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Significant of Antimullerian Hormone [AMH] Test for Women Infertility-Juniper Publishers

Juniper Publishers-Open Access Journal of Case Studies

Significant of Antimullerian Hormone [AMH] Test for Women Infertility

Authored by Battikhi MN

Introduction

Over the last decade, a large number of studies examining the multiple roles of AMH have been published [1]. AMH produced by granulosa cells [GC] of the ovary [2,3]; AMH, also known as Mullerian-inhibiting substance, is a dimeric glycoprotein that belongs to the transforming growth factor -β family [4,5]. It is virtually undetectable but increases gradually until puberty and remains relatively stable through the reproductive period [6,7]. It is widely accepted that the reduction of AMH levels in serum is the first indication for decline in the follicular reserve of the ovaries and can be measured in the blood at any time in the menstrual cycle due to its stability [8,9]. AMH is a marker for ovarian reserve and naturally lower in older women [>40 year] and higher in women with Polycystic ovaries [PCO] and polycystic Ovary Syndrome [P OCS] [10,11]. It was reported that Follicle stimulating hormone [FSH), Estradiol [E2] levels and antral follicle count [AFC] have been used for evaluation of ovarian reserve to determine suitable treatment strategy for female infertility by age [2,11], which becomes very essential in recent years.

Traditionally, age, follicle stimulating hormone [FSH), [E2] levels and antral follicle count [AFC] at have been used for evaluation of ovarian reserve the early follicular phase [2]. Levels of FSH and E2 were considered to be the determining biochemical markers for assessment of low ovarian reserve for many years [2] and FSH level was found above the norm only in cases when the ovary function is largely decreased [12] however, it is still the most commonly used test although its reliability is weak and also FSH association with significant inter- and intra-cycle variability is documented [13,14]. Opposing to FSH, AMH is considered to be more specific marker for ovarian response to gonadotrophins In comparison with other ovarian reserve assessment tests and is characterized by a number of advantages. AMH level is stable throughout the menstrual cycle and therefore can be measured at any day of the cycle [14,15] and it is not affected by other hormonal variations, including the use of oral contraceptives [16].

Recent studies have shown that AMH can be a good predictor of ovarian reserve and the success rates of in vitro fertilization [IVF] [17-19] however, both AMH and FSH are still used as ovarian reserve tests [20] although FSH showed several obstacles where patients have been reported to show discordant values for their ovarian reserve and cycle outcome [10,21-23], poor response to gonadotrophin stimulation on day 3 [23], lower chances of pregnancy [24] except at high threshold level of ovarian response. Adding to that FSH needs to be measured during early follicular phase [25-27]. In contrast AMH comparing to other ovarian reserve assessment tests is characterized by a number of advantages and can be tested on any day of the menstrual cycle [28-30], although variation in level of FSH between different blood samples for the same patient was reported during the same menstrual cycle especially in young patients [31,32] never the less AMH can still show 80% sensitivity and 93% specificity in predicting poor ovarian response at random blood test [33].

AMH level showed correlation with number of oocytes retrieved and hence treatment can be individualized for optimal cycle [28-30]. The fact that AMH reported to show assays controversies [34], pregnancies even at undetectable levels [35] and intra-cycle variations level [32] raised question mark about the possible role of AMH in reproduction assessment. Although other studies showed that levels of FSH and E2 were used as biochemical markers for assessment of low ovarian reserve for many years, identification of AFC at later stage still considered more reliable marker in assessment of the ovarian reserve where, Follicle count can be determined easily using high resolution sonographic systems [26,36,37], although few reports showed that some difficulties were faced in obtaining AFC however, it had been recommended over basal FSH [38].

Thus, by some investigators AFC is considered as the first choice test and FSH and AMH are two different hormones that can be used to predict ovarian reserve at two different stages of follicular development [26,38] although FSH level had been reported to reflect antral and postantral follicular development while, AMH values represent post primordial prenatal follicular pool [21]. Despite the use of both FSH and AMH hormones in parallel to determine ovarian reserve, there is not much literature about the frequency of discordance and concordance between them and its clinical significance [21]. Therefore, future research still required to determining the frequency of concordance and discordance between AMH and FSH levels in female infertility patients and assessment of ovarian reserve to determine the strategy for treatment of female infertility. Recently, identification of AMH levels became important in assessment of ovarian reserve and identification of AMH level for assessment of ovarian reserve is a recent method to follow and the obtained data are divergent, implementation of further studies and obtaining more materials in this field are viewed as justified and reasonable.

The available test measures how much “anti-müllerian hormone” a woman produces in her ovarian follicles, is fast becoming the pre-eminent tool for fertility specialists in North America and Europe to determine the chances of their patients getting pregnant reported by Dr. Tom Hannam of the Hannam Fertility Centre in Toronto as reported by Cathy Gulli [39]. The objective of this editorial is to illustrate the significant of anti- Mullerian hormone [AMH] in respect to other fertility hormone such as follicle stimulating hormone [FSH] so that we the most reliable marker could be indicated and adequate strategy for the initial stages of infertility treatment could be laid out.

