A mastalgia pré-menstrual está associada a ciclos ovulatórios / The premenstrual breast pain is associated with ovulatory cycles

Objetivo: O presente estudo teve como objetivo avaliar a associação entre o sintoma de mastalgia pré-menstrual com a existência de ciclos ovulatórios. Métodos: O estudo foi do tipo observacional, prospectivo, com corte transversal. Oitenta e cinco mulheres (85), algumas (65) com sintomas de mastalgia pré-menstrual (mastalgia cíclica), foram submetidas a um exame ultrassonográfico transvaginal com Doppler colorido, no 22º dia do ciclo menstrual (fase lútea média), para constatação da ovulação (imagem sugestiva de corpo lúteo e endométrio secretor). A seguir, foram determinados os índices de resistência arterial na periferia do corpo lúteo e no ovário contralateral. Como referência, foi usado o índice de resistência arterial de Pourcelot (RI=S-D/S). Resultados: Índices de resistência arterial significantemente mais baixos foram observados nos ovários nos quais havia ocorrido a ovulação (periferia do corpo lúteo), quando comparados com os índices de resistência das artérias ovarianas contralaterais. Todas as mulheres com sintomas de mastalgia pré-menstrual haviam ovulado, segundo os critérios da pesquisa. Conclusão: O sintoma de mastalgia pré-menstrual pode ser associado a ciclos ovulatórios.

Objective: This study aimed to evaluate the association between breast pain symptom withthe presence of ovulatory cycles. Methods: The study was observational, prospective, and crosssectional. Eight five women (85), some of them (65) with premenstrual mastalgia symptoms (cyclic mastalgia), underwent a transvaginal ultrasound with color Doppler, in the 22th day of the menstrual cycle (luteal phase), for confirmation of ovulation (suggestive image of corpus luteum and secretory endometrium). Then, it was determined the arterial resistance indexes on corpus luteum periphery and on the contralateral ovary. As a reference, we used the arterial resistance index of Pourcelot (RI=S-D/S). Results: Indices of arterial resistance significantly lower were observed in the ovaries in which ovulation had occurred (the periphery of the corpus luteum),compared with the contralateral ovarian arteries. All women with symptoms of pré-menstrual mastalgia had ovulated, according to the research criteria. Conclusion: Symptoms of premenstrual breast pain may be associated with ovulatory cycles.

Biochemical evaluation in human saliva with special reference to ovulation detection.

Aim : The aim of the present study was to investigate the level of salivary sialic acids and glycosaminoglycans with reference to salivary hormones during the normal menstrual cycle. Settings and Design: Fifty women volunteers were selected for the present study. Materials and Methods : Saliva was collected from 50 women and ovulation was detected in women with normal menstrual cycles through basal body temperature (BBT), ultrasound and salivary ferning. Samples were divided into five categories, as prepubertal (6-9 years), pre-ovulatory phase (6-12 days), ovulatory phase (13-14 days), postovulatory phase (15-26 days) and menopause (above 45 years). Each sample was subjected to evaluation of the sialic acids and glycosaminoglycans along with salivary hormones. Results : The result revealed that the ovulatory phase has increased sialic acid and glycosaminoglycans during the menstrual cycle when compared with that of the other phases. Consequently, an increased level of hormones such as luteinizing hormone and estrogen during the ovulatory period when compared to that of the pre-ovulatory and postovulatory periods appeared to be noteworthy. Statistically, analysis was performed using one way-ANOVA (LSD; post hoc method) to determine the significance as P < 0.001, 0.01, 0.05 in between the reproductive phases of the menstrual cycle. Conclusion : This study concluded that saliva-specific carbohydrates in the ovulatory saliva make the possibility to develop a biomarker for detection of ovulation by non-invasive methods.

The salivary ferning test and ovulation in clomiphene citrate-stimulated cycles.

OBJECTIVE: To determine the day of ovulation by the salivary ferning test in clomiphene citrate-treated women. DESIGN: A descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. SUBJECT: Seventy-five infertile women with regular menstrual cycles. MATERIAL AND METHOD: Infertile women were given 100 mg of clomiphene citrate for five days and collected their saliva samples daily until seven days after ovulation. Transvaginal ultrasound was performed daily to detect ovulation. The salivary ferning formation was examined by a normal light microscope and graded from 1-3, according to its extent and intensity. MAIN OUTCOME MEASURE: The salivary ferning score, the peak salivary ferning day, and the day of ovulation detected by ultrasound. RESULTS: The patients' age and cycle length (mean +/- SD) were 32.9 +/- 3.7 years and 28.4 +/- 1.3 days. The peak salivary ferning day corresponded with the ultrasound ovulation day in only 7.1%. There were two peaks of median salivary ferning scores; one was two days prior ovulation and the other was five days post ovulation. There was no correlation between the peak salivary ferning day and day of ovulation detected by ultrasound (r = 0.102, p > 0.05). CONCLUSION: In clomiphene citrate-stimulated cycles, the saliva ferning test does not seem to associate with ovulation.

