Effect of weight loss orientation on BMI in obese and overweight infertile patients.

OBJECTIVE: The aim of this study was to evaluate the response to weight loss guidance in the anthropometric parameters of obesity and overweight infertile patients assisted fertilization treatment (high and low complexity). METHODS: Retrospective cohort study. This survey was conducted in a population of overweight and obese infertile patients. In the first consultation at the assisted reproduction clinic (Human Reproduction Laboratory HC / UFG), obese and overweight patients were weighed, measured and instructed to lose weight and informed that being overweight could reduce the chances of success in the treatment. RESULTS: We analyzed 56 overweight and obese patients admitted for infertility treatment at the Human Reproduction Center HC/UFG. The mean age of overweight and obese patients was 35.78 years, SD 3.70. After the orientation, only 8.92% of patients would achieve the normality rating for BMI, overweight 39.28% (decreased 14.29%), obesity I 37.5%, obesity II 10.71% and obesity III 3.57% (all degrees of obesity increased 1.79%). The mean weight of patients before and after guidance was statistically significant (p<0.0046). The mean values of BMI before and after guidance were also statistically significant (p<0.0038). CONCLUSIONS: Weight loss guidance in this population had no effect on weight loss. On the contrary, the mean weight of patients after guidance was statistically higher than the mean in the first consultation (both weight and BMI). It is suggested that for obese and overweight infertile patients, in addition to guidance for reduction, an appointment with a nutritionist and/or endocrinologist should be immediately scheduled.

Bilateral but not unilateral tubal obstruction is associated with positive chlamydia serology.

OBJECTIVE: To assess the association between positive Chlamydia trachomatis (C. trachomatis) serology and unilateral or bilateral tubal obstruction. METHODS: This was a cross sectional study that evaluated the association of positive C. trachomatis serology (Immunofluorescence Indirect Serology, IIF or Enzyme Immune Essay, EIE), in two infertile groups: A. 243 patients (27 with unilateral obstruction and 216 without it). B. 247 patients (31 with bilateral obstruction and 216 without it). The exclusion criteria were tubal ligation (tubectomy) and tubal surgery. The statistical test (SPSS 17.0) was the Chi-Square with a p=5%. Tubal obstruction was diagnosed through hysterosalpingography (HSG). RESULTS: The mean age of the patients without obstruction was 33.6 years, SD 4.9. The mean age of the patients with unilateral obstruction was 33.7 years SD 4.9. The mean age of the patients with bilateral obstruction was 33.6 years, SD 4.9. There was no statistically significant difference between the age groups. In group A (unilateral obstruction versus serology) the Chi-Square was 0.02 (p=n.s.) and the Attributable Risk (AR) = 0.7%. In Group B (bilateral obstruction versus serology) the Chi-Square test was 9.87 (p<0.005) and the AR = 14.8%. CONCLUSION: This study found a strong and statistically significant association between bilateral tubal obstruction and C. trachomatis positive serology. The power of the test was 86%. There was no association between unilateral obstruction and positive serology.

Endometriosis III and IV as a risk factor for tubal obstruction in infertile women.

OBJECTIVE: A previous study carried out among infertile women with tubal obstruction identified a relative risk of 2.5 for Chlamydia trachomatis seropositivity. However, endometriosis may also be associated with increased risk. This study aimed to evaluate the risk of tubal obstruction associated with endometriosis III/IV among women submitted to assisted reproductive procedures. METHODS: A case-control study was performed among 144 women with and without tubal obstruction. We calculated the odds ratio with 95% CI regarding the association of endometriosis III/IV and tubal obstruction. Calculations were performed using the SPSS v.17.0 package. RESULTS: The mean age was 33.7 years (4.76 SD), and the mean infertility duration time was 66.7 months (120.6 SD). The total prevalence of endometriosis was 20/144 (13%). Among 144 women, the risk group with tubal obstruction and endometriosis III/IV comprised 7out of 20 (35%), compared with the group without such risk, that comprised 22 out of 124 (17%). The X2 test was 3.19 with a p-value of 0.07. The odds ratio (OR) was 2.5 (95% CI: 0.647-9.639). CONCLUSION: Although the OR was 2.5, there was no significant difference between the groups with and without endometriosis III/IV. Further studies are needed to increase the sample size.

Ovulatory status of overweight women without Polycystic Ovary Syndrome.

