginal ultrasonography and venipuncture every-other-day for one inter-ovulatory interval (IOI) both before (baseline) and during the final month (Month 7) of a six-month hypocaloric dietary intervention. Participants were aged 24-34 years and had a self-reported history of regular menstrual cycles (25-35 days). Follicle number and diameter (≥2 mm) were quantified at each study visit, and individual growth profiles for all follicles ≥7 mm were determined. Blood samples were assayed for reproductive hormones. Follicle dynamics and reproductive hormone concentrations were compared pre- and post-intervention. Further, post-intervention follicle and endocrine dynamics (Month 7 IOI) were compared to an age-matched reference cohort of lean women with regular ovulatory cycles (total body fat <35%, N = 21)., Main Results and the Role of Chance: Participants lost an average of 11% of their original body weight with the hypocaloric dietary intervention. More dominant follicles were detected (≥10 mm) at Month 7 compared to baseline (0. 3 ± 0.4 versus 0.4 ± 0.5 follicles, P = 0.001), and ovulatory follicles were selected at larger diameters post-intervention (7.3 ± 2.0 versus 10.9 ± 2.6 mm, P = 0.007). Luteal progesterone concentrations were increased at Month 7 compared to baseline (5.3 ± 3.65 versus 6.3 ± 4.74 ng/ml, P < 0.0001). However, risk for luteal phase dysfunction as judged by the prevalence of a luteal phase length <10 days, integrated luteal progesterone levels <80 ng/ml or peak progesterone <10 ng/ml did not differ pre- versus post-intervention (all, P > 0.05). In Month 7, follicle dynamics and endocrine profiles were similar to the reference cohort across all measures., Limitations, Reasons for Caution: This study does not inform on the earliest stages of ovarian follicle development and is limited to providing knowledge on the later stages of antral follicle development. This study cannot fully address causation between weight loss and sustained improvements in antral follicle dynamics. The data cannot be extrapolated to comment on potential improvements in fertility and fecundity with weight loss. The small group sizes limit statistical power., Wider Implications of the Findings: The increasing prevalence of obesity necessitates an understanding of the mechanisms that underlie potential improvements in reproductive health outcomes with weight loss. Women with obesity and regular ovulatory cycles who undertook a 6-month hypocaloric dietary intervention demonstrated improvements consistent with benefits of lifestyle intervention on reproductive health even in those without overt signs of reproductive dysfunction. Potential improvements in the cellular makeup of follicles, which may underlie the restoration of normal follicle development and amelioration of subfertility, require further investigation., Study Funding/competing Interest(s): Cornell University, President's Council of Cornell Women, United States Department of Agriculture (Grant No. 8106), and National Institutes of Health (R01-HD0937848). B.Y.J. and H.V.B. were supported by doctoral training awards from the National Institutes of Health (T32-DK007158) and Canadian Institutes of Health Research (Grant No. 146182), respectively. The authors have no competing interests., Trial Registration Number: NCT01927432 and NCT01785719., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This study evaluated the effects of antral follicle count (AFC) in female cattle on offspring characteristics. Recently calved multiparous Bos indicus cows (Nelore; n = 222) were evaluated using ultrasonography on random days of their estrous cycle to determine the AFC and were classified into "low" (≤15 follicles), "intermediate" (≥16 and ≤ 29 follicles), and "high" (≥30 follicles) AFC groups. Weight and scrotal circumference (SC) of male offspring from these cows (n = 127) were determined from 20 to 27 months, and the data were added to a genetic evaluation program (economic total genetic merit, MGTe and TOP value) that uses the kinship matrix to evaluate the genetic relationship between animals. The AFC of female offspring from these cows (n = 95) was evaluated to analyze the relationship between the AFC of mothers and daughters. The effects of maternal AFC on the genetic merit of male and female offspring were analyzed using GLIMMIX and GLM, respectively. Correlations were assessed using the Pearson's coefficient. Male offspring of cows with high AFC had superior MGTe (P = 0.005) and TOP values (P = 0.01) than those from cows with low AFC. Additionally, the AFC of mothers was positively correlated with MGTe (R = 0.33; P < 0.0001) and negatively correlated with TOP values (R = -0.32; P < 0.0001). The SC (P = 0.01), but not body weight of the offspring (P = 0.46) was affected by maternal AFC. The daughters' AFC were correlated (R = 0.29; P = 0.004) with mothers' AFC and were influenced by maternal (P = 0.05) but not paternal (P = 0.77) effect. In conclusion, cows with high AFC produced males with greater MGTe, superior TOP values and higher SC. Maternal AFC did not influence the weight of male offspring but was correlated with the AFC of daughters., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The aim of this study was to evaluate follicular dynamics and ovum pick-up (OPU) efficacy in untreated mares or mares treated with an intravaginal progesterone (P4) device during seasonal anestrus (acyclic) and during the breeding season (cyclic). Six mares (mean age = 5 years), were recruited into an ovum pick-up scheme that was performed every 14 days with and without the P4 device, during the acyclic and cyclic phases. Aspirations amounted to seven procedures with or without the P4 device during each phase. Five ultrasound assessments were performed at each interval between the OPUs. Data on follicular number and diameter as well as the numbers of recovered and the percentage of recovered oocytes were also collected. The number of follicles from mares in the acyclic phase was higher (P < .005) regardless of the treatment. However, the follicular diameter was smaller for the P4 group (P < .005) from the 2nd to the 5th evaluation post-OPU procedure. The percentage of oocytes recovered during the acyclic phase was higher for mares treated with the P4 device (P < .005). The P4 device resulted in follicles with smaller diameters and facilitated OPU efficacy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The objective of this research was to investigate the diagnostic accuracy of post-mortem ultrasound in antral follicle count (AFC) determination and compare it with visual AFC in grazing crossbred Holstein cows, at high altitude in Ecuador. Pre-mortem blood from 80 cows was collected, and AFC and ovarian characteristics were analysed post-mortem by ultrasound and visual techniques. AFC counts were stratified as high, medium or low by terciles. Mean AMH concentration in pre-mortem blood was 280.1 ± 15.53 pg/mL. The AFC obtained by visual inspection (26.9 ± 9.49 follicles) was 23.8% higher than by ultrasound (20.5 ± 7.53 follicles) in all ovaries. Body condition score, age and weight of the cattle did not interact with the count technique. In the low AFC group, visual inspection and ultrasound provided similar AFC results. However, in the Medium- and High-AFC groups, AFC by ultrasound was 14.9% lower than AFC by visual inspection. We confirm that ultrasound can be used with great accuracy for AFC >3 mm (close to the resolution limit) in grazing crossbred Holstein cows at high altitude., (© 2023 The Authors. Reproduction in Domestic Animals published by Wiley-VCH GmbH.)

