Treatment Progress in Diminished Ovarian Reserve: Western and Chinese Medicine / 中国结合医学杂志

Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.

Effect of acupuncture on pregnancy outcomes of frozen embryo transfer in patients with anovulatory infertility / 中国针灸

OBJECTIVE@#To observe the effect of conventional ovulation induction protocol and acupuncture combined with conventional ovulation induction protocol on pregnancy outcomes of frozen embryo transfer (FET) in patients with anovulatory infertility.@*METHODS@#A total of 60 patients with anovulatory infertility were randomized into an observation group and a control group, 30 cases in each group. In the control group, conventional ovulation induction protocol was applied to prepare endometrium. On the basis of the control group, acupuncture was started on the 2nd day of menstrual cycle in the observation group，Baihui (GV 20), Mingmen (GV 4), Geshu (BL 17), Guanyuan (CV 4), Qihai (CV 6), etc. were selected, once every other day, until 1 day before transplantation. The clinical pregnancy rate, embryo implantation rate, endometrial morphology on HCG trigger day, ovulation rate and cycle cancellation rate were compared in the two groups. The endometrial thickness before treatment and on HCG trigger day, TCM symptom score before and after treatment were observed in the two groups.@*RESULTS@#In the observation group, the embryo implantation rate and clinical pregnancy rate were higher than the control group (P<0.05), endometrial thickness and endometrial morphology on HCG trigger day were superior to the control group (P<0.05). After treatment, the TCM symptom score in the observation group was decreased compared with before treatment (P<0.05), and the variation was greater than the control group (P<0.01).@*CONCLUSION@#On the basis of the conventional ovulation induction protocol, acupuncture could enhance the embryo implantation rate and clinical pregnancy rate of FET, improve the endometrial receptivity of patients with anovulatory infertility.

Infertilidade feminina e conjugalidade: revisão integrativa da literatura / Female infertility and conjugality: integrative literature review / Infertilidad femenina y conjugalidad: revisión integrativa de la literatura

A infertilidade repercute como uma problemática em diferentes âmbitos. No tocante à esfera do casal, trata-se de uma situação que pode afetar ambos os cônjuges e opera na satisfação conjugal. Portanto, o objetivo do presente estudo foi conhecer de que modo a conjugalidade é afetada pela infertilidade feminina a partir da produção científica nacional e internacional. Trata-se de uma revisão integrativa da literatura científica indexada nas bases/bibliotecas PUBMED, PsycINFO e LILACS entre 2008 e 2018, nos idiomas português, espanhol e inglês, que recuperou 34 publicações, as quais foram submetidas à análise crítica. Trata-se de uma produção predominantemente internacional, de abordagem quantitativa. A pergunta norteadora que conduziu a presente revisão foi respondida, de modo que se constatou que a infertilidade transforma a relação conjugal, na maioria das vezes negativamente, o que não tem influência direta do fator feminino enquanto causa. Em contrapartida, a busca por tratamento se mostra como um aspecto de coesão entre o casal, que se fortalece ao buscar um objetivo comum. Por isto, faz-se necessário o desenvolvimento de ações que almejem a melhoria na qualidade de vida conjugal e sexual dos casais que estão passando pelo diagnóstico e tratamento para infertilidade.

Infertility has repercussions as a problem in different areas. Regarding the sphere of the couple, this is a situation that can affect both spouses and operates in marital satisfaction. Therefore, the objective of the present study was to know how the conjugality is affected by the female infertility from the national and international scientific production. It is an integrative review of the scientific literature indexed in the databases/libraries PUBMED, PsycINFO and LILACS published between 2008 and 2018, in the Portuguese, Spanish and English languages, which recovered 34 publications, which were submitted to critical analysis. It is a predominantly international production, with a quantitative approach. The guiding question that led to the present revision was answered, so that it was found that infertility transforms the conjugal relationship, most often negatively, which has no direct influence of the female factor as cause. In contrast, the search for treatment is shown as an aspect of cohesion between the couple, which strengthens itself in pursuit of a common goal. Therefore, it is necessary to develop actions that aim at improving the marital and sexual quality of life of couples who are undergoing diagnosis and treatment for infertility.

