Reprodu??o & Climatério最新文献

Introduction

Multiple studies suggest that the amount of β‐hCG and progesterone can be good predictors of pregnancy.

Objective

To investigate the potential of β‐hCG and progesterone values in predicting evolutive pregnancy and twin pregnancy, 14 days after oocyte puncture in IVF/ICSI cycles, establishing a predictive model.

Methods

A retrospective study of cycles with the use of a puncture and fresh embryo transfer between May/2011 and September/2015. The defined groups were: with no pregnancy; without evolutive pregnancy; and with evolutive (single or twin) pregnancy. Statistical analysis considered α = 5%. To assess the ability to predict evolutive pregnancy and twin pregnancy, a multivariate analysis model was carried out, with the use of a binary logistic regression process. ROC curves were used to evaluate the ability of β‐hCG and progesterone values in differentiating between non‐evolutive and evolutive pregnancy.

Results

149 cases were found: no pregnancy 11.4%, without evolutive pregnancy 24.8%, with evolutive pregnancy 63.8% (83 single, 12 twins). Excluding progesterone and β‐hCG values, there were no statistically significant differences between the variables of non‐evolutive and evolutive pregnancy groups (β‐HCG: 38.9 vs. 159 IU/L, progesterone: 20.4 vs. 60 ng/mL). In a comparison between single and twin pregnancies, only the amount of β‐hCG was statistically significant (β‐HCG: 147 vs. 331 IU/L). When progesterone value is >25, the probability of pregnancy is 5.4 times greater (95% CI, 1.18‐24.8). In a logistic regression for twin pregnancies, only β‐hCG value was statistically significant.

Conclusion

A single assessment of progesterone and β‐hCG values 14 days after the puncture has a good predictive value of evolutive pregnancy, but with limited ability to discriminate between single and twin pregnancies.

Background

The primary function of the menstrual cycle is to promote the reproductive capacity of women and changes in this cycle impact on female fertility. Obesity is often associated with changes in the menstrual cycle.

Objective

Assess whether there is difference between ovulation's day in patients with normal BMI and those with overweight or obesity in infertile patients without Polycystic Ovary Syndrome.

Methods

Cross‐sectional study in Human Reproduction Outpatient Clinic. Two groups, one with 71 patients with normal BMI and the other with 45 patients with a BMI indicating overweight/obesity. It was next analyzed the day of ovulation of patients in each group. The samples included patients 18‐38 years without Polycystic Ovary Syndrome, whith the variables that could interfere with ovulation, matched, ensuring the homogeneity of the groups.

Results

Patients with overweight or obese had an average ovulation in 14.62° day of the cycle, and patients with normal BMI average at 14.21° day, with no statistical significance between groups.

Conclusion

there was no statistical difference of day of ovulation among patients with normal BMI and those with overweight or obesity, which had no other comorbidities that would put affect fertility.

Objective

To evaluate the role of laparoscopy in the investigation of infertility at the University of Campinas in the last five years.

Methods

Retrospective descriptive study with all diagnostic laparoscopy in the last five years made in endoscopic gynecology clinic of the tertiary hospital. 353 medical records of women with infertility undergoing diagnostic laparoscopy between the years 2008 to 2012 were analyzed the clinical characteristics of these women and the indications of laparoscopy and intraoperative findings were evaluated. Descriptive analysis (frequency, mean and standard deviation) was performed for categorical variables. To evaluate the association between the variables, we used the Kruskal Wallis test.

Results

The women were on average 32 ± 4.4 years. Laparoscopy found 52.98% of tubal alterations, 17.84% of endometriosis and 11.33% of adhesions. Almost 18% of tests did not show any change. The hysterosalpingography had a sensitivity of 84.61% and specificity of 32.58% compared to laparoscopy. Infertile women have a higher risk for tubal changes.