Feasibility of using paper impregnated with urine instead of liquid urine for assessing ovarian activity.

BACKGROUND: Ovarian activity should ideally be assessed by serial non-invasive methods that require simple procedures for sample collection and storage. Measurement of urinary oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide is a non-invasive method available for assessment of ovarian activity, but transport of large numbers of urine samples is cumbersome and samples need to be stored frozen. An alternative sample collection, transport and storage procedure that is easier to handle and requires no or minimal cold storage facilities will particularly benefit studies in which ovulatory activity needs to be assessed in field settings. OBJECTIVE: To evaluate the feasibility of using paper impregnated with urine as an alternative to liquid urine for the measurement of oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide concentrations in the assessment of ovarian activity. METHODS: Urine samples collected daily throughout regular menstrual cycles were stored as liquid urine at -20 degrees C, and as paper impregnated with urine, in the refrigerator for 3 to 12 months or at room temperature for 1 to 6 months. Oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide concentrations were measured in these urine samples by enzyme immunoassay. Values obtained were correlated using Spearman's correlation test. RESULTS: The pattern of oestrone-3 glucuronide and pregnanediol-3 alpha-glucuronide concentrations estimated using paper impregnated with urine followed that of liquid urine in all storage conditions used. Values obtained by two methods correlated significantly (p < 0.001 to 0.0001) though the paper impregnated with urine gave slightly higher values. CONCLUSIONS: Paper impregnated with urine can be used to facilitate sample collection, transport and storage of urine when oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide measurements are required in a large number of serial samples to assess ovarian activity.

Day 3 serum inhibin B level of poor and good ovarian responders in the IVF-program.

The aim of this study was to compare day-3 serum inhibin B levels of poor and good ovarian responders in the IVF-program. The study group consisted of 20 poor ovarian responders. The control group composed of 40 good ovarian responders who had similar demographic characteristics. The serum inhibin B levels were analysed by two-site-immunosorbent assay or sandwich ELISA (Enzyme Linked ImmunoSorbent Assay). The mean inhibin B level of the study group was 113.18 +/- 57.96 picogram per millilitre and of the control group was 94.05 +/- 61.81 picogram per millilitre. There was no statistically significant difference. The results might be useful as base-line data for further study.

Changes in lysosomal enzyme activities in pre-ovulatory follicles and endometrium of PMSG superovulated rats

Large superovulatory doses of gonadotrophins result in reduced fertility in laboratory and large domestic animals and it has been postulated that some of the superovulated oocytes are derived from abnormal follicles wich would not ovulate under normal physiological stimuli. Follicular growth, follicular maturation and atresia, ovulation and the nidation of the fertilized oocute require intense tissue remodelation which can be accomplished only through the action of hydrolytic enzymen. We have studied the activities and sub-cellular distribution of three lysosomal ensymes (acid phosphatase, N-acetyl-ß-D-glucosaminidase and ß-glucuronidase) in the follicular fluid, granulosa and theca cells of preovulatory follicles and in the endometrial tissue of immature Wistar rats injected with 4 (control) or 40 (superovulated) IU of pregnant mare serum gonadotrophin (PMSG). Enzyme activities were from four to ten time higher in theca than in granulosa cells. This difference was particularly important in the case of ß-glucuronidase. Large preovulatory follicles tended to have higher activities of lysosomal ensymes in the free fraction of all the compartments studied. This difference was remarkable in theca cells where free enzymes could be required to help ovulation. Forty IU of PMSG induced higher activities of acid phosphatase in theca and granulosa cells than 4 IU, but in endometrial tissue this latter dose of PMSG was more efficient to induce higher activities of this enzyme. The endometrial bound fraction of N-acetyl-ß-D-glucosaminidase was almost three times higher than the free activity. This behavior was also observed in endometrial ß-glucosaminidase but only in the control rats. The results observed in follicular fluid were less homogeneous. The activities of glucosaminidase and acid phosphatase were two to three times higher in rats overstimulated with 40 IU of PMSG than int he controls rats, whereas the activities of ß-glucuronidase were lower in the superovulated rats. Our results suggest that alterations in the process of tissue remodeling required for ovulation of mature, normal oocytes and for nidation of the fertilized ovum may be important factors to explain pregnancy failure in the PMSG superovulated female

Avaliaçäo da metodologia diagnóstica de ovulaçäo / Evaluation of the methods for the diagnosis of ovulation

Neste trabalho analisamos os diferentes métodos utilizados na prática clínica diária para o diagnóstico da ovulaçao, em dois ciclos consecutivos, e observamos que a monitorizaçao do ciclo através da avaliaçao do muco cervical e ultra-sonografia pélvica apresentou os melhores resultados, que foram coincidentes entre si.