Heat stress negatively impacts the reproductive performance of sheep including the efficiency of estrous synchronization regimens. This study aimed to investigate the potential effects of L-Carnitine (LC) administration on the efficacy of the OvSynch protocol in ewes under summer climatic conditions. Ewes were synchronized for estrus using the OvSynch protocol and a dose of LC (20 mg/kg body weight) was intravenously (IV) administered on the same day of PGF 2α injection to one group (n = 8; LC group), while other ewes (n = 8; control group) received the same protocol without LC. Ultrasonographic evaluation (including B-mode, color, and pulsed Doppler) was used to assess the morphometrical and hemodynamic parameters of ovarian structures [number, size, and blood flow of follicles (GFs) and corpora lutea (CLs)] and uterus during the estrous phase (Day 0), and on Day 8 post ovulation (luteal phase). Uterine artery blood flow (MUA) was assessed by measuring the resistive index (RI) and pulsatility index (PI) at both stages. The serum samples were collected to measure the concentrations of estradiol (E2), progesterone (P4), and total antioxidant capacity (TAC) using commercial kits. Results revealed a significant (P<0.05) increase in the colored pixel area of GFs and uterus in the LC group (392.84 ± 31.86 and 712.50 ± 46.88, respectively) compared to the control one (226.25 ± 17.74 and 322 ± 18.78, respectively) during Day 0. Circulating E2 and TAC levels were significantly (P<0.05) higher in the LC-treated ewes (31.45 ± 1.53 pg/ml and 1.80 ± 0.13 mM/L, respectively) compared to those in the control ewes (21.20 ± 1.30 pg/ml and 0.98 ± 0.09 mM/L, respectively) during Day 0. Moreover, LC improved the colored pixel area of CLs (2038.14 ± 102.94 versus 1098 ± 82.39) and uterus (256.38 ± 39.28 versus 121.75 ± 11.36) and circulating P4 (2.99 ± 0.26 ng/ml versus1.67 ± 0.15 ng/ml) on Day 8. Values of RI of MUA were significantly lower in the LC group compared to the control one on Day 0 and Day 8 (0.48 ± 0.03 versus 0.72 ± 0.03 and 0.58 ± 0.03 versus 0.78 ± 0.02, respectively). In conclusion, LC incorporation in the OvSynch protocol enhanced the morphometrical and hemodynamic parameters of the ovarian structures and the uterus concomitantly with improvements in the TAC, E2, and P4 concentrations in ewes under hot summer conditions., (© 2023. The Author(s).)

Background: The Greek or Mediterranean tortoise (Testudo graeca), commonly known as the spur-thighed tortoise, is a species of tortoise in the family Testudinidae that is found in North Africa, Western Asia and Europe. Several species of this genus are under threat in the wild, mainly from habitat destruction therefore, accurate information about the sexual cycle and the exact time of follicular development can be effective in successful reproduction planning and preventing species extinction., Objective: The experimental part of this study is focused on the evaluation of the reproductive apparatus of tortoises and development of follicles in ovaries during 1 year by ultrasonography and computed tomography., Methods: Ultrasonography and CT scanning was carried out on 10 female 'T. Graeca' tortoises which were maintained at Tehran Eram Zoo from November 2021 to November 2022 (1 year). Ultrasonography and CT exams were performed on all animals., Results: In the first study, on 28 November 2021, the ovarian cycle was characterized by the presence of previtellogenic follicles and atretic follicles. The numbers of follicles were best demonstrated on CT examination. Ultrasonography and CT scan in the second study showed no change in type of follicles from previous study. In the third study, atretic follicles were more than previtellogenic follicles, whereas in the fourth one, the numbers of previtellogenic follicles were more than atretic follicles. In following, at 6 and 29 June 2022, the absence of atretic follicles and just presence of previtellogenic follicles were observed. On 20 July 2022, the presence of a few number of atretic follicles and more previtellogenic follicles were noticed. On 30 July 2022, the absence of atretic follicles and presence of previtellogenic follicles and, for the first time, preovulatory follicles were obvious. In four following studies the absence of atretic follicles and the presence of previtellogenic follicles were diagnosed. In the last study, the absence of atretic follicles and the presence of preovulatory and previtellogenic follicles were observed., Conclusion: In current study, the reproductive cycle of female T. Graeca is evaluated during 1 year in captivity with ultrasonography and CT scan. It can be concluded that in captivity, the reproductive cycle does not result in the formation of eggs or calcareous shells and atretic follicles in the study year continued as before; so this should be highly considered in captivity breeding programmes. This study also revealed that among imaging modalities, CT scan is the best modality for detecting the shape, size, type and numbers of the follicles for further evaluation of location and shape of the follicles., (© 2023 Faculty of Veterinary Medicine, University Of Tehran. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

