Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study / Associação entre sobrepeso e anovulação consistente em mulheres inférteis com ciclo menstrual regular: Um estudo de caso-controle

Abstract Objective It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles. Methods We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0- 29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels. Results Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels>5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98). Conclusion Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.

Resumo Objetivo O excesso de peso corporal tem sido associado como fator de risco para infertilidade. Este estudo teve como objetivo avaliar a associação de sobrepeso e anovulação entre mulheres inférteis com ciclos menstruais regulares. Métodos Realizamos um estudo retrospectivo de caso-controle com mulheres com anovulação consistente em tratamento por reprodução assistida. As pacientes foram estratificadas entre aquelas com peso normal (índice de massa corporal [IMC]: 18,5- 24,9 Kg/m2) e as com sobrepeso (IMC: 25,0-29,9 Kg/m2). As pacientes com síndrome do ovário policístico ou obesidade foram excluídas. Os grupos foram pareados por idade, duração da infertilidade, níveis de prolactina, hormônio folículo-estimulante (FSH), hormônio tiroestimulante (TSH), hormônio luteinizante (LH) e estradiol. Resultados O excesso de peso associou-se significativamente à anovulaçãoquando usados os critérios de anovulação da Organização Mundial de Saúde (OMS): níveis de progesterona>5,65 ng/ml e evidência ultrassonográfica de colapso folicular (razão de chances [RC]: 2,69; IC95%: 1,04-6,98). Conclusão O IMC acima da faixa normal compromete a ovulação em mulheres inférteis não obesas com ciclos menstruais regulares.

Síndrome de ovario poliquístico e infertilidad / Polycystic ovary syndrome and infertility

Una de las manifestaciones del síndrome de ovario poliquístico (SOP) es la infertilidad, y hoy es la primera causa de infertilidad por anovulación, representando aproximadamente el 80% de los casos. Las alteraciones del SOP en su mayoría son tratables y el diagnóstico temprano de las pacientes mejora su pronóstico reproductivo. Pese a su alta incidencia e importancia, los mecanismos fisiopatológicos del SOP aún son relativamente desconocidos. Recientemente se han publicado recomendaciones internacionales basadas en evidencia para su tratamiento.

Infertility is one of the main manifestations of the polycystic ovary syndrome (PCOS), and to day PCOS is the main cause of anovulatory infertility accounting for 80% of the cases. The majority of PCOS causes of infertility are treatable, and early diagnosis improves the patient's fertility outcome. In spite of its incidence and importance, the physiopathological mechanisms of PCOS are still relatively unknown. Recently an international evidence base recommendation for treatment have been published.

Revisión de los criterios diagnósticos para el síndrome de ovario poliquístico / Review of diagnostic criteria for polycystic ovary syndrome

Resumen El síndrome de ovario poliquístico, es la alteración endocrina metabólica más frecuente en mujeres en edad fértil, teniendo implicaciones a nivel reproductivo, metabólico, cardiovascular y psicosocial. Actualmente, su sobrediagnóstico corresponde a una problemática común derivada de la heterogeneidad en la aplicación de los criterios actualmente avalados para su hallazgo, lo que ha contribuido en el incremento de tratamientos innecesarios, así como los efectos negativos en la calidad de vida y el bienestar de las pacientes falsamente calificadas con este trastorno. Se realizó una búsqueda en PubMed-MENDELEY y Ovid entre los meses de Febrero a Abril del 2020, obteniendo 43 artículos relacionados con el tema, publicados en los últimos 10 años. El conocimiento por parte del personal médico capacitado sobre los consensos actuales para la correcta evaluación del síndrome y el estudio individualizado de cada caso, corresponden las medidas más apropiadas para la reducción del sobrediagnóstico. MÉD.UIS.2020;33(3):21-28