La infertilidad repercute como una problemática en diferentes ámbitos. En cuanto a la esfera de la pareja, se trata de una situación que puede afectar a ambos cónyuges y opera en la satisfacción conyugal. Por lo tanto, el objetivo del presente estudio fue conocer de qué modo la conyugalidad es afectada por la infertilidad femenina a partir de la producción científica nacional e internacional. Se trata de una revisión integradora de la literatura científica indexada en PubMed, PsycINFO y LILACS entre 2008 y 2018, en portugués, español e Inglés, que se recuperó 34 publicaciones, que se sometieron a un análisis crítico. Se trata de una producción predominantemente internacional, de abordaje cuantitativo. La pregunta orientadora que condujo la presente revisión fue respondida, de modo que se constató que la infertilidad transforma la relación conyugal, en la mayoría de las veces negativamente, lo que no tiene influencia directa del factor femenino en cuanto causa. En contrapartida, la búsqueda por tratamiento se muestra como un aspecto de cohesión entre la pareja, que se fortalece al buscar un objetivo común. Por eso, se hace necesario el desarrollo de acciones que anhelan la mejora en la calidad de vida conyugal y sexual de las parejas que están pasando por el diagnóstico y tratamiento para la infertilidad.

Effectiveness of Counseling for Infertile Couples on Women's Emotional Disturbance: A Randomized Clinical Trial / Eficácia do aconselhamento a casais inférteis nos distúrbios emocionais das mulheres: um ensaio clínico randomizado

Abstract Objective The psychosocial burden of infertility among couples can be one of the most important reasons for women's emotional disturbance. The goal of the present study was to investigate the effect of counseling on different emotional aspects of infertile women. Methods The present randomized clinical trial was performed on 60 couples with primary infertility who were referred for treatment for the first time and did not receive psychiatric or psychological treatment. Samples were allocated to an intervention group (30 couples) and a control group (30 couples) by simple randomization. The intervention group received infertility counseling for 6 45-minute sessions twice a week, and the control group received routine care. The Screening on Distress in Fertility Treatment (SCREENIVF) questionnaire was completed before and after the intervention. Samples were collected from November to December 2016 for 3 months. For the data analysis, we used the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 19.0, and the paired t-test, the independent t-test, the Mann-Whitney test, the Wilcoxon test, and the Chi-squared test. Results The mean age of the participants was 33.39±5.67 years. All studied couples had primary infertility and no children. The mean duration of the couples' infertilitywas 3 years. There was a significant difference regarding depression (1.55±1.92; p<0.0001), social support (15.73±3.41; p<0.0001), and cognitions regarding domains of fertility problems (26.48±3.05; p=0.001) between the 2 groups after the intervention, but there was no significant difference regarding anxiety (25.03±3.09; p=0.35). Conclusion The findings showed that infertility counseling did not affect the total score of infertile women' emotional status, but improved the domains of it except, anxiety.

Resumo Objetivo A carga psicossocial da infertilidade entre casais pode ser uma das razões mais importantes para os distúrbios emocionais emmulheres. O objetivo deste estudo foi investigar o efeito do aconselhamento em diferentes aspectos emocionais de mulheres inférteis. Métodos Este ensaio clínico randomizado foi realizado com 60 casais com infertilidade primária indicados para tratamento pela primeira vez mas que não receberam tratamento psiquiátrico ou psicológico. As amostras foram alocadas em um grupo de intervenção (30 casais) e um grupo de controle (30 casais) por randomização simples. O grupo de intervenção recebeu aconselhamento sobre infertilidade por 6 sessões de 45 minutos 2 vezes por semana e o grupo controle recebeu cuidados de rotina. O questionário de Triagem por Aflição no Tratamento da Infertilidade (Screening on Distress in Fertility Treatment SCREENIVF em inglês) foi preenchido antes e após a intervenção. As amostras foramcoletadas de novembro a dezembro de 2016 durante 3 meses. Para a análise dos dados usamos o programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows IBMCorp. Armonk NY Estados Unidos) versão 19.0 e os testes-t pareado e independente e os testes de Mann-Whitney de Wilcoxon e do qui quadrado. Resultados A média de idade dos participantes foi de 33 39 ± 5 67 anos. Todos os casais estudados tinham infertilidade primária e não tinham filhos. A duraçãomédia da infertilidade dos casais era de 3 anos. Houve diferença significativa quanto à depressão (1 55±1 92; p<0 0001) ao apoio social (15 73±3 41; p <0 0001) e às cognições em relação aos campos dos problemas de fertilidade (26 48±3 05; p=0 001) entre dois grupos após a intervenção mas não houve diferença significativa com relação à ansiedade (25 03±3 09; p=0 35). Conclusão Os achados mostraram que o aconselhamento sobre infertilidade não afetou a pontuação total do estado emocional de mulheres inférteis mas melhorou seus campos exceto a ansiedade.