To investigate the ovarian responses, ovarian and uterine hemodynamics, circulating ovarian hormones, and nitric oxide (NO) with their relations in superstimulated cows. Eight Holstein Friesian dry cows previously synchronized with CIDR underwent rectal Doppler ultrasound scanning and blood sampling after administrating eCG (1500 I.U) on day 10 of the second ovulation (day -5). Cows were treated with 12.5 mg prostaglandin F 2 α (PGF 2 α) on days 10 and 17 after ovulation. Estradiol, progesterone, and NO were measured. Results showed that from ≥ 13 follicles, five follicles ovulated from both ovaries. The ovulated follicles increased antrum colored area and colored area % till day -1. The developed corpora lutea (CLs) attained similar diameter, area, colored area, and colored area % from day 2 till day 15. The peak point of velocity (PSV) of uterine arteries decreased while that of ovarian arteries increased from day -4 to day 0. Both ovarian arteries diameter, resistance index (RI), PSV, end velocity (EDV) and systolic/diastolic ratio (S/D) positively correlated (P < 0.0001), but their pulsatility index (PI) negatively correlated (P < 0.0001). The uterine arteries PI, RI, PSV, EDV, time average velocity (TAMV) and S/D negatively correlated (P < 0.0001) but their diameters positively correlated. Estradiol increased but progesterone decreased from day -5 till day 0. After ovulation, P4 reached maximum values on day 9 and started to decrease till day 19.NO showed one peak on day -3 and another one from day 3 to day 9. Conclusions: Blood flow of ovarian arteries is different from uterine arteries and depended on pre- or post-ovulation., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Natural cycle- in vitro fertilization (NC-IVF) is particularly recommended for women with decreased ovarian reserve (DOR) or poor response to controlled ovarian hyperstimulation. In these cases, it can be challenging to determine the optimal timing for a trigger, and follicles of varying sizes are typically obtained. The influence of follicular size on IVF outcomes in women with DOR remains uncertain. This study aims to investigate the association between different follicular sizes and NC-IVF outcomes in women with DOR., Methods: A retrospective cohort study involving 477 NC-IVF cycles from 2015 to 2021 was conducted at one of the largest reproductive medical centers in China. Follicular growth was monitored using transvaginal ultrasonography, and the follicles were categorized into three groups based on their diameters:12-15 mm; 16-17 mm and ≥ 18 mm. Laboratory outcomes were evaluated, including the number of canceled cycles, number of oocytes retrieved, 2PN fertilization, embryo and good-quality embryo, fresh embryo transfers, and frozen embryo. Additionally, clinical outcomes, such as the rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth, were investigated and compared among the different follicular size groups., Results: A total of 68 cycles with follicles sizes of 12-15 mm, 171 cycles with follicles sizes of 16-17 mm, and 236 cycles with follicles sizes ≥ 18 mm were included in this study. The basic characteristics, including female age, male age, infertility duration, infertility type, and parity, were comparable among the groups. The rate of cycle cancellation in the 12-15 mm group (27.9%) was higher compared to the other two groups. The 2PN fertilization rate for follicles with a diameter of 16-17 mm (75.0%) was higher than that of follicles with a diameter of 12-15 mm (61.3%) and ≥ 18 mm (56.6%) (P = 0.031). Other clinical outcomes, such as the number of oocytes retrieved, good-quality embryos, fresh embryo transfers, and frozen embryos, did not show significant differences between groups. Further analysis revealed no significant difference in the rates of clinical pregnancy, ongoing pregnancy, and live birth rate among the three groups., Conclusions: This study indicates that in women with DOR undergoing NC-IVF, if a premature LH surge occurs and small follicles are retrieved, these follicles can still be used in subsequent treatment and provide a comparable chance of clinical pregnancy to normal-sized follicles. These findings have important implications for guiding NC-IVF treatment in patients with severe DOR., Trial Registration Number: N/A., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: In dairy cattle, numerous factors determine the success of an insemination. The aim of the present study was to generate findings concerning the association between the preovulatory follicles, the corpora lutea with or without cavities and pregnancy in dairy cows under field conditions., Material and Methods: Data was obtained from 176 dairy cows scheduled for artificial insemination. The cows were gynecologically examined using sonography at the time of insemination, 24 hours later, on day 9, on day 34 and after day 42 after insemination. Additionally, blood samples were collected from the coccygeal vein at the time of insemination and on day 9 in order to determine blood progesterone level., Results: Depending on the result of the pregnancy test, no difference was detected between the dimensions of the follicles, corpora lutea as well as their cavities and progesterone levels 9 days after insemination in the dairy cows with spontaneous ovulations. In contrast to the corpus luteum without cavity, the surface area of the corpus luteum with cavity remained constant during the study period, while at the same time the cavity decreased in size to a significant degree. In addition, breed differences in corpus luteum sizes were detected on day 34., Conclusion: No cause was detected for the formation of cavities in corpora lutea and there was no link to the follicle from which the corpus luteum developed., Clinical Relevance: Both the changes in corpus luteum sizes over time and their breed-related differences could have an impact on insemination outcome., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht.Herrn Prof. Dr. Dr. h.c. mult. H. Bostedt zum 85. Geburtstag gewidmet., (Thieme. All rights reserved.)

The antral follicle count (AFC) and Anti-Müllerian hormone (AMH) concentration are validated markers for ovarian reserve in cattle, but their use as fertility markers is controverse. Here we assessed the effects of postpartum diseases on AFC and AMH concentration, as well as the influence of parity and breed on these parameters. Cows (n = 513, mostly Holstein Friesian and Brown Swiss, parity 3.0 ± 1.8) underwent a single ultrasonography examination 28-56 days after parturition and categorized as having low (n ≤ 15 follicles), intermediate (n = 16-24 follicles), or high (n ≥ 25 follicles) AFC based on objective video analysis of recorded sequences. Blood samples for AMH determination were collected at the time of examination and animals divided into low (< 0.05 ng/ml) and high AMH (≥ 0.05 ng/ml) group, respectively. No effects of postpartum diseases or breed on either AFC or AMH groups could be observed. There was a strong interaction between parity and AFC, primiparous cows having less follicles (13.6 ± 6.2 vs. 17.1 ± 7.0, P < 0.001) than pluriparous cows. The AFC did not affect reproductive parameters or productivity of the cows. In comparison, pluriparous cows with high AMH concentration had shorter calving to first service (86.0 ± 37.6 vs. 97.1 ± 46.7 days, P < 0.05) and calving to conception (123.8 ± 51.9 vs. 135.8 ± 54.4 days, P < 0.05) intervals, but lower milk yield (8440.3 ± 2292.9 vs. 8927.9 ± 2192.5 kg, P < 0.05) compared to cows with low AMH. In conclusion, no effect of postpartum diseases on AFC or AMH concentration of dairy cows could be observed. However, an interaction between parity and AFC, as well as associations of AMH with fertility and productivity in pluriparous cows, were demonstrated., Competing Interests: Declaration of Competing Interest The authors declare that they have no financial or personal relationship with other people or organizations that could inappropriately influence or bias the publication of this manuscript., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives : The goal of this study was to investigate the effect of selective serotonin reuptake inhibitor treatment on the ovarian reserves of women of reproductive age with major depressive disorder. Materials and Methods : The current study is a prospective controlled trial including 48 women with major depressive disorder and 48 age-matched healthy controls. Ovarian reserve tests are performed prior to treatment and after six cycles of selective serotonin reuptake inhibitor treatment in the major depressive disorder group. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, and anti-Müllerian hormone levels were evaluated from blood samples, and endometrial thickness, total antral follicle count, and volume of both ovaries were assessed using transvaginal ultrasonography. Results : When the first measurements were compared, menstrual duration and menstrual bleeding increased ( p = 0.007 and 0.005, respectively) and luteinizing hormone decreased ( p = 0.045) in the major depressive disorder group, while follicle-stimulating hormone, estradiol, anti-Müllerian hormone, endometrial thickness, total antral follicle count, and mean ovarian volume did not differ significantly between groups ( p > 0.05). When the major depressive disorder group's first and final measurements were compared, follicle-stimulating hormone, estradiol, and endometrial thickness increased ( p = 0.05, 0.0001, and 0.005, respectively), luteinizing hormone remained constant ( p = 0.541), and anti-Müllerian hormone and total antral follicle count decreased ( p = 0.024 and 0.042, respectively). Conclusions : In this study, we observed that the ovarian reserve test results of patients diagnosed with major depression for the first time after 6 months of SSRI treatment were significantly different from the results of the pretreatment and control groups.