Abstract Polycystic ovary syndrome is the most frequent metabolic endocrine disorder in women of childbearing age, having implications at both the reproductive, metabolic, cardiovascular and psychosocial levels. Currently, its overdiagnosis corresponds to a common problem derived from the heterogeneity in the application of the criteria currently endorsed for its discovery, which has contributed to the increase in unnecessary treatments, as well as the negative effects on the quality of life and well-being of falsely rated patients with this disorder. A search was made in PubMed-MENDELEY and Ovid between the months of February to April of 2020, obtaining 43 articles related to the topic, published in the last 10 years. The knowledge on the part of the trained medical personnel about the current consensuses for the correct evaluation of the syndrome and the individualized study of each case, correspond to the most appropriate measures for the reduction of this event. MÉD.UIS.2020;33(3):21-28

Anovulación y amenorrea secundaria: enfoque fácil y práctico / Anovulation and secondary amenorrhea: easy and practical approach / Anovulação e amenorreia secundária: abordagem fácil e prática

Resumen: La anovulación ocurre en el 30 % de la Infertilidad y la amenorrea secundarla en el 4% de mujeres en edad reproductiva. Ambas alteraciones se pueden tornar crónicas conllevando riesgos de hiperestrogenismo e hipoestrogenismo crónicos. Tanto la anovulación como la amenorrea secundaria tienen las mismas causas endocrinas, excepto que la amenorrea tiene una adicional de causa uterina. No obstante existen muchas clasificaciones etiológicas, unas combinan la amenorrea secundaria con la primaria, otras se enfocan más a la anovulación y algunas agrupan las etiologías en compartimentos, sin lograr hacerlo en forma integral. El objetivo es revisar las clasificaciones etiológicas de anovulación y amenorrea secundaria, junto con la actualización de cada una de esas causas, a fin de seleccionar la clasificación que las agrupe integralmente para enfocar el manejo en forma fácil y práctica. Para ello, se revisó la literatura médica reciente en libros de texto, PubMed, Ovid, Clinical guidelines y Cochrane library, con palabras claves. Se concluye que la clasificación etiológica integral en cinco compartimentos es una guía fácil de seguir, para lograr el diagnóstico de cada una de esas causas, actualmente, cuando existen medicamentos y procedimientos quirúrgicos seguros para manejarlas como anovulación o como amenorrea secundaria.

Abstract: Anovulation occurs in 30% of infertility and secondary amenorrhea In 4% of women In reproductive age. Both alterations can become chronic, carrying risks of chronic hyperestrogenism and hypoestrogenism. Both anovulation and secondary amenorrhea have the same endocrine causes, except that amenorrhea has an additional uterine cause. However, there are many etiological classifications, some combine secondary and primary amenorrhea, others focus more on anovulation and some group the etiologies into compartments, without achieving a comprehensive approach. The objective is to review the etiological classifications of anovulation and secondary amenorrhea, together with the update of each one of these causes, in order to select the classification that can integrally groups them so that to their management can be focused on an easy and practical way. For this purpose, recent medical literature in textbooks, PubMed, Ovid, Clinical guidelines and Cochrane library was reviewed with key words. It is concluded that the comprehensive etiological classification in five compartments is an easy guide to follow to achieve the diagnosis of each of these causes, currently, when there are drugs and safe surgical procedures to manage them as anovulation or secondary amenorrhea.

Resumo: A anovulação ocorre em 30 % da Infertilidade e a amenorreia secundária em 4 % de mulheres em idade reprodutiva. Ambas as alterações podem se tornar crônicas, implicando riscos de hiperestrogenismo e hipoestrogenismo crônicos. Tanto a anovulação quanto a amenorreia secundária têm as mesmas causas endócrinas, exceto que esta última tem ainda causa uterina. Contudo, existem muitas classificações etiológicas, umas combinam a amenorreia secundária com a primária, outras se focam mais na anovulação, e algumas agrupam as etiologias em compartimentos sem poder fazer isso de forma integral. O objetivo é revisar as classificações etiológicas de anovulação e amenorreia secundária, junto com a atualização de cada uma dessas causas, a fim de selecionar a classificação que as agrupe integralmente para focar o manejo de forma fácil e prática. Para isso, foi revisada a literatura médica recente em textos consultados em PubMed, Ovid, Clinical guidelines e Cochrane library, a partir de palavras-chave. Conclui-se que a classificação etiológica integral em cinco compartimentos é um guia fácil de seguir para obter o diagnóstico de cada uma dessas causas, atualmente, quando existem medicamentos e procedimentos cirúrgicos seguros para manejá-las como anovulação ou como amenorreia secundária.

