The Addition of Dydrogesterone after Frozen Embryo Transfer in Hormonal Substituted Cycles with Low Progesterone Levels / Uso adicional de didrogesterona após transferência de blastocisto em ciclos substituídos com valores baixos de progesterona

Abstract Objective To determine whether a rescue strategy using dydrogesterone (DYD) could improve the outcomes of frozen embryo transfer cycles (FET) with low progesterone (P4) levels on the day of a blastocyst transfer. Methods Retrospective cohort study including FET cycles performed between July 2019 and October 2020 following an artificial endometrial preparation cycle using estradiol valerate and micronized vaginal P4 (400 mg twice daily). Whenever the serum P4 value was below 10 ng/mL on the morning of the planned transfer, DYD 10 mg three times a day was added as supplementation. The primary endpoint was ongoing pregnancy beyond 10 weeks. The sample was subdivided into two groups according to serum P4 on the day of FET: low (< 10 ng/mL, with DYD supplementation) or normal (above 10 ng/mL). We performed linear or logistic generalized estimating equations (GEE), as appropriate. Results We analyzed 304 FET cycles from 241 couples, 11.8% (n = 36) of which had serum P4 below 10 ng/mL on the FET day. Baseline clinical data of patients was comparable between the study groups. Overall, 191 cycles (62.8%) had a biochemical pregnancy, of which 131 (44,1%) were ongoing pregnancies, with a 29,8% miscarriage rate. We found no statistically significant differences in the hCG positive (63 vs 64%) or ongoing pregnancy rates (50 vs 43,3%) between those FETs with low or normal serum P4 values, even after multivariable logistic regression modelling. Conclusion Our results indicate that DYD 10 mg three times a day administered in women who perform FET with P4 serum levels < 10 ng/mL, allows this group to have pregnancy rates beyond 12 weeks at least as good as those with serum levels above 10 ng/mL.

Resumo Objetivo Determinar se uma estratégia de resgate usando didrogesterona (DYD) pode melhorar os resultados dos ciclos de transferência de embriões congelados (TEC) com baixos níveis de progesterona (P4) no dia de uma transferência de blastocisto. Métodos Estudo de coorte retrospectivo que incluiu ciclos TEC realizados entre julho de 2019 e outubro de 2020 após um ciclo de preparação endometrial artificial usando valerato de estradiol e P4 vaginal micronizado (400 mg duas vezes ao dia). Sempre que o valor de P4 sérico estava abaixo de 10 ng/mL na manhã da transferência planejada, adicionou-se 10 mg de DYD tri-diário como suplementação. O desfecho primário foi gravidez evolutiva após 10 semanas. A amostra foi subdividida em dois grupos de acordo com o P4 sérico no dia da TEC: baixo (< 10 ng/mL, com suplementação de DYD) ou normal (acima de 10 ng/mL). Realizamos equações de estimativa generalizada linear ou logística (GEE), conforme apropriado. Resultados Analisaram-se 304 ciclos de FET de 241 casais, dos quais 11,8% (n = 36) tinham valores de P4 sérico abaixo de 10 ng/mL no dia da TEC. Os dados clínicos e demográficos dos pacientes eram comparáveis entre os grupos. Globalmente, 191 ciclos (62,8%) tiveram uma gravidez bioquímica, dos quais 131 (44,1%) foram gestações em curso, com uma taxa de aborto espontâneo de 29,8%. Não encontramos diferenças estatisticamente significativas na taxa de gravidez bioquímica (63 vs. 64%) ou nas taxas de gravidez evolutiva (50 vs. 43,3%) entre TEC com valores séricos de P4 baixos ou normais, mesmo após modelação com regressão logística multivariável. Conclusão Nossos resultados indicam que a suplementação com DYD 10 mg três vezes ao dia em mulheres com níveis séricos de P4 abaixo de 10 ng/mL em ciclos de TEC substituídos parecem conseguir resultados pelo menos tão bons como nos ciclos com valores superiores para taxas de gravidez em curso além de 12 semanas.

Oral dydrogesterone in frozen-thawed embryo transfer cycles

SUMMARY OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Mapping changes in women's visual functions during the menstrual cycle: narrative review

ABSTRACT BACKGROUND: This article systematically updates the literature on changes in visual functions during the phases of the normal menstrual cycle in women. OBJECTIVES: To update Guttridge's 1994 review of visual structures and functions associated with the menstrual cycle and broaden the search through psychophysical, neuroimaging and neurobehavioral measurements covering 1994-2020. DESIGN AND SETTING: Narrative review conducted in a neurosciences and behavior laboratory in Brazil. METHODS: The PubMed, Cochrane Clinical Answers and Google Scholar databases were searched. After screening and applying the eligibility criteria, 32 articles were examined. Through this analysis, the following information was extracted: (1) geographical distribution of the study; (2) sample size (according to age and phase of the menstrual cycle); (3) type of measurements according to psychophysical, neuroimaging and neurobehavioral instruments; (4) vision testing model; (5) visual subcategory evaluated; (6) categories of processed visual stimuli; and (7) main findings. RESULTS: The menstrual phases give rise to significant changes in visual functions, including in relation to orientation and spatial attention, visual campimetry and visual sensitivity. These relate specifically to the follicular and luteal phases. CONCLUSIONS: These findings theoretically expand the effects of menstrual cycles on visual functions found by Guttridge (1994). Despite some inconsistencies in the studies analyzed, it was found that visual processing during the follicular and luteal phases of the normal menstrual cycle of healthy women can explain physiological, cognitive, behavioral and social modulations.

Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization

Abstract Background: Pruritic urticarial papules and plaques of pregnancy development may have a strong relationship with hormone treatments during in vitro fertilization and hormonal changes during pregnancy. Objectives: The aim of this study was to evaluate and compare the frequency of papules and plaques of pregnancy and related factors in in vitro fertilization pregnancies and spontaneous pregnancies. Methods: In this study, 517 in vitro fertilization pregnancies and 1253 spontaneous pregnancies were retrospectively reviewed for papules and plaques of pregnancy frequency. The diagnosis of papules and plaques of pregnancy was performed by referral to the dermatology department and according to the typical clinical manifestations of the disease. Results: The papules and plaques of pregnancy was more common in all in vitro fertilization pregnancies (including single pregnancies) than in spontaneous pregnancies. Age, Rh positivity, mother weight gain, onset of disease during gestation, duration of disease, birth weight and the frequency of male fetus were similar between the two groups (p > 0.05). The rate of multiple pregnancies was higher in in vitro fertilization pregnancies with papules and plaques of pregnancy than in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Duration of progesterone treatment was also significantly longer in in vitro fertilization pregnancies with papules and plaques of pregnancy compared to in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Study limitations: The limitations of the study were the retrospective and single-centered design. Conclusion: The results of this study indicate that increased progesterone dosage or prolonged treatment may play a role in the pathogenesis papules and plaques of pregnancy.

Pregnancy rates and luteal phase characteristics of bovine embryo recipients treated with flunixin meglumine / Taxas de prenhez e características da fase lútea de receptoras de embriões tratadas com flunixina meglumina em bovinos

The aim of this study was to evaluate the effects of flunixin meglumine administration on pregnancy rates and luteal phase characteristics in bovine embryo recipients at the moment of embryo transfer. In experiment 1, in vitro produced embryos were transferred to 184 females divided as control and treated group (recipients treated with 1.1mg/kg flunixin meglumine). In experiment 2, 22 females were divided as control group; group 2 (animals submitted to a reproductive tract manipulation similar to an embryo transfer on the 7th day after estrous); and group 3 (females submitted to a manipulation and treatment with 1.1mg/kg flunixin meglumine). In experiment 1 no difference was observed between control and treated groups (40.2% and 44.6%, respectively) for pregnancy rates. In experiment 2 no difference was observed on the length of luteal phase between groups, however, animals in group 2 presented lower plasma progesterone concentrations than the control group and group 3. Therefore, we concluded that although the administration of flunixin meglumine at the moment of embryo transfer inhibited the reduction plasma progesterone concentrations, it was not effective in increasing pregnancy rates of bovine recipients.(AU)

O objetivo deste estudo foi avaliar os efeitos da administração de flunixina meglumina sobre as taxas de prenhez e características da fase lútea da receptora no momento da transferência de embriões em bovinos. No experimento 1, embriões produzidos in vitro foram transferidos para 184 fêmeas, divididas em grupos controle e tratado (tratados com 1,1mg/kg de flunixina meglumina). No experimento 2, 22 fêmeas foram divididas em grupo controle (n=7); grupo 2 (n=8; animais submetidos à manipulação do trato reprodutivo semelhante à transferência de embriões no sétimo dia pós-cio); e grupo 3 (n=7; fêmeas submetidas à manipulação e ao tratamento com 1,1mg/kg de flunixina meglumina). No experimento 1, não foi observada diferença nos grupos controle e tratado (40,2% e 44,6%, respectivamente) para as taxas de prenhez. No experimento 2, não houve diferença na extensão da fase lútea entre os grupos, entretanto os animais do grupo 2 apresentaram concentrações plasmáticas de progesterona mais baixas que o grupo controle e o grupo 3. Portanto, conclui-se que a administração de flunixina meglumina no momento da transferência de embriões inibiu a redução das concentrações plasmáticas de progesterona, no entanto não foi eficaz para aumentar as taxas de prenhez de receptoras em bovinos.(AU)

Relação do proteinograma sérico e as fases folicular e luteal do ciclo estral em éguas / Relation of the serum proteins and the follicular and luteal phasesof the estrous cycle in mares

O objetivo deste estudo foi obter o perfil eletroforético das proteínas séricas em éguas cíclicas e verificar as diferenças entre as fases folicular e luteal do ciclo estral nesta espécie. Foram utilizadas 18 éguas, totalizando 36 amostras de soro, sendo duas de cada égua. As amostras foram colhidas no estro e no diestro. As proteínas séricas totais foram obtidas pelo método do Biureto, a partir da utilização de Kits comerciais (LABTEST®) e, as diferentes subfrações proteicas, por eletroforese em gel de poliacrilamida (SDS-PAGE). O eletroforetograma das proteínas séricas colocou em evidência a presença de 17 a 25 frações proteicas, cujos pesos moleculares variaram de 22 a 254 kDa. Identificaram-se duas proteínas ainda não nomeadas oficialmente, de massas moleculares (MM) 23 kDa e 144 kDa. Os valores médios ± SEM obtidos para cada variável no estro e no diestro, respectivamente, foram: proteínas totais (g/dL) 7,11 ± 0,07 e 7,36 ± 0,07; albumina (mg/dL) 4790,83 ± 69,10 e 5027,19 ± 69,10; α1 glicoproteína ácida (mg/dL) 4,90 ± 0,31 e 4,93 ± 0,31; ceruloplasmina (mg/dL) 15,28 ± 1,31 e 10,65 ± 1,31; haptoglobina (mg/dL) 22,70 ± 1,16 e 27,06 ± 1,16; transferrina (mg/dL) 329,00 ± 9,78 e 350,16 ± 9,78; IgA (mg/dL) 119,91 ± 6,30 e 107,03 ± 6,30; IgG (mg/dL) 1525,07 ± 40,18 e 1517,25 ± 40,18; MM 23 (mg/dL) 204,44 ± 8,61 e 219,79 ± 8,61; MM 144 (mg/dL) 22,13 ± 0,55 e 21,49 ± 0,55. Não houve diferença significativa das proteínas totais e suas frações do estro para o diestro. Conclui-se que as modificações hormonais durante as fases do ciclo estral da égua não interferem no proteinograma sérico.

