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.

Effect of therapies for kidney-tonifying and blood-activating in treatment of anovulatory infertility in eugenics / 中国中药杂志

In the context of the new era, paying attention to maternal and child health and advocating prenatal and postnatal care can effectively improve the quality of the birth population. Traditional Chinese medicine has a long history of prenatal and postnatal healthcare with rich content, which is the theoretical basis of modern related services. With the social development and the improvement of people's awareness of prenatal and postnatal healthcare, people have gradually shifted the focus of prenatal and postnatal healthcare to the peri-pregnancy stage at present, namely that couples of childbearing age are guided to prepare for pregnancy under the premise of solving their basic diseases. Infertility is a common and refractory disease for women of childbearing age. Ovulation disorder is one of its common pathological mechanisms. Traditional Chinese medicine believes that kidney deficiency is the main cause and pa-thogenesis of anovulation infertility and blood stasis is an important factor throughout the disease course. In clinical practice, therapies for invigorating kidney and activating blood are safe and reliable to treat anovulatory infertility mainly by adjusting the hypothalamus-pituitary-ovarian axis, improving ovarian function, uterine environment and gamete quality and increasing endometrial volume. Under the guidance of the thought of prenatal and postnatal healthcare, the authors tried to explore the effect of therapies for kidney-tonifying and blood-activating in the treatment of anovulatory infertility in eugenics, with the purpose of providing ideas and basis for subsequent relevant clinical studies and contributing to prenatal and postnatal healthcare services.

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

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.

Síndrome dos ovários policísticos: particularidades no manejo da infertilidade / Polycystic ovary syndrome: particularities in the management of infertility

A síndrome dos ovários policísticos (SOP) é responsável por cerca de 80% dos casos de infertilidade anovulatória. Não há na literatura evidências suficientes para a definição do tratamento ideal da infertilidade na SOP, mas repete-se que deve ser iniciado por mudanças no estilo de vida, e frequentemente envolve a indução farmacológica da ovulação e, em casos selecionados, as técnicas de reprodução assistida e o drilling ovariano laparoscópico. Este texto pretende reunir informações atuais sobre o manejo da infertilidade em mulheres com SOP e, dessa forma, permitir ao ginecologista a escolha da melhor abordagem, de forma Individualizada e baseada nas melhores evidências disponíveis.(AU)

Síndrome de Ovarios Poliquísticos / Polycystic ovary syndrome

Resumen El síndrome de ovarios poliquísticos (SOPQ) es la disfunción endocrino- metabólica más frecuente en mujeres de edad reproductiva. El diagnostico de esta patología se basa en la presencia de anovulación, hiperandrogenismo y ovarios poliquísticos. La etiología del SOPQ es compleja y multifactorial; por lo cual el tratamiento se basa en tratar las manifestaciones clínicas y la inducción de la ovulación en el momento que se desee la concepción.

Abstract Polycystic ovary syndrome is the most common endocrinologic and metabolic disfunction in reproductive- aged women. The diagnosis of this pathology is based on the presence of ovulatory dysfunction, hyperandrogenism and polycystic ovaries. Its ethiology is complex and with multiple factors, therefore its treatment is based on fixing the clinical manifestations of the syndrome and in the case of women who would like to conceive, in inducing ovulation.

Impact of laparoscopic ovarian drilling [LOD] on ovarian reserve and ovarian stromal blood flow using two-dimensional [2D] power doppler in anovulatory women with polycystic ovary syndrome [PCOS]

Aim of the Study: This study aimed to determine the effect of LOD on ovarian reserve and ovarian stromal blood flow changes, by using Two-Dimensional [2D] Power Doppler Ultrasongraphy in anovulatory women with Polycystic Ovary Syndrome [PCOS] and whether this could explain the mechanism of action of LOD

Patients and methods: This study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Al-Hussein University Hospital, El-Sayed Galal Hospital and EL-Sheikh Zayed Especialized Hospital in the period between November 2016 and February 2018. This study included 30 anovulatory polycystic ovary women with clomiphene citrate [CC]-resistant and 30 fertile women as the control group. Laparoscopic ovarian drilling was done. Serum levels of hormonal profile were measured [AMH, LH, FSH, LH/FSH ratio and total testosterone], ovarian stromal blood flow Doppler indices [RI and PI] and occurrence of ovulation or pregnancy

