Variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey

Fundamento: la infertilidad femenina es un término utilizado para referirse a una mujer que no ha podido quedar embarazada después de haberlo intentado por lo menos en un año al mantener relaciones sexuales desprotegidas. Objetivo: caracterizar algunas variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Hospital Docente Ginecobstétrico Provincial Ana Betancourt Mora de Camagüey durante el año 2021. El universo estuvo constituido por 304 pacientes con diagnóstico de infertilidad. Las variables estudiadas incluyeron: grupo etáreo, tipo de infertilidad, municipio de origen, tasa de incidencia, nivel educacional, hábitos tóxicos, factores de riesgo y antecedentes personales. Los datos se expresaron en números y porcientos. Resultados: el 30,9 % correspondió al grupo etáreo de 30 a 34 años, procedentes en su mayoría del municipio Camagüey (43,5 %), mientras Céspedes alcanzó la mayor tasa de incidencia (13,8 %) por cada 1000 mujeres con rango de edad que pudieran ser admitidas en el programa. Un porciento elevado tenía estudios universitarios (45,4 %) y preuniversitarios (24,3 %), predominó el consumo de café (24,0 %) y tabaco (14,5 %) como hábitos tóxicos; así como enfermedades de trasmisión sexual (24,7 %) y el uso de anticonceptivo (21,1 %). La obesidad (13,5 %) resultó ser el principal antecedente personal. Conclusiones: la infertilidad femenina está determinada por varios factores, incluidos los epidemiológicos, como los hábitos tóxicos, el estado nutricional, los antecedentes personales, entre otros, en su mayoría modificables, que pueden ser tratados desde la Atención Primaria de Salud.

Background: female infertility is a term used to refer to a woman who has not been able to get pregnant after trying for at least a year by having unprotected sexual intercourse. Objective: to characterize some socio-epidemiological variables of female infertility in Camagüey province. Methods: a descriptive, cross-sectional study was carried out at the Ana Betancourt Mora Camagüey Provincial Gynecobstetric Teaching Hospital during the year 2021. The universe consisted of 304 patients diagnosed with infertility. The variables studied included: age group, type of infertility, municipality of origin, incidence rate, educational level, toxic habits, risk factors, and personal history. Data were expressed in numbers and percentages. Results: 30.9 % corresponded to the age group of 30 to 34 years, coming mostly from the Camagüey municipality (43.5 %), while Cespedes reached the highest incidence rate (13.8 %) per 1000 women with age range that could be admitted to the program. A high percentage had university studies (45.4 %) and pre-university studies (24.3 %), the consumption of coffee (24.0 %) and tobacco (14.5 %) predominated as toxic habits; as well as sexually transmitted diseases (24.7 %) and the use of contraception (21.1 %). Obesity (13.5 %) turned out to be the main personal history. Conclusions: female infertility is determined by several factors, including epidemiological ones, such as toxic habits, nutritional status, personal history, among others, mostly modifiable, which can be treated from Primary Health

Determination of endometrial receptivity by three-dimensional power ultrasound for evaluation of pregnancy outcome after in vitro fertilization and embryo transfer / 中国基层医药

Objective:To investigate the clinical value of endometrial receptivity determination by transvaginal three-dimensional power ultrasound in the prediction of pregnancy outcome after in vitro fertilization and embryo transfer. Methods:A total of 220 infertile patients who underwent in vitro fertilization and embryo transfer in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2018 to July 2021 were included in this study. Before in vitro fertilization and embryo transfer, all patients were tested for endometrial receptivity by transvaginal two-dimensional and three-dimensional power ultrasound. Pregnancy outcomes were followed up. Anatomical indexes (endometrial thickness, endometrial volume, and endometrial morphology) and endometrial blood flow indexes [endometrial blood flow type, pulsation index, resistance index (RI), ratio of peak systolic velocity to end-diastolic velocity (S/D), vascularization index (Vl), blood flow index (FI) and vascular blood flow index (VFI)] were compared between different pregnancy outcomes. Results:There were no significant differences in endometrial thickness, endometrial volume, and endometrial morphology between successful pregnancy and failed pregnancy groups ( t or χ2 = 0.23-0.54, P = 0.523-0.890). There was no significant difference in endometrial blood flow typing between successful pregnancy and failed pregnancy groups ( χ2 = 0.217, P = 0.897). PI, RI, and S/D in the successful pregnancy group were (2.46 ± 0.29), (1.07 ± 0.21), and (0.57 ± 0.10), respectively, which were significantly lower than (2.71 ± 0.34), (1.35 ± 0.24), and (0.66 ± 0.11) in the failed pregnancy group ( t = 4.51, 5.27, 3.43, all P < 0.001). VI, FI, and VFI values in the successful pregnancy group were (23.04 ± 2.95), (32.26 ± 3.17), and (6.59 ± 0.94) respectively, which were significantly higher than (16.85 ± 2.17), (28.42 ± 3.04), and (4.88 ± 0.86) in the failed pregnancy group ( t = 10.94, 6.25, 8.37; all P < 0.001). Conclusion:Endometrial blood flow parameters such as PI, RI, S/D, VI, FI, and VFI determined by transvaginal three-dimensional power ultrasound have a certain predictive value for pregnancy outcomes after in vitro fertilization and embryo transfer. They can be used as sensitive indexes for evaluating endometrial receptivity.

