Obesidad: epidemia del siglo XXI y su relación con la fertilidad / Obesity: an epidemic of the 21st century and its relation to fertility

En Chile, la obesidad y el sobrepeso han presentado un constante incremento, en las últimas décadas. Cifras del Ministerio de Salud (MINSAL) dan cuenta de un aumento de prevalencia, desde un 61% en 2003, hasta una preocupante estimación de 74% de la población adulta, en 2019 según la Organización para la Cooperación y el Desarrollo Económicos (OCDE). La Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO por sus siglas en inglés) estimó que 4 millones de adultos chilenos padecían de obesidad en 2019, situando a Chile como el país latinoamericano con el más alto índice de la condición. El porcentaje de la población adulta, en edad reproductiva, que presenta obesidad, se estima en 9 -18% para hombres y 12 -28% para mujeres. El exceso de grasa corporal tiene serias consecuencias adversas, para el potencial fértil y la capacidad reproductiva de las parejas, comprometiendo fecundidad y determinando infertilidad, trastornos de la ovulación, función sexual y peores resultados en técnicas de reproducción asistida y pronóstico obstétrico

In Chile, excess weight and obesity have shown a steady increase over the last decades. Data from the ministry of health (MINSAL) show a rise in prevalence from 61% in 2003 to an alarming 74% of the adult population by 2019 according to the Organization for Economic Cooperation and Development (OCDE). The United Nations Food and Agriculture Organization (FAO) estimates that 4 million adult Chileans suffered obesity in 2019, placing Chile as the country in Latin America with the highest incidence of the condition. The percentage of reproductive age adults that suffer obesity is estimated in 9-18% for men and 12-28% for women. The excess body fat has serious detrimental effects on fertility potential and the reproductive capacity of couples compromising fecundity and causing anovulatory infertility and sexual dysfunction as well as poorer results in assisted reproductive technologies and obstetric outcome

Consideraciones en el manejo del adulto con Hiperplasia Suprarrenal congénita clásica por déficit de 21-Hidroxilasa / Management considerations for the adult with congenital adrenal hyperplasia due 21-hydroxylase deficiency

La Hiperplasia Suprarrenal Congénita (HSRC) corresponde a un grupo de defectos genéticos en la síntesis de cortisol. El 95% de ellas son debidas al déficit de 21-hidroxilasa por lo que nos referiremos solo a esta deficiencia. La hiperplasia suprarrenal congénita clásica (HSRC-C) debuta en recién nacidos o lactantes con insuficiencia suprarrenal primaria, diferentes grados de hiperandrogenismo clínico en mujeres y puede coexistir con hipotensión, hiperkalemia e hiponatremia si hay un déficit clínico de aldosterona. El objetivo de este artículo es actualizar el conocimiento y enfoques sugeridos para el manejo de la HSRC-C desde el inicio de sus controles en la etapa adulta. El diagnóstico diferencial en retrospectiva de la HSRC-C y la no clásica (HSRC-NC) a veces resulta difícil ya que esta enfermedad es un espectro fenotípico continuo. La insuficiencia suprarrenal y la dependencia a terapia corticoidal son los eventos principales para diferenciar estas dos patologías que tienen enfoques terapéuticos diferentes. El tratamiento de la HSRC-C en adultos abarca 2 objetivos primarios: la adecuada sustitución de la falla suprarrenal y el control de hiperandrogenismo mediante el uso de corticoides en sus dosis mínimas efectivas. En la mujer existen terapias complementarias para el control del hiperandrogenismo como anticonceptivos y otras que se encuentran en diferentes fases de investigación. Esto permite disminuir las dosis de corticoides en algunos casos. Es importante a la vez abordar tres objetivos secundarios: controlar el riesgo cardiometabólico propio de la enfermedad, evitar el sobre tratamiento corticoidal y manejar la infertilidad. La correcta monitorización del tratamiento en adultos tomando en cuenta los objetivos descritos permite una mejor calidad de vida en estos pacientes. Finalmente el consejo genético debe realizarse en todos los pacientes con HSRC que deseen fertilidad y en sus parejas. El estudio requiere de secuenciación del gen CYP21A2 y debe realizarse en un laboratorio de experiencia.