This study aimed to obtain the electrophoretic profile of serum proteins in cyclic mares and to verify the differences between the follicular and luteal phases of the estrous cycle in this species. Eighteen mares were used, totaling 36 serum samples, two of each mare. Samples were collected both in estrus and in diestrus. Total serum proteins were obtained by the Biureto method, by using commercial kits (LABTEST®), while the different protein subfractions by polyacrylamide gel electrophoresis (SDS-PAGE). The electroforetogram of serum proteins evidenced the presence of 17 to 25 protein fractions, whose molecular weights ranged from 22 to 254 kDa. Two proteins that were not yet officially named were identified, of molecular weights (MW) of 23 kDa and 144 kDa. The mean values (± SEM) obtained for each variable in estrus and diestrus were, respectively: total proteins (g/dL) 7.11 ± 0.07 and 7.36 ± 0.07; albumin (mg/dL) 4790.83 ± 69.10 and 5027.19 ± 69.10; α1 acid glycoprotein (mg/dL) 4.90 ± 0.31 and 4.93 ± 0.31; ceruloplasmine (mg/dL) 15.28 ± 1.31 and 10.65 ± 1.31; haptoglobine (mg/dL) 22.70 ± 1.16 and 27.06 ± 1.16; transferrin (mg/ dL) 329.00 ± 9.78 and 350.16 ± 9.78; IgA (mg/dL) 119.91 ± 6.30 and 107.03 ± 6.30; IgG (mg/dL) 1525.07 ± 40.18 and 1517.25 ± 40.18; MW 23 (mg/dL) 204.44 ± 8.61 and 219.79 ± 8.61; MW 144 (mg/dL) 22.13 ± 0.55 and 21.49 ± 0.55. No significant difference was verified in total proteins and its fractions in estrus and diestrus. The hormonal changes during the specific stages of the estrous cycle of the mare do not interfere with the serum proteinogram.

Efeito da técnica de coleta e do estágio do ciclo estral na recuperação de oócitos de boa qualidade em felinos e caninos domésticos / The effect of recovery technique and stage of estrous cycle on the recovery of good quality oocytes in domestic felines and canines

A obtenção de oócitos de boa qualidade é essencial para o sucesso de diversas biotécnicas reprodutivas. Objetivou-se determinar o efeito de duas técnicas na recuperação de oócitos de boa qualidade em gatas e cadelas em diferentes estágios reprodutivos. Foram utilizados 43 pares de ovários de gata e 35 de cadela após realização da ovariosalpingohisterectomia eletiva. A fase do ciclo estral foi classificada em inativa, folicular ou luteal. Os ovários da fase folicular foram divididos em três grupos: PUN) punção dos folículos com agulha; PUN+FAT) fatiamento do mesmo ovário já puncionado; e FAT) fatiamento do segundo ovário. Os ovários das fêmeas em fase luteal e inativa foram submetidos ao FAT. Foram obtidos no total 974 oócitos (~23/animal) nas fêmeas felinas e 940 (~27/animal) nas caninas. O fatiamento recuperou número superior (P<0,05) de oócitos. Não houve diferença (P>0,05) entre as técnicas de coleta na qualidade de estruturas recuperadas. A quantidade de oócitos recuperados em cada fase foi similar (P>0,05). Contudo, a fase inativa foi superior à luteal (P<0,05) e semelhante à folicular na quantidade de oócitos de boa qualidade em gatas e não houve diferença em cadelas. Conclui-se que o fatiamento recupera maior quantidade de oócitos, não influenciando em sua qualidade. As fases inativa e folicular recuperam maior quantidade de oócitos de boa qualidade em gatas e não afetam a recuperação em cadelas. Portanto, para otimizar o uso das biotecnologias, deve-se levar em consideração o estágio do ciclo estral em fêmeas felinas e a técnica de coleta utilizada na recuperação de oócitos.