Purpose: We examine the use of transvaginal sonography in imaging ovarian follicles among non-pregnant reproductive-aged women enrolled in a contraceptive clinical trial., Methods: Ten sites conducted a clinical trial comparing three oral ulipristal acetate regimens for ovulation inhibition. Enrollees underwent twice weekly transvaginal sonography and hormonal blood testing throughout treatment and until the second menses post-treatment. The primary outcome of the present analysis was success in identifying follicles ≥10 mm in a subgroup of sonograms performed at times of likely follicular activity (estradiol <100 pg/ml and progesterone >3 ng/ml). Secondarily, an overall analysis assessed all sonograms regardless of timing., Results: At times of likely follicular activity, 135 women underwent 969 sonograms. The proportion of sonograms without follicles ≥10 mm ranged from 8.3% to 46.3% when stratified by site (p = .01). The odds of no follicle among higher-body mass index (BMI) women were 1.91 times those among lower-BMI women after controlling for site and treatment arm (95% CI: 1.13, 3.22). Results were similar for the overall population., Conclusion: Sonographers were less likely to identify follicles for higher-BMI women and results varied by site. Machine quality slightly impacted sonogram results, but did not sufficiently explain site differences., (© 2022 Wiley Periodicals LLC.)

In this paper, we present a new way to assess the concentration of estradiol (E2) and Insulin Growth Factor-1 (IGF) based on the results from ultrasound scans combined with mathematical models. The IGF1 model is based on the progesterone (P4) concentration, which can be estimated with models calculating P4 level based on the size/volume of corpus luteum (CL) measured during ultrasound scans. At this moment little is known about the underlying reasons for double ovulation and silent heat occurrences. Both of these are linked to the level of IGF1: double ovulations are linked to higher IGF1 levels and and silent heat is linked to lower E2 to P4 ratio. These models can help to improve understanding of the related concentrations of E2 and IGF1. Currently, it is known that diet and genetic factors have an impact on ovulation rates and silent heat. In this study, we also examine the decline of the production of E2 in vivo by atretic follicles throughout the process of atresia. This is the first recorded quantitative description of this decline., Competing Interests: The authors declare no conflict of interest.

In an attempt to develop accessible methods for the precocious individual selection based on phenotypic attributes related to reproductive superiority, this study evaluated the effects of follicular wave stages (emergence and dominance) and the repeatability coefficients of potential fertility predictors (vulvar morphometry, uterine biometry, echogenicity and echotexture, ovarian biometry, and antral follicle count - AFC) in two breeds of purebred prepubertal heifers. Nellore (n = 30) and Caracu (n = 28) heifers were submitted to a sequence of 11 evaluations conducted every 48 h (D0 - random day of the antral follicular wave until D20) to study potential fertility indicators under natural conditions. The data obtained were compared according to breed and follicular wave stage. Statistical analysis included the fixed effects of breed, evaluation day, and their statistical interaction and was performed using MIXED, GENMOD, GLM, and CORR procedures of the SAS program. Breed was found to influence rima height, ovarian area, and AFC, which were greater in Nellore heifers (P < 0.02). The follicular wave stage also influenced most of the potential predictors, highlighting AFC which was higher in the presence of a dominant follicle in both breeds (P < 0.0001). The repeatability coefficients for vulvar width (0.76 and 0.66), ovarian area (0.70 and 0.62), and AFC (0.76 and 0.74) were considered to be high in Nellore and Caracu heifers, respectively. Only ovarian biometry was able to predict AFC (Pearson correlation coefficient ≥ 0.66; P < 0.0001) in prepubertal heifers. The results indicate that most of the phenotypic reproductive parameters analyzed can be characterized throughout prepuberty using a single measure since they are intrinsic attributes of the individual., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