Result: In this study we reported our findings regarding the effects of LOD on AMH, hormonal profile and ovarian stromal blood flow in women with PCOS with clomiphene resistance. These results suggested that the measurement of AMH, LH, LH/FSH ratio, total testosterone, ovarian volume and ovarian stromal blood flow by Doppler were in discrimination of PCOS from potentially normal women. The data in our study suggested that there were no significant differences as regard AMH, hormonal profile except total testosterone, ultrasound ovarian findings and ovarian stromal blood flow before and after LOD, but there were significant differences as regard total testosterone before and after LOD. Also, there was good predictive value for AMH after LOD for ovulation and clinical pregnancy

Conclusion: Measuring AMH for anovulatory women with PCOS undergoing LOD may be a useful tool in evaluating the outcome of LOD, but ovarian stromal blood flow 2D Doppler indices did not show significant changes predicting ovulation or pregnancy rate after LOD

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.

Metformina en mujeres con síndrome de ovarios poliquísticos resistentes al citrato de clomifeno / Metformin in women with polycystic ovary syndrome resistant to clomiphene citrate

El objetivo de la investigación fue determinar la utilidad del uso de metformina en mujeres con síndrome de ovarios poliquísticos resistentes al citrato de clomífero. Esta investigación se realizó en el Hospital Central Dr. Urquinaona, Maracaibo, Venezuela, en el periodo de junio del 2012 a julio del 2017. Se incluyeron mujeres con infertilidad primaria por anovulación debido a síndrome de ovarios poliquísticos resistente a citrato de clomifeno. Las pacientes fueron elegidas al azar para ser asignadas al grupo A (casos ­ metformina) o grupo B (controles ­ placebo). Se analizaron las características generales, tasa de ovulación y de embarazo en las pacientes de cada uno de los grupos. Se seleccionaron 90 pacientes, las cuales fueron asignadas al grupo A (n = 45) o aquellas pacientes asignadas al grupo B (n = 45. No se observaron diferencias estadísticamente significativas entre los grupos con respecto a edad, índice de masa corporal, duración de la infertilidad y concentraciones de hormonales (p = ns). En el grupo A se observó que 62,2 % de las pacientes presentó ovulación comparado con 35,5 % en el grupo B (p = 0,0199). Por otra parte, 46,6 % de las pacientes del grupo A quedó embarazada comparado con 20,0 % en las pacientes del grupo B (p = 0,0132). Se concluye que el uso de metformina es útil en mujeres con síndrome de ovarios poliquísticos resistentes al citrato de clomifeno, ya que aumenta la tasa de ovulación y embarazo en este grupo de pacientes.

The aim of the research was to determine the usefulness of metformin in women with polycystic ovary syndrome resistant to clomiphene citrate. This research was conducted at the Hospital Central Dr. Urquinaona, Maracaibo, Venezuela, from June 2012 to July 2017. Women with primary infertility due to anovulation by polycystic ovary syndrome resistant to clomiphene citrate were included. Patients were randomized to be assigned with group A (cases - metformin) or group B (controls - placebo). General characteristics, ovulation rate and pregnancy in the patients of each of the groups were analyzed. A total of 90 patients were assigned to group A (n = 45) or patients assigned to group B (n = 45). There were no statistically significant differences between groups with respect to age, body mass index, duration of infertility and hormonal concentrations (p = ns). In group A, 62,2 % of the patients presented ovulation compared to 35,5 % in group B (p = 0.0199). On the other hand, 46,6 % of patients in group A became pregnant compared to 20.0% in patients in group B (p = 0.0132). It is concluded that treatment with metformin is useful in women with clomiphene citrate-resistant polycystic ovary syndrome since it increases the rate of ovulation and pregnancy in this group of patients.

