RESUMO
SUMMARY OBJECTIVE: This study sought to evaluate the influence of time (early <90 days and late >90 days) and endometrial injury on pregnancy success. METHODS: This is a retrospective study in which all infertile women who underwent at least one in vitro fertilization cycle at Clinica Gera between 2010 and 2015 were considered for inclusion. We included patients with a normal ovarian reserve and regular menses at intervals of up to 30 days. A total of 315 patient files were reviewed, and the study group was composed of patients who faced fertility issues and had male-caused infertility or idiopathic infertility. Also, women with male or unknown cause of infertility who have performed endometrial biopsy and have undergone embryo transfer up to 180 days after this procedure between 2010 and 2015 were included. The patients were divided into two groups according to the interval between biopsy and embryo transfer: group 1 (early—an interval of <90 days) and group 2 (late—an interval of >90 days and up to 180 days). RESULTS: The results were superior for the group with an interval of less than 90 days relative to the group with an interval of more than 90 days (p<0.04). The pregnancy rates for group 1 and group 2 were 58.5% and 43.4%, respectively. The odds ratio for pregnancy success was 1.63 (95% confidence interval: 1.04 to 2.55). CONCLUSION: The early transfer of embryos (<90 days) may produce better results with a high rate of pregnancy. Further studies are necessary to identify the mechanism involved in this phenomenon.
RESUMO
A má resposta ovariana em fertilização in vitro apresenta uma prevalência de 2 a 30% dos ciclos de estimulação ovariana. Diversos tratamentos adjuvantes são encontrados na literatura, no entanto, a utilização de hormônio de crescimento (GH) adjuvante foi o que apresentou os resultados mais promissores, com elevação da taxa de gravidez em até 17% nestas pacientes. O objetivo deste estudo foi realizar uma revisão da literatura para esclarecer como o GH atua na estimulação ovariana e para investigar as formas de utilização em más respondedoras. Foram encontrados estudos que relacionam a utilização de GH com o aumento no número de oócitos, na sua qualidade, na redução do tempo de êxito na concepção, na taxa de nascimentos, no estímulo de secreção de progesterona e de gonadotrofina coriônica humana (hCG). Foram discutidas as limitações dos estudos anteriores e de que forma limitam ou condicionam os resultados encontrados. Apesar dos estudos revisados terem diferido na dosagem e na forma de utilização do GH, seus resultados suportaram a proposta de utilização de GH no protocolo de estimulação de pacientes más respondedoras.(AU)
Between 2 and 30% of the patients submitted to ovarian stimulation present poor ovarian response. Several adjuvant treatments were found in the literature, however, the use of growth hormone (GH) as adjuvant presented the most promising results, increasing pregnancy rates in up to 17% in these patients. The objective of this study was to review the literature in order to clarify how GH acts on ovarian stimulation and to investigate ways to use it in poor responders. Studies that relate the use of GH with increase in the number of oocytes, on its quality, in the reduction of time to conception, life birth rate, in the stimulus of progesterone and human corionic gonadotropin (hCG) secretion were found.. The limitations found on previous studies and the way in which they limit or condition the founded results were discussed. Although the dosage and ways of use of GH have differed on the reviewed studies, their results supported the proposal of GH use on the stimulation protocols for poor responder patients.(AU)