The exploration of infertility′s pathogenesis through gene editing technology / 中国医师杂志

Recently, the incidence rate of infertility has been increasing year by year. Lesions of the female reproductive system are the most important causes of infertility, such as premature ovarian failure, polycystic ovary syndrome, pelvic inflammatory disease, endometriosis, recurrent abortion, etc. However, the specific pathogenesis of infertility needs to be further studied. Gene editing is a technical method to change the sequence of deoxyribonucleic acid (DNA) in biological cells, which is an indispensable tool for studying gene function and disease pathogenesis. In this research, we review the recent progress in studying the pathogenesis of female infertility related diseases through gene editing technology, so as to explore a new direction for the clinical diagnosis and treatment of infertility.

The value of serum anti-Mullerian hormone combined with transvaginal color Doppler ultrasonography in predicting ovarian reserve function in infertility patients / 中国医师进修杂志

Objective:To investigate the predictive value of serum anti-Mullerian hormone (AMH) combined with transvaginal color Doppler ultrasonography (vaginal color ultrasound) for ovarian reserve function in infertility patients.Methods:A total of 105 infertility patients diagnosed and treated in Dezhou People′s Hospital from January 2018 to October 2020 were selected as study subjects. Among them, 32 patients with less than 5 eggs obtained after the first treatment (low ovarian response) were included in group A, and 73 patients with 5 to 15 eggs obtained (normal ovarian response) were included in group B. Serum AMH levels were measured, antral follicle count (AFC), ovarian volume (OV), and ovarian stromal peak diastolic systolic velocity (PSV) were recorded by vaginal ultrasound. The levels of above index in A, B groups, patients aged > 35 years old, and those aged ≤35 years old were compared. Moreover, the correlation among serum AMH level and aged, ultrasonic parameters were analyzed. The efficacy of serum AMH level and AFC, OV and PSV in predicting low ovarian response was analyzed by receiver operating characteristic (ROC) curve.Results:The levels of serum AMH, AFC, OV and PSV in group A were lower than those in group B: (0.69 ± 0.28) μg/L vs. (1.43 ± 0.44) μg/L, (8.52 ± 2.29) eggs vs. (11.15 ± 2.56) eggs, (3.12 ± 0.70) cm 3 vs. (4.50 ± 1.31) cm 3, (8.80 ± 2.14) cm/s vs. (15.80 ± 4.43) cm/s, the differences were statistically significant ( P<0.05). The levels of serum AMH, AFC, OV and PSV in aged > 35 years old group were lower than those in aged ≤35 years old group: (0.64 ± 0.20) g/L vs. (1.71 ± 0.46) μg/L, (8.35 ± 2.68) eggs vs. (12.17 ± 2.79) eggs, (3.05 ± 0.78) cm 3 vs. (5.02 ± 1.26) cm 3, (9.01 ± 3.04) cm/s vs. (17.90 ± 4.19) cm/s, the differences were statistically significant ( P<0.05). Serum AMH level was negatively correlated with age ( r = -0.317, P<0.05), and positively correlated with AFC, OV and PSV ( r = 0.288, 0.326, 0.370, P<0.05). The sensitivity and specificity for the evaluation of low ovarian response by AMH+AFC+OV+PSV were 96.90% and 100.00% respectively. Conclusions:The sensitivity and specificity of serum AMH combined with vaginal color ultrasound for the evaluation of ovarian reserve function in infertility patients are both high.

Clinical study of Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization for the patients with tubal obstructive infertility of liver depression and qi stagnation type / 国际中医中药杂志

Objective:To evaluate the efficacy of Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization in the treatment of tubal obstructive infertility of liver depression and qi stagnation type.Methods:A total of 60 patients with tubal obstructive infertility of liver depression and qi stagnation type who met the inclusion criteria were selected, between August 2018 and June 2020, and they were divided into the observation group with 31 cases and the control group with 29 cases, according to the random number table method. The control group was treated with hysteroscopic recanalization, while the observation group was given Chaichuan Tongren Mixture on the basis of the control group. Both groups were treated for 4 months and followed up for 12 months. TCM syndromes were scored before and after treatment, and prostaglandin E 2 (PGE 2) was detected by fully automatic biochemical analyzer and levels of TNF-α, CRP and IL-6 were measured by ELISA. The tubal patency of patients after treatment was observed, the pregnancy status was recorded after the end of follow-up and the clinical efficacy was evaluated. Results:The total effective rate was 96.77% in the observation group and that in the control group was 75.86% ( χ2=4.01, P<0.01). The scores of breast distending pain, irregular menstruation, dark purple menstrual flow and lumbosacral pain in the observation group after treatment were significantly lower than those in the control group ( t values were 17.69, 21.67, 20.89, 14.67, 18.20, respectively, all Ps<0.001). After treatment, the levels of serum PGE 2, TNF-α, CRP, and IL-6 were significantly lower in the observation group than those in the control group [(65.31±6.73) ng/L vs. (87.10±8.85) ng/L, t=10.78; (6.90±0.71) ng/L vs. (11.35±1.23) ng/L, t=17.30; (2.47±0.25) mg/L vs. (5.10±0.52) mg/L, t=25.23; (12.38±1.26) ng/L vs. (30.16±3.15) ng/L, t=29.05] ( P<0.01). After treatment, there was statistical significance in the total effective rate of tubal patency of 96.8% (30/31) in the observation group compared to 79.3% (23/29) in the control group ( χ2=4.43, P<0.01). At the end of follow-up, the pregnancy rate was 71.0% (22/31) in the observation group and 44.8% (13/29) in the control group, and the difference was statistically significant ( χ2=4.21, P<0.01). Conclusion:The Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization can reduce the levels of inflammatory mediators and increase the pregnancy rate of patients with tubal obstructive infertility of liver depression and qi stagnation type.