Síndrome de ovario poliquístico / Polycystic ovary syndrome

El síndrome de ovario poliquísticos (SOP) representa una de las endocrinopatías más frecuentes en la mujer y es la principal causa de hiperandrogenismo (HA). Se trata de un trastorno complejo, multifactorial, poligénico con influencias ambientales. Aunque se han propuestos diferentes criterios para su diagnóstico, se prefiere el uso del más abarcativo (Criterio de Rotterdam) con la presencia de 2 de 3 de los siguientes: 1) HA clínico o bioquímico, 2) oligoanovulación crónica (OA), 3) poliquistosis ovárica por ecografía, excluyendo otras etiologías. Es frecuente su asociación con comorbilidades metabólicas (obesidad, diabetes 2, dislipidemia, apnea del sueño, etc.) y trastornos reproductivos (hiperplasia endometrial e infertilidad), sobre todo en los fenotipos clásicos, con HA y OA. El tratamiento estará orientado a las características clínicas de cada paciente y al deseo reproductivo. La pérdida de peso en aquellas con sobrepeso u obesidad o ambos factores puede restaurar los ciclos menstruales y disminuir el riesgo metabólico y representa la primera línea de tratamiento. Los anticonceptivos orales (ACO) son el tratamiento farmacológico de elección ya que atenúan las manifestaciones de HA y ofrecen protección endometrial. En las pacientes con oligoanovulación que buscan embarazo, el citrato de clomifeno es el tratamiento aconsejado en primera instancia. La metformina podría usarse en aquellas con intolerancia a la glucosa o diabetes 2 y también como segunda línea de tratamiento para restaurar los ciclos e inducir la ovulación. (AU)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, the main cause of hyperandrogenism (HA). It is a complex, multifactorial polygenic disorder with environmental influences. Although there have been proposed different criteria for diagnosis, using the most comprehensive (Criteria Rotterdam) with the presence of 2 of 3 of the following is preferred: 1) HA clinical or biochemical, 2) oligo-anovulation chronic (OA), 3) polycystic ovaries by ultrasound, excluding other etiologies. It is frequently associated with metabolic comorbidities (obesity, type 2 diabetes, dyslipidemia, sleep apnea, etc.) and reproductive disorders (endometrial hyperplasia and infertility), especially in the classical phenotypes, with HA and OA. The treatment will be oriented to the clinical characteristics of each patient and reproductive desire. Weight loss in those who are overweight and / or obesity can restore menstrual cycles and decrease metabolic risk and represents the first line of treatment. Oral contraceptives (OC) are the pharmacological treatment of choice as it attenuates the manifestations of HA and offer endometrial protection. In patients seeking pregnancy with oligo-anovulation, clomiphene citrate would be used at first instance. Metformin may be used in those with impaired glucose tolerance or type 2 diabetes and also as a second-line treatment to restore cycles and induce ovulation. (AU)

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).

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.

Experiencia preliminar en el uso del registro de fertilidad en una cohorte de pacientes de infertilidad en un servicio de ginecología y obstetricia / Preliminary experience in the use of fertility charting in a cohort of infertility patients at a department of obstetrics and gynecology / Experiência preliminar no uso do registro de fertilidade em um coorte de pacientes de infertilidade num serviço de ginecologia e obstetrícia