The recovery of good quality oocytes is essential for the success of various reproductive biotechniques. The aim of this study was to determine the effect of two techniques on the recovery of good quality oocytes in queens and bitches at different reproductive stages. A total of 43 pairs of ovaries of queens and 35 of bitches after elective ovariosalpingohisterectomy were performed. The estrous cycle phase was classified as inactive, follicular or luteal. The ovaries of the follicular phase were allocated into three groups: PUN) puncture of the follicles with a needle; PUN + SLI) slicing of the same ovary already punctured; and SLI) slicing of the second ovary. The ovaries of luteal and inactive females were submitted to SLI. A total of 974 oocytes (~23/animal) were obtained in feline females and 940 (~27/animal) in canines females. The SLI technique recovered superior number (P<0.05) of oocytes. There was no difference (P>0.05) between the collection techniques in the quality of recovered structures. The number of oocytes recovered in each phase was similar (P>0.05). However, the inactive phase was higher than luteal (P<0.05) and similar to the follicular phase in the quantity of good-quality oocytes in queens and there was no difference in bitches. In conclusion, it is preferable to perform the slicing technique to recover more oocytes in both species. Moreover, in queens it is possible to obtain good quality oocytes in the inactive phase and in bitches the estrous cycle phase does not influence the quality.

Relação do proteinograma sérico e as fases folicular e luteal do ciclo estral em éguas / Relation of the serum proteins and the follicular and luteal phases of the estrous cycle in mares

O objetivo deste estudo foi obter o perfil eletroforético das proteínas séricas em éguas cíclicas e verificar as diferenças entre as fases folicular e luteal do ciclo estral nesta espécie. Foram utilizadas 18 éguas, totalizando 36 amostras de soro, sendo duas de cada égua. As amostras foram colhidas no estro e no diestro. As proteínas séricas totais foram obtidas pelo método do Biureto, a partir da utilização de Kits comerciais (LABTEST) e, as diferentes subfrações proteicas, por eletroforese em gel de poliacrilamida (SDS-PAGE). O eletroforetograma das proteínas séricas colocou em evidência a presença de 17 a 25 frações proteicas, cujos pesos moleculares variaram de 22 a 254 kDa. Identificaram-se duas proteínas ainda não nomeadas oficialmente, de massas moleculares (MM) 23 kDa e 144 kDa. Os valores médios ± SEM obtidos para cada variável no estro e no diestro, respectivamente, foram: proteínas totais (g/dL) 7,11 ± 0,07 e 7,36 ± 0,07; albumina (mg/dL) 4790,83 ± 69,10 e 5027,19 ± 69,10; α1 glicoproteína ácida (mg/dL) 4,90 ± 0,31 e 4,93 ± 0,31; ceruloplasmina (mg/dL) 15,28 ± 1,31 e 10,65 ± 1,31; haptoglobina (mg/dL) 22,70 ± 1,16 e 27,06 ± 1,16; transferrina (mg/dL) 329,00 ± 9,78 e 350,16 ± 9,78; IgA (mg/dL) 119,91 ± 6,30 e 107,03 ± 6,30; IgG (mg/dL) 1525,07 ± 40,18 e 1517,25 ± 40,18; MM 23 (mg/dL) 204,44 ± 8,61 e 219,79 ± 8,61; MM 144 (mg/dL) 22,13 ± 0,55 e 21,49 ± 0,55. Não houve diferença significativa das proteínas totais e suas frações do estro para o diestro. Conclui-se que as modificações hormonais durante as fases do ciclo estral da égua não interferem no proteinograma sérico.

This study aimed to obtain the electrophoretic profile of serum proteins in cyclic mares and to verify the differences between the follicular and luteal phases of the estrous cycle in this species. Eighteen mares were used, totaling 36 serum samples, two of each mare. Samples were collected both in estrus and in diestrus. Total serum proteins were obtained by the Biureto method, by using commercial kits (LABTEST), while the different protein subfractions by polyacrylamide gel electrophoresis (SDS-PAGE). The electroforetogram of serum proteins evidenced the presence of 17 to 25 protein fractions, whose molecular weights ranged from 22 to 254 kDa. Two proteins that were not yet officially named were identified, of molecular weights (MW) of 23 kDa and 144 kDa. The mean values (± SEM) obtained for each variable in estrus and diestrus were, respectively: total proteins (g/dL) 7.11 ± 0.07 and 7.36 ± 0.07; albumin (mg/dL) 4790.83 ± 69.10 and 5027.19 ± 69.10; α1 acid glycoprotein (mg/dL) 4.90 ± 0.31 and 4.93 ± 0.31; ceruloplasmine (mg/dL) 15.28 ± 1.31 and 10.65 ± 1.31; haptoglobine (mg/dL) 22.70 ± 1.16 and 27.06 ± 1.16; transferrin (mg/dL) 329.00 ± 9.78 and 350.16 ± 9.78; IgA (mg/dL) 119.91 ± 6.30 and 107.03 ± 6.30; IgG (mg/dL) 1525.07 ± 40.18 and 1517.25 ± 40.18; MW 23 (mg/dL) 204.44 ± 8.61 and 219.79 ± 8.61; MW 144 (mg/dL) 22.13 ± 0.55 and 21.49 ± 0.55. No significant difference was verified in total proteins and its fractions in estrus and diestrus. The hormonal changes during the specific stages of the estrous cycle of the mare do not interfere with the serum proteinogram.