Congenital Adrenal Hyperplasia (CAH) are a group of genetic defects characterized by impaired cortisol synthesis. 95% of them are due to 21-hydroxylase deficiency. We will discuss only this enzyme's deficiency. Classic congenital adrenal hyperplasia (CAH-C) debuts in newborns or infants with primary adrenal insufficiency, some degree of clinical hyperandrogenism in newborn females, and can coexist with hypotension, hyperkalemia, and hyponatremia if there is a clinical aldosterone deficiency. The objective of this article is to update the knowledge and suggested approaches for the management of CAH-C from the beginning of its controls in the adult stage. The retrospective differential diagnosis of CAH-C and non-classical (CAH-NC) is sometimes difficult because this disease is a continuous phenotypic spectrum. Adrenal insufficiency and dependence on corticosteroid therapy are the main events to differentiate these two pathologies that have different therapeutic approaches. In adults, the treatment of CAH-C must include 2 primary objectives: adequate the replacement of adrenal failure and control of hyperandrogenism, through the use of corticosteroids in their minimum effective doses. In women there are complementary therapies for the control of hyperandrogenism, such as contraceptives and others that are in different phases of research. This makes it possible to reduce the doses of corticosteroids in some cases. It is important at the same time to address three secondary objectives: control the cardiometabolic risk of the disease secondary to corticosteroid treatment, avoid corticosteroid overtreatment and manage infertility. The correct monitoring of treatment in adults and taking in to account the objectives described, allows a better quality of life in these patients. Finally, genetic counseling must be carried out in all patients planning for children, with any type of CAH and in their partners. The study requires sequencing of the CYP21A2 gene and must be performed in a certified laboratory.

Factores causales de infertilidad / Fatores causadores de infertilidade / Causative factors of infertility

Introducción: la infertilidad adquiere cada día mayor auge en las sociedades. Objetivo: facilitar la labor del médico de la familia en la captación y seguimiento de los casos de infertilidad. Método: se realizó una revisión bibliográfica, mediante consulta digital de las revistas especializadas, actualizadas y de libre acceso disponibles en el sitio web de la Biblioteca Virtual de Salud. Para la localización de las publicaciones fueron empleadas varias palabras clave, que contuvieron fundamentalmente el término infertilidad. Las citas digitales más recientes y que mostraban el trabajo de manera íntegra, fueron sometidas a un análisis que permitió obtener la información. Desarrollo: dentro de las causas de infertilidad identificadas con mayor frecuencia se encuentran en el caso de las femeninas, las infecciones genitales y como exponente de la masculina con el varicocele. Conclusiones: fomentar la incorporación del conocimiento permitirá el diseño de acciones preventivas sobre los principales factores causales de la infertilidad desde la Atención Primaria de Salud(AU)

Introduction: infertility is becoming increasingly popular in societies. Objective: to facilitate the work of the family doctor in the collection and follow-up of cases of infertility. Method: a bibliographic review was carried out, through digital consultation of specialized journals, updated and freely available on the website of the Virtual Health Library. Several keywords were used to locate the publications, which mainly contained the term infertility. The most recent digital citations, which showed the work in their entirety, were subjected to an analysis that allowed obtaining the information. Development: Among the causes of infertility identified most frequently are in the case of females, genital infections and as an exponent of the male with the varicocele. Conclusions: promoting the incorporation of knowledge will allow the design of preventive actions on the main causal factors of infertility from the Primary Health Care(AU)

Introdução: a infertilidade está se tornando cada vez mais popular nas sociedades. Objetivo: facilitar o trabalho do médico de família na coleta e acompanhamento de casos de infertilidade. Método: foi realizada uma revisão bibliográfica, por meio de consulta digital de periódicos especializados, atualizado e disponível gratuitamente no site da Biblioteca Virtual em Saúde. Diversas palavras-chave foram utilizadas para localizar as publicações, que continham, principalmente, o termo infertilidade, sendo que as citações digitais mais recentes, que apresentaram o trabalho na íntegra, foram submetidas a uma análise que permitiu a obtenção das informações. Desenvolvimento: Dentro das causas da infertilidade identificaram mais freqüentemente encontrada no caso das mulheres, infecções genitais e como um expoente do sexo masculino com os varicocele. Consideraciones finais: promover a incorporação do conhecimento permitem o desenho de ações preventivas em principais fatores causais da infertilidade da Atenção Primária à Saúde(AU)