After having been brought to America 400 years ago, the Criollo horse reproduced freely for centuries in the southern part of the American continent. Roughness, resistance, and endurance are typical characteristics of this breed of horses. Although the natural selection that occurred over the centuries may have positively influenced the fertility and longevity of this breed, information regarding ovarian function and other reproductive aspects of Criollo breed mares under natural or controlled management conditions is scarce. The objectives of the present study were to (1) characterize the follicular dynamics of Criollo breed mares, (2) characterize growth and regression of the corpus luteum, and (3) study the cervical and uterine tone and ultrasonographic echotexture changes during two consecutive estrous cycles. In this study, 26 interovulatory intervals (IOI) were evaluated in 13 mares. Spontaneous estrous cycles were characterized by the following: (1) the IOI length was 21 days; (2) dominant and subordinate follicles emerged together at day 5 (ovulation = day 0), and their growth rates were slower until the day of deviation; (3) the deviation in growth rates between the two largest follicles of the ovulatory wave occurred when the dominant and subordinate follicles reached 22 and 21 mm in diameter, respectively; (4) the mean diameter of the preovulatory follicle at the day before ovulation was 43 mm; (5) different combinations of follicular waves were observed in each interovulatory interval; (6) the corpus luteum reached its maximum diameter about 2 days after ovulation and decreased gradually afterward; (7) after ovulation, the cervical and uterine tones were positively correlated and remained elevated until the onset of the expected luteolysis (days 12-14); and (8) after the expected luteolysis, the endometrial echotexture started to increase and reached maximum values 5-3 days before ovulation, when it started to decrease. Moderate-to-strong positive correlations between IOIs revealed repeatability within animals for the diameter of the preovulatory follicle at maximum and at the day before ovulation, cervical and uterine tones, endometrial echotexture, and corpus luteum diameter. The findings herein presented are of fundamental importance for a better understanding of the reproductive physiological patterns of the estrous cycle in the Criollo breed mare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To test whether volume-based follicular output rate (FORT-V) is superior to diameter based follicular output rate (FORT-D) in predicting the number of mature oocytes. The follicular output rate (FORT) is the ratio between preovulatory follicle count (PFC) and antral follicle count (AFC) and has been proposed as a better predictor of the ovarian response compared with AFC alone., Design: A prospective observational study of 215 consecutive women (80 oocyte donors and 135 in vitro fertilization [IVF] patients) undergoing ovarian stimulation for IVF., Setting: University affiliated private IVF center., Patient(s): Women undergoing ovarian stimulation between May 2018 and September 2021., Intervention(s): Manual two-dimensional ultrasound and computer-generated (three-dimensional ultrasound, [3D]) AFCs were performed at baseline. During ovulation induction, follicular growth was monitored in each patient using both two-dimensional and 3D ultrasound. Preovulatory follicles were defined as those with a mean diameter of 16-22 mm. The trigger was based on the follicular volume according to our standard protocol: at least 2 follicles with a volume of >2 cc with 70% of the follicles having a volume of >0.7 cc., Main Outcome Measure(s): The primary outcome was the difference between FORT-V and FORT-D in their ability to predict the mature oocyte output rate., Result(s): In both IVF patients and oocyte donors, the computer-generated AFC was greater than the manual AFC. The FORT-V was higher than the FORT-D for both computer-generated (the difference was 35 [95% CI {confidence interval}, 32-45] in oocyte donors and 21 [95% CI, 5-46] in IVF patients) and manual FORT (the difference was 38 [95% CI, 32-45] in oocyte donors and 15 [95% CI, 3-43] in IVF patients) and was closer to the mature oocyte output rate. There was a direct correlation between the computer-generated AFC and the PFC based on volume and between PFC based on volume and the number of mature oocytes in oocyte donors and IVF patients., Conclusion(s): In this prospective study of 215 women, the FORT based on 3D ultrasound derived follicular volume (FORT-V) was superior to the FORT-D in determining the ovarian response in both oocyte donors and IVF patients. Moreover, our results support the non-inferiority of the computer-generated method compared with the manual method for the determination of AFC. Further studies on the role of computer-generated antral follicle characteristics may be useful in evaluating follicle stimulation regimens., (Copyright © 2022 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Context: Anti-Müllerian hormone (AMH) levels strongly correlate with the number of antral follicles (total follicle count, TFC) in the ovary. In women with polycystic ovary syndrome (PCOS), this is reflected by significantly increased serum AMH levels. Different assays have been developed to measure AMH. However, little is known about the interassay correlation in women with increased AMH levels., Objective: To investigate the correlation of AMH values between different AMH assays and with TFC in PCOS patients., Methods: AMH levels were measured in 1660 PCOS patients, using 3 different AMH assays: Gen II (Beckman Coulter); picoAMH (Ansh Labs); and Elecsys (Roche). Passing Bablok regression was used to compare assay methods. Spearman's correlation was used to correlate AMH levels and TFC., Results: Strong interassay correlations were present over the total range of AMH levels (0.81-0.94). Stratification in subgroups, revealed an AMH level-dependent interassay correlation with strong interassay correlations in the low (<2.80 ng/mL) and high (>7.04 ng/mL) subgroups (0.62-0.86). However, the correlation in the mid-AMH subgroup (2.80-7.04 ng/mL) was only moderate (0.28-0.56). A strong correlation was present between the total range of AMH levels and TFC (0.57-0.62). However, in all 3 AMH subgroups the correlation became moderate at best, independently of assay method (0.11-0.45)., Conclusion: In conclusion, both the interassay correlation and the correlation between AMH level and follicle count depend on the range of serum AMH levels. This once more emphasizes the need of a standardization of AMH measurement for an accurate interpretation of AMH in clinical practice., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.)

Objective We aimed to assess whether ovarian reserve test including serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Mullerian hormone (AMH) levels, and antral follicle count (AFC) which are ovarian reserve markers are affected by ultraviolet (UV) radiation or not. Methods Women between the ages of 25 and 40 who served as flight crew constituted the study population in this prospective case-control study. Age-matched women having no risk factor for low ovarian reserve were selected as control group. Participants were compared according to age, duration in profession, and ovarian reserve markers. Results A total of 134 patients were included: 66 participants in study group and 68 participants in control group. Serum AMH levels and AFC were found to be significantly lower while serum FSH and E2 levels were significantly higher in the study group. This difference was found to be more significant, especially in the advanced age group. When the participants were classified according to their working time, lower ovarian reserve was observed in women with longer working time. Discussion Working for a while in the air and being closer to the sun have negative effects on ovarian functions. Preventive measures may be taken earlier in flight crew than those in the normal population to prevent the decline of ovarian functions and possible conceiving problems.

As prenatal transportation stress altered behavior and adrenal glucocorticoid secretion of calves, we hypothesized that prenatal transportation stress would decrease ovarian reserve size and negatively impact female offspring fertility. The impact of prenatal transportation stress on ovarian follicle numbers in female offspring for three generations was studied. Brahman cows were transported for 2 h on day 60 ± 5, 80 ± 5, 100 ± 5, 120 ± 5, and 140 ± 5 of gestation. Ovaries were collected from offspring of transported or non-transported dams at multiple ages. Primordial, primary, secondary, and antral follicles were histologically analyzed. Antral follicle numbers were determined by ultrasound in a subset of offspring. Numbers of primordial, primary, secondary, and antral follicles were analyzed using the MIXED procedure, while the CORR procedure of SAS was used to determine the correlation between follicles observed by ultrasonography and histology. There were no differences (P > 0.05) in the number of primordial, primary, secondary, antral, or total follicles observed histologically due to treatment. Younger females had significantly greater numbers of follicles than older females (P < 0.0001). Antral follicles tended to be correlated with total histological ovarian follicles (P = 0.10). There was no difference in the number of antral follicles observed at ultrasound due to treatment (P = 0.3147), or generation (P = 0.6005) when controlling for age at observation. These results show that short-term transportation stress during early- to mid-gestation did not impact fertility as measured by ovarian follicle numbers in female Brahman offspring for three generations., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC ( n  < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC ( n  ≥ 7) and group 3: patients with normal AMH (≥1.1 ng/dl) and low AFC ( n  < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66-150), group 2: 71 (57-100), group 3: 136 (96-200), p <.01 - median FOI score with quartiles: group 1: 83 (50-140), group 2: 71 (40-100), group 3: 116 (66-216), p <.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC.Impact Statement What is already known on this subject? Female age, serum Anti-Müllerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve. What do the results of this study add? If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC. What are the implications of these findings for clinical practice and/or further research? It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone.