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.

Effects of hydrosalpinx on endometrial implantation failures: evaluating salpingectomy in women undergoing in vitro fertilization / Efeitos do hydrosalpinx no falho de implantação endometrial: Avaliar a salpingectomia nas mulheres em curso de fertilização in vitro

Abstract Hydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF).We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal

El defecto inherente del endometrio causa fallo de implantación en Técnica de Reproducción Asistida / Inherent defect of the endometrium causes implantation failure in Assisted Reproductive Technique

Introduction. Implantation failure appears to be a significant factor in Assisted reproductive technique (ART) procedures. Even a mature endometrium may be non-receptive, preventing implantation or rejection of implanted embryo in early months of pregnancy, resulting in miscarriage or unexplained infertility with or without other associated factors. Objective. To investigate causes of failed implantation inspite of uneventful Grade I embryo transfer in ART procedure Material and Method. 90 women aged range between 25-40 yr old who visited Department of Reproductive Medicine at Calcutta Fertility Mission, over a period of 24 months(January 2017 to December 2019) , satisfying the inclusion criteria, were enrolled in this observational study. Endometrial aspirate histopathology was done along with ∞5ß3 integrin expression. They were treated with natural micronized progesterone (NMP) or oral dydrogesterone and results of endometrial changes were statistically analyzed. Results. 28.89% and 31.11% of women were seen to have mid-secretory changes of the endometrium after being treated with NMP and dydrogesterone respectively. Integrins were expressed in only 59.26% of women with mid-secretory endometrium and 5.41% of early secretory endometrium, which was statistically significant (p value <0.001). Conclusion. About 70% patients even after treatment with estrogen and progestin did not have adequate response in endometrial maturation. Not all patients with mid-secretory endometrium had integrin positive, when tested. NMP and oral Dydrogesterone have similar effect in endometrial maturation as well as in yielding successful pregnancy in some patients with previously failed In-vitro fertilization embryo transfer (IVF-ET).

The effect of antidepressant treatment on the HPA axis, changes in depression score and serum levels of TNF-α in depressed infertile women

Abstract Objectives This study aimed to explore the effect of antidepressant treatment on the HPA axis, changes in depression score, and serum levels of TNF-α in depressed infertile women. Methods In this randomized controlled trial research, 60 infertile women who had undergone in vitro fertilization (IVF) treatment with depression scores between 16-47 were divided into two groups. The intervention group with fluoxetine capsule was under treatment for two months before the embryo transfer, while the control group was given placebo. Depression score, serum levels of tumor necrosis factor alpha (TNF-α) as well as cortisol hormone levels were measured and recorded both before and after the intervention. The data were analyzed using SPSS version 21 software. Results We analyzed the data related to 55 subjects who had undergone embryo transfer. 7 subjects in the intervention group and 3 in the control group got pregnant. We observed a significant decrease in the depression score (p < 0/001) and serum levels of cortisol (p = 0/001) in the intervention group. There was a significant increase in the serum levels of TNF-α in the intervention group (p < 0/001). There was a significant difference between the two groups in the number of pregnancies (p = 0.04). However, there was no statistical difference between them with regard to the number of harvested oocytes (p = 0.174). Discussion Decrease in depression score and cortisol level, and an increase in the levels of TNF-α in the intervention group caused any changes in the number of oocytes in comparison with the control group. However, the number of pregnancies was larger in the intervention group.