Monitoreo de ovulación bajo control ecográfico: estudio reapizado durante 1993 / Ultrasonographic monitoring of ovulation

Los objetivos de la presente monografía son: evaluar el parámetro semiinvasivo (laboratorio) para evaluar del monitoreo de la ovulación si es mejor, igual o peor, que el seguimiento ecográfico del mismo; describir los alcances y limitaciones de la ecografía en el monitoreo de la ovulación, obedeciendo al avance logrado en su utilización en el tratamiento de la pareja estéril, seleccionamos el presente tema al haber encontrado en la ecografía un método no invasivo para dicho fin y observado en la bibliografía seleccionada su utilidad como medio diagnóstico. Indudablemente desde el comienzo de su utilización el perfeccionamiento de la misma nos obliga a haber introducido en el desarrollo del texto la evolución y su actual alcance, comparando los métodos de ecografía abdominal y transvaginal, y presentando nuevas metodologías para este fin como es el Doppler color. Mencionaremos la técnica con la cual se utiliza, los parámetros básicos de anatomía ultrasonográfica normal y anormal, las modificaciones foliculares a lo largo del ciclo, los introducidos durante la inducción de la ovulación y la evaluación de sus resultados, y aspectos relacionados con la recuperación de oocitos para los programs de fertilización asistida

Ultrasound and infertility

The method used for the assessment of ovarian function, is noninvasive with a high degree of acceptability by the patients and supplying the clinician with readily accessible information. In this study 42 infertile women were studied by ultrasound and hormonal assays for luteinizing hormone, progesterone and estradiol. Ovulation was detected in 71% by ultrasound in all women studied which was comparable to hormonal evidence of ovulation. However, ultrasound was superior to any of the hormones used for the diagnosis of ovulation. In addition to diagnosis and prediction of ovulation, ultrasound was capable of diagnosing other pathological conditions, like polycystic ovary syndrome, luteinized unruptured follicles, small fibroids and hydrosalpinx

Caracterización ultrasonográfica del endometrio durante el ciclo menstrual ovulatorio espontáneo / Ultrasonographic caracterization of endometrium during spontaneous ovulatory menstrual cycle

Se pacticaron ultrasonogramas transvaginales seriados del endometrio a lo largo del ciclo menstrual en 70 mujeres sanas que ovularon espontáneamente. Se analizó un total de 604 endometrios que fueron clasificados en 4 tipos (0,1,2 y 3) de acuerdo a las interfases miometrio-endometrio, textura de la capa funcional y grosor. Tipo 0 se definió como una tenue refringencia lineal o de grosor inferior a 4mm; Tipo 1 como estructura trilaminar con 3 interfases de similar grosor, capa funcional iso o hipoecogénica con respecto al miometrio y grosor mayor de 4mm; Tipo 2 con interfases miometrio-endometrio engrosadas con tendencia a llenar la capa funcional y Tipo 3 como refringencia homogénea con pérdida de estructura trilaminar y grosor superior a 4mm. En cada día del ciclo se determinó la frecuencia relativa de cada tipo de endometrio encontrado. El día 0 se definió como el primer día en que se comprobó la ruptura del folículo (ovulación). El tipo 0 se encontró en el 100% de los casos en la fase preovulatoria inicial (menstrual y postmenstrua). El tipo 1 se encontró en el 99% de los casos en el período preovulatorio y postovulatorio inmediato (hasta el día +2). Los tipos 2 y 3 se ubicaron en el 100% de los casos en la fase postovulatoria (después del día +3). El endometrio aumentó progresivamente su grosor en 7,7mm como promedio y su crecimiento más rápido se observó en la fase preovulatoria. Se concluye que el endometrio sufre cambios morfológicos progresivos a lo largo del ciclo que pueden ser identificados por ultrasonografía vaginal de acuerdo a la clasificación descrita. Su aplicación en clínica es de gran utilidad para el diagnóstico de normalidad anatómica y funcional cuando se relaciona con la actividad folicular ovárica y el momento del ciclo menstrual

Profile of the Billings Ovulation Method acceptors and use-effectiveness of the method in Korea