Jennies' follicular wave patterns have not yet been addressed during the non-breeding and transition seasons in anoestrous jennies. Twelve non-pregnant females of the Miranda donkey breed were followed to describe follicular wave characteristics during the non-reproductive season and determine the anoestrous effect in follicular wave patterns. Five jennies enrolled in this study experienced anoestrus during the non-breeding season, but all retained the continuous emergence of follicular waves. The average duration of the waves from emergence to peak was 11.2 ± 0.021 days (3-29 days). The duration of the different type of waves was 9.91 ± 0.034 days for minor waves,12.5 ± 0.232 days for major secondary waves and 12.5 ± 0.057 for major primary waves. The major waves were significantly longer than the minor waves (p < .001). Older jennies presented longer waves (p = .021). In the jennies presenting anoestrus, the wave duration during anoestrus (11.2 ± 0.125 days, n = 31) was not different from the waves detected in the preceding and subsequent ovulatory cycles (11.3 ± 0.084 days, n = 43) (p = .978). The number of follicular waves emerging in each ovulatory cycle (n = 59) was 2.36 ± 0.011, varied from 1 to 4. Only in a small proportion of cycles, one wave (0.8%) was recorded, with 41 cycles (67.2%) presenting two waves; fourteen cycles presenting three waves (24.6%); and three cycles (6.6%) showing 4 waves. It was concluded that follicular waves do occur in anoestrous jennies during the non-breeding season with two-wave cycles being common., (© 2022 Wiley-VCH GmbH.)

Objective: A case-control study was conducted to explore the clinical value of three-dimensional transvaginal ultrasound in the diagnosis of endometrial receptivity (ER) and ovarian function in patients with infertility., Methods: A total of 308 infertile women treated in our hospital from March 2020 to June 2021 were enrolled as the observation group, and another 300 women of childbearing age who underwent physical examination in the same period were enrolled as the control group. The clinical value of three-dimensional transvaginal ultrasound in ER in patients with infertility was analyzed by comparing the classification of endometrial and subendometrial blood perfusion, endometrial AUC value and Pi value, and subendometrial AUC value and Pi value. According to the number of oocytes obtained, the patients were assigned into the normal response group (182 cases, ≥5 oocytes) and the low response group (126 cases, <5 oocytes). The levels of some hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and FSH/LH, were measured. Transvaginal ultrasonography was performed to detect ovarian volume (OV), antral follicle count (AFC), and peak flow rate of the ovarian interstitial artery (PSV). The peak of end-diastolic flow velocity (EDV) and other indexes were analyzed. The correlation between FSH level, FSH/LH, and ultrasound indexes was analyzed, and the ROC curve was established to analyze the value of transvaginal Doppler ultrasound in evaluating ovarian reserve function and predicting ovulation., Results: There were significant differences in late proliferation type I and type III, ovulatory type II and type III ( P < 0.05). There exhibited no significant difference in late proliferation type II, ovulation stage type I, and implantation window stage type I, type II, and type III ( P > 0.05). Regarding the endometrial AUC and Pi values, the endometrial AUC and Pi values in the observation group were lower compared to the control group during late proliferation and ovulation ( P < 0.05). There exhibited no significant difference in AUC and Pi ( P > 0.05). Regarding the subintimal AUC and Pi values, the subintimal AUC and Pi values in the observation group were higher compared to the control group during late proliferation and ovulation ( P < 0.05). There exhibited no significant difference in AUC and Pi during the implantation window ( P > 0.05). There exhibited no significant difference in menarche age, age, body mass index, and menstrual cycle between the normal response group and the low response group ( P > 0.05). The levels of EDV, OV, AFC, and PSV in the normal response group were higher compared to the low response group ( P < 0.01). Compared with the low response group, the levels of FSH and FSH/LH in the normal response group were lower, but the levels of LH and E2 in the normal response group were higher ( P < 0.05). The results of correlation analysis of FSH, FSH/LH, and ultrasound parameters between the normal response group and the low response group indicated that FSH was negatively correlated with E2, EDV, OV, AFC, and PSV in 308 infertile women ( r = -0.817, -0.846, -0.707, -0.845, -0.911, P < 0.01), but it was positively correlated with FSH/LH ( r = 0.714, P < 0.01). The ultrasound parameters of ovarian reserve function in the normal response group and the low response group were compared with the indexes that predicted ovulation. The results of ROC curve analysis indicated that the cutoff values of EDV, OV, AFC, and PSV were 4.141, 3.726, 4.106, and 13.944, respectively, the specificity of each index was higher than 90.00%, and the sensitivity was higher than 80.00% except PSV., Conclusion: Transvaginal ultrasound can not only accurately evaluate the ER of infertile women but also directly observe follicular development and monitor ovulation, which is of high value in evaluating ovarian reserve function and predicting ovulation., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2022 Jingjing Wu et al.)