Esterilidade por salpingite e tratamento homeopático com nosódio: relato de caso / Sterility caused by salpingitis and nosode homeopathic treatment: case report

A infertilidade em casais frequentemente é multifatorial. Dentre elas alterações tubárias respondem por até 20% dessa causalidade, sendo a histerossalpingografia o exame de escolha para verificarem alterações em sua anatomia, orientando desde a opção por tratamentos mais conservadores até mesmo a salpingectomia com posterior fertilização in vitro. O relato de caso em questão trata de uma mulher que já se encontrava em tratamento para fertilidade há 3 anos e, antes da cirurgia definitiva, optou por buscar o tratamento homeopático como alternativa. Após repertorização chegou-se ao medicamento Sycotic co, um nosódio preparado com Entercococcus faecalis, agente que é um dos principais responsáveis por doenças inflamatórias pélvicas que, por sua vez, encontram-se na etiologia das salpingites. Após trinta dias de utilização a paciente consegue engravidar, demonstrando possivelmente que o organismo recuperou sua capacidade autopoiética (regenerativa) frente ao estímulo ocasionado pela medicação homeopática, embasando novos ensaios capazes de trazer maiores evidências da utilização da homeopatia como possibilidade no tratamento adjuvante da infertilidade. (AU)

Infertility in couples is often multifactorial. Tubal disorders account for up to 20% of causes, and hysterosalpingography is the test of choice to investigate anatomical changes, which orient the option for more conservative treatments or salpingectomy with subsequent in vitro fertilization. The present case report concerns a woman under fertility treatment for 3 years, but choose to seek homeopathic treatment before final surgery. Repertory analysis led to the selection of Sycotic co, a nosode prepared from Enterococcus faecalis, which is one of the main responsible pathogens associated with pelvic inflammatory disease, which is one of the causes of salpingitis. After 30 days of treatment, the patient became pregnant, which possibly shows that her body had regained its autopoietic (regenerative) ability against the stimulus represented by homeopathic medication. These findings support the need to perform new studies to gather further evidence of the use of homeopathy as possible adjuvant treatment for infertility. (AU)

Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice

Polycystic ovary syndrome represents 80% of anovulatory infertility cases. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective with cumulative live birth rates of approximately 70%. Ovarian drilling should be performed when laparoscopy is indicated; this procedure is typically effective in approximately 50% of cases. Finally, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is recommended when the previous interventions fail. This option is also the first choice in cases of bilateral tubal occlusion or semen alterations that impair the occurrence of natural pregnancy. Evidence for the routine use of metformin in infertility treatment of anovulatory women with polycystic ovary syndrome is not available. Aromatase inhibitors are promising and longer term studies are necessary to prove their safety.

Indicaciones de tratamientos de reproducción asistida de alta complejidad en la Unidad de Reproducción Humana del INMP 2013 / Indications for assisted reproductive treatments in highly complex in the Humana Reproduction Unit at the INMP 2013

Introducción: El problema de infertilidad afecta el 15 por ciento de la población. Cerca del 20 por ciento de estas pacientes necesitan técnicas de reproducción asistida de alta complejidad, siendo lo más representativo la fertilización in vitro (FIV). En el Servicio de Reproducción Humana del INMP se están implementando los tratamientos de reproducción asistida de alta complejidad, sin embargo se desconocen la frecuencia y las indicaciones a este tipo de tratamiento que presentan nuestros pacientes. Asimismo existe carencia de estudios de este tema en nuestra realidad. Objetivo: Determinar las indicaciones de tratamientos de reproducción asistida de alta complejidad en la Unidad de Reproducción Humana del INMP Enero-Diciembre 2013. Materiales y Métodos: Estudio observacional, descriptivo, retrospectivo y transversal. Se seleccionó a través de un muestreo aleatorio sistemático a intervalos constantes una muestra, el cuál fue elegido de manera randomizada. Se confeccionó un formulario de recolección de datos evaluada por juicio de expertos, Test de v-aiken y alfa de Cronbach, el cual realizó una evaluación en un periodo de 12 meses (enero-diciembre 2013); se procesó toda la información en una base de datos y se analizó a través de estadísticas descriptivas e inferenciales con prueba de hipótesis significativos a un nivel de significación estadístico p<0,05. Se utilizó el paquete estadístico SPSS v.22. Resultados: Se analizaron 169 casos. Las pacientes evaluados tuvieron una edad promedio de 35 años, el mayor grupo etario estuvo entre 36-40 años y el 53.3 por ciento era mayor de 35 años. La mayor cantidad de pacientes fue conviviente (46.7 por ciento), con instrucción secundaria (52.1 por ciento), amas de casa 46.7 por ciento y sin hábitos nocivos (94.1 por ciento). El 65.7 por ciento de pacientes no tenían hijos vivos, presentaban un ritmo catamenial regular en 91.7 por ciento y un 52 por ciento de pacientes tenía algún grado de obesidad. La mayor...