Prévalence et profil des coules pris en charge pour infertilité du couple à l'Hôpital de la Mère et de l'enfant de N'Djamena

Introduction: L'infertilité est une pathologie fréquente dans les pays en développement et pose un problème de prise en charge. L'objectif était de déterminer sa prévalence et le profil des couples consultant pour infertilité dans de la Mère et de l'enfant de N'Djamena. Méthodologie:Nous avons mené une étude transversaledescriptive portant les couples ayant consulté pour infertilitédu 1er Décembre 2014 au 30 Novembre 2015. Tous les couples vus pour infertilité ayant effectué tous les bilans et ayant accepté de participer à l'étude après un consentement éclairéont été inclus. Résultats: La prévalence de l'infertilité était de 14%. Cette infertilité était de prédominance secondaire(61%). La majorité des couples dans cette série avait une infertilité d'une durée d'un à trois ans (67,9%). Les tranches d'âges les plus touchées étaient celles de 30 à 34 ans avec un âge moyen de 28,9 ans ± 6,1 chez les femmes et de 40 ans et plus et 30 à 34 ans et 25-29 ans avec un âge moyen de 34,1 ans ± 6,7 chez les hommes. Le statut matrimonial était dominé parles monogames (60,7%). L'infertilité était féminine dans 42% des cas, masculine dans 30% des cas et mixte dans 28% des cas. Les anomalies de spermogramme étaient présentes chez 50% des couples, les infections dans 48,2%, les troubles hormonaux dans 39,3% et les obstructions tubaires dans 23,2%. Conclusion: L'infertilitéest un réel problème dans nos milieux dont la responsabilité incombe également aux 2 sexes. Cela devrait être pris en compte dans la prise en charge

Subclinical Hypothyroidism: Frequency, clinical presentations and treatment indications

Objective: To determine the frequency, modes of clinical presentation and indications for replacement therapy in a cohort of patients with subclinical hypothyroidism [SCH]

Methods: This study was conducted at the Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre from September 2007 - October 2015. This was a retrospective chart analysis of prospectively collected data in which the medical records of 4448 patients who had presented to the Endocrine Clinic from 2007 to 2015 were reviewed. A total of 2760 [62.05%] patients were diagnosed with thyroid disorders, whereas 260 [9.42%] patients had SCH. The SCH patients were between the age of 12 to 70 years; TSH was >4mlU/l with normal levels of FT3 and FT4. Patients were enrolled using a predesigned structured proforma. Those having chronic systemic diseases were excluded from this study. SPSS 13 was used to evaluate the data

Results: Female patients comprised 93.8% [244 patients] of those with SCH, whereas only 6.2% [16 patients] were male. Common presenting symptoms were, lethargy in 146 patients [56.2%]; increase in weight in 102 patients [39.2%] and menstrual irregularities in 90 patients [34.6%]

TSH level of < 10mlU/l [4-10] was seen in 177 patients [68.1%] and 83 patients [31.9%] had TSH > 10mU/l. Thyroxine was given to 183 [70.4%] of these patients. Common treatment indications were TSH of > 10, which was seen in 83 patients [31.9%], subfertility in 32 patients [12.3%], troublesome symptoms suggestive of hypothyroidism in 31 patients [11.9%] and high titers of antibodies in 23 patients [8.8%]

Conclusion: SCH is frequently seen in our population, with most patients complaining of lethargy. The most common treatment indications were a TSH > 10mlU/l, whereas troublesome symptoms of hypothyroidism and subfertility were the common treatment indications in patients who had a TSH of < 10mlU/l