Clomiphene citrate versus letrozole for ovulation induction in anovulatory infertility: a prospective study

Background: The objective of this study was to compare clomiphene citrate with letrozole for ovulation induction in anovulatory infertile women.Methods: This study was conducted in the infertility clinic and department of obstetrics and gynecology, S.P. Medical College and Associated P. B. M. Hospital, Bikaner, Rajasthan, from 1st August 2018 to 31st July 2019. The study group comprised of infertile females attending infertility clinic or gynae outdoor in department of obstetrics and gynecology, S. P. Medical College Bikaner for infertility. 100 women with anovulatory infertility were enrolled in the study after fulfilling the inclusion and exclusion criteria. Proper counseling was done and written informed consent taken.Results: Ovulation rate was statistically significantly greater in letrozole group. Monofollicular development was statistically significant greater in let group (CC 18%, Let 66%). The endometrial thickness on the day of ßhCG administration in CC group was 7.40±1.08 mm and in let group was 8.20±0.82 mm. Letrozole treated cases had better trilaminar pattern of endometrium as compared to clomiphene. The pregnancy rate was higher in letrozole group.Conclusions: As compare to clomiphene, letrozole is associated with higher pregnancy rate and ovulation rates among infertile women with anovulation.

Letrozole: an emerging array of hope for infertile women

Ovulation induction has been a major breakthrough in the management of female infertility since many decades. Letrozole, an aromatase inhibitor has been used as a potential therapy for ovulation induction. A large number of clinical evidences have been emerging which cite the beneficial role of Letrozole in conditions like anovulatory infertility, polycystic ovary syndrome (PCOS), unexplained infertility and an incipient role in endometriosis- related infertility with regards to higher live-birth rates. Letrozole is a superior alternative to Clomiphene citrate (CC) which has been used conventionally as ovulation inducer. Clomiphene citrate has certain well-defined disadvantages, whereas Letrozole overcomes these limitations to a reasonable extent. The peripheral anti-estrogenic effect of CC leads to prolonged depletion of estrogens receptors, adversely affecting endometrial growth and development as well as quantity and quality of cervical mucus. Persistent blockade of estrogen receptor leads to CC resistance and is associated with reduced ovulation and pregnancy rates. Available evidences suggest Letrozole is superior to CC owing to the lack of persistent anti-estrogenic action due to its short half- life and lack of action on estrogen receptors. This typically leads to monofollicular growth and also higher live birth rates. The current evidences suggest that Letrozole can be placed as first line therapy for the management of infertility due to PCOS and unexplained infertility.

Clinical pattern and presentation of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a very common debilitating gynecological condition among women of the reproductive age group. This diagnosis is given to women in whom no clear etiology is identified. It can occur in ovulatory and anovulatory cycle. It influences the physical, emotional, sexual and professional life of a woman. This study was carried out to evaluate the clinical profile of abnormal uterine bleeding.Methods: This cross-sectional study was carried out among 350 patients who were clinically diagnosed with AUB for a period of one year from April 2018 to March 2019. Patients with uterine polyp, adenomyosis, Leiomyoma, malignancies and with various coagulopathies were excluded from the study by physical examination, ultrasound, histopathology and blood test. The remaining 280 patients between the ages 20-60 years were selected for clinical classification of AUB.Results: Majority of the participants were in the age group of 41-50 years (60%). AUB is most commonly seen in multiparous women (48.92%). The prominent bleeding pattern seen was menorrhagia (52.2%).Conclusions: Menorrhagia is the most common form of AUB and there is a need to prevent the consequences of menorrhagia by way of creating awareness among the women, and by early diagnosis and clinical management of complications.