Introduction: The problem of infertility affects 15 per cent of the population. About 20 per cent of these patients require assisted reproductive treatments, being the most representative in vitro fertilization (IVF). In the Service of Human Reproduction INMP are being implemented assisted reproduction treatment techniques, however the frequency and indications for this type of treatment that our patients have are unknown. There is also lack of studies on this issue in our reality. Objective: To determine the indications for assisted reproduction treatments in the Human Reproduction Unit INMP January - December 2013. Materials and methods: It was an observational, descriptive, retrospective and cross-sectional study. Was selected through a systematic random sampling at regular intervals a sample, which was the randomly chosen way. An data collection form was evaluated by expert judgment, v-aieken test and Cronbach Alfa test, which conducted an evaluation over a period of 12 months (January-December 2013) was drawn; all information is processed in a database and analyzed using descriptive and inferential statistics for hypothesis test significant at a level of statistical significance p<0.05. SPSS v.22 was used. Results: 169 cases were analyzed. The patients evaluated had a mean age of 35 years, the largest age group was between 36-40 years and 53.3 per cent were older than 35 years. Most patients were cohabiting (46.7 per cent), with secondary education (52.1 per cent), 46.7 per cent housewives without harmful habits (94.1 per cent). 65.7 per cent of patients had no living children, had a regular menstrual periods 9l.7 per cent and 52 per cent of patients had some degree of obesity. Most medical comorbidity presented pulmonary and pleural tuberculosis was 5.3 per cent. 84.3 per cent of patients had at least one surgical history, being the tubal surgeries (27.9 per cent) and the most frequent surgeries curettage (13.6 per cent), Overall, 65.7 per cent had...

Maduración in vitro de ovocitos humanos: una opción para preservar la fertilidad de las mujeres: reporte del primer caso realizado en Chile / Oocyte in vitro maturation: alternative approach for fertility preservation: report the first case in Chile

La maduración in vitro (MIV) de ovocitos humanos es parte de las técnicas de fecundación in vitro, que consiste en la aspiración de ovocitos inmaduros. Es ofrecida principalmente a pacientes con alto riesgo de desarrollar un síndrome de hiperestimulación ovárica, especialmente pacientes con síndrome de ovario poliquístico. Adicionalmente, es un método ofrecido a las pacientes oncológicas para preservar su fertilidad. Presentamos el primer caso de MIV realizado en Chile, en la Unidad de Medicina Reproductiva de Clínica Monteblanco, en una paciente con sospecha de resistencia ovárica a la FSH y quien, con el consentimiento de sus padres, realizó este procedimiento para preservar su fertilidad a futuro.

Oocyte in vitro maturation (IVM) is an assisted reproductive technology in which immature oocytes are retrieved from antral follicles. It has been applied mainly in patients with an increased risk of ovarian hyperstimulation syndrome, particularly in patients with polycystic ovarian syndrome. Moreover, it has been proposed as an alternative approach for fertility preservation for oncological patients. We report the first IVM case in Chile, preformed at the Centre for Reproductive Medicine at Clínica Monteblanco, in a patient with suspected ovarian resistance to FSH, who with the consent of her parents, performed IVM to preserve her fertility.