Interactions between prolactin and kisspeptin to control reproduction

ABSTRACT Prolactin is best known for its effects of stimulating mammary gland development and lactogenesis. However, prolactin is a pleiotropic hormone that is able to affect several physiological functions, including fertility. Prolactin receptors (PRLRs) are widely expressed in several tissues, including several brain regions and reproductive tract organs. Upon activation, PRLRs may exert prolactin’s functions through several signaling pathways, although the recruitment of the signal transducer and activator of transcription 5 causes most of the known effects of prolactin. Pathological hyperprolactinemia is mainly due to the presence of a prolactinoma or pharmacological effects induced by drugs that interact with the dopamine system. Notably, hyperprolactinemia is a frequent cause of reproductive dysfunction and may lead to infertility in males and females. Recently, several studies have indicated that prolactin may modulate the reproductive axis by acting on specific populations of hypothalamic neurons that express the Kiss1 gene. The Kiss1 gene encodes neuropeptides known as kisspeptins, which are powerful activators of gonadotropin-releasing hormone neurons. In the present review, we will summarize the current knowledge about prolactin’s actions on reproduction. Among other aspects, we will discuss whether the interaction between prolactin and the Kiss1-expressing neurons can affect reproduction and how kisspeptins may become a novel therapeutic approach to treat prolactin-induced infertility.

Promise(s) of using mesenchymal stem cells in reproductive disorders.

In recent times, infertility among both man and woman has become a major concern affecting about 20 per cent of the population worldwide and has been attributed in part to several aetiological factors such as changes in lifestyle, which includes sedentary life, dietary habits, sleep anomalies, environmental pollution, etc. Assisted reproductive technologies (ART) have come to the rescue of many such couples, but presence of metabolic disorders such as obesity, diabetes with insulin resistance (IR) and its secondary complications (micro- and macro-vascular complications), become confounders to the outcome of ART. Cell therapies are arising as a new hope in the management of reproductive disorders and currently, the efficacy of mesenchymal stem cells (MSCs) harvested from the adult sources finds wide application in the management of diseases like stroke, neuropathy, nephropathy, myopathy, wounds in diabetes, etc. Given the capacity of MSCs to preferentially home to damaged tissue and modulate the cellular niche/microenvironment to augment tissue repairs and regeneration, the present review outlines the applications of MSCs in the management of infertility/reproductive disorders.

Emergency contraception - Potential for women's health.

Emergency contraception (EC) is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills) or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent.

[Effects of mouse paternal age on sperm parameters, reactive oxygen species levels, intraspermic antioxidants and in vitro fertilization results]

Oxidative stress as a consequence of aging can induce infertility in males. In this study, we have investigated the effects of aging on sperm parameters, intra-spermatic water soluble antioxidants, reactive oxygen species [ROS], and in vitro blastocyst formation. We chose 5 older NMRI male mice [10-12 months] and 5 younger NMRI male mice [2-3 months]. Sperm parameters, ROS, soluble antioxidants level and in vitro fertilization rate were assessed in both groups. The results were analyzed by the independent sample and chi square tests. A correlation test was performed between ROS generation and soluble antioxidant levels. Our data showed a significant decrease [P

Aspects epidemiologiques et etiologiques des couples infertiles a Abidjan

Objectif : Ce travail avait pour objectifs d'identifier les caracteristiques sociodemographiques des couples infertiles et de preciser les principales etiologies. Methode : Nous avons mene une etude retrospective descriptive portant sur 210 couples consultant pour infertilite dans les services de gynecologie du CHU de Treichville et d'une clinique privee de la place durant la periode 1er fevrier 2013 au 30 septembre 2014 (20 mois). Resultats. La prevalence de l'infertilite etait de 14;03%. L'age moyen etait de 34;31 ans chez les femmes et de 43;2 ans chez les hommes. La majorite des patientes avait atteint au moins le niveau d'etude secondaire (77;1%). Les couples residant hors d'Abidjan etaient de 15%; et les differentes couches socio-economiques etaient touchees par l'infertilite. La duree moyenne de vie commune des couples etait de 6;9 ans avec une duree moyenne d'infertilite de 6;3 ans. L'infertilite etait en general de type secondaire; touchant aussi bien les femmes (41%) que les hommes (30%). Les etiologies chez les femmes etaient d'origine uterine (47;06%); hormonale (22;79%) et tubo peritoneale (17;65%). Chez l'homme les troubles du sperme etaient domines par l'oligoasthenospermie (69;91%) d'etiologie generalement infectieuse. Conclusion. l'infertilite etait frequente dans nos services; touchant aussi bien les femmes que les hommes

Propedêutica básica da infertilidade conjugal / Basic propedeutics of conjugal infertility

A infertilidade é um problema que afeta cerca de 10%-20% da população, com incidência variável em todo o mundo. A avaliação do casal infértil é geralmente indicada depois de um ano, tempo em que a maioria dos casais normais teria sido bem sucedida na tentativa de concepção. Algumas investigações são controversas, e, na presença de múltiplos métodos, o custo, a segurança e a conveniência deveriam ajudar a decidir o mais apropriado.

