La cirugÝa pÚlvica como un marcador predictivo de la respuesta folicular a los inductores de ovulación / Pelvic surgery as a predictive marker of the follicular response to ovulation inducers

OBJECTIVE: Comparing the follicular response in a group of patients with previous pelvic surgery submitted to in vitro fertilization. MATERIAL AND METHODS: Patients who were going to be submitted to controlled ovarian stimulation and in vitro fertilization were included. Two groups were formed: one with those patients who had had a previous pelvic operation and the other with those patients who had not. The characteristics which were analyzed included: age, weight, body mass index, FSH, LH and estradiol levels, as well as total ova numbers, grade of embryonic maturity, and number of transferred embryos. RESULTS: Ninety nine patients were studied: 46 had been submitted to pelvic surgery and 53 had not. Due to the design of the study there were no differences regarding age, weight, size and body mass index; the evaluation of the ovarian reserve was similar in both groups. However, the group of patients previously submitted to pelvic surgery presented a lower quantity of total ova (p = 0.004), less mature ova (p = 0.008) with a significantly lower pregnancy rate. CONCLUSIONS: Surgical procedures, combined with adherence processes, probably have a direct incidence on the characteristics of the perifollicular environment which interfere with adequate development of the ovum. All these can be observed in a decrease of fertilization processes and embryonic development, regardless of the expression of the adequate biochemical markers of the ovarian reserve. Our research shows that the group under study presents a decrease in follicular response affecting the quality of the ovum-embryo expressed in the pregnancy rate.

Competitividad óvulo-embrionaria determinada a través de la cuantificación de los Ýndices perifoliculares en la microarquitectura vascular por Doppler / Ovum-embryo competitiveness determined by the quantification of perifollicular indices in Doppler vascular micro-architecture

OBJECTIVE: To obtain the linear correlation between Doppler flowmetry rates and follicular development and the observed embryo growth in ovarian hyperstimulation cycles in the IVFTE/ICSI results. MATERIAL AND METHODS: A prospective and observational study including 29 patients was carried out. The ovarian reserve was determined--by the ovaries morphometric conditions--as well as basal FSH. These were correlated with pulsatility rates (PR), resistance rates (RR), and the systole/diastole ratio (S/D) and the maximum flow rate (TAmax), using a USG pulse-colour Doppler. All these were correlated to embryo development. Covariance, regression lines and confidence intervals analyses were performed for its statistical determination. RESULTS: A correlation between RR and the formation of mature follicles was observed (p = 0.05), and, at the same time, a negative relationship between FSH and ovarian volume was found. CONCLUSIONS: A series of markers of ovarian reserve have been described, however, none of these is a specific marker when ovum quality is expressed through the administration of ovulation inducers. Considering the data obtained in our study, we can say that Doppler flowmetry rates can indicate follicular expression and the resulting ovum and embryo development.

Alteración en los potenciales de membrana mitocondrial y su relación exponencial con la translocación de fosfatidilserina en la membrana plasmßtica como marcadores en los eventos iniciales de apoptosis: evaluación en diferentes fracciones espermáticas / Changes in mitochondrial membrane potentials and its exponential relation with phosphatidylserine translocation in the plasma membrane as markers in the initial events of apoptosis: evaluation in different spermatic fractions

OBJECTIVE: To determine the integrity of the plasmatic membrane through phosphatidylserine (PS) translocation in two spermatic fractions and their correlation with the spermatic mitochondrial membrane potential. MATERIAL AND METHODS: The analysis of both spermatic fractions was carried out through a discontinuous gradient separation with Percoli, in order to obtain two samples with high and low mobility (90-40). Twelve patients were recruited for the initial evaluation of seminal parameters. Mitochondrial membrane integrity was determined using a second antibody (Mitosensor), and was analyzed by fluorescence microscopy, evaluating an average of 200 cells. A 450-490 nm excitation filter was used for this analysis. Cytoplasmatic assessment was carried out by anexine V bonding to PS, in order to determine the initial events of cellular death. Non parameter tests were used in order to determine the differences between mitochondrial potentials and plasmatic membrane processes. Linear correlation tests were used for the anexine V and Mitosensor ratios. RESULTS. Due to the study's design, some differences were observed regarding the displacement parameters and the presence of apoptosis, both, in the plasmatic membrane and in mitochondrial membrane potentials. A positive correlation between both, mitochondrial and cytoplasmic membrane functions was also found. CONCLUSIONS. This is the first study performing a comparative analysis between mitochondrial membrane function and cytoplasmatic PS expression as early cellular death markers. The male infertility population is probably associated with an increase in this kind of apoptosis processes.