Dolor pélvico crónico en mujeres / Chronic pelvic pain in women

RESUMEN Fundamento: el dolor pélvico crónico es un problema ginecológico frecuente en las mujeres de edad fértil. Se define como el dolor no cíclico que persiste durante seis meses o más, localizado en la pelvis, en la porción infra umbilical de la pared abdominal anterior, en la región lumbosacra o en la región glútea lo que provoca discapacidad funcional. Las mujeres en edad fértil, son sin lugar a duda el grupo etario fundamental para la salud global y de las futuras generaciones. Muchas mujeres acuden a consulta de Ginecología por presentar dolor pelviano crónico y al realizarles la historia clínica, se observan problemas de fertilidad. Objetivo: caracterizar el comportamiento del dolor pélvico crónico de causa ginecológica en pacientes en edad fértil. Métodos: se realizó un estudio observacional, descriptivo, transversal. La población de estudio estuvo constituida por 123 mujeres con diagnóstico de dolor pélvico crónico de causa ginecológica y en edad fértil, que fueron atendidas en consulta de Ginecología en el Hospital Docente Clínico Quirúrgico Comandante Manuel Fajardo Rivero de Villa Clara durante el período comprendido entre el 1ro de septiembre de 2017 al 30 de septiembre de 2019. Resultados: las mujeres en el estudio eran adultas. La principal causa del dolor fue la endometriosis. La mayoría eran multíparas y presentaron infertilidad. Conclusiones: la mayoría de las pacientes con dolor pélvico crónico en edad fértil eran adultas. La principal causa del dolor pélvico crónico fue la endometriosis, seguido de las adherencias. La mayoría de las mujeres eran multíparas y presentaron infertilidad.

ABSTRACT Background: chronic pelvic pain is a frequent gynecological problem in women of childbearing age. It is defined as non-cyclical pain that persists for six months or more, located in the pelvis, in the infra-umbilical portion of the anterior abdominal wall, in the lumbosacral region or in the gluteal region, causing functional disability. Women of childbearing age are without a doubt the fundamental age group for global health and for future generations. Many women come to the gynecology clinic for having chronic pelvic pain and when the medical history is done, a high incidence of fertility problems is observed. Objective: to characterize the behavior of chronic pelvic pain of gynecological cause in patients of childbearing age. Methods: an observational, descriptive, cross-sectional study was carried out. The study population consisted of 123 patients with a diagnosis of chronic pelvic pain of gynecological cause and of childbearing age, which weretreated in a gynecology consultation at the Comandante Manuel Fajardo Rivero Teaching Clinical Hospital of Villa Clara during the period from September 1st, 2017 to September 30th, 2019. Results: the women in the study were adults. The main cause of pain was endometriosis. Most of the women were multiparous and had infertility. Conclusions: most of the patients with chronic pelvic pain in childbearing age were adults. The main cause of chronic pelvic pain was endometriosis, followed by adhesions. Most of the women were multiparous and had infertility.

Caracterización clínico-epidemiológica de la mujer infértil / Epidemiological-clinical characterization of infertile women

RESUMEN Fundamento: la infertilidad es la incapacidad para tener hijos, pero con posibilidad de embarazo que no llega a término. En el mundo existen 187 millones de parejas afectadas. Objetivo: caracterizar las mujeres atendidas en la consulta municipal de infertilidad. Métodos: se realizó un estudio descriptivo observacional y retrospectivo en Policlínico Docente Emilio Daudin Bueno, de la provincia Guantánamo, durante el periodo enero de 2017 a junio de 2020. El universo estuvo constituido por las 128 mujeres infértiles de 19-39 años atendidas en consulta. Fueron evaluadas variables cualitativas y cuantitativas. La información de cada variable estudiada se obtuvo de las historias clínicas de las pacientes atendidas en consulta. Resultados: predominaron las féminas de 25-29 años con infertilidad secundaria; las infecciones genitales como factor causal predominante, seguido de los antecedentes obstétricos desfavorables y en la mayoría de las pacientes el peso saludable como evaluación nutricional. Se pudo percibir que del total de las pacientes, en algunas existió algún grado de aumento del peso corporal. Conclusiones: la consulta de infertilidad cumple el objetivo de lograr la concepción de las féminas según las causas que impiden la misma, la actuación de cada profesional de la salud al incorporar los conocimientos necesarios a emplear en su adecuado seguimiento, permitirá concretarlo desde la Atención Primaria de Salud.