The prevent miscarriage effects of Yun Kang oral liquid on threatened abortion rat induced by kidney deficiency and luteum inhibition / 中国应用生理学杂志

OBJECTIVE@#Yun Kang oral liquid is a listed proprietary Chinese Medicine. To further evaluate its efficacy, this experiment established a kidney deficiency and luteum inhibition threatened abortion rat model to observe the effects of Yun Kang oral liquid.@*METHODS@#Sixty pregnant rats were randomly divided into normal control group (NC), model group (MG), dydrogesterone group (DT, 3.02 mg/kg), and Yun Kang oral liquid low-dose group (YK-L, 4 ml/kg), medium dose group (YK-M, 6 ml/kg), high dose group (YK-H, 9 ml/kg), 10 in each group. On the first day of pregnancy, each administration group was treated with the test drug at the prescribed dose every morning, and the NC group and the MG group were given an equal volume of purified water for 10 days; the rats were intragastrically administrated every afternoon, except for the NC group. In addition, the other groups were intragastrically administered with hydroxyurea at a dose of 450 mg/kg for 9 days, and mifepristone was administered at a dose of 4.0 mg/kg on the 10th day. On the 9th day of pregnancy, behavioral signs such as back temperature, grasping force, pain threshold, and autonomic activity were measured in each group. On the 11th day of pregnancy, blood was collected from the abdominal aorta in each group to determine serum levels of estradiol (E) , progesterone (P) and thromboxane B (TXB) . Ovary and fetal uterus were removed, the number and diameter of embryos were observed, and the ovary and uterus indexes were calculated.@*RESULTS@#Compared with the NC group, the back temperature, grip, pain threshold, number of spontaneous activities, number of embryos, embryo diameter, uterus index and serum E, P, TXB levels in the MG group were decreased significantly (P＜0.05, 0.01). Compared with the MG group, the back temperature, grasping force, number of embryos, embryo diameter and serum E and P levels were increased significantly in each dose group (P＜0.05, 0.01); the pain threshold, autonomic activity, and uterus index of YK-M and YK-H group were increased significantly (P＜0.05); serum level of TXB in YK-H group were increased significantly (P＜0.05).@*CONCLUSION@#Yun Kang oral liquid has a clear kidney-filling effect on rats with threatened abortion caused by kidney deficiency-luteal suppression. The mechanism may be related to raising serum E, P, TXB levels, improving kidney deficiency and improving embryo quality.

Effect on follicular development and pregnancy outcome treated with acupuncture and moxibustion therapy of in patients with luteal phase defect / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture and moxibustion therapy of on ovulation and embryo implantation in luteal phase defect patients with spleen-kidney deficiency.@*METHODS@#A total of 80 patients were randomly divided into an observation group and a control group, 40 cases in each one.In the observation group,acupuncture was applied at Shenting (GV 24), Shenque (CV 8), Guanyuan (CV 4), Qixue (KI 13), Lieque (LU 7), Gongsun (SP 4), Taixi (KI 3), Zusanli (ST 36) and Taichong (LR 3). And moxibustion was given at Taixi (KI 3) using moxibustion box during follicular phase, the stimulation of Taichong (LR 3) was strengthened during ovulatory phase, moxibustion was adopted at Shenque (CV 8) to Guanyuan (CV 4), Zusanli (ST 36) and Taixi (KI 3) during luteal phase. In the control group, acupuncture was applied at Guanyuan (CV 4), Dahe (KI 12), Sanyinjiao (SP 6), Ciliao (BL 32), Zhibian (BL 54) and Shenque (CV 8). Moxibustion was given at Sanyinjiao (SP 6) using moxibustion box during follicular phase, and moxibustion was adopted at Shenque (CV 8) to Guanyuan (CV 4) during luteal phase. The treatment were given every Monday, Wednesday and Friday, and the treatment were stoped during menstrual period in the two groups. Totally 3 menstrual cycle treatment were required, and 3 menstrual cycles were followed up. The pregnancy rate was observed after treatment, the ovulation rate, maximum folliclular diameter and difference of maximum folliclular diameters in ovulatory phase, serum progesterone (P) and basal body temperature (BBT) were compared before and after treatment in the two groups.@*RESULTS@#In the observation group, 6 cases of successful pregnancy during treatment,10 cases in follow-up, the clinical pregnancy rate was 40.0% (16/40). In the control group, 1 case of successful pregnancy during treatment, 5 cases in follow-up, the clinical pregnancy rate was 15.0% (6/40). The clinical pregnancy rate in the observation group was higher than the control group (0.05). Compared before treatment, the maximum folliclular diameter and difference of maximum folliclular diameters in ovulatory phase, serum P after treatment were improved in the two groups (<0.05), and the improvements of the observation group were significant compared with the control group (<0.05). The BBT after treatment were superior to before treatment in the two groups (<0.05). After treatment, the normal BBT in the observation group was 33 cases, while the control group was 22 cases (<0.05).@*CONCLUSION@#Acupuncture and moxibustion therapy of can promote folliclar development, improve dominant follicle morphology, increase the level of serum P. The therapeutic effect is superior to routine acupuncture in increasing ovulation rate and improving pregnancy outcome.

A systematic review of the role of vitamin D and calcium in premenstrual syndrome

Premenstrual syndrome (PMS) is a common disorder that affects millions of women of reproductive age worldwide. In recent years, there has been a focus on finding accessible, acceptable, and cost-effective therapeutic approaches with minimal side effects to treat the symptoms of PMS. This systematic review aimed to investigate the role of calcium and vitamin D in Premenstrual syndrome. The PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar databases were systematically searched for relevant articles from clinical trial, case-control, and cross-sectional studies. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess the quality of the selected papers. A total of 28 eligible high-quality papers were reviewed. Low serum levels of calcium and vitamin D during the luteal phase of the menstrual cycle were found to cause or exacerbate the symptoms of PMS. Therefore, the administration of calcium and vitamin D supplements or the use of a diet rich in these two substances can restore serum levels and eliminate or reduce the symptoms of PMS. Calcium and vitamin D supplementation are recommended as an inexpensive, low-risk, acceptable, and accessible approach to eliminate or reduce the symptoms of PMS.

