Polycystic ovary syndrome (PCOS) is often associated with metabolic disturbances such as insulin resistance, glucose intolerance, dyslipidemia, obesity, and chronic low-grade inflammation. Low grade inflammation is also a central part of endometrioses, another common disease related to infertility. Based on the hypothesis that low-grade inflammation affects the oocyte microenvironment and oocyte maturation, the aim of the study is to investigate how low-grade inflammation contributes to impaired oocyte development, by investigating the degree of local and systemic inflammatory response in PCOS patients, patients with endometriosis and normal controls. Furthermore, the study will address the basic question of whether plasma levels of inflammatory markers and different hormones are mirrored in follicular fluid and explore any differences in inflammatory profile between endometriosis and PCOS patients.

(Kirstine Kirkegaard, Fertility Clinic Horsens)

A multicenter, prospective observational cohort study aimed at evaluating the diagnostic accuracy of the MUSA (Morphological Uterus Sonographic Assessment) terminology in differentiating between benign and malignant myometrial lesions. Coordinated by University Hospitals Leuven, this study involves ultrasound assessments of the myometrium in women scheduled for hysterectomy or myomectomy, with the histological results serving as the gold standard. The study seeks to develop prediction models based on ultrasound characteristics and assess the safety and long-term outcomes of myomectomy.

(Ina Marie Dueholm Hjorth local coordinator, study from UZ Leuven: PhD fellow, Christine De Bruyn)

Premature ovarian insufficiency (POI) is a clinical syndrome defined as the loss of ovarian function before the age of 40 years. POI is estimated to affect 3-4 % of all women.  For the majority of women presenting with POI, the cause is unexplained. Overall, untreated POI is associated with reduced life expectancy, where the main causes of premature death are cardiovascular disease, osteoporosis and fractures. While there is strong consensus to recommend HRT to women with POI, research on the optimal regimens of HRT is highly limited. Traditionally, estradiol has been recommended. Often a contraceptive pill (COCP)is preferred by the patient or is prescribed as it adds contraception, which is relevant for women with intermittent ovarian function.  Moreover, dose-response trials for HRT in women with POI are rare. The aims of the study are therefore The aims of the present register-based study is therefore to perform a systematic epidemiological description of the population, the present treatment regimens, the long term health and to investigate if there is a difference in the effect of HRT versus COCP on bone and cardiovascular health.

(Kirstine Kirkegaard, AUH, collaboration with Dep of Endocrinology, AUH)

Fibroids in the uterus are present in 20-40 % of women in the fertile age. The most common symptoms are bleeding disorders, pain and pressure symptoms on adjacent organs. For some women fibroids can have a negative effect on fertility, especially if they are close to the uterine cavity.

It is well known that the growth of fibroids is related to estrogen and within the recent years evidence supports that progesterone also is an important factor. The presence of fibroids also affects the surrounding myometrium and possibly the mucosa in the uterine cavity.

Another important factor for fertility is a cavity without adhesions. Recent studies have shown that up to 25 % of women had intrauterine adherences after myomectomy.

By looking at patients before and after myomectomy the study wants to investigate

1. If the amount of progesterone receptors in the endometrium changes after removal of uterine fibroids.
2. How many patients have intrauterine adherences after myomectomy.

The study is performed in collaboration with Odense University Hospital, Denmark and Kvinneklinikken in Oslo, Norway.

(Bente Bækholm Poulsen, AUH)

Based on a hypothesis that inflammation, mitochondrial function and oxidative stress are involved in the pathogenesis of unknown infertility and poor ovarian response, the aims of the present study are to:

• Describe inflammatory response in women with POR
• Describe oxidative stress response and mitochondrial function in women with POR
• Describe inflammatory response in women with unknown cause of infertility
• Describe oxidative stress response and mitochondrial function in women with unknown cause of infertility
• Relate inflammation, mitochondrial function and oxidative stress to female and male factors (lifestyle, BMI, AMHU/AFC), cycle factors (FSH dose, ovarian response, fertilization, embryo quality, time-lapse data) and clinical outcome

The study is a prospective cohort study of fertility patients aged 18-35 with poor ovarian response (women with unknown cause for infertility and fertile women with male factor Mitochondrial function, oxidative stress and inflammatory markers are measured in follicular fluid, granulosa cells and serum.

(Kirstine Kirkegaard, Fertility Clinic Horsens)

Deep infiltrating endometriosis (DIE) affecting the rectum or sigmoid colon is associated with infertility, severe pain, and decreased quality of life. As most women with DIE are young, many have a pregnancy intention. Treatment possibilities of endometriosis-associated infertility are surgery or assisted reproductive technologies (ART), such as in vitro fertilization (IVF). IVF has been shown to increase the fertility rate in these women but has no or in some cases even a detrimental effect on pain symptoms. In opposition, surgical treatment of rectosigmoid DIE has shown to decrease pain score and increase quality of life after 12 months. At the same time, there seems to be up to 57% of these women, who can obtain a spontaneous pregnancy after such surgery. However, no studies have compared the two interventions directly. Therefore, this multicenter randomized controlled trial aims to determine the cumulative pregnancy rate and the live birth rate after first-line surgery compared to first-line ART for women with rectosigmoid DIE and a pregnancy intention.

 (Mikkel Seyer Hansen, AUH, Maja Raos, ph.d. studerende, Fertilitets Klinikken Horsens)