Objetivo: estudiar los resultados de las pacientes con infertilidad tratadas con un enfoque de medicina restaurativa (naprotecnología) en un servicio de ginecología y obstetricia. Metodología: estudio de cohorte retrospectivo realizado por el departamento de obstetricia y ginecología de la Universidad de los Andes (Santiago, Chile) en pacientes con infertilidad de un área suburbana de Santiago de Chile, que recibieron tratamiento entre el 2006 y 2014. Todas las parejas recibieron instrucción para reconocer su período de fertilidad según un modelo local de enseñanza, basado en el modelo Creigthon (Creigthon Model FertilityCare System). Recibieron, además, tratamiento médico para inducción de ovulación, mejoramiento del período fértil o cirugía reparadora. La medición primaria fue el número de embarazos. Resultados: 131 pacientes recibieron la instrucción. El promedio de edad fue de 33.6 años. 78 pacientes (59.5%) consultaron por infertilidad primaria; 53 (40.5%), infertilidad secundaria. El tiempo de infertilidad del grupo fue de 4.1 años. El promedio de uso del método fue de 12.6 meses (mediana, 9 meses). Las causas de infertilidad identificadas fueron anovulación (50.4%), tubo-peritoneal (18.3%), endometriosis (14.5%), uterino (9.2%), cervical (8.4%) y masculino (19.1%). Hubo 33 embarazos (25.2 global). La proporción cruda de embarazos a los 24 meses fue de 22.9% y la ajustada por tabla de vida a los 24 meses fue de 40 por 100 parejas. Conclusiones: el enfoque de medicina restaurativa es efectivo para lograr embarazos pero requiere de un manejo longitudinal a largo plazo. El abandono temprano del uso del registro de fertilidad afecta la eficacia del enfoque. Se requiere de mayor investigación para optimizar el manejo médico.

Objective: to study the results in patients undergoing infertility treatment with a focus on restorative medicine (NaProTechnology) at a department of obstetrics and gynecology. Methodology: retrospective cohort study conducted by the gynecology and obstetrics department at Universidad de los Andes (Santiago, Chile) in infertility patients from a suburban area of Santiago de Chile, who received treatment between 2006 and 2014. All couples received instructions on how to recognize their fertility period according to a local teaching model based on the Creighton Model FertilityCare System. They also received medical treatment to induce ovulation and/or widen their fertile period, or surgical treatment. The main outcome was the number of pregnancies. Results: 131 patients received instructions. The mean age was 33.6 years. Seventyeight patients (59.5%) consulted due to primary infertility; 53 (40.5%) due to secondary infertility. The duration of group infertility was 4.1 years. The mean use of the method was 12.6 months (median, 9 months). The infertility causes identified included anovulation (50.4%), tubo-peritoneal factors (18.3%), endometriosis (14.5%), uterine factors (9.2%), cervical factors (8.4%) and masculine factors (19.1%). There were 33 pregnancies (25.2 global). The crude proportion of pregnancies at 24 months was 22.9% and the proportion adjusted by the life table at 24 months was 40 per 100 couples. Conclusions: the focus on restorative medicine is effective to achieve pregnancy but it requires a long-term longitudinal treatment. Early discontinuation of fertility charting affects the efficacy of this focus. More research is warranted to optimize medical treatment.

Objetivo: estudar os resultados das pacientes com infertilidade tratadas com um enfoque de medicina restaurativa (naprotecnologia) em um serviço de ginecologia y obstetrícia. Metodologia: estudo de coorte retrospectivo realizado pelo departamento de obstetrícia e ginecologia da Universidad de los Andes (Santiago, Chile) em pacientes com infertilidade de uma área suburbana de Santiago de Chile, que receberam tratamento entre 2006 e 2014. Todas os casais receberam instrução para reconhecer seu período de fertilidade segundo um modelo local de ensinamento, baseado no modelo Creigthon (Creigthon Model FertilityCare System). Receberam, ademais, tratamento médico para indução de ovulação, melhoramento do período fértil ou cirurgia reparadora. A medição primária foi o número de gravidez. Resultados: 131 pacientes receberam a instrução. A média de idade foi de 33.6 anos. 78 pacientes (59.5%) consultaram por infertilidade primária; 53 (40.5%), infertilidade secundária. O tempo de infertilidade do grupo foi de 4.1 anos. A média de uso do método foi de 12.6 meses (mediana, 9 meses). As causas de infertilidade identificadas foram anovulação (50.4%), tubo-peritoneal (18.3%), endometriose (14.5%), uterino (9.2%), cervical (8.4%) e masculino (19.1%). Houve 33 gravidezes (25.2 global). A proporção crua de gravidezes aos 24 meses foi de 22.9% e a ajustada por tabela de vida aos 24 meses foi de 40 por 100 casais. Conclusões: o enfoque de medicina restaurativa é efetivo para conseguir gravidezes mas requere de um manejo longitudinal a longo prazo. O abandono precoce do uso do registro de fertilidade afeta a eficácia do enfoque. Se requere de maior investigação para otimizar o manejo médico.