Influence of the Phase of Menstrual Cycle on Postoperative Nausea and Vomiting after Breast Cancer Surgery / 이화의대지

OBJECTIVES: The phase of the menstrual cycle was demonstrated to have an influence on the incidence of postoperative nausea and vomiting (PONV) after gynecologic laparoscopic surgery, but little was known for breast surgery, which was shown to have relatively higher incidence of PONV, >60%. We performed this study to investigate the influence of the phase of menstrual cycle on PONV after breast cancer surgery. METHODS: A total of 103 patients, who were scheduled for breast cancer surgery under general anesthesia, were recruited, and patients with irregular menstrual cycles, history of previous history of PONV were excluded. Groups were divided in two ways as follows: 1) gynecologic classification: premenstrual and menstrual (days 25 to 6), follicular (days 8 to 12), ovulation (days 13 to 15), and luteal phase (days 20 to 24); 2) menstrual classification: menstrual (days 1 to 8) and non-menstrual (days 9 to 28). PONV were recorded using Rhodes index of nausea, vomiting and retching at postoperative 6 and 24 hours. RESULTS: The overall incidence of PONV during postoperative 24 hours was 35.4%. At the menstrual classification, the incidence of PONV at postoperative 24 hours was higher in the menstrual group than that in the non-menstrual group (16.7% vs. 4.2%, P=0.057). The severity of PONV, measured with Rhodes index of nausea, vomiting and retching was significantly different between menstrual and non-menstrual groups (P=0.034). CONCLUSION: The duration and severity of the PONV after breast cancer surgery were demonstrated to be prolonged and aggravated during menstruation, respectively. Therefore, consideration of menstrual cycle for scheduling breast cancer surgery could effectively prevent the PONV and reduce medical cost.

Three Cases of Autoimmune Progesterone Dermatitis

Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to progesterone produced during the luteal phase of the menstrual cycle. The clinical symptoms of autoimmune progesterone dermatitis overlap with other forms of dermatosis such as erythema multiforme, eczema, fixed drug eruption, urticaria, and angioedema. We experienced 3 cases of autoimmune progesterone dermatitis. All patients had a recurrent history of monthly skin eruptions. Skin lesions normally began a few days before menstruation and resolved a few days later. Patients were confirmed to have autoimmune progesterone dermatitis by the results of the progesterone intradermal test. All three patients had different clinical findings such as erythema annulare centrifugum, urticaria, contact dermatitis, and rosacea. Because patients presented with variable clinical manifestations, they could have been easily misdiagnosed. The patients were treated with oral contraceptive, antihistamine and steroids for symptom control. We propose that dermatologists should consider autoimmune progesterone dermatitis in cases of recurrent cyclic skin eruptions in female patients. Further, if this condition is suspected, thorough history taking including that on menstrual cycle and intradermal progesterone test should be performed.

Variabilidade da contagem automática tridimensional de folículos ovarianos durante o ciclo menstrual / Variability of Three-dimensional Automatic Ovarian Follicle Count in Menstrual Cycle

Objetivos Avaliar a variabilidade da contagem automática tridimensional dos folículos ovarianos que mediram 2 a 6 mm e 2 a 10 mm durante o ciclo menstrual. Verificar se este exame pode ser aplicado fora da fase folicular precoce do ciclo. Método Prospectivo observacional. Foram incluídas todas as pacientes inférteis submetidas à monitorização da ovulação de 20 de abril de 2013 a 30 de outubro de 2014, com18 a 35 anos; IMC de 18 a 25 kg/m2, eumenorréicas; semhistória de cirurgia ovariana e sem alterações nas dosagens do TSH, prolactina, insulina e glicemia. Foram excluídas aquelas que apresentaram cistos ovarianos e as que faltaram algum dia da monitorização. A contagem ultrassonográfica dos folículos foi feita pelo modo 3D com Sono AVC na fase folicular precoce, folicular media, periovulatória e lútea do ciclo. Resultados Quarenta e cinco mulheres foram incluídas. Houve diferença entre as médias das contagens dos folículos com 2 a 6 mm (p = 0,001) e 2 a 10 mm (p = 0,003) pelo teste de Friedman que avaliou conjuntamente as quatro fases do ciclo. Quando se aplicou o teste t-Student pareado, houve aumento significativo na contagem dos folículos de 2 a 6 mm quando se comparou a contagem desses folículos na fase folicular média e periovulatória com a contagem da fase lútea. Não houve diferença significante entre a contagem destes folículos pequenos nas fases folicular precoce, média e periovulatória. Conclusões A variação da contagem automática tridimensional dos folículos de 2 a 6 mm, nas fases folicular precoce, folicular média e periovulatória, não mostrou significância estatística. Houve uma variação significativa da contagem automática 3D dos folículos ovarianos de 2 a 10 mmdurante o ciclo. A variabilidade significativa da contagem dos folículos de 2 a 10 mm durante o ciclo não permite que este exame seja realizado fora da fase folicular precoce.