Objective: To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment., Methods: We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority., Results: Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19-35 years), BMI (19.5-33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met "clinical quality." The difference of -2.4% (97.5% CI lower bound -5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI -0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3-79.0, P<.01), indicating greater satisfaction with the virtual experience., Conclusion: Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care., Funding Source: This study was sponsored by Turtle Health., Clinical Trial Registration: ClinicalTrials.gov, NCT04687189., Competing Interests: Financial Disclosure: The authors Esther H. Chung, Laura C. Petishnok, Jesse M. Conyers, David A. Schimer, Wendy S. Vitek, Amy L. Harris, Michelle A. Brown, Julie A. Jolin, Anatte Karmon and Aaron K. Styer are paid consultants and advisors of Turtle Health. None hold equity or options in the Company. The other authors did not report any potential conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: The relationship between smoking and ovarian reserve markers is inconclusive. The primary objective of our study was to assess the effect of cigarette smoking on the quantitative ovarian reserve parameters, serum anti-Mullerian hormone (AMH) and antral follicle count (AFC) as relevant to prediction of fertility outcomes in women seeking fertility treatment. Our secondary aims were to validate self-reported smoking behaviour using biomarkers and evaluate the association between biomarkers of ovarian reserve (serum AMH and AFC) with biomarkers of smoking exposure (breath carbon monoxide (CO) and urine cotinine levels)., Design: Prospective, cross-sectional study., Setting: Single tertiary care fertility centre., Participants: Women ≤35 years seeking fertility treatment., Primary Outcome Measures: Serum AMH and AFC., Results: Significant differences were found among current smokers, ex-smokers and never smokers for breath CO (F(2,97)=33.32, p<0.0001) and urine cotinine levels (p<0.001). However, no significant differences were found either for serum AMH (F(2,91)=1.19, p=0.309) or total AFC (F(2,81)=0.403, p=0.670) among the three groups. There was no significant correlation between pack years of smoking and serum AMH (r=-0.212, n=23, p=0.166) or total AFC (r=-0.276, n=19, p=0.126). No significant correlation was demonstrated between breath CO and serum AMH (r=0.082, n=94, p=0.216) or total AFC (r=0.096, n=83, p=0.195). Similarly, no significant correlation was demonstrated between urine cotinine levels and serum AMH (r=0.146, n=83, p=0.095) or total AFC (r=-0.027, n=77, p=0.386)., Conclusion: We did not find a statistically significant difference in quantitative ovarian reserve markers between current smokers, ex-smokers and never smokers which would be clinically meaningful in our study population. We confirmed that self-reported smoking correlates well with quantitatively measured biomarkers of smoking. This validated the self-reported comparison groups to ensure a valid comparison of outcome measures. There was no significant association between biomarkers of smoking and biomarkers of ovarian reserve. We were also unable to demonstrate a correlation between the lifetime smoking exposure and ovarian reserve., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although it is well known that the ovulation occurs during a period of time after LH surge in dogs, there are few reports of observing the entire process of development, ovulation and luteinization of each follicle. This study aimed to detect the ovulation kinetics by ultrasonography in combination with progesterone monitoring and therefore identify the time-range of the ovulation process in a dog. Daily transabdominal ultrasonography and progesterone monitoring were conducted for 24 natural oestrus cycles of Labrador Retrievers. Ovarian follicles were observed as anechoic structure with contours before ovulation. Ovulation (follicular collapse) was defined as when follicles became cloudy and contours obscure by transabdominal ultrasonography. Ultrasound imaging was capable of identifying the day of ovulation for 94.7% (178/188) of the follicles through the appearance of collapsed follicle or corpus luteum. Ovulation was observed between LH 0 (the day of LH surge) and LH 5, with 48.0%, 33.5% and 15.0% for LH 2, LH 3 and LH 1, respectively. The total number of ovulations on LH 2 and LH 3 accounted for 81.5% (141/173) of the total ovulation in 24 cycles examined. Ovulation occurred in 12 cycles for 2 d and for 3 d in 12 cycles. Seventeen cycles (70.8%) with multiple days of ovulation showed the largest number of ovulations on LH 2. The average follicle diameter 3 d before the LH surge was less than 5 mm, then exceeded 5 mm 2 d before the LH surge. The average follicle diameter at the time of ovulation (follicular collapse) was 6.1 ± 1.0 mm (n = 118). On the day before ovulation, the average diameters of the follicles ovulated on LH 1, LH 2 and LH 3 were 5.0 ± 0.7 mm, 5.8 ± 1.2 mm and 6.2 ± 1.3 mm, respectively. There was a significant difference in the follicle diameter between LH1 and LH2 (p < .001), LH2 and LH3 (p < .05), and LH1 and LH3 (p < .001). Suggesting that it is difficult to estimate the ovulation day based on follicle size. This study showed that combination of ultrasonography with progesterone monitoring could follow follicular development, ovulation and luteinization of the ovary in Labrador Retrievers. The direct visualization of the ovulation was achieved in a non-invasive, labour-friendly way. Furthermore, the time-range of the ovulation process was clarified in a dog. These results may contribute to an accurate understanding of the optimum timing of mating and improved breeding efficiency, including artificial insemination and embryo transfer for Labrador Retrievers., (© 2021 Wiley-VCH GmbH.)

This study was conducted to compare the effectiveness of two methodologies in evaluating B- and Doppler-mode ultrasonic images: analysis using ultrasonic software and utilizing a computer with ImageJ software. To determine if ImageJ software utilization is an efficacious alternative to ultrasonic software device- analysis, there were comparisons of values when using the two methods for morphological and vascular characteristics of follicular dynamics and luteal function in 18 crossbred cattle. From day 8 of an ovarian dynamics synchronization treatment regimen period until the time of ovulation (Day 10), B-mode and power-flow ultrasonic cineloops were obtained every 12 h to assess follicular diameter, wall area, and wall blood perfusion area. On Day 14 after ovulation, US cineloops of ovaries were obtained in B mode and power flow to evaluate various morphological and vascular characteristics of the corpus luteum (CL), including luteal diameter, luteal area, and CL blood perfusion area. Cineloops were evaluated and analyzed using ultrasonic software, and in a computer with ImageJ software. To evaluate consistency in results between the two methods, there was evaluation utilizing paired t-test, Pearson correlation coefficient, Bland-Altman plot, and Linear Regression Test procedures to calculate proportion of bias between values for measurements of variables evaluated. Results indicated none of the values for variables before and after ovulation differed (P > 0.05). It, therefore, was concluded that utilization of ImageJ software is an efficacious biomedical technique to analyze ultrasonic images of morphological and vascular characteristics before and after ovulation in cattle., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed., Methods: 410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase., Results: Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively)., Conclusion: AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.

In order to determine whether seasonal variations may influence the estrous cycle length (ECL), corpus luteum size (CLS), maximum area of CL (MACL), day of cycle with maximum area of CL (DCMACL), and pre-ovulatory follicles size (PFS), ten Criollo Limonero heifers were subjected to daily ultrasound ovary scanning throughout their estrous cycles during three seasons: hot-dry (HD), hot-humid (HH), and wind-rain (WR). The effect of season on ECL, MACL, DCMACL, and PFS was analyzed with an ANOVA (PROC GLM, SAS), whereas, for the effect of season on CLS, an ANOVA with repeated measures (PROC MIXED, SAS) was used. Results showed no effect (P > 0.05) of season on ECL, MACL, and DCMACL. However, size of PFS was larger (P < 0.02) during the WR season and the CLS tended (P < 0.09) to be lower during the HH. In conclusion, the relative stability of ECL, MACL, DCMACL, PFS, and CLS measures suggests no major seasonal variations which could imply adaptation capability of Criollo Limonero cattle to the tropical environment., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Cryopreservation of ovarian tissue is a powerful technique for preserving female fertility, as it can restore fertility and endocrine function. To increase the longevity of the transplant and decrease the risk of reimplantation of neoplastic cells, several studies have been carried out with culture of ovarian tissue. The aim of this study was to compare a conventional (2D) culture with an alginate matrix three-dimensional (3D) model for ovarian tissue culture., Results: The ovarian tissue culture within the alginate matrix (3D) was similar to 2D culture, regarding follicular density and cell apoptosis in follicles and stroma. The proliferation rate remained stable in both models for follicles, but for stromal cell proliferation it decreased only in 3D culture (p = 0.001). At 24 h of culture, cytotoxicity was lower in the 3D model (p = 0.006). As culture time increased, cytotoxicity seemed similar. Degradation of the tissue was suggested by the histological score analysis of tissue morphology after 72 h of culture. Tissue injury was greater (p = 0.01) in 3D culture due to higher interstitial oedema (p = 0.017) and tissue necrosis (p = 0.035)., Conclusion: According to our results, 3D culture of ovarian tissue has no advantage over 2Dculture; it is more time consuming and difficult to perform and has worse reproducibility., (© 2021. The Author(s).)