Prevalencia de tirotropina superior a 2, 5 5 µUI/mL en mujeres infértiles / Prevalence of thyrotropin higher tan 2, 5 5 µUI/mL in infertile women

OBJETIVO. Determinar la prevalencia de TSH > 2,5 µUI/mL en mujeres con infertilidad. MATERIAL Y MÉTODOS. Estudio descriptivo, retrospectivo. Se revisaron 272 historias clínicas de las pacientes del Servicio de Reproducción Humana del Hospital Nacional Arzobispo Loayza de Lima, que fueran ingresadas al programa entre setiembre 2009 y setiembre 2010. Se evaluó a 135 mujeres que tenían un resultado de TSH. RESULTADOS. El valor promedio de TSH fue de 3,25 µUI/mL. Sesenta y cuatro mujeres (47,4%) presentaron una TSH > 2,5 µUI/mL: 67,19% tuvo una TSH entre 2,5 y 4,2 µUI/mL y 32,81% una TSH mayor a 4,2 µUI/mL. El valor máximo encontrado fue 40 µUI/mL. La edad promedio fue 34 años y el tipo de infertilidad más frecuente, la secundaria. Además, se encontró hiperprolactinemia en 16 mujeres (12,59%) de 127, a las que se les determinó prolactina y tenían TSH dentro del rango de normalidad. CONCLUSIONES. Casi la mitad de mujeres con infertilidad tuvo un valor de TSH > 2,5 µUI/mL, lo que debe tenerse en cuenta en la evaluación de dichas pacientes.

OBJECTIVE: to determine the prevalence of TSH > 2,5 µUI/mL in women in infertility. DESIGN. A descriptive, retrospectives study was done on the medical records of patients who were admitted to the infertility program in the Human Reproduction Service from September 2009 to September 2010. The study comprised 135 women who had a TSH evaluation. RESULTS. The average value of TSH was 3,5 µUI/mL. Sixty-four women (47,4%) had a TSH > 2,5 µUI/mL: 67,19% had a TSH between 2,5-4,2 µUI/mL and 32,81% had TSH higher to 4,2 µUI/mL. The top TSH value was 40 µUI/mL. The mean age was 34 year-old. Secondary infertility was the more common type. Besides, hyperprolactinemia was found in 12,59% among 127 women who had a prolactin result, with TSH values in the normal range. CONCLUSIONS. Almost an half of infertile women had a TSH > 2,5 µUI/mL that it must be taken into account in the assessment of these patients.

Management of adenomyosis in subfertile women and pregnancy outcome

To assess the outcome of treatment with only gonadotropin releasing hormone agonists [Gn-RHa] versus combined conservative surgery and Gn-RHa therapy in the management of sub-fertile patients with symptomatic uterine adenomyosis. A retrospective study of the two treatment modalities allocated to 40 sub-fertile patients with pathology-proven adenomyosis over a period of eight years was undertaken at the Obstetrics and Gynecology department, King Fahad Hospital, Dammam University, Saudi Arabia. Twenty-two patients [Group A] were treated with Gn-RHa alone, and 18 patients [Group B] received combined conservative surgery with Gn-RHa therapy. After completion of six courses of Gn-RHa injections, there was a 3-year follow up period for all patients. Treatment outcome included relief of symptoms, pregnancy rate and successful deliveries, which were compared between the two groups. The patients in group A were younger in age, had lower CA-125 levels and shorter infertile years than Group B. Three [13.6%] spontaneous pregnancies resulted upto 18 months of stopping Gn-RHa in group A, while 8 [44.4%] pregnancies resulted upto 36 months in group B patients, which was statistically significant [p=0.0393]. Term delivery occurred normally in one [4.5%] Group A patient, while 6 [33.3%] patients in Group B had cesarean section at term [p=0.0328]. Combined conservative surgery and Gn-RHa may provide effective symptom relief, better reproductive performance in subfertile patients with uterine adenomyosis and longer period of pregnancy prospects after treatment than patients who recieved Gn-RHa alone. Due to the nature of this study, a well conducted randomized trial is needed in the future to assess the benefits of the two treatment modalities

Uso de la metformina en el tratamiento de pacientes infértiles con síndrome de ovarios poliquísticos / Use of metformin in the treatment of infertile patients with polycystic ovary syndrome