Infertility is a problem affecting approximately 10%-20% of the population with variable incidences across the world. Evaluation of a couple is generally indicated after one year, by which time most normal couples attemptiong conception would have been successful. Some of the investigations are controversial and in the presence of multiple methods of investigating one aspect, the cost, safety, convenience and evidence-base should help in deciding on the appropriate method.

Factores asociados a infertilidad en pacientes atendidos en el Servicio de Reproducción Humana del Hospital Nacional Dos de Mayo Enero 2011 a Diciembre 2012 / Factors associated with infertility in patients treated in the Service of Human Reproduction at the National Hospital Dos de Mayo from January 2011 to December 2012

Objetivo: Determinar los factores asociados a infertilidad en pacientes atendidos en el servicio de Reproducción Humana del Hospital Nacional Dos de Mayo de Enero 2011 a Diciembre 2012. Material y métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y transversal. Se revisaron 465 historias clínicas de pacientes que ingresaron con el diagnostico de Infertilidad en el servicio de Reproducción Humana del Hospital Nacional Dos de Mayo en el periodo correspondiente al estudio. Los datos fueron ingresados en una base de datos en el programa Excel 2007 a partir del cual se realizó el análisis estadístico descriptivo, se realizó pruebas Chi cuadrado cuando fueron apropiadas, se consideró a una p<0,05 como una relación estadísticamente significativa, para lo cual se usó el programa SPSS V.15. Resultados: En el estudio realizado se obtuvo una prevalencia del 48.9 por ciento, el 77.4 por ciento presentaba infertilidad femenina, 16.1 por ciento infertilidad mixta, 6.5 por ciento infertilidad masculina, no se encontró relación estadísticamente significativa. La edad más frecuente de infertilidad fue de 35 a 40 años (32.9 por ciento), se encontró relación estadísticamente significativa para los pacientes entre los 25 y 45 años. El 56.8 por ciento presentaron infertilidad secundaria y el 43.2 por ciento infertilidad primaria. Dentro de los factores asociados femeninos el 58.03 por ciento fueron ovulatorios, 23.8 por ciento tubáricos y 18.13 por ciento uterinos, se encontró relación estadísticamente significativa para los factores femeninos ovulatorios y tubáricos. De las causas ovulatorias el 31.6 por ciento presentó disfunción ovárica, de las causas tubáricas el 16.58 por ciento presento obstrucción de trompas uterinas y de las causas uterinas el 14.51 por ciento presentaron miomas intramurales. De los pacientes que presentaban infertilidad masculina el 100 por ciento tenían anormalidades espermáticas, de ellas el 45 por ciento presentó...

Minimal and mild endometriosis negatively impact on pregnancy outcome / Endometriose mínima e leve e seu impacto negativo sobre a gravidez