Genetic analysis and cAMP measurement: comparison between lean and obese anovulating mice / Análise genética e dosagem de AMP cíclico: comparação entre camundongos fêmeas anovuladoras magras e obesas

PURPOSE: To evaluate genes differentially expressed in ovaries from lean (wild type) and obese (ob/ob) female mice and cyclic AMP production in both groups. METHODS: The expression on messenger RNA levels of 84 genes concerning obesity was analyzed through the PCR array, and cyclic AMP was quantified by the enzyme immunoassay method. RESULTS: The most downregulated genes in the Obesity Group included adenylate cyclase-activating polypeptide type 1, somatostatin, apolipoprotein A4, pancreatic colipase, and interleukin-1 beta. The mean decrease in expression levels of these genes was around 96, 40, 9, 4.2 and 3.6-fold, respectively. On the other hand, the most upregulated genes in the Obesity Group were receptor (calcitonin) activity-modifying protein 3, peroxisome proliferator activated receptor alpha, calcitonin receptor, and corticotropin-releasing hormone receptor 1. The increase means in the expression levels of such genes were 2.3, 2.7, 4.8 and 6.3-fold, respectively. The ovarian cyclic AMP production was significantly higher in ob/ob female mice (2,229±52 fMol) compared to the Control Group (1,814±45 fMol). CONCLUSIONS: Obese and anovulatory female mice have reduced reproductive hormone levels and altered ovogenesis. Several genes have their expression levels altered when leptin is absent, especially adenylate cyclase-activating polypeptide type 1. .

OBJETIVO: Avaliar os genes diferencialmente expressos em ovários de camundongos fêmeas magras (tipo selvagem) e obesas (ob/ob) e a produção de AMP cíclico em ambos os grupos. MÉTODOS: A expressão nos níveis de RNA mensageiro de 84 genes relacionados à obesidade foi analisada por PCR Array, e o AMP cíclico foi quantificado por método imunoenzimático. RESULTADOS: Os genes que mais sofreram diminuição da expressão no Grupo Obesidade incluíram o tipo 1 de polipeptídeo ativador da adenilato ciclase, o da somatostatina, da apolipoproteína A4, da colipase pancreática e da beta interleucina 1. A média de redução na expressão desses genes foi de aproximadamente 96, 40, 9, 4,2 e 3,6 vezes, respectivamente. Por outro lado, os genes que mais tiveram aumento na expressão no Grupo Obesidade foram o gene da proteína modificadora da atividade do receptor de calcitonina 3, do proliferador de peroxissomos ativados por proteína alfa, do receptor de calcitonina e do receptor para hormônio liberador de corticotropinas 1. As médias de acréscimo nos níveis de expressão de tais genes foram de 2,3, 2,7, 4,8 e 6,3 vezes, respectivamente. A produção de AMP cíclico ovariana foi significantemente aumentada em camundongos fêmeas ob/ob (2.229±52 fMol) quando comparada ao Grupo Controle (1.814±45 fMol). CONCLUSÕES: Camundongos fêmeas obesas e anovuladoras possuem níveis de hormônio reprodutivo reduzidos e ovulogênese alterada. Vários genes mostram níveis de expressão alterados quando a leptina está ausente, principalmente o tipo 1 de polipeptídeo ativador da adenilato ciclase. .