Determinar el efecto de la terapia con metformina en pacientes infértiles con síndrome de ovarios poliquísticos. Estudio clínico, prospectivo y descriptivo. Incluyó pacientes con diagnóstico de síndrome de ovarios poliquísticos, infertilidad y resistencia a la insulina, a las que se les administró tratamiento con metformina por 3 meses. Las pacientes que no se embarazaron en ese período recibieron tratamiento con citrato de clomifeno, hasta un máximo de 6 meses. En el Servicio de Fertilidad Maternidad "Concepción Palacios". Caracas. Resultados: Se completó un total de 62 pacientes. La tasa de embarazo de 25,8 por ciento (19 pacientes). Un 57,9 por ciento de las pacientes lograron embarazo con 3 meses de tratamiento, con una P= 0,492 lo cual no fue estadísticamente significante. La tasa de embarazos con citrato de clomifeno fue de 23,5 por ciento (8 pacientes), P=0,684. El 63,2 por ciento (12) tuvo un embarazo a término. La tasa de aborto fue de 26,3 por ciento (5). La metformina induce ovulación espontánea en pacientes con síndrome de ovarios poliquísticos. No existe diferencia estadística entre la tasa de embarazos con la terapia con metformina sola y metformina con citrato de clomifeno. La metformina mejora la evolución de embarazo

To determine the effect of treatment with metformin in infertile patients with polycystic ovary syndrome. Clinical, prospective and descriptive study. Infertile anovulatory patients with polycystic ovary syndrome and insulin resistant were included, and all of them, were treated with metformin for 3 months. Patients who did not ovulate in this time, received clomiphene citrate for 6 months. Fertility Service of Maternidad "Concepcion Palacios". 62 infertile patients were included in this study. The pregnancy rate was 25.8 percent (19 patients). The 57.9 percent of women became pregnant with metformin administration for 3 months, with P= 0.492, it was not statistical significance. The pregnancy rate with clomiphene citrate was 23.5 percent (8 patients), P= 0.684. The abortion rate was 26.3 percent (5). The metformin induce ovulation in anovulatory polycystic ovary syndrome women, whereas the pregnancy rate resulted similar in both treatment groups: metformin alone and metformin and clomiphene citrate

Laparoscopia na decisão da estratégia terapêutica para o casal infértil / Laparoscopy in the decision of treatment strategy for the infertile couple

OBJETIVO: avaliar a contribuição da laparoscopia diagnóstica na abordagem do casal infértil. MÉTODOS: estudo retrospectivo com análise dos 86 casos consecutivos de pacientes acompanhadas em consulta de esterilidade que foram submetidas à laparoscopia entre Janeiro de 2004 e Dezembro de 2006. Oitenta e duas pacientes tinham realizado histerossalpingografia (HSG) previamente à laparoscopia. Avaliaram-se os achados laparoscópicos bem como os procedimentos acessórios efetuados, e correlacionaram-se os achados histerossalpingográficos com os da laparoscopia. A análise estatística foi efetuada com o Statistical Package for the Social Sciences 15. A sensibilidade e a especificidade da HSG foram determinadas e os intervalos de confiança calculados assumindo-se um erro alfa de 0,05 (IC95 por cento). RESULTADOS: na laparoscopia foram identificadas alterações compatíveis com endometriose em 21 casos (24,4 por cento), salpinge uni/bilateral em 14 casos (16,3 por cento) e doença inflamatória pélvica em 16 casos (18,6 por cento). Procedeu-se à adesiólise e à fulguração dos focos de endometriose em oito pacientes. Foram feitas duas salpingostomias, duas quistectomias do paraovário, duas quistectomias do ovário e três drillings do ovário. A prova de permeabilidade tubar foi normal em 44 casos (53 por cento), revelou obstrução unilateral em 21 (25,3 por cento) e obstrução bilateral em 17 (20,5 por cento). Os resultados da histerossalpingografia foram concordantes com os da laparoscopia em 44 dos 82 casos (53,7 por cento). Quando definimos doença como qualquer forma de obstrução tubar presente na laparoscopia, a sensibilidade da HSG foi 0,79 (IC95 por cento=0,62-0,9) e a especificidade 0,58 (IC95 por cento=0,42-0,73). Quando limitamos a definição de doença à presença de obstrução tubar bilateral na laparoscopia, a sensibilidade e a especificidade da HSG foram 0,47 (IC95 por cento=0,24-0,71) e 0,77 (IC95 por cento=0,64-0,86), respectivamente. Em nove casos (15,3 por cento) em que a HSG havia sido normal ou revelado apenas obstrução unilateral, a laparoscopia revelou obstrução bilateral. Em 15 casos (65,2 por cento) em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95 percentCI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4 percent), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3 percent), and 16 cases of pelvic inflammatory disease (18.6 percent). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53 percent), revealed unilateral obstruction in 21 cases (25.3 percent) and bilateral obstruction in 17 cases (20.5 percent). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7 percent). HSG sensitivity was 0.79 (95 percentCI=0.62-0.9) and its specificity was 0.58 (95 percentCI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95 percentCI=0.24-0.71) and 0.77 (95 percentCI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3 percent) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2 percent) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.