Incidence and risk factors of polycystic ovary syndrome among women in reproductive age group attending a tertiary health care hospital in Western Maharashtra

Background: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting women of reproductive age group. Though its incidence is markedly increasing, the awareness is still low; as a result it remains undiagnosed. Aim of this study was to find the incidence and risk factors of PCOS among women in reproductive age group, so as to encourage young women to seek timely treatment and prevent its long term complications.Methods: A study was conducted over a period of 1 year amongst 100 women attending the Gynecology OPD using a paper based questionnaire. General examination and the required laboratory tests were done to confirm the diagnosis.Results: It was found that the incidence of PCOS among the study population was 21%. Risk factors include lack of physical activity, irregular menstrual cycle, body mass index more than 25, and Waist-hip ratio above 0.86.Conclusions: It is seen that there is a need to educate women at an early stage to prevent the development of this syndrome and its early detection by them. This will facilitate the health professionals to start the treatment at a stage where the complications have not yet set in.

Diagnosis classification and clinical significance of polycystic ovarian syndrome / 中国实用妇科与产科杂志

Polycystic ovary syndrome(PCOS)is char⁃acterized by diverse clinical manifestations and big individual differences.Through the diagnosis classifi⁃cation of PCOS,attention is paid to the different clin⁃ical features,biochemical characteristics and risk of long-term metabolic complications of PCOS patients,which is conducive to the individualized treatment and long-term management of patients.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women

OBJECTIVES: This study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters. METHODS: The study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile. RESULTS: Of the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64). CONCLUSIONS: A history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Managing polycystic ovary syndrome in primary care

Polycystic ovary syndrome (PCOS) presents with a spectrum of conditions resulting from androgen excess, anovulation and metabolic syndrome. Patients with PCOS may see their primary care physicians for various presentations, including hirsutism, acne, menstrual irregularities, infertility, obesity, and psychiatric disorders such as anxiety and depression. Management of these patients should include screening for Type 2 diabetes mellitus, dyslipidaemia and hypertension. Treatment should be targeted to each patient's phenotype and personal expectations such as desire for pregnancy. Psychological well-being due to the effects on physical appearance is also an important consideration. Diet and exercise are major components in the management of patients with PCOS and obesity. The first-line therapy for fertility and metabolic syndrome in PCOS is lifestyle modification with diet and exercise, followed by pharmacological therapy.

Antral Follicles Count and Anti-Müllerian Hormone Levels after Gonadotoxic Chemotherapy in Patients with Breast Cancer: Cohort Study / Contagem de folículos antrais e níveis de hormônio anti-Mülleriano após quimioterapia gonadotóxica em pacientes com câncer de mama: estudo de coorte

Abstract Aim To assess ovarian reserve (OVR) by means of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) measurement in eumenorrheic women with breast cancer, exposed to gonadotoxic chemotherapy. Method Fifty-two women (35.3 ± 3.8 years old) with breast cancer and undergoing cyclophosphamide-containing chemotherapy were enrolled. The assessment was performed before chemotherapy (T1) and after 2 (T2) and 6 months (T3). Results Six months after chemotherapy, the prevalence of regular cycles was 60%. Anti-Müllerian hormone decreased down to undetectable levels at T2 and T3 (T1: 2.53 [1.00–5.31]; T2 < 0.08; T3: < 0.08 [< 0.08–1.07] ng/mL), (p< 0.0001). Antral follicle count was 11 [8.0–13.5] follicles at T1 and lower at T2 (5.50 [3.75–8.0] and T3 (5.0 [2.5–7.0]) (p< 0.0001). In patients who remained with regular cycles during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged. Conclusion Anti-Müllerian hormone and AFC are useful as markers of OVR decline in women exposed to chemotherapy. Follicle-stimulating hormone is only adequate in women who become amenorrheic.