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

RESUMO O objetivo desta revisão sistemática é apresentar estudos sobre a associação entre as taxas de gravidez e a presença de fases iniciais de endometriose. Estudos relacionados com a infertilidade e estágios mínimos e leves (estágios I,II, American Society of Reproductive Medicine [ASRM]) foram identificados por busca na base de dados MEDLINE, de 1985 a setembro de 2011. Os seguintes termos foram usados como palavras-chave: endometriose, infertilidade, taxa de gravidez; estágio mínimo; estágio leve de endometriose. Entre janeiro de 1985 e novembro de 2011, 1188 artigos foram recuperados; com base no título, 1038 citações foram excluídas e, finalmente, depois de critérios de inclusão e exclusão, 18 artigos foram selecionados para fazer parte desta revisão sistemática. Várias razões têm sido discutidas na literatura na tentativa de explicar o impacto da endometriose mínima no resultado da fertilidade, tais como: disfunção ovulatória, foliculogênese alterada prejudicada, defeito na implantação, baixa qualidade embrionária, ambiente peritoneal inflamatório e hostil e problemas da fase lútea. Apesar de toda polêmica envolvendo o tópico, o maior ensaio clínico randomizado foi publicado por Marcoux et al. Os autores encontraram uma taxa de gravidez estatisticamente significante após a ressecção de lesões superficiais de endometriose. Estágios iniciais de endometriose desempenham um papel crítico relacionado à infertilidade e, provavelmente proporcionam um impacto negativo nas taxas de gravidez em pacientes com endometriose. Outros estudos envolvendo estágios iniciais de endometriose, especialmente ensaios clínicos randomizados, ainda precisam ser realizados.

Current chlamydia trachomatis infection, a major cause of infertility

In India, the impact of current Chlamydia trachomatis [C. trachomatis] in reproductive health remains a neglected area of investigation. The present study evaluates if current Chlamydia infection is associated with any clinical complication that needs the attention of clinical investigators. In this cross-sectional study, we enrolled 896 women attending the Gynecology Out Patient for the detection of C. trachomatis infection. Polymerase chain reaction was used to diagnose current C. trachomatis infection and ELISA for past infections. Bacterial vaginosis, Candida and Trichomonas were screened. The results of symptomatic and asymptomatic groups were compared. The data was analyzed using Epi Info version 6 and "Z" test. A probability value of p

Prevalence of bovine viral diarrhoea, bovine herpesvirus type 1 and 4 infections in repeat breeding cows in Western Turkey / Prevalência de infecções por vírus da diarreia viral bovina e herpesvírus tipos 1 e 4 em fêmeas bovinas repetidoras do cio na região oeste da Turquia

Bovine Viral Diarrhoea Virus, Infectious Bovine Rhinotracheitis and Bovine Herpesvirus Type 4 infections are widelyknown viral infections as the reproductive system pathogen in cattle. The purpose of this study was to investigate thepresence and prevalence of these infections in Repeat Breeding diagnosed cows. A total of 139 blood samples werecollected from nine different dairy herds in Western Turkey. All sampled animals were clinically healthy but not becomepregnant even though they were three to eleven times artificially inseminated. The samples were controlled serologicallyfor BHV1 and BHV4 using ELISA test, 2% and 3.9% proportions were detected, respectively. These values were foundto be very low in comparison to other studies in Turkey. Out of 139, 81 (58.2%) cows were found to be seropositive forBVDV, and the percentage was above the 70% in six herds. BVD antigen was detected in two animals in a herd with71.4% antibody rates. Antigen positive animals were sampled and tested again four weeks later and persistent viremiawere confirmed. In conclusion, BVDV infection may be responsible for repeat breeding in studied herds

Infecções por Vírus da Diarréia Viral Bovina (BVDV), Vírus da Rinotraqueíte Infecciosa Bovina (BHV-1) e HerpesvírusTipo 4 (BHV-4) são amplamente reconhecidas como infecções do trato reprodutivo em bovinos. O objetivo desteestudo foi investigar a presença e a prevalência destas infecções em fêmeas bovinas repetidoras de cio. Um total de 139amostras de sangue foi colhido de nove diferentes propriedades leiteiras na região Oeste da Turquia. Todos os animaisamostrados estavam clinicamente saudáveis, embora não tenham sido enxertados por inseminação artificial após trêsa onze tentativas. As amostras de soro foram testadas por método ELISA para detecção de anticorpos anti-BHV-1 eBHV-4, e 2,0 e 3,9% das amostras, respectivamente, foram consideradas positivas. Estes valores foram consideradosbaixos quando comparados com os de outros estudos na Turquia. De 139 amostras, 81 (58,2%) foram positivas para apresença de anticorpos anti-BVDV e mais de 70% das propriedades foram reveladas positivas. O antígeno de BVDVfoi detectado em dois animais em uma propriedade em que 71,4% dos animais eram soropositivos. Animais positivospara a presença de antígenos foram amostrados e testados novamente quatro semanas depois e viremia persistente foidetectada. Concluindo, infecção por BVDV pode ser responsável pelas perdas reprodutivas nas propriedades estudadas