El factor tubario en la era de la fertilización in vitro / Tubal factor infertility in the era of assisted reproduction

El desarrollo de las técnicas de fecundación asistida ha desplazado a la cirugía como procedimiento de elección en el tratamiento de la infertilidad tubaria secundaria a procesos inflamatorios pelvianos, ligadura tubaria y endometriosis. Sin embargo, la cirugía aún conserva un sitio reconocido, especialmente en casos de daño tubario leve o moderado o cuando existen limitaciones económicas y conflictos éticos o religiosos con las técnicas de fecundación asistida.

The development of Assisted Reproductive Technologies has displaced surgery as first-line treatment of tubal infertility secondary to pelvic inflammatory disease, tubal sterilization or endometriosis. However surgery might still have some place in minimal or moderate tubal damage and when financial, ethical or religious conflicts exist.

Inseminación intrauterina / Intrauterine insemination

La Inseminación Intrauterina (IIU) es un procedimiento utilizado para el tratamiento de la infertilidad. En la actualidad las dos principales indicaciones para la IIU son el factor masculino leve y la infertilidad de causa desconocida. Los resultados obtenidos de la medicina basa en evidencias recomiendan que la IIU se realice en ciclos estimulados, en los cuales se gatille la ovulación con Gonadotropina Coriónica humana (hCG) y se suplemente la fase lútea con progesterona. Igualmente, se recomienda una monitorización ecográfica del crecimiento folicular y la realización de dos inseminaciones por cada ciclo de tratamiento. Para realizar la IIU se requiere de la indemnidad anatómica de los genitales internos de la mujer y de una separación espermática > 1,0 - 1,5 millones de espermatozoides conmotilidad progresiva. Las evidencias muestran que las mejores probabilidades de embarazo se producen cuando la mujer es menor de 35 años y la infertilidad es menor a cinco años. Nuestra tasa global de embarazo por ciclo con IIU en parejas infértiles es de 14,1 por ciento. Por otro lado, la tasa cumulativa de embarazo con IIU no recomienda realizar más de 4 a 6 ciclos de tratamiento, ya que las posibilidades de éxito después de ese tiempo son mínimas.

Intrauterine insemination (IUI) is procedure used for the treatment of infertility. At present, there are two principal indications for IUI: mild male factor and unexplained infertility. Results obtained through evidence based medicine, recommend IUI to be performed in stimulated cycles, triggering ovulation with human Chorionic Gonadotrophin (hCG) and giving a luteal phase supplementation with Progesterone. Ultrasound monitoring of the follicular growth and two inseminations per treatment cycle, are also recommended. In order to perform an IUI, a normal woman internal genital tract and a sperm count > 1,0 - 1,5 million with progressive motility after sperm preparation, are required. Evidence suggests that pregnancy is more likely in women less than 35 years and with infertility of 5 years, at the most. Our overall pregnancy rate per cycle with IUI in infertile couples is 14.1 percent. On the other hand, the cumulative pregnancy rate with IUI does not recommend performing more than 4 to 6 treatment cycles, since the probability of success after that is minimal.