Objective: To examine the association between ambient temperature and antral follicle count (AFC), a standard measure of ovarian reserve., Design: Prospective cohort study., Setting: Fertility center at an academic hospital in the northeastern United States., Patient(s): 631 women attending the Massachusetts General Hospital Fertility Center (2005-2015) who participated in the Environment and Reproductive Health Study., Intervention(s): Daily temperature at the women's residential address was estimated for the 90 days before their antral follicle scan using a spatially refined gridded climate data set. We evaluated the associations between temperature and AFC using Poisson regression with robust standard errors, adjusting for relative humidity, fine particulate matter exposure, age, education, smoking status, year and month of AFC, and diagnosis of diminished ovarian reserve and ovulation disorders., Main Outcome Measure(s): Antral follicle count as measured with transvaginal ultrasonography., Result(s): A 1°C increase in average maximum temperature during the 90 days before ovarian reserve testing was associated with a -1.6% (95% confidence interval [CI], -2.8, -0.4) lower AFC. Associations remained negative, but were attenuated, for average maximum temperature exposure in the 30 days (-0.9%, 95% CI, -1.8, 0.1) and 14 days (-0.8%, 95% CI, -1.6, 0.0) before AFC. The negative association between average maximum temperature and AFC was stronger in November through June than during the summer months, suggesting that timing of heat exposure and acclimatization to heat may be important factors to consider in future research., Conclusion(s): Exposure to higher temperatures was associated with lower ovarian reserve. These results raise concern that rising ambient temperatures worldwide may result in accelerated reproductive aging among women., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine a cutoff for the Elecsys AMH Plus immunoassay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland) to identify polycystic ovarian morphology (PCOM), a polycystic ovary syndrome (PCOS) criterion., Design: The AMH Protein in Humans for polycystic ovaRian mOrphology DIagnostic TEsting (APHRODITE) study was a retrospective, multicenter, case-control study. The serum antimüllerian hormone (AMH) level was measured using the Elecsys AMH Plus immunoassay. The antral follicle count was determined using transvaginal ultrasound. An AMH cutoff was derived and validated in separate cohorts with cases of PCOS with full phenotype A (oligo/anovulation, hyperandrogenism, and PCOM) versus that with controls. Exploratory analyses of age and PCOS phenotype were performed., Setting: Not applicable., Patient(s): Polycystic ovary syndrome-positive (PCOS A-D per the Rotterdam criteria) and PCOS-negative women aged 25-45 years., Intervention(s): None., Main Outcome Measure(s): A validated cutoff for AMH using the Elecsys AMH Plus assay for PCOM., Result(s): In the validation cohort (455 cases and 500 controls), an AMH cutoff of 3.2 ng/mL (23 pmol/L) resulted in a sensitivity of 88.6% (95% confidence interval [CI] 85.3-91.3) and specificity of 84.6% (95% CI 81.1-87.7) for PCOM diagnosis as well as an area under the receiver-operator characteristic curve of 93.6% (95% CI 92.2-95.1). In women aged 25-35 years, the sensitivity and specificity for the cutoff were 88.5% and 80.3%, respectively, versus 77.8% and 90.1%, respectively, in women aged 36-45 years. The results were consistent across PCOS phenotypes A-D., Conclusion(s): The Elecsys AMH Plus immunoassay, with a cutoff of 3.2 ng/mL (23 pmol/L), is a robust method for identifying PCOM to aid in PCOS diagnosis., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: we evaluated clinical features, the hormonal status, and ovarian morphological characteristics using ultrasound (US) in adolescents with polycystic ovary syndrome (PCOS) and an 'increased risk' of PCOS, and compared the data to age-matched controls., Methods: the prospective study involved 154 adolescents (≥2 and <8 years post menarche): Group I-adolescents with PCOS ( n  = 60), Group II- adolescents with an 'increased risk' of PCOS ( n  = 48), and Group III- control group ( n  = 46). PCOS patients met all 3 diagnostic criteria of the Rotterdam consensus (2003), an 'increased risk' of PCOS was accepted as 'menstrual irregularities and clinical and/or biochemical hyperandrogenism'., Results: In adolescents with PCOS and 'increased risk' of PCOS, AMH and SHBG did not differ significantly. In Group I and Group II, the average AMH level was significantly higher, while SHBG was significantly lower than in the controls ( p  < .001). Androgen levels and mFG in Group I and Group II did not differ significantly, but were significantly higher than in controls ( p  < .001). In Group I, index of insulin resistance and the number of antral follicles (AFC) were significantly higher than in the comparison groups ( p  < .05). There was no significant difference in ovarian volume between comparison groups ( p  < .001)., Conclusions: A combination of AMH, SHBG, clinical and biochemical hyperandrogenism and menstrual irregularities may be considered as diagnostic markers of PCOS in adolescents and for the identification of a 'risk group' for developing PCOS. Ultrasound estimation of AFC are a more specific marker of ovarian morphology in adolescents with PCOS, rather than ovary volume.

In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 ± 4.75 to 10.2 ± 3.4 p  < .01; 12.23 ± 2.53 to 5.02 ± 2.44 p  = .02; score 1:28 to 10 p  < .01, respectively). There was no statistically significant difference in terms of mean RI and PI values between the groups ( p  > .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 ± 2.65 to 1.78 ± 1.2, p  < .01; 50.76 ± 4.45 to 40.6 ± 3.64, p  = .03; and 2.34 ± 1.02 to 1.12 ± 0.65, p  = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statement What is already known on this subject? Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries. What do the results of this study add? 3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries. What are the implications of these findings for clinical practice and/or further research? In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.