ABSTRACT Background: infertility is the inability to have children, but with the possibility of pregnancy, which does not reach term. There are one hundred and eighty-seven million affected couples in the world. Objective: to characterize women treated in the municipal consultation of infertility. Methods: an observational and retrospective descriptive study was carried out in Emilio Daudinot Bueno Docent Polyclinic, Guantánamo, during the period January 2017 to June 2020. The universe was made up of 128 infertile women who met the inclusion criteria: 19-39 years old, seen in infertility consultation and fulfill the concept of infertility. Qualitative and quantitative variables were evaluated. The primary data was obtained from the medical records of the patients seen. Results: females aged 25-29 years with secondary infertility predominated; genital infections as the predominant cause factor, followed by unfavorable obstetric history and, in most patients, healthy weight as a nutritional assessment. It was possible to perceive that of the total number of patients, in some there was some degree of increase in body weight. Conclusions: the infertility consultation fulfills the objective of achieving the conception of women by attenuating the causes that prevent it, the performance of each health professional by incorporating the necessary knowledge to be used in its adequate follow-up, will allow specifying it from Primary Care of health.

Miomectomía múltiple por vía abdominal / Multiple abdominal myomectomy

RESUMEN Se presentaron dos pacientes a las cuales se les realizó una miomectomía en los meses de enero y marzo de 2017, en la localidad de Luanda, Angola. Ambas fueron atendidas en la consulta de Ginecología por: aumento de volumen del abdomen, sangramiento genital durante la menstruación y fuera de ella, síntomas compresivos caracterizados por urgencia miccional y estreñimiento, además de infertilidad. Se les realizaron: exámenes de laboratorio, ultrasonido ginecológico y renal, así como histerosalpingografía. Después del análisis de estos exámenes se les diagnosticó una miomatosis uterina múltiple; fueron remitidas al salón de operaciones con previo consentimiento informado y se les practicó una miomectomía múltiple sin complicaciones transoperatorias. Se conservó el útero en ambas pacientes, las cuales tuvieron una recuperación postoperatoria satisfactoria. Una de estas pacientes logró un embarazo cinco meses después de la cirugía.

ABSTRACT We present two patients who had a myomectomy in January and March 2017, in Luanda, Angola. Both were treated in the Gynecology consultation due to increased abdominal volume, genital bleeding during and between periods, compressive symptoms characterized by urinary urgency, constipation and infertility. Laboratory tests, gynecological and renal ultrasound, as well as hysterosalpingography were performed. After the analysis of these tests, they were diagnosed with multiple uterine myomas, referred to the operating room with prior informed consent and underwent a multiple myomectomy without transoperative complications. The uterus was preserved in both patients, who had a satisfactory postoperative recovery. One of these patients got pregnant five months after surgery.

Analysis of hope level and influencing factors of infertile patients with first or repeated IVF-ET / 中华健康管理学杂志

Objective:To explore the hope level and influencing factors of infertile patients with first or repeated in vitro fertilization-embryo transfer (IVF-ET).Methods:Female patients receiving IVF-ET treatment during January to June, 2019 in reproductive Medicine Center, Ruijin Hospital, Shanghai Jiaotong University School of medicine, were enrolled in this study. All patients were divided into first and repeated cycles (≥2 cycles), then a questionnaire survey was conducted. The questionnaire included demographic information, Herth hope index (HHI) scale, Locke-Wallace short marital-adjustment test scale and social support rating scale. Multiple linear regression was used to analyze the associated influencing factors of hope level.Results:A total of 251 IVF-ET patients were recruited in the study, including 142 (56.6%) in the first cycle and 109 (43.4%) in the repeated cycle. The HHI score of the repeated cycle was significantly lower than that of the first cycle [(32.0±3.3) vs (36.0±3.1) points] ( P<0.001). Multiple linear regression analysis indicated that repeated IVF-ET was independently negatively correlated with HHI, with a standardized coefficient β of -0.406 ( P<0.001). While living in a city ( P=0.013), high monthly income ( P=0.026), high degree short marital-adjustment test ( P=0.006) and social support rating ( P=0.002) were independently positively correlated with HHI. Conclusions:Repeated IVF-ET treatment patients have a significantly lower HHI score. The residence, monthly income, marital-adjustment, and social support are significantly associated with hope level.

Influence of female age on the fresh cycle live birth rate of different controlled ovarian hyperstimulation protocols in poor ovarian response patients / 中华妇产科杂志