Data from a survey of 200 Billings Ovulation Method acceptors in Korea were used to describe a profile of these natural family planning acceptors, and to calculate use effectiveness rates for twelve months of use among women using the method for avoiding an unplanned pregnancy. The majority of acceptors were women of proven fertility who wanted to limit their family size, and many of them (79%) had previously used a family planning method. Fifty-six percent were Catholics, and those study subjects were above middle income group by Korean annual household income estimates. The mean number of living children the NFP acceptors had was 2.3 +/- 1.4 and the number of children they desired to have was 2.4 +/- 1.4. The cumulative life table rate for unplanned pregnancies at the end of 12 months of use was 7 (+/- 2.5 S.E.) per 100 women, and women ever attending the learning sessions as couples experienced relatively less unplanned pregnancies compared to those women attending the sessions alone.

Analisis de medición única de progesterona como indice de ovulación en la esterilade inexplicable / Analysis of a single measurement of progesterone as on index of ovulation in inexplainable sterility

La determinación única de progesterona en suero como prueba definitiva de ovulación es discutible y los valores hormonales mínimos propuestos como tal varíam ampliamente en diferentes estudios. En este trabajo se analizan los valores de progesterona en fase lútea en cinco tipos de ciclo menstrual; el grupo I correspondiente a pacientes con esterilidad inexplicable, el grupo II formado por ciclos de concepción de pacientes embarazadas en forma espontánea, el grupo III compuesto por ciclos de concepción de pacientes embarazadas bajo estímulo con citrato de clomifeno, y los grupos IV y V correspondientes a pacientes con evidencia de ovulación por ultrasonido, en ciclos espontáneos y estimulados con citrato de clomifeno, respectivamente. Se encontró que la concentración de progesterona en el grupo con esterilidad inexplicable fue significativamente menor que el resto de los grupos. Además, se observó que las pacientes estimuladas con citrato de clomifeno presentaban concentraciones de progesterona significativamente mayores que aquellas con ciclos espontáneos. Los resultados de este trabajo indican que algunas pacientes con diagnóstico de esterilidad inexplicable puede cursar con alteraciones en el proceso de secreción de progesterona por el cuerpo lúteo, las cuales pasan generalmente inadivertidas

Estudio comparativo de métodos para la predicción y el diagnóstico de la ovulación / Comparative study of methods for the prediction and diagnosis of ovulation

Cuarenta y una mujeres fueron evaluadas durante 79 ciclos menstruales mediante mediciones de temperatura basal, cambios en el moco cervical, niveles de LH urinario y de diámetro folicular por ecografías. La temperatura basal corporal descendió en 35/79 ciclos (44%) antes de la ovulación y subío entre 3 a 4 décimas de grado depués de la ovulación en todos los casos. El moco cevical experimentó cambios que no permitieron precisar ni predecir el día de la ovulación. La observación del crecimiento y de la rotura folicular por ecografía permitió precisar el día de la ovulación, pero no predecirlo. La medición de LH urinario por Higonavis permitió predecir la ovulación entre 0 y 2 días antes que ocurriera en 70/79 (89%) ciclos

Estudio comparativo de 3 métodos para el diagnóstico ovulatorio en la paciente infértil / Comparative study of 3 methods for ovulatory diagnosis in the infertile female patient

Se presentan los resultados del estudio de la función ovárica y ovulatoria mediante 3 métodos diagnósticos diferentes: la curva de temperatura basal, la determinación de progesterona plasmática y el microlegrado premenstrual en 322 pacientes consultantes por trastornos en su fertilidad. Se ofrecen los valores porcentuales del carácter ovulatorio o anovulatorio del ciclo estudiado en cada paciente y las correlaciones y coincidencias diagnósticas entre los 3 métodos. Se discuten los resultados y se demuestra el valor de la utilización en conjunto de los 3 métodos al aumentar las posibilidades de ofrecer un diagnóstico de certeza más seguro de la función ovárica y el diagnóstico ovulatorio del ciclo

La laparoscopia en el diagnóstico de ovulación / Laparoscopy in the diagnosis of ovulation

Se estudiaron 43 casos con laparoscopia diagnóstica indicada por patología tuboperitoneal, y esterilidad de causa no conocida. En 30 casos fue posible visualizar toda la superficie de ambos ovarios. A pesar de estar la paciente en el periodo postovulatorio inmediato (1 a 4 días) en ocho casos (27%) no se encontró el estigma ovulatorio. En cinco casos con edometriosis mínima, cuatro no tenían estigma y en cuatro más de 14 casos con esterilidad de causa desconocida