OBJECTIVE: Obesity is one of the extra hypothalamic-pituitary-ovarian axis factors that can influence ovulation. The isolated impact of obesity on ovulation without other comorbidities needs to be further studied. Our goal is to evaluate the association between the anovulation in the ultrasonographic monitoring of the ovulation cycle and the body mass increase of infertile patients without polycystic ovaries of a university service. METHODS: Case-control study performed at the Human Reproduction Laboratory of the University Hospital. We evaluated 1,356 ultrasound monitoring reports of ovulation between January 2011 and December 2015. We named case those patients who ovulated on the monitored cycle. After applying the exclusion criteria, we consolidated a total of 110 cases and 118 controls. The exposure variables were normal BMI or patients classified with a BMI above normal. Data analysis was performed using SPSS 22.0. Differences in proportions were assessed by X2 test Pearson, Fisher and Wilcoxon test. The value of p<0.05 was considered statistically significant. RESULTS: The groups were comparable in age, age at menarche, number of pregnancies, deliveries, cesarean sections and abortions, number of antral follicles, FSH, prolactin and TSH values. Among the anovulatory patients, 57 (51.82%) were overweight, while among ovulatory patients, 44 (37.29%) were in this same BMI category. The odds ratio was 1.8655, with a significant p value (p<0.05). CONCLUSION: There was an association between anovulation and increase in the Body Mass Index, with an increased risk of anovulation in patients with BMI above normal.

Patients' auto report of regularity of their menstrual cycles. Medical history is very reliable to predict ovulation. A cross-sectional study.

OBJECTIVE: Infertility of ovulatory cause can account for a quarter of infertility etiologies and one of the questions in the patients' clinical history is about their self-perception of the regularity of their menstrual cycles. The aim of this study was to assess whether the information on menstrual regularity is consistent with the assessment of the presence or absence of ovulation. METHODS: Cross-sectional study. The inclusion criteria were: patients with infertility for at least one year, complete examination and ovulation monitoring, aged between 18 and 38 years completed. The patients were divided into two paired groups: those who reported regular menstrual cycles and those who reported irregular cycles. In the ultrasonographic monitoring of ovulation we separated those who ovulated from those who did not ovulate, and applied the Fischer's test. RESULTS: Among the 199 patients who reported having regular menstrual cycles, 113 had proven ovulation upon ultrasound monitoring and 86 patients did not ovulate. Among the 29 patients who reported irregular cycles, 24 did not ovulated at the cycle monitoring. The Fisher's exact test was applied and the p-value found was significant. CONCLUSION: The story of the patient in the clinical interview about the presence of regular or irregular menstruation correlates with the presence or absence of ovulation, it should be taken into consideration in the reasoning regarding the infertility etiology. This report would be important to guide the patient's ovulatory regularity diagnosis.

Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients.

Controlled ovarian stimulation has become an integral part of a high complexity infertility treatment. Treatment options with recombinant gonadotrophins add more to knowledge on folliculogenesis and ovarian steroidogenesis. Therefore, a literature search was conducted in the following data bases: Medline, Scielo and PubMed. The descriptors/ key words used were ovarian stimulation, in vitro fertilization, recombinant luteinizing hormone, supplementation LH. The aim of this study was to review the available literature and to assess the benefits of using recombinant luteinizing hormone associated with recombinant follicle stimulating hormone in different populations who have undergone assisted reproduction procedures.

Low progesterone levels and ovulation by ultrasound assessment in infertile patients.

OBJECTIVE: To assess the correlation between low levels of progesterone and ovulation by ultrasound monitoring in infertile patients with regular menstrual cycles. METHODS: Case-control study. The sample consisted of 302 women aged 20-40 years, treated from 2000 to 2014 in the Human Reproduction Laboratory of the University Hospital of the Federal University of Goiás and in the Department of Gynecology and Obstetrics in Goiânia, Goiás. Data collection was performed by analysis of physical records (Medical Records and Health Information Services) and electronic ones (Sisfert©, 2004) after approval by a Human Research Ethics Committee. Patients were classified according to their ovulatory status, evaluated by progesterone levels and ultrasound monitoring and divided into two groups: Group I (anovulatory cycle patients, n=74) and Group II (ovulatory patients, n=228). In both groups associations were made between the percentage of patients with normal progesterone (≥ 10 ng/ml) and percentage of patients with low progesterone (5.65 - 9.9 ng/ml). The groups were paired for comparisons related to age, body mass index, duration of infertility, follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), luteinizing hormone (LH) and estradiol (E2). RESULTS: There was a significant association between the percentage of ovulation by ultrasound monitoring and the percentages of patients who presented low levels of progesterone. CONCLUSION: The study suggests that low serum levels of progesterone are associated with low percentage of ovulation in infertile women with regular menstrual cycles and women with unexplained infertility.

Obesity and anovulatory infertility: A review.