Aspiração do muco cervical e infusão de jato com meio de cultivo no canal cervical antes da transferência embrionária e resultados de fertilização in vitro / Cervical mucus aspiration and flushing with culture medium cervical canal prior to embryo transfer and in vitro fertilization outcomes

A transferência de embriões é considerada uma etapa fundamental nos ciclos de fertilização in vitro. Os resultados reprodutivos do tratamento são diretamente relacionados à técnica da transferência embrionária. Alguns trabalhos mostraram que o muco cervical poderia afetar os resultados da fertilização in vitro. A aspiração do muco cervical e a limpeza do canal cervical com jato de meio de cultivo foram incorporadas à prática dos serviços de reprodução assistida em todo o mundo. A presente revisão tem como objetivo esclarecer a verdadeira eficácia desses procedimentos no incremento das taxas de gravidez em ciclos de fertilização in vitro.

Embryo transfer is considered an essential stage for in-vitro fertilization cycles. Reproductive outcomes of treatment are directly related to embryo transfer technique. Some papers showed that cervical mucus could affect in-vitro fertilization outcomes. Aspiration of cervical mucus and flushing cervical canal with culture media were incorporated to practice in assisted reproduction technologies centers all over the world. This review aimed to make clear the true efficacy of these procedures with respect to the increase in pregnancy rates of in-vitro fertilization cycles.

Folículos antrais como marcadores da reserva ovariana / Antral follicles as markers of ovarian reserve

Objetivo: Comparar as curvas padrões de decréscimo da reserva ovariana considerando a dosagem do hormônio folículo estimulante (FSH) e a contagem dos folículos antrais (CFA). Método: Estudo transversal prospectivo de pacientes atendidas no Centro de Reprodução Fêmina no período de 01/03/2010 a 31/08/2010. As pacientes foram submetidas à ultrassonografia transvaginal e à dosagem do FSH do 2º ao 4º dia da menstruação. Foram incluídas pacientes de 21 a 44 anos, com ciclos regulares, dois ovários íntegros, nenhuma evidência de endocrinopatias, que não recebiam medicamentos há 6 meses, e que assinaram o consentimento. Foram excluídas as tabagistas, portadoras de galactosemia, cistos ovarianos, com antecedente de hepatopatia, cirurgia ginecológico-ovariana, tratamento com quimioterapia ou radioterapia. O teste utilizado foi o coeficiente de correlação de Pearson. Resultados: Sessenta e oito pacientes com idade entre 22 e 44 anos foram incluídas. O fator masculino foi a principal etiologia da infertilidade, contribuindo com 41% dos casos. A correlação entre a dosagem do FSH e a CFA foi fraca (r=-0,269) e o teste de Pearsonfoi estatisticamente signifi cante (p=0,026). Conclusão: A correlação entre a contagem dos folículos antrais e a dosagem sérica do hormônio folículo estimulante foi fraca e estatisticamente signifi cante.

Objective: To compare the curves patterns of ovarian reserve decline taking into account the follicle stimulating hormone measurement (FSH) and the antral follicles count (AFC). Methods: Prospective transversal study of patients attended at Fêmina Reproduction Center from March 2010 to August 2010. The patients were submitted to transvaginal ultrasonography and had FSH measurement from days 2 to 4 of their period. Patients included were the ones who were 21 to 44 years old, with regular menses, two healthy ovaries, without any evidence of endocrinopathies, that were not taking medicines for 6 months, and signed the consent. Patients excluded: smokers, with galactosemia or ovarian cysts, with antecedents of hepatopathies, gynecological ovarian surgeries or were treated with chemotherapy or x-ray. Pearson’s correlation coefficient was used to analyze the data. Results: Sixty-eight patients were included in the trial, age ranged from 22 to 44 years old. The male factor was the main etiology of infertility, contributing with 41% of the cases. The correlation between FSH measurement and AFC was weak (r=-0,269) and Pearson test was statistically signifi cant (p=0,026). Conclusions: The correlation between the antral follicles count and the serum dosage of FSH was weak and statistically signifi cant.