Resumo Objetivo Avaliar a reserva ovariana (OVR) através da contagem de folículos antrais (AFC), dosagem sérica de hormônio folículo estimulante (FSH) e hormônio anti-Mülleriano (AMH) em mulheres com câncer de mama submetidas a quimioterapia gonadotóxica. Método Foram incluídas na pesquisa 52 mulheres (35,3 ± 3,8 anos) com câncer de mama, em tratamento com quimioterapia com ciclofosfamida. As dosagens e medidas foram realizadas antes do início da quimioterapia (T1) e após 2 (T2) e 6 meses (T3). Resultados Seis meses após quimioterapia, a prevalência de ciclos regulares foi de 60%. O AMH sérico diminuiu a níveis indetectáveis em T2 e T3 (T1: 2,53 [1,00–5,31] ]; T2 < 0,08; T3: < 0,08 [< 0,08–1,07] ng/mL) (p< 0,0001). A contagem de folículos antrais foi de 11 [8,0–13,5] folículos em T1, e ainda menor em T2 (5,50 [3,75–8,0] e T3 (5,0 [2,5–7,0]), (p< 0,0001). Em pacientes que mantiveram ciclos regulares durante a quimioterapia ou retomaram a menstruação normalmente, os níveis de FSH e estradiol permaneceram inalterados. Conclusão O AMH e a AFC são marcadores úteis do declínio da OVR em mulheres expostas à quimioterapia. O FSH só é adequado em mulheres que se tornam amenorreicas.

Sequential use of clomiphene citrate and human menopausal gonadotropin in anovulatory infertility

Background: Infertility is a complex disorder with significant medical, psychosocial and economic aspects. Infertility causes great distress to many couples, causing increased numbers of them to seek specialist fertility care. Objectives: To measure the success rate of combined clomiphene citrate and gonadotropin therapy in anovulatory infertile patients overcoming the drawbacks of clomiphene alone treatment. Materials and methods: In this observational analytical study, total of 100 anovulatory infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotropin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in present study, 46 patients became pregnant. Primary infertility was seen in 81 patients (81%) and secondary infertility in remaining 19(19%) of patients. Polycystic ovary disease (PCOD) was the commonest cause of anovulation seen in 62% of patients. Miscarriage was seen in 3 patients (3%). Multiple pregnancies were observed in 8 patients (8%). Number of patients conceived after 1 cycle was 12 (26%), 2 nd cycle was 20 (43.47%), 3 rd cycle was 14 (30.43%). Conclusions: Present study shows the success rate of 46% with CC-HMG combined regimen. Sequential clomiphene/ HMG regimen appears to be an effective protocol for controlled ovarian stimulation in infertile women who are resistant to clomiphene alone which has drawback of poor endometrial quality. It is easy to administer, requires less intense monitoring, fewer medications, and Ashwini Devarashetty, Humera Sultana, G. Nikhat Parveen, Yasmin Iqbal. Sequential use of clomiphene citrate and human menopausal gonadotropin in anovulatory infertility. IAIM, 2017; 4(10): 236-249. Page 237 is cheaper without sacrificing efficacy, in other words it’s a cost effective technique in the management of infertile patients.

Therapeutic Observation of ZHU Lian's Acupuncture plus Wen Ren Tiao Shu Method in Treating Anovulatory Infertility / 上海针灸杂志