This global overweight and obesity epidemics has become one of the largest public health problem worldwide and is increasingly more common among women in reproductive age. Along with the prevalence of overweight women, there is an increase in women with anovulatory infertility. Thus, we carried out a bibliographic research in the PubMed, Lilacs and SciELO databases, using the combinations in Portuguese, Spanish and English of the following descriptors: "Body Mass Index", "obesity", "overweight", "female infertility" and "anovulation". The aim of this study was to assess the effects of obesity on the ovulatory profile of infertile women in the available literature.

Music therapy in stress: proposal of extension to Assisted Reproduction.

Infertility is recognized as a disease of several causes by the World Health Organization. Assisted reproduction has a historic of progress since the development of biotechnology. Women who need this treatment are under stress and emotional tension. Since the 1980´s, professionals have been worried with psychological aspects of the patient that undergoes the Assisted Reproduction treatment. Studies about music therapy show positive results in diminishing/reducing patients' emotional stress in many specialties. However, there were not studies showing scientific results of this therapeutic approach. There were, though, works in correlated areas, such as Gynecology and Obstetrics. Therefore, a literature review was conducted in the following data bases: PubMed, Lilacs, Medline and Scielo in studies published between 2004 and January 2014. The descriptors/key words used were music therapy and stress; music therapy and infertility; music therapy and assisted reproduction; music therapy and gynecology and obstetrics. The therms were searched both in Portuguese and English. Therefore, this study aims to analyze what is discussed in literature about music therapy and stress in the context of health. The study will be a base for further research in the post-graduation program about the use of music therapy on emotional stress experienced by women during assisted reproduction. Articles about correlated themes, such as gynecology and obstetrics, were also considered, trying to relate them to assisted reproduction.

Transmigraçäo de gametas: estudo da salpingectomia unilateral com ooforectomia contralateral em coelhas / Gamete transmigration: study of unilateral salpingectomy with contralateral oophorectomy in rabbits

Ocasionalmente, pacientes com ooforectomia unilateral por tumores de ovário säo submetidas a salpingectomia contralateral por prenhez ectópica ou outras intercorrências. A possibilidade de gravidez espontânea nestes casos, embora näo possa ser descartada, tem freqüencia imprevisível, induzindo pacientes a aguardar gravidez por longo tempo. Discute-se, nestes casos, a possibilidade de haver gravidez por transmigraçäo de gametas (espermatozóide de um lado fecundar um ovócito contralateral). Para avaliar esta possibilidade, sete coelhas foram submetidas a ooforectomia unilateral com salpingectomia contralateral pela técnica de Pomeroy. Seis coelhas serviram de controle. Quinze ou mais dias após a cirurgia, as coelhas do grupo estudo e do grupo controle foram cruzadas com dois machos férteis e seguidas. Näo houve gravidez no grupo salpingectomizado. No grupo controle, 66,6 por cento das coelhas engravidaram. Conclui-se que, nestes casos, a possibilidade de gravidez é remota, embora descrita na literatura. Considerando a alta fertilidade em coelhas em comparaçäo com seres humanos, reforça-se a idéia de que técnicas de rotaçäo de ovário ou trompas devem ser consideradas.

Influência da salpingectomia unilateral com ooferectomia contralateral no comportamento sexual de coelhas / Effect of unilateral salpingectomy and opposite oophorectomy on sexual behavior of rabbits

Diversos autores tem relatado que a salpingectomia induz vários efeitos indesejáveis na mulher, tais como: sangramento uterino anormal e dor pélvica. O objetivo deste trabalho foi avaliar a influência da salpingectomia unilateral com ooforectomia contralateral no comportamento sexual de coelhas. Em estudo prospectivo sete coelhas da raça Nova Zelândia foram submetidas a salpingectomia pela técnica de Pomeroy, e comparadas com seis coelhas controles pelo teste exato de Fisher. O peso médio foi de 2320g no grupo operado e 2850g no grupo controle (idade entre 4 a 6 meses). Para estudar o efeito da cirurgia os seguintes parâmetros foram avaliados: 1 - Aceitaçäo do macho na primeira tentativa de cruzamento. 2 - Aceitaçäo do macho após três ou mais tentativas de cruzamento. Sessenta e seis por cento do grupo controle aceitaram o macho na 1( tentativa de cruzamento contra 14 por cento do grupo salpingectomizado p = 0,08). Quarenta e três por cento das operadas aceitaram o macho após três ou mais tentativas de cruzamento contra 66 por cento do grupo controle (p = 0,38). Concluiu-se que a salpingectomia näo reduziu significativamente o comportamento sexual das coelhas.