Objective:To investigate the influence of age on the fresh cycle live birth rate in patients with poor ovarian response in different controlled ovarian hyperstimulation groups.Methods:The clinical data of 3 342 patients in The First Affiliated Hospital of Zhengzhou University from February 2014 to November 2018 were retrospectively collected, including early-follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol group (1 375 cases), mid-luteal phase short-acting GnRH agonist long protocol group (1 161 cases) and GnRH antagonist protocol group (806 cases); each group was divided into 4 subgroups according to age: ≤30 years, 31－35 years, 36－40 years and >40 years, the pregnancy outcomes in each age subgroup were analyzed under different controlled ovarian hyperstimulation protocols.Results:In early-follicular phase long-acting GnRH agonist long protocol group, the final live birth rates of each age subgroup were 39.4% (228/579), 36.1% (135/374), 16.6% (48/290) and 3.0% (4/132); in mid-luteal phase short-acting GnRH agonist long protocol group, live birth rates of each age subgroup were 32.1% (99/308), 20.8% (55/264), 13.0% (45/346) and 7.0% (17/243); in GnRH antagonist protocol group, live birth rates of each age subgroup were 22.8% (26/114), 16.3% (25/153), 11.2% (31/278), and 3.8% (10/261); the live birth rate of each group decreased significantly with the increase of age (all P<0.01). When the age≤35 years old, the fresh cycle live birth rate of the early-follicular phase long-acting GnRH agonist long protocol group was significantly better than those of the other two groups (all P<0.01). The multivariate logistic regression analysis of age and live birth rate of the three controlled ovarian hyperstimulation groups showed age was the independent influence factor ( OR=0.898, 95% CI: 0.873-0.916, P<0.01; OR=0.926, 95% CI: 0.890-0.996, P<0.01; OR=0.901, 95% CI: 0.863-0.960, P<0.01). Conclusions:Age is an independent influencing factor for the prediction of fresh cycle live birth rate in low ovarian response patients. No matter which controlled ovarian hyperstimulation protocol is adopted, the final live birth rate decreases significantly with the increase of women′s age. In addition, the early-follicular phase long-acting GnRH agonist long protocol has the highest fresh cycle live birth rate among all controlled ovarian hyperstimulation groups.

Infertilidad e hipotiroidismo subclínico / Infertility and subclinical hypothyroidism

RESUMEN Fundamento: la infertilidad adquiere cada día mayor auge en las sociedades desarrolladas, la misma se define como la incapacidad para procrear después de un año de vida sexual activa no protegida por algún tipo de contracepción, el hipotiroidismo que se define como la hiposecreción de hormonas por la glándula tiroides se relaciona con problemas ovulatorios, de implantación, infertilidad abortos y complicaciones durante el embarazo. Objetivo: identificar la presencia de hipotiroidismo subclínico en mujeres con infertilidad. Métodos: se realizó un estudio transversal y descriptivo en pacientes atendidas en el servicio de reproducción asistida de la provincia Pinar del Río, desde el 1ro enero de 2017 hasta el 30 junio de 2019. Los datos se obtuvieron de las historias clínicas. Para el análisis de la información se utilizó el sistema estadístico SPSS (versión 22.0), se confeccionó una base de datos en Excel 2010, se aplicó análisis univariado de carácter descriptivo, se utilizaron estadígrafos descriptivos como la distribución de frecuencias absoluta y relativa. Se utilizaron las pruebas T de Student para datos cuantitativos y Chi cuadrado para datos cualitativos, ambas con un nivel de significancia del 95 % (p < 0,05). Resultados: la mayor parte de las mujeres tenían infertilidad secundaria. El hipotiroidismo subclínico resultó más frecuente en la infertilidad secundaria. Los valores medios de hormona estimulante de la tiroides resultaron mayores en mujeres con infertilidad primaria, quienes presentaron de manera significativa niveles menores de triyodotironina en suero, la mitad tuvo un tiempo de infertilidad entre dos y cinco años. Predominó el sobrepeso. Conclusiones: se encontró mayor prevalencia de hipotiroidismo subclínico entre las mujeres con infertilidad secundaria.

ABSTRACT Background: infertility acquires a growing boom in developed societies, it is considered as the inability to procreate after a year of active sexual life not protected by some type of contraception; the hypothyroidism that is defined as the hyposcretion of hormones by the thyroid gland is related to ovulatory problems, implantation, infertility, abortions and complications during pregnancy. Objective: to identify the presence of subclinical hypothyroidism in women with infertility. Methods: a cross-sectional and descriptive study was carried out on patients treated in the assisted reproduction service of the Province of Pinar del Río, in the period from January 1st, 2017 to June 30th, 2019. Data were obtained from the medical records. For the analysis of the information, the statistical system SPSS (version 22.0) was used, a database was created in Excel 2010, descriptive univariated analysis was applied, descriptive statistics were used as the absolute and relative frequency distribution. The Student's T test was used for quantitative data and Chi square for qualitative data, both with a level of significance of 95% (p<0.05). Results: most of the women had secondary infertility. Subclinical hypothyroidism was more frequent in secondary infertility. The average values ​​of thyroid stimulating hormone were higher in women with primary infertility who presented significantly lower levels of serum triiodothyronine, half had an infertility time between two and five years. Overweight predominated. Conclusions: A higher prevalence of subclinical hypothyroidism was found among women with secondary infertility.

Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura / Protocol for the management of infertile couples with catgut implantation in acupuncture points