Conclusion

Tubal alterations are still the leading cause of infertility. Laparoscopy appears as a better technique hysterosalpingography for detecting tubal alterations, in addition to be able to detect changes in other organs that can cause infertility.

Objective

Address male infertility caused by microdeletions on Y chromosome and present possible treatment through assisted human reproduction techniques.

Methods

Survey data from the scientific literature in the field of reproductive medicine.

Results

When compared with other causes of infertility, the microdeletions on Y chromosome are the relatively frequent. The Y chromosome is essential for male sex determination and there are in his long arm regions responsible for spermatogenesi, it's they AZFa, AZFb and AZFc. Such regions may be deleted causing male infertility by contain multiple genes essential for spermatogenesis. Thanks to advances in medicine, now several cases of infertility are treatable through assisted reproduction techniques. Among the techniques, the MSOME stands out as a methodology that selects only morphologically normal sperm to be used in insemination increasing the chances of pregnancy.

Conclusions

Male infertility has increased considerably in recent years and the genetic causes are one of the major consequences of this. Y chromosome microdeletions can cause mild oligozoospermia or azoospermia depending on the AZF region affected. For lighter causes, the couple may use some assisted reproductive techniques and to the most serious causes the solution to the couple is using donated gametes.

The homeopathy is a low‐cost and toxicity alternative to using in the human and animal reproduction. However, the effect homeopathy awakens a skepticism about its effectiveness, because of the possible placebo effect. The in vitro models, as artificial ovary, is a excellent tool to resolve this controversy. Therefore, the aim of this review to provide some basis on folliculogenesis and its regulation, to report the importance of in vitro culture, with an emphasis on follicle stimulating hormone (FSH), in assessing the role of homeopathic medicines in treating ovarian reproductive disorders and its use to improve reproductive biotechnologies.

Objectives

The aim of this study was to evaluate the uterine cavity in cases of endometriosis associated infertility using office hysteroscopy.

Study design

A retrospective observational analytical study.

Patients and methods

The study conducted on 50 women with endometriosis diagnosed by laparoscopy seeking fertility treatment between December 2013 and October 2015. The study was approved from Ethical committee board of the faculty of Medicine Alexandria University. After explanation of the study objectives and procedures to all eligible women, informed written consent was signed. Thorough history taking, clinical examination and vaginal ultrasound examination was conducted to all participants. Office Hysteroscopy was done in the early proliferative phase using normal saline as a distention medium. All data were pulled from the reports at Elshatby Maternity University Hospital.

Results

The age of the study group was ranging from 20 to 34 years with the mean of 29 years ± 3 years. 42 cases were primary infertility counting for 84% of patients and 8 cases were secondary infertility counting for 16% of patients. This reflects the strong impact of endometriosis on fertility. Normal uterine cavity was diagnosed in 35 cases representing 70% of the studied patients group. 10 cases had endometrial polyps representing 20% of the studied patients group. 5 cases had a uterine septum representing 10% of the studied patients group. 2 cases had a hypo plastic uterus in addition to uterine septum representing 4% of the studied patients group. Normal uterine cavity were diagnosed using hysteroscopy in 63.0% (18/23) in women having ovarian endometrioma while this normality was 78.3% (17/27) in women without endometrioma however, The prevalence of endometrial polyp was 25.9% in cases with endometrioma and 13% in cases without endometrioma. Cases with a uterine septum were 7.4% (2/23) of cases having ovarian endometrioma and 13.0% (3/27) of cases without it. Two cases with endometrioma out of 23 cases were diagnosed to have hypoplastic uterus. No uterine abnormalities were found in stage 1 endometriosis in contrast to the presence of 53.2% of patients with a uterine abnormality in stage 2. Also stage 3 patients were all having a normal uterine cavity while only 72.4% of patients with stage 4.

Conclusion

From the results of this study we can conclude that there is a High prevalence of endometrial polyps in cases of endometriosis. Also there is a High prevalence of uterine anomalies in cases of endometriosis. Still, we neither cannot recommend hysteroscopy as a routine in any endometriosis patient undergoing laparoscopy.