Objective To observe the efficacy difference between ZHU Lian's acupuncture plusWen Ren Tiao Shu method (warming the Conception Vessel and regulating back-Shu points) and ovulation drugs in treating anovulatory infertility.Method Seventy patients were randomized into an observation group and a control group, 40 cases each. The control group was given ovulation triggering medications; the observation group was intervened by ZHU Lian's acupuncture plusWen Ren Tiao Shu method, with Tianshu (ST25), Zigong (EX-CA 1), Guanyuan (CV4), Xuehai (SP10), Zusanli (ST36), Sanyinjiao (SP6), Ganshu (BL18), Pishu (BL20), Sanjiaoshu (BL22) and Shenshu (BL23) selected, once per day, 10 sessions as a course of treatment. The two groups were observed for 3 menstrual cycles. The symptoms score of traditional Chinese medicine (TCM), menstruation score, basal body temperature (BBT), and ovulation rate by gynecological scanning were compared before and after the treatment, and the clinical efficacies were compared between the two groups.Result The TCM symptoms score changed significantly after the intervention in the observation group (P<0.05); the TCM symptoms score didn't show significant change after the treatment in the control group (P>0.05); after the treatment, there was a significant difference in comparing the symptoms score between the two groups (P<0.01); there was a significant difference in comparing the BBT between the two groups after the intervention (P<0.05); according to Chi-square test, after the treatment, the difference in ovulation rate between the two groups was statistically significant (P<0.05); the total effective rate was 94.3% in the observation group, higher than 82.9% in control group.ConclusionZHU Lian's acupuncture plusWen Ren Tiao Shu method can improve the symptoms of anovulatory fertility, increase the conception rate, and reduce adverse reactions; this method can produce a more significant efficacy than oral administration of Western medications in treating anovulatory fertility.

Therapeutic Observation of ZHU Lian's Acupuncture plus Wen Ren Tiao Shu Method in Treating Anovulatory Infertility / 上海针灸杂志

Objective To observe the efficacy difference between ZHU Lian's acupuncture plusWen Ren Tiao Shu method (warming the Conception Vessel and regulating back-Shu points) and ovulation drugs in treating anovulatory infertility.Method Seventy patients were randomized into an observation group and a control group, 40 cases each. The control group was given ovulation triggering medications; the observation group was intervened by ZHU Lian's acupuncture plusWen Ren Tiao Shu method, with Tianshu (ST25), Zigong (EX-CA 1), Guanyuan (CV4), Xuehai (SP10), Zusanli (ST36), Sanyinjiao (SP6), Ganshu (BL18), Pishu (BL20), Sanjiaoshu (BL22) and Shenshu (BL23) selected, once per day, 10 sessions as a course of treatment. The two groups were observed for 3 menstrual cycles. The symptoms score of traditional Chinese medicine (TCM), menstruation score, basal body temperature (BBT), and ovulation rate by gynecological scanning were compared before and after the treatment, and the clinical efficacies were compared between the two groups.Result The TCM symptoms score changed significantly after the intervention in the observation group (P<0.05); the TCM symptoms score didn't show significant change after the treatment in the control group (P>0.05); after the treatment, there was a significant difference in comparing the symptoms score between the two groups (P<0.01); there was a significant difference in comparing the BBT between the two groups after the intervention (P<0.05); according to Chi-square test, after the treatment, the difference in ovulation rate between the two groups was statistically significant (P<0.05); the total effective rate was 94.3% in the observation group, higher than 82.9% in control group.ConclusionZHU Lian's acupuncture plusWen Ren Tiao Shu method can improve the symptoms of anovulatory fertility, increase the conception rate, and reduce adverse reactions; this method can produce a more significant efficacy than oral administration of Western medications in treating anovulatory fertility.

Epidemiología del síndrome de ovario poliquístico en Chillán-Chile / Epidemiology of polycystic ovary syndrome in Chillan-Chile