RESUMEN Introducción: en la mujer, el hallazgo inmediato más importante en los estudios de infertilidad es la ausencia de ovulación y aunque en su tratamiento existen alternativas, aún son ineficaces debido a limitaciones diagnósticas y terapéuticas. En las causas masculinas, las alteraciones idiopáticas de la calidad del semen predominan, son más frecuentes la astenozoospermia y oligozoospermia, asociado al diagnóstico de varicocele. Las razones por las cuales el potencial de fertilidad no siempre se mejora después de tratamiento quirúrgico oportuno y adecuado del varicocele, están todavía en estudio, y los tratamientos convencionales propuestos son costosos y no siempre efectivos. Objetivo: elaborar un protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura. Desarrollo: se analizaron temáticas sobre la atención a la mujer con ciclos anovulatorios y a hombres infértiles después del tratamiento quirúrgico del varicocele y con infertilidad idiopática y los tratamientos tradicionales propuestos. Se generaron preguntas científicas para confeccionar el protocolo. Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura que incluye: profesionales a quienes va dirigido, población diana, recursos necesarios, equipo de trabajo, papel de los miembros del equipo, secuencia de actuación, modo de realización, ventajas, desventajas y contraindicaciones de la implantación de catgut, diferenciación y tratamiento en cada caso según el diagnóstico tradicional chino e indicadores de evaluación. Conclusiones: la modalidad terapéutica propuesta, es una alternativa inocua y poco costosa que contribuye a mejorar la fecundidad y la natalidad de la pareja infértil.

ABSTRACT Introduction: in women, the most important immediate finding in infertility studies is the nonexistence of ovulation and although there are alternatives in their treatment, they are still ineffective due to diagnostic and therapeutic limitations. In male causes, idiopathic alterations in semen quality predominate, the most frequent being asthenozoospermia and oligozoospermia associated with the diagnosis of varicocele. The reasons why fertility potential is not always improved after timely and adequate surgical treatment of varicocele are still under study, and the proposed conventional treatments are expensive and not always effective. Objective: to elaborate a protocol for the management of the infertile couples with catgut implantation in acupuncture points. Development: topics regarding this protocol were analyzed on the care of women with anovulatory cycles and infertile men after surgical treatment of varicocele along with idiopathic infertility as well as the proposed traditional treatments, generating scientific questions to draw up the protocol. The protocol for the management of infertile couples with implantation of catgut in acupuncture points includes: professionals to whom it is directed, target population, necessary resources, teamwork, role of team members, sequence of action, approach for its implementation, advantages, disadvantages and contraindications concerning the implantation of catgut, differentiation and treatment in each case according to the traditional Chinese diagnosis and assessment indicators. Conclusions: the proposed therapeutic modality is an innocuous and inexpensive alternative that contributes to the improvement of fertility and birth rate in the infertile couples.

Hipotiroidismo asociado con infertilidad en mujeres en edad reproductiva / Hypothyroidism associated with infertility in women in reproductive age

Resumen: OBJETIVO: Revisar la bibliografía más reciente para valorar y sintetizar los aspectos más importantes relacionados con las repercusiones del hipotiroidismo y su asociación con infertilidad en la mujer en edad reproductiva. METODOLOGÍA: Estudio de investigación documental consistente en la búsqueda en las bases electrónicas de PubMed y Google Scholar (1993-2018) con las palabras clave: hipotiroidismo subclínico, hipotiroidismo, disfunción tiroidea, hipofunción tiroidea, enfermedad de tiroides subclínica, pérdida de embarazo, aborto y embarazo; escritos en español e inglés y estudios retrospectivos publicados en libros de texto. RESULTADOS: Se incluyeron 39 documentos y se seleccionaron los de mayor relevancia científica y epidemiológica. El hipotiroidismo afecta a las mujeres en edad reproductiva con prevalencia de 0.4-0.5% para el evidente y 2-8% para el subclínico, este último puede resultar en infertilidad femenina y pobres desenlaces reproductivos. CONCLUSIÓN: El hipotiroidismo es una enfermedad que afecta más a las mujeres que a los hombres, con mayor incidencia en la etapa fértil. El diagnóstico y tratamiento oportuno mejoran el pronóstico de la fertilidad, embarazo y vida del recién nacido.

Abstract: OBJECTIVE: To review the most recent bibliography to assess and synthesize the most important aspects in relation to the repercussions of hypothyroidism and its association with infertility in women of reproductive age. METHODOLOGY: Documentary research study carried out based on the search in PubMed and Google Scholar; from the years 1993 to 2018 with the keywords: subclinical hypothyroidism, hypothyroidism, thyroid dysfunction, thyroid hypofunction, subclinical thyroid disease, pregnancy loss, abortion and pregnancy in Spanish and English and retrospective study in textbooks. RESULTS: 39 documents were included, selecting the ones with the highest scientific and epidemiological relevance. Hypothyroidism affects women of reproductive age with a prevalence of 0.4-0.5% for the obvious and 2-8% for the subclinical, the latter can result in female infertility and poor reproductive results. CONCLUSION: Hypothyroidism is a pathology that affects women, with a higher incidence in the fertile stage. A timely diagnosis and treatment improve the prognosis of fertility, pregnancy and life of the newborn.

Association of obesity and anovulatory infertility / Associação entre obesidade e infertilidade anovulatória

ABSTRACT Objective To verify the association of obesity and infertility related to anovulatory issues. Methods This case-control study was carried out with 52 women, aged 20 to 38 years, divided into two groups (infertile − cases − and fertile − control), seen at outpatient clinics, in the period from April to December, 2017. Results We found significant evidence that obesity negatively affects women's fertility (p=0.017). The group of infertile women was 7.5-fold more likely to be obese than fertile women. Conclusion Strategies that encourage weight control are indicated for women with chronic anovulation, due to hight metabolic activity of adipose tissue.