Objective To evaluate the variability of three-dimensional automatic counts of ovarian follicles measuring 2-6 to 2-10 mm during the menstrual cycle and to determine if this test can be applied outside the early follicular phase of the menstrual cycle. Methods in a prospective observational study, serial transvaginal ultrasound scans were performed from April 20, 2013, to October 30, 2014, on infertile patients. Inclusion criteria: age between 18 and 35 years, BMI 18-25 kg/m2, regular menstrual cycles, no history of ovarian surgery and no hormonal changes in TSH, prolactin, fasting insulin or glucose. We excluded patients with ovarian cysts or who did not complete one or more days of the serial transvaginal ultrasound scans. The follicle count was performed in 3D mode ultrasound with a Sono AVC system. Visits were scheduled for the early follicular, mid-follicular, periovulatory and luteal phases of the menstrual cycle. Results Forty-five women were included. The Friedman test showed that the total number of follicles measuring 2-6 mmvaried significantly (p = 0.001) across the four periods of the menstrual cycle. The Paired Student t-test showed a significant increase in 2-6 mm follicle count from the mid-follicular and periovulatory phase to the luteal phase. We found no significant intra-cycle variation between the small follicles (2-6 mm) in the early follicular, mid-follicular and periovulatory phases. The Friedman test showed that the total number of follicles measuring 2-10 mm varied significantly (p = 0.003) across the menstrual cycle. Conclusions The variation of three-dimensional automatic counts of 2-6 mm follicles in the early follicular, mid-follicular and periovulatory phases was not statistically significant. The significant variability in the counts of follicles measuring 2-10 mm across the menstrual cycle does not permit this examination to be performed side the early follicular phase.

Salivary ferning as an alternative to sonographic follicle monitoring for determining ovulation: A comparative study / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To determine if salivary ferning correlates significantly with sonographic indices in identifying the fertile period, and whether it may be used as a cheaper, and more convenient way to aid infertility patients in achieving pregnancy. POPULATION: Subjects who complain of difficulty achieving pregnancy and for whom follicle monitoring was indicated were recruited from the Outpatient Department in a tertiary hospital in Manila. METHODOLOGY: Patients (n=40) with Primary or Secondary Infertility from April 2013 to August 2015 who require serial follicle monitoring as part of infertility work up were recruited in the study. For every follicle monitoring by ultrasound done by one sonologist, a salivary sample was obtained from the subject and the ferning pattern was determined and recorded by one pathologist blinded as to the day of the subject's menstrual cycle. RESULTS: There was a total of 40 subjects who underwent 2 serial follicle monitoring during the study. The 1 st TVS (preovulatory) was done between Day 9 to 14 of the cycle with an average of Day 11. Correspondingly, salivary ferning done showed that there were 26 (65.0%) with Salivary Ferning 1 pattern and 14 (35.0%) with Salivary Ferning 2 pattern (p=0.35). This showed no significant difference between follicle monitoring and salivary ferning pattern and either may be used in identifying fertile period preovulatory. The 2nd TVS (postovulatory) was done between Day 12 to 21 with an average of Day 16. All the second ultrasound findings showed signs of ovulation. Correspondingly, there were 1 (2.0%) showed Salivary Ferning 1 pattern, 11 (27.5%) showed Salivary Ferning 2 Pattern and 28 (70.0%) showed Salivary Ferning 3 Pattern 9 (p=0.05). This showed no significant difference between follicle monitoring and salivary ferning pattern, hence, TVS follicle monitoring remains more reliable in identifying that ovulation has occurred. CONCLUSION: Salivary ferning corresponded well with ultrasonographic findings during the preovulatory phase of the cycle, while no correlation was noted between the salivary ferning pattern and the postovulatory phase of the cycle. Hence, sonographic follicle monitoring remains a better predictor of ovulation, and more effective in identifying the fertile period

Establishing Reference Intervals for Sex Hormones on the Analytical Platforms Advia Centaur and Immulite 2000XP

Reliable reference intervals for sex hormones are indispensable in evaluations of the hypothalamo-pituitary-gonadal axis. This study established reference intervals for estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, and prolactin with the immunoassay platforms Advia Centaur and Immulite 2000XP (Siemens Healthcare, Germany). We recruited healthy men (n=220), women in the follicular (n=139) or luteal (n=87) phases of the menstrual cycle, and postmenopausal women (n=103). Data was analyzed according to CLSI EP28-A3c guidelines. Although reference intervals established with both platforms showed good agreement with ranges quoted by the assay manufacturer, two discrepancies were noted. First, intervals for prolactin in women were influenced by hormonal status, and the partition analysis supported their separation into subgroups based on menstrual cycle. Second, the upper limit for estradiol in the follicular phase was nearly a half of that provided by the manufacturer. This discrepancy was attributed to the stringent definition of the follicular phase (consistently set at days 3-5 after menstruation onset). Our findings suggest that reference values for prolactin should both be gender specific and account for menstrual cycle phase. The results also emphasize that clear-cut selection criteria are required when assembling populations for establishing endocrine reference intervals.