Introducción: El síndrome de ovario poliquístico (SOP) es una disfunción endocrino metabólica de alta prevalencia, definida por alteraciones menstruales, hirsutismo, y ováricos morfológicamente poliquístico. Objetivos: Describir las características clínicas de las pacientes con SOP atendidas en el consultorio adosado de especialidades (CAE) del Hospital clínico Herminda Martin (HCHM) de Chillán. Materiales y método: Estudio transversal de 116 pacientes con diagnóstico de SOP (CIE-10 E28.2), en edad fértil, con diagnóstico realizado en CAE del HCHM durante 2010 y 2014. Se obtuvieron datos demográficos y clínicos, luego fueron tabulados en Excel para su análisis. Resultados: El grupo etario más frecuente fueron las pacientes entre 15 y 19 años. En la mayoría de los casos, la consulta se debió a alteraciones menstruales e hirsutismo. Un 33,6% de las pacientes correspondieron a SOP clásico. Un 72,4% presentó insulinoresistencia (IR) y un 40% sobrepeso. Discusión: Su fuerte relación con síndrome metabólico, nos lleva a plantear la posibilidad de aplicar medidas de prevención primaria, en los grupos poblacionales que han sido caracterizados enfrentando esta patología como una enfermedad endocrino-metabólica y tratarla de forma integral por un grupo multidisciplinario. Se sugiere realizar una pesquisa sistemática en pacientes de riesgo, incluyendo el SOP en programas de pesquisa específicos para enfermedades no transmisibles (examen médico preventivo del adolecente y del adulto).

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic dysfunction highly prevalence, defined by menstrual alterations, hirsutism, and polycystic ovarian morphologically. Objetive: To describe the clinical characteristics of patients with PCOS treated at the "Consultorio adosado de especialidades" (CAE) of the Hospital Clínico Herminda Martin (HCHM) of Chillán. Materials and methods: A cross-sectional study of 116 patients with a diagnosis of PCOS (ICD-10 E28.2), of childbearing age, with a diagnosis made at the HCHM CAE during 2010 and 2014. Demographic and clinical data were obtained and then tabulated in Excel for your analysis. Results: The most frequent age groups were patients aged 15 to 19 years. In most cases, the consultation was due to menstrual alterations and hirsutism. A total of 33.6% of the patients were classical PCOS. 72.4% had insulin resistance (IR) and 40% were overweight. Discussion: Its strong relationship with metabolic syndrome leads us to consider the possibility of applying primary prevention measures in the population groups that have been characterized as endocrine-metabolic disease and treated in an integral way by a multidisciplinary group. It is suggested to conduct a systematic study in patients at risk, including PCOS in specific programs for noncommunicable diseases (preventive medical examination of adolescents and adults).

Clinical research of integrated traditional Chinese medicine in the treatment of infertility resulted from ovulation dysfunction / 中国基层医药

Objective To observe the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of infertility resulted from ovulation dysfunction.Methods 106 patients with ovulation dysfunction were divided into observation group(n =56)and control group(n =50)in stratified randomization.Both two groups were given clomiphine to induce ovulation.Futhermore,the observation group was added Chinese herb recipe.Both two groups were treated for 3 menstruations.The basic body temperature,follicle development,endometrium depth, ovulation and pregnancy were observed.The serum levels of E2,LH and FSH were detected.Results There was no difference in the basic body temperature between the two groups(P >0.05).After treatment,the basic body tempera-ture of the observation group was obviously superior to that of the control group(χ2 =0.627,P =0.049),there was no difference in the endometrium depth between the two groups(P >0.05).After treatment,the endometrium in the observation group was significantly better than before treatment and that in the control group(t =5.132,P <0.05). After treatment,the serum levels of E2 ,LH and FSH in the observation group were all improved more obviously than those in the control group(t =6.489,5.167,6.035,all P <0.05).The efficacy of the two groups was higher than that of the control group(χ2 =6.049,P =0.048).Conclusion The method of integrated traditional Chinese and western medicine can promote the development of follicle and endometrium,improve levels of E2,LH and FSH,enhance ovula-tion rate and pregnancy rate in the treatment of infertility resulted from ovulation dysfunction,which is worthy of clini-cal promoting.