RESUMO Objetivo Verificar em mulheres a associação entre obesidade e infertilidade relacionada a questões anovulatórias. Métodos Estudo de caso-controle com 52 mulheres, de 20 a 38 anos, divididas em dois grupos (mulheres inférteis − casos − e férteis − controles), atendidas em ambulatórios, no período de abril a dezembro de 2017. Resultados Verificou-se evidência significativa de que a obesidade afeta negativamente na fertilidade das mulheres (p=0,017). O grupo de mulheres inférteis teve 7,5 vezes mais chances de serem obesas quando comparadas às mulheres férteis. Conclusão Estratégias que estimulem o controle do peso são indicadas para mulheres com anovulação crônica devido à elevada atividade metabólica do tecido adiposo.

Clinical study of hysteroscopy combined with laparoscopy in the diagnosis and treatment of unexplained infertility / 中华妇产科杂志

Objective@#To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility.@*Methods@#A total of 519 cases diagnosed as unexplained infertility, received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015. The causes of infertility were evaluated, and the subjects were followed up to observe the nature pregnancy rate.@*Results@#Among 519 unexplained infertility patients, pelvic abnormalities had been explored in 466 (89.8%, 466/519) cases. Pelvic endometriosis combined with adhesions, pelvic adhesion alone, uterine leiomyoma and uterine cavity polyp were 72.4% (376/519), 12.3% (64/519), 3.7% (19/519) and 1.3% (7/519) respectively. The total natural pregnancy rate within the 3 years of follow up was 53.9% (208/386), and the natural pregnancy rate was 29.8% (31/104) in patients aged 35 years and over.@*Conclusions@#The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy. Under the examination, the causes of infertility could be found more intuitively, and targeted treatment could be carried out to improve the pregnancy rate. The natural pregnancy rate of the elderly patients decrease obviously after operation, and the time of natural trying pregnancy should not be too long.

Therapeutic efficacy of moxibustion plus medicine in the treatment of infertility due to polycystic ovary syndrome and its effect on serum immune inflammatory factors / 针灸推拿医学（英文版）

Objective: To explore the effects and related mechanism of heat-sensitive moxibustion plus clomifene citrate capsules for infertility due to polycystic ovary syndrome (PCOS). Methods: A total of 70 patients were randomized into a control group and an observation group by the random number table method, with 35 cases in each group. The control group was treated with clomifene citrate capsules, while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group. The treatment course lasted for 6 menstrual cycles. The endometrial thickness and ovarian volume of the patients were measured before and after treatment. The levels of serum sex hormones, tumor necrosis factor-α (TNF-α) and nuclear factor-κB (NF-κB) were detected. Follow-up was performed for 1 year after treatment, and the pregnancy rate was recorded. Results: After treatment, the endometrium of the patients in both groups was significantly thickened, the ovarian volume was significantly reduced, and the intra-group differences were statistically significant (all P<0.05). The endometrium thickness and ovarian volume in the observation group were significantly different from those in the control group (both P<0.05). After treatment, the levels of serum testostrn (T) and luteinizing hormone (LH) in both groups decreased significantly, the level of estradiol (E2) increased obviously, and the intra-group differences were statistically significant (all P<0.05). The levels of serum T and LH in the observation group were lower than those in the control group, and the E2 level in the observation group was higher than that in the control group, and the between-group differences were statistically significant (all P<0.05). After treatment, the levels of serum TNF-α and NF-κB of the patients in both groups decreased, and the intra-group differences were statistically significant (all P<0.05). The levels of serum TNF-α and NF-κB in the observation group were significantly lower than those in the control group (both P<0.05). After 1-year follow-up, the pregnancy rate was 20.0％ in the control group, versus 51.5％ in the observation group. The pregnancy rate in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05). Conclusion: The treatment of heat-sensitive moxibustion plus clomifene citrate capsules can increase the endometrium thickness, reduce the ovarian volume, improve the status of serum sex hormone disorders, and increase the conception rate in patients with infertility due to PCOS, which may be related to the adjustment of the levels of immune inflammatory factors such as serum TNF-α and NF-κB.

Caracterización de mujeres con infertilidad de causa endocrina / Characterization of Women with Endocrine Infertility

RESUMEN Fundamento: existe un incremento de la infertilidad en las parejas y las causas endocrinas femeninas están entre las primeras responsables. Objetivo: describir el comportamiento de la infertilidad femenina de causa endocrina en pacientes estudiadas en el Centro Territorial de Reproducción Humana de Cienfuegos. Método: se realizó un estudio descriptivo, de serie de casos en el que se incluyeron a todas las mujeres que se atendieron por infertilidad de causa endocrina desde enero de 2012 hasta enero de 2013. Las variables analizadas fueron: edad, antecedentes patológicos personales, tipo de sangrado, historia obstétrica, valoración nutricional, hirsutismo, bocio, galactorrea, acantosis nigricans, tiempo de infertilidad, tipo de infertilidad. Se creó una base de datos, con ayuda del programa SPSS con el que se realizó el procesamiento para su posterior análisis. Se aplicó la estadística descriptiva, frecuencias y porcientos. Resultados: el grupo de edad que predominó fue el de 30 a 34 años y el 9,4 % de las féminas tenían antecedentes patológicos personales de obesidad, casi la mitad presentaron oligomenorrea, un 33,6 % de ellas presentaron sobrepeso y se detectó que en el examen físico un 34,3 % de las pacientes presentaron acantosis nigricans. El mayor número de mujeres acudieron con un tiempo de infertilidad menor de 3 años para un 50,4 %. Un 66,4 % presentó infertilidad secundaria y según el diagnóstico endocrino la hiperprolactinemia fue la más representativa con el 38,7 %. Conclusiones: la infertilidad de causa endocrina se presentó principalmente en mujeres con sobrepeso, con un tiempo de infertilidad de tipo secundaria menor de 3 años y la hiperprolactinemia fue la más representativa.

