Reproducibility of the Endometriosis Fertility Index: a prospective inter/intra-rater agreement study.

To evaluate the reproducibility of the EFI (Endometriosis Fertility Index).Single-cohort prospective observational study.University hospital.Women undergoing laparoscopic resection of any rASRM-stage endometriosis.Details of pre- and per-operative findings were collected into a coded research file. EFI-scoring was performed ‘en-bloc’ by three different raters (expert-1 (C.T.), expert-2 (C.M.), junior (C.B.)). Required sample size: 71. Definitions used for agreement: clinical (scores within same range: 0-4, 5-6, 7-10) and numerical (difference ? 1 EFI-point).Primary outcome: rate of clinical agreement between two experts.expert numerical agreement, clinical and numerical agreement between expert-1 and junior and within expert-1 (intra-observer), agreement of rASRM-score and -stage.A near-to-perfect ‘inter-expert’ clinical agreement rate (1.000 (95% CI 0.956-1.000), p=0.0149) was observed. The numerical agreement between two experts was also high (0.988 (95% CI 0.934-1.000)); similarly high agreement rates were observed for both ‘junior-expert’ comparison (clinical 0 .963 (95% CI 0.897-0.992), numerical 0.988 (95% CI 0.934-1.000) and ‘intra-expert’ comparisons (clinical 0.988 (95% CI 0.934-1.000); numerical 1.000 (95% CI 0.956-1.000)). Reasons for disagreements were different scoring of the least-function score and disagreements in rASRM-scores. The reproducibility of the rASRM-score was clearly inferior to that of the EFI for all comparisons.The EFI can be reproduced reliably by different raters, further supporting its use in daily clinical practice as the principal clinical tool for postoperative fertility counselling/management of women with endometriosis. This article is protected by copyright. All rights reserved.

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Quantitative differences in TGF-? family members measured in small antral follicle fluids from women with or without PCO.

Members of the Transforming-Growth-Factor-? (TGF-?) family have been implicated in aberrant follicle development in women with polycystic ovaries (PCO).Are there quantitative differences in the concentrations of TGF-? family members in fluid from small antral follicles (hSAF) from women with or without PCO?& Follicle fluids (FF) were collected from 4-11 mm hSAF obtained from women undergoing ovarian tissue cryopreservation for fertility preservation.FFs from 16 women with PCO (FF=93) and 33 women without PCO (FF=92).Intrafollicular concentrations of Growth-Differentiation-Factor-9 (GDF9), Anti-Müllerian-Hormone (AMH), inhibin-A and -B, total inhibin, activin-A, -B and -AB, follistatin, follistatin-like-3, estradiol, and testosterone.Activin-B concentrations are reported for the first time in hSAF and concentrations were 10 times higher than activin-A and -AB. Activin-B showed significant associations to other growth factors. Concentrations of inhibin-A and -B were significantly lower in FF from women with PCO, especially in hSAF below 8 mm in diameter. AMH concentrations did not differ between the groups in hSAF below 8 mm, however, AMH remained high in hSAF above 8 mm in PCO but decreased in non-PCO women. Estradiol was significantly lower in FF from women with PCO and showed significant associations with AMH. Concentrations of GDF9 are reported for the first time showing significantly higher concentrations in PCO FF of follicles above 6 mm.Altered concentrations of TGF-? family members in hSAF from women with PCO highlight altered growth factor signaling as a potential mechanism for follicle growth arrest.

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Gene expression in granulosa cells from small antral follicles from women with or without polycystic ovaries.

Polycystic ovary syndrome (PCOS) is the commonest cause of anovulation. A key feature of PCOS is arrest of follicles at the small-medium sized antral stage.To provide further insight into the mechanism of follicle arrest in PCOS, we profiled; (1) gonadotropin receptors; (2) characteristics of aberrant steroidogenesis, and (3) expression of anti-Mullerian hormone (AMH) and its receptor in granulosa cells (GCs) from unstimulated, human small antral follicles (hSAFs) and from granulosa-lutein cells (GLCs).GCs from hSAFs were collected at the time of cryopreservation of ovarian tissue for fertility preservation and GLCs collected during oocyte aspiration before IVF/ICSI.hSAF GCs were collected from 31 women (98 follicles), 10 with polycystic ovaries (PCO) and 21 without. GLCs were collected from 6 women with PCOS and 6 controls undergoing IVF.Expression of the following genes: LHCGR, FSHR, AR, INSR, HSD3B2, CYP11A1, CYP19, STAR, AMH, AMHR2, FST, INHBA, INHBB in GCs and GLCs were compared between women with PCO and controls.GCs in hSAFs from PCO women showed higher expression of LHCGR in a subset (20%) of follicles. Expression of FSHR (p<0.05), AR (p<0.05), CYP11A1 (P<0.05) was lower, and expression of CYP19A1 (p<0.05), STAR (p<0.05), HSD3B2 (ns), INHBA (p<0.05) higher in PCO GCs. Gene expression in GL cells differed between women with and without PCOS but also differed from that in GCs.Follicle arrest in PCO is characterised in GCs by differential regulation of key genes involved in follicle growth and function.

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