A randomized, single-blind, parallel-controlled and multicentre study：compare the efficacy and safety of domestic and imported human recombinant FSH in WHO group Ⅱ anovulatory infertility / 中华妇产科杂志

Objective To evaluate the efficacy and safety of domestic human recombinant FSH (rhFSH) in women with anovulation of WHO groupⅡ. Methods A randomized, blind, parallel-controlled, non-inferiority and multicenter study was performed. A total of 534 admitted to 13 hospitals from May 2008 to August 2009. There were 531 women with ovulatory disorder was included in the statistical analysis, were randomly divided into test group (domestic rhFSH, n=352) and control group (imported rhFSH, n=179). Percentage of cycle with mature follicle, ovulation rate, clinical pregnancy rate, multiple pregnancy rate, ovarian hyperstimulation syndrome (OHSS) and adverse events were observed. Results No statistical significant differences (P>0.05) were observed between the two groups in terms of the efficiency on mature follicle [91.8%(323/352) versus 88.8%(159/179)], ovulation rate [91.3%(295/323) verus 90.6%(144/159)], clinical pregnancy rate [19.2%(62/323) verus 18.2%(29/159)], the number of the follicles0.05), and no other adverse events were observed in test group during treatment. Conclusion Ovarian stimulation with domestic rhFSH is effective, safe and economical in women with anovulation of WHO groupⅡ.

Drilling: medical indications and surgical technique / Drilling: indicações e técnica

SUMMARY Introduction: anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation. Objective: to identify the current indications of laparoscopic ovarian drilling and the best surgical technique. Method: a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling. Results: we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling. Conclusion: laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

RESUMO Introdução: a anovulação é uma das principais causas de infertilidade feminina, e a síndrome dos ovários policísticos (SOP) é a principal causa de anovulação. As mulheres com SOP, quando submetidas a indução medicamentosa da ovulação, costumam ter resposta satisfatória, recrutando folículos. No entanto, algumas podem não recrutar folículos ou, muitas vezes, têm uma produção excessiva deles, o que pode resultar em síndrome de hiperestímulo ovariano e/ou gravidez múltipla. O tratamento cirúrgico por laparoscopia comdrilling ovariano pode evitar ou reduzir a necessidade de indução da ovulação com medicamentos. Objetivos: identificar as indicações atuais do drilling ovariano laparoscópico e qual a melhor técnica operatória. Método: revisão da literatura médica, por meio de busca sistemática nas bases de dados MEDLINE, LILACS e Cochrane, utilizando as palavras-chave: laparoscopia, síndrome dos ovários micropolicísticos edrilling. Resultados: foram encontrados 105 artigos na literatura, sendo 27 de grande relevância descrevendo achados sobre o drilling ovariano. Conclusão: o drilling laparoscópico está indicado para pacientes com SOP com resistência ovulatória ao uso do citrato de clomifeno, índice de massa corpórea (IMC) inferior a 30 kg/m2 e hormônio luteinizante (LH) pré-cirúrgico superior 10 UI/L. A técnica operatória de preferência deve ser a realização de 5 a 10 perfurações na superfície de cada ovário bilateralmente por meio do uso de energia monopolar.

Examination stress and its effect on ovulation of female undergraduate students.

Background: Students are susceptible to academic stress which is higher during examination period. Academic stress has been found to activate the Hypothalamic-Pituitary-Adrenal axis resulting in increased cortisol and progesterone levels in circulation. This study sets out to investigate the effects of examination stress on ovulation of 32 apparently healthy female students. Methods: Serum levels of cortisol (μg/dl), glucose (mmol/L) and progesterone (ng/ml) was determined using blood samples collected on day 21 of the menstrual cycle before and after examination. Results: The result showed significant elevation in pre-examination serum cortisol (15.3 ± 5.9μg/dl) but significant reduction in Progesterone (3.5± 1.5ng/ml) when compared with post-examination mean serum concentrations of cortisol (10.5 ± 5.1μg/dl) and progesterone (4.2 ± 2.6ng/ml) (P<0.001 and P<0.001) respectively. There was no significance difference in glucose level before examination (5.4 ± 0.8mmol/L) and after examination (5.3 ± 0.7mmol/L) P=0.282. Conclusions: These findings demonstrated that examination triggers stress, which altered progesterone level in female students.