ABSTRACT Foundation: there is an increase in couple infertility and female endocrine causes are among the main reasons. Objective: to describe the behavior of endocrine female infertility in patients studied at the Territorial Center for Human Reproduction of Cienfuegos. Method: a descriptive series of case studies was conducted in which all women treated for endocrine infertility from January 2012 to January 2013 were included. The variables analyzed were age, personal pathological history, type of bleeding, obstetric history, nutritional assessment, hirsutism, goiter, galactorrhea, acanthosis nigricans, time and type of infertility. A database, using SPSS program was created and processed for further analysis. Descriptive statistics, frequencies and percentages were applied. Results: the predominant age group was 30 to 34 years old and 9.4 % had a personal pathological history of obesity, almost half had oligomenorrhea 33.6 % of them were overweight and on physical examination 34.3 % of the patients showed acanthosis nigricans. The largest number of women attended with less than 3-year infertility was 50.4 %. Secondary infertility was 66.4 % and according to the endocrine diagnosis, hyperprolactinemia was the most representative with 38.7 %. Conclusions: endocrine infertility occurred mainly in overweight women; with a secondary, less than 3-year time infertility and hyperprolactinemia was the most representative.

The role of laparoscopy in the propaedeutics of gynecological diagnosis

Abstract Purpose: To evaluate agreement between pre- and post-laparoscopy gynecological diagnosis in order to demonstrate the rationality of this minimally invasive technique use in gynecological propaedeutics. Methods: Retrospective chart review study conducted between March 2010 and October 2016 based on a convenience sample. 315 patients undergoing surgical laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were compared by the diagnosis agreement test considering the proportions of events. Results: Laparoscopy contributed to diagnosis in 59.6% of infertility cases (P>0.05), in 93.7% of chronic pelvic pain of undetermined origin (P<0.01) and conclusively elucidated the diagnosis of acute abdomen and the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05). Conclusion: The use of laparoscopy considerably contributed to diagnostic elucidation, especially in cases of undetermined chronic pelvic pain.

Transvaginal four-dimensional hysterosalpingo-contrast sonography in evaluation on patency of fallopian tubes in infertile patients / 中国医学影像技术

Objective: To explore the application value of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) with transvaginal ultrasound in evaluation of fallopian tube patency in infertile patients. Methods Clinical data of 112 infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation using methylene blue (LC) were retrospectively analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and AUC of 4D-HyCoSy in diagnosis of tubal obstruction were calculated. Then the consistency between 4D-HyCoSy and LC in diagnosis of fallopian tube patency was evaluated. Results: A total of 218 fallopian tubes were examined in 112 infertile patients. Taken LC results as gold standards, the coincidence rates of 4D-HyCoSy in diagnosis of tubal patency, partially obstructed and completely obstructed were 88.64% (39/44), 72.09% (62/86) and 89.77% (79/88), respectively, and the overall coincidence rate was 82.57% (180/218). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 4D-HyCoSy in diagnosis of tubal obstruction were 80.61% (79/98), 92.50% (111/120), 89.77% (79/88), 85.38% (111/130), 10.75 and 0.19, respectively, AUC was 0.87 (P<0.01). 4D-HyCoSy had higher consistency with LC in diagnosis of tubal patency (Kappa=0.74). Conclusion: 4D-HyCoSy is consistent with LC in diagnosis of fallopian tube patency, which has high specificity in diagnosing tubal obstruction.

Reproductive Health Promotion Behavior of Infertility Women and Normal Women / 여성건강간호학회지

PURPOSE: To compare reproductive health promoting behaviors (RHPBs) of infertile women with those of normal women and identify effects of RHPB on infertility. METHODS: A total of 148 females (73 infertile women and 75 normal women) were enrolled in this study. Measurements included their general characteristics and RHPB using self-report questionnaires. Data were analyzed with descriptive statistics, χ2 test, ANCOVA, and hierarchical logistic regression using SPSS. RESULTS: There were significant difference in incomes, number of family, number of term deliveries, and number of abortions according to infertility diagnosis. Mean duration of infertility was 32.16 months. Only 12.32% women had known cause of infertility. The most common cause of infertility was unknown. Mean RHPB score was 3.98 for infertile women and 4.41 for normal women. In logistic regression, total RHPB (odds ratio [OR], 0.21) and safe sex of RHPB (OR, 0.66) were significant factors influencing infertility. Infertile women's total RHPB and subcategories of RHPB (safe sex behavior and sexual transmitted disease [STD] prevention) were lower than those of normal women. CONCLUSION: For infertility women, RHPB-related intervention programs are needed, especially information about safe sex behavior and STD prevention.