A cross‐sectional study was conducted in Ouro Preto, Minas Gerais, Brazil to evaluate the factors associated with quality of life in climacteric women. It was used for this evaluation the questionnaire SF‐36 of quality of life and one interview about socioeconomic, demographic, medicines used and living habits. The average age of the 113 participant was 53.3 ± 4.4 years, 49.6% living with a partner and 77.4% using the public health system as the exclusive health insurance. It was observed that the income of 54% of them were less than or equal to the minimum wage and 69% had low education. Assessing the association between the variables of the interview and the eight domains of the SF‐36, there was significant difference in the quality of life in relation to: (i) age, in the mental health domain; (ii) living with or without a partner, related to general health and limitation by emotional aspect; (iii) the presence of any chronic disease correlated to general health and mental health; (iv) continuous‐use medication in the mental health domain. Concluding, the higher the age, in association with chronic diseases and medicines intake, the worse the quality of life of these women. Moreover, living with a partner positively modifies some areas associated with quality of life.

Objective

To evaluate the adherence to outpatient follow‐up among patients with gestational trophoblastic disease (GTD) in a reference center in the Midwest region of Brazil.

Methods

This was an observational, retrospective study that included all patients diagnosed with GTD in the Maternity School of the Universidade Federal de Goiás in one year. Data were collected regarding age, parity and B‐hCG values. Adherence to follow‐up and histopathological examination of the uterine evacuation product were obtained by chart review.

Results

Among the 55 patients included in the study, only 27 (49%) continued with the treatment properly; of which 11 (40.7%) had chemotherapy indication by the protocol service.

Conclusion

The adherence rate to outpatient follow‐up was low. The high rate of patients in need of chemotherapy determines an alarming scenario on the prognosis of patients who did not complete the follow‐up. This study highlights the need for effective strategies for the management and control of the disease.

During the mammalian folliculogenesis, a long and complex process occurs, which the oocyte acquires the necessary competence for fecundation. In this process there is a metabolic bidirectional communication among the oocyte and somatic cells inside the follicle, which provides substrates for the oocyte developmental competence. This communication is mediated by cellular junctions (occlusions, adherens and gap junctions) localized in the transzonal projections. Cellular junctions and adhesion mollecules are responsable mainly for promoving the adhesion among follicular cells, however they can act in cellular signaling pathways and in regulation of genic transcription in the follicular cells and oocyte. Moreover, the communication junctions (gap junctions) are intermembrane channels that intermediate the communication among these cells through the passage of small molecules. These gap junctions are composed by connexins, of which the connexins 37 and 43 are the most frequently found in the ovarian follicle. Thus, knowledge of these cellular junctions are of great importance for studying the folliculogenesis process. The aim of this review was to report the main types of cellular junctions localized among the follicular cells, especially the gap junctions and the main membrane proteins (connexins) found in different stages of the follicular development.

Objective

To identify how was the process of discovery of homosexual orientation in lesbians and gays.

Methods

Cross-sectional and qualitative study of homosexuals in Juazeiro municipality, Ceará, Brazil, by applying a semi-structured interview. Data were organized according to Bardin Analysis Technique and analyzed from the training category. It adhered to the ethical principles of research approval by the Research Ethics Committee.

Results

The participants were 27 homosexuals (gays and lesbians). The interviewees revealed that in childhood there were the first manifestations of sexual desires and curiosities with individuals of the same sex, and having during adolescence, the definition of homosexual orientation as result of the implementation of the first homosexual relationships. They revealed that the identity crisis they went through are not unique to homosexuality discovery process, but are also present in adulthood as a result of prejudice and social discrimination, resulting in health problems, especially the psychological.

Conclusion

Homosexual individuals have difficulties in discovery, definition and disclosure of their sexual orientation due to the prevailing heteronormative cultural patterns.