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Salting and Freezing of Fish-A Case Study of Successful Practice-Juniper Publishers

 

Juniper Publishers-Open Access Journal of Case Studies

 

Salting and Freezing of Fish-A Case Study of Successful Practice

Authored by Kaufui V Wong

Abstract

The objective of the current paper is to identify a sustainable process of preserving and moving fish across distant countries, which unless demonstrated otherwise, does not negatively impact the nutrition and taste of fish, a famously perishable food. It is suggested that fishermen worldwide strive to salt and freeze their medium and large fishes after filleting, while still at sea (especially when they stay out at sea overnight or longer), and then sell them on returning home for superlative prices.

Keywords: Preservation; Fishing; Japanese; Sushi; food

Introduction

There have been many publications about modern processing of foods [1,2]. The WHO made the pronouncement in 2015 about the avoidance of processed meats. As stated in the refereed journal publication [3], this should be followed faithfully if synthetic preservatives are used. Otherwise, preserved foods may be safe to eat, and may be the only kind of food available. Food preservation has been practiced for ages since the frigid and temperate regions of the world necessitated that ability for human beings to live and thrive. In addition, the formation of cities required foods to be brought into the cities from elsewhere, as cities were not built to allow large tracts of land for agriculture or animal husbandry.

Case Study of Japanese Fish Producer Naoki Maeda

Japanese fish producer Naoki Maeda was featured by Newsroom Tokyo on Thanksgiving Day, 2016 [4,5]. In the feature, his custom-method of preserving and transporting fish overseas by air, is presented as the main point of success for his sushi products. Naoki Maeda is shown filleting his fresh fish (tuna, as an example) and salt his fish with sea salt, then placed in an inclined wooden plane to ‘dry’ indoors (in the absence of sun) in an air-conditioned space. The quantity of salt is not measured out precisely, but liberally applied all over the flesh surface of the fish (not the skin side). It is not stated how long the fish is ‘dried’ in that position, except that the fish is then frozen (at an unspecified temperature) and shipped out on the same day as the filleting process. When the salted but uncooked fish arrives in Chicago, United States of America (USA), it becomes the basis of much of the fish sushi dishes. That Naoki sushi is popular and much acclaimed is founded on the freshness and taste of the fish.

This freshness and taste test, though without any scientific precedence, is as imperious a test as the ‘white bed-sheet test’ performed by mothers-in-law (of old) on their new daughters-in-law on wedding night to obtain physical proof of their virginity. The purpose of the current communication is to encourage this simple and seemingly effective method of short-term preservation of fish in all of the fish industry worldwide. No synthetic preservatives are used, so the fish is nutritionally safe. Since the time allowed for the fish to ‘dry’ in an air-conditioned space is nominal, the loss of water and nutrients (more importantly) cannot be too much. From the popularity of Chef Naoki Maeda sushi products, the taste of the fish by this method of preservation and transportation could be concluded as being superior. These are all points that contribute positively to promote this type of fish processing.

Since most commercial fishermen in developed countries do not go out to fish and return on the same day, the process described here may be adopted for the betterment of the fish industry. That the fish is first filleted by Naoki Maeda before freezing, tells the author that the fish head, bones and inner organs of the fish need to be removed before the freezing of the fish. From biological considerations, this makes sense. The muscle meat of the fish has the least micro-organisms present (as compared to the stomach, say), and thus will deteriorate much more slowly. Salting and freezing is limited to only the muscle meat of the fish, so the optimum process is achieved automatically, while minimizing the amount of electricity consumed in the process. Packaging and air transportation costs are also reduced by the fact that bulk and weight of the commodity has been reduced. There is no use to package the bones and inner organs of the fish, since no endconsumer wants these parts of the fish either.

Discussion and Conclusion

The current article has been written from the facts presented about Naoki Maeda, a phenomenal success story of the Japanese fish industry. The success of his method of preserving the fish using only salt and freezing, and the popularity of his product worldwide, provided the motivation to write this article. The purpose is to recognize this sustainable method of preserving and transporting fish across continents, which unless proven otherwise, does not affect adversely the nutritional and taste value of this perishable food commodity.

It is recommended that fishermen everywhere strive to salt and freeze their fishing catch while still at sea (especially when they stay out at sea for more than 1 day), and then sell them on returning to shore for the best prices. If the fisherman is not already practicing this method of salting and freezing, and benefitting from the better prices, it is recommended that he/she adopts the method. It is predicted that their fish product would fetch the best prices because of the superiority of the preservation method described. Obviously, other factors come into consideration. One worth noting is that the fish should be large enough to be filleted. Industry standards should be followed with respect to factors like that mentioned.

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