Correlation between Luteal Eating Behavior Symptom and Trait Anxiety in Premenstrual Dysphoric Disorder : A Preliminary Study / 신경정신의학

OBJECTIVES: The aim of this study was to examine the correlation between anxiety and premenstrual eating symptoms in premenstrual dysphoric disorder (PMDD). METHODS: A total of 49 women in the late luteal phase participated in this study. The psychiatric symptoms were assessed by Hamilton Rating Scale for Depression, State Trait Anxiety Inventory, and Menstrual Distress Questionnaire. Eating symptoms were assessed using the Dutch Eating Behavior Questionnaire and cocoa intake experiment. Estradiol, progesterone, and leptin were collected through venous blood. RESULTS: Participants with PMDD (n=25) showed a higher level of depression (p<0.001), trait anxiety (p=0.012), restrained eating symptoms (p=0.039), and leptin (p=0.015). Among PMDD patients in the luteal phase, trait anxiety showed correlation with emotional eating (p=0.023), alcohol (p=0.022), and unrestricted intake of cocoa (p=0.001). CONCLUSION: Our data suggest that PMDD subjects showed higher trait anxiety, depression, and difficulty in eating behavior control. Trait anxiety plays an important role in increased and uncontrolled eating symptoms during the premenstrual period and chronic course of PMDD.

Measurement of serum estrogen and estrogen metabolites in pre- and postmenopausal women with osteoarthritis using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry

Although 17β-estradiol (E2) deficiency has been linked to the development of osteoarthritis (OA) in middle-aged women, there are few studies relating other estrogens and estrogen metabolites (EMs) to this condition. We developed a high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS) method to measure the levels of six EMs (i.e., estrone, E2, estriol, 2-hydroxyestrone, 2-hydroxyestradiol, and 16a-hydroxyestrone) in healthy pre- and postmenopausal women and women with OA. This method had a precision ranging from 1.1 to 3.1% and a detection limit ranging from 10 to 15 pg. Compared to healthy women, serum-free E2 was lower in the luteal and postmenopausal phases in women with OA, and total serum E2 was lower in postmenopausal women with OA. Moreover, compared to healthy women, total serum 2-hydroxyestradiol was higher in postmenopausal women with OA and total serum 2-hydroxyestrone was lower in both the luteal and follicular phases in women with OA. In conclusion, our HPLC-ESI-MS/MS method allowed the measurement of multiple biochemical targets in a single assay, and, given its increased cost-effectiveness, simplicity, and speed relative to previous methods, this method is suitable for clinical studies.

Vaginal micronized progesterone capsule versus vaginal progesterone gel for luteal support in normoresponder IVF/ICSI-ET cycles

To compare the outcomes of luteal phase support by micronized progesteron vaginal capsule 600mg/day and progesterone vaginal gel 180 mg/day in the normoresponder IVF/ICSI-ET cycles of the patients down-regulated via GnRH agonist long protocol or fixed antagonist protocol below 40 years of age. A total of 463 normoresponder cycles between January 2013 and December 2013 were retrospectively analyzed. Those with a BMI>28 kg/m[2], any kind of uterine, ovarian or adnexial pathology, any significant systemic, endocrine or metabolic disease or who were reported as azoospermia, were excluded from the study. The patients were grouped according to the usage of micronized progesterone vaginal capsule 600 mg/day [Group 1] or progesterone vaginal gel 180 mg/day [Group 2] as luteal phase Treatment cycle characteristics and pregnancy outcomes were compared between groups. Group-I included 220 cycles and group 2 included 243 cycles. Although the MII oocyte percentage among the total number of MII oocytes was significantly higher in Group-II [77.5% and 80.2%; p=0.034], positive beta-hCG [32.3% and 21.8%; p=0.015] and clinical pregnancy [27.3% and 17.7%; p=0.018] rates were significantly higher in Group-I. No difference was observed between groups regarding the ongoing pregnancy rates [23.2% and 17.3%; p=0.143]. Micronized progesterone vaginal capsule 600 mg daily used for luteal support in the IVF/ICSIET cycles was observed to significantly increase the biochemical and clinical pregnancy rates compared to progesterone vaginal gel 180 mg daily. However, no difference was observed between two groups regarding ongoing pregnancy rates

Comparison of oral dydrogesterone with vaginal progesterone for luteal support in IUI cycles: arandomized clinical trial

The aim of this study, we have compared the advantages of oral dydrogestrone with vaginal progesterone [cyelogest] for luteal support in intrauterine insemination [IUI] cycles. Progesterone supplementation is the first line treatment when luteal phase deficiency [LPD] can reasonably be assumed. This study was conduct to compare the effect of oral dydrogestrone with vaginal Cyelogest on luteal phase support in the IUI cycles. This prospective, randomized, double blind study was performed in a local infertility center from May 2013 to May 2014. It consisted of 150 infertile women younger than35years old undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with oral dydrogesterone [20 mg] as group A and vaginal cyelogest [400 mg] as group B in preparation for the IUI cycles. Clinical pregnancy and abortion rates, mid luteal progesterone [7 days after IUI] and patient satisfaction were compared between two groups, The mean serum progesterone levels was significantly higher in group A in comparison with group B [p=0.001]. Pregnancy rates in group A was not statistically different in comparison with group B [p =0.58]. Abortion rate in two groups was not statistically different [p =0.056] although rate of abortion was higher in group B in comparison with A group. Satisfaction rates were significantly higher in group A compared to group B [p<0.001]. We concluded that oral dydrogestrone is effective as vaginal progesterone for luteal-phase support in woman undergoing IUI cycles. Moreover, the mean serum progesterone levels and satisfaction rates in dydrogestrone group were higher than cyelogest group