Hyper - prolactinemiea in subfertile women

To determine the frequency of Hyperprolactinemia in subfertile women presenting to Nishtar Hospital Multan. Case series study. This study was carried out in Gynae and Obst. Outpatient Department and Gynae and Obst. Units of Nishtar Hospital, Multan from Oct. 2009 to March 2010. A total of 111 Patients with subfertility were selected which were fulfilling inclusion criteria. The prevalence of HPR in subfertile women at Nishtar Hospital Multan is 31.53%, and it is more common in women with primary subfertility i.e. 23.42% than in secondary subfertility where it is 8.10%. It is concluded that hyperprolactinemia [HPR] leads to anovulation which is a main cause of subfertility, more common among women with primary subfertility than secondary subfertility

Metabolic effects of polycystic ovary syndrome in adolescents

PURPOSE: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenic anovulation in women of reproductive age. We investigated the metabolic effects of lean and overweight adolescents with PCOS. METHODS: Anthropometric measurements and biochemical parameters were evaluated in 49 adolescents with PCOS and 40 age- and body mass index (BMI)-matched controls. We further divided both PCOS and control groups into those having BMI within the normal range of less than 85th percentile and those being overweight and obese with a BMI greater than 85th percentile. RESULTS: Hemoglobin, gamma-glutamyl transferase (r-GT), total cholesterol, low-density lipoprotein-cholesterol and 2-hour postglucose load plasma insulin levels were significantly elevated in the lean PCOS group than in the lean control group. In the overweight/obese PCOS group, hemoglobin and r-GT levels were significantly elevated than in the overweight/obese control group. In the normal weight group, none of the subjects had metabolic syndrome according to the Adult Treatment Panel III criteria, but the incidence of metabolic syndrome in the overweight/obese PCOS group was 8.3% and that in the overweight/obese control group was 6.7%. CONCLUSION: PCOS in adolescents causes metabolic abnormalities, underscoring the importance of early diagnosis of PCOS in oligomenorrheic adolescents.

Use of In Vitro Fertilisation Prediction Model in an Asian Population-Experience in Singapore

<p><b>INTRODUCTION</b>This retrospective study was conducted to perform an external validation of the in vitro fertilisation (IVF) predict model developed by Scott Nelson et al in an Asian population.</p><p><b>MATERIALS AND METHODS</b>All IVF cycles registered in the study centre from January 2005 to December 2010 were included. Observed and predicted values of at least 1 live birth per cycle were compared by discrimination, calibration. Hosmer-Lemeshow test was used to assess the goodness-of-fit of the model calibration and Brier score was used to assess overall model performance.</p><p><b>RESULTS</b>Among 634 IVF cycles, rate of at least 1 live birth was 30.6%. Causes of infertility were unexplained in 35.5% cases. Fifty-seven percent of women came for their first IVF treatment. First IVF cycle showed significantly higher success in comparison to subsequent cycles. The odds ratio of successful live birth was worse in women with endometriosis. Observed outcome was found to be more than the prediction of the model. The area under the curve (AUC) in this study was found to be 0.65 that was close to that of Nelson model (0.6335) done in internal validation. Brier score (average prediction error) of model was 0.2. Chi square goodness-of-fit test indicated that there was difference between the predicted and observed value (x² =18.28, df = 8, P = 0.019). Overall statistical findings indicated that the accuracy of the prediction model fitted poorly with the study population.</p><p><b>CONCLUSION</b>Ovarian reserve, treatment centre and racial effect on predictability cannot be excluded. So it is important to make a good prediction model by considering the additional factors before using the model widely.</p>

Polycystic Ovary Syndrome / 고신대학교의과대학학술지

Polycystic ovary syndrome affects 6%-7% of reproductive-aged women, making it the most common endocrine disorder in this population. It is characterized by chronic anovulation and hyperandrogenism. Affected women may present with reproductive manifestations such as irregular menses or infertility, or cutaneous manifestations, including hirsutism, acne, or male-pattern hair loss. Over the past decade, several serious metabolic complications also have been associated with polycystic ovary syndrome including type 2 diabetes mellitus, metabolic syndrome, sleep apnea, and possibly cardiovascular disease and nonalcoholic fatty liver disease. In addition to treating symptoms by regulating menstrual cycles and improving hyperandrogenism, it is imperative that clinicians recognize and treat metabolic complications. Lifestyle therapies are first-line treatment in women with polycystic ovary syndrome, particularly if they are overweight. Pharmacological therapies are also available and should be tailored on an individual basis. This article reviews the diagnosis, clinical manifestations, metabolic complications, and treatment of the syndrome.