O hormônio antimulleriano e a reserva ovariana: uma revisão integrativa da literatura / The anti-mullerian hormone and the ovarian reserve: an integrative literature review

O hormônio antimulleriano é secretado pelas células da granulosa dos folículos que estão em desenvolvimento no ovário. Por meio da sua dosagem, é possível avaliar a reserva ovariana. A mulher tem seu número máximo de oócitos no perío- do fetal, mas, conforme o tempo passa, existe uma queda do número de células germinativas. Desse modo, para mulheres que têm o desejo de engravidar, a dosa- gem de hormônios e a avaliação da reserva ovariana podem ajudar no processo. O objetivo do estudo foi encontrar evidências na literatura que comprovem que o hormônio antimulleriano é o melhor marcador da reserva ovariana. Para isso, foi realizada uma revisão integrativa, classificada como qualitativa; a busca de da- dos foi realizada no PubMed, utilizando a seguinte palavra-chave: "hormônio anti- mulleriano (HAM)". Foram encontrados oito artigos que abordavam diretamente o tema, e há evidências que corroboram a hipótese de que o hormônio antimulleria- no é um bom marcador da reserva ovariana, sendo necessários mais estudos para determinar a sua superioridade.

The anti-mullerian hormone is secreted by the granulosa cells of follicles that are developing in the ovary. Though its dosage is possible to evaluate the ovarian re- serve. Women have their maximum number of oocytes in the fetal period, but there is a decrease in the number of germinative cells as time goes by. Thus, women that desire to get pregnant can have hormones dosed and the ovarian reserve evalua- ted to help them with this process. The objective of this study was to find evidence in the literature that proves that the anti-mullerian hormone is the best marker of ovarian reserve. For this purpose, an integrative review was conducted, using the key word: "anti-mullerian hormone (AMH)". Eight articles were found on the subject and there is evidence that proves the hypothesis of the anti-mullerian hormone as a good marker, however more studies are needed to determine its superiority.

Leptin, ghrelin, & insulin levels and food intake in premenstrual syndrome: A case-control study.

OBJECTIVES: The objective of this study was to evaluate the relationship between food intake and serum levels of leptin and ghrelin in the luteal (LP) and follicular (FP) phases of the MC (menstrual cycle) in participants with and without PMS (premenstrual syndrome). METHODS: This was a case-control study with healthy participants aged 20-45 years with regular menstrual cycles (24-35 days) with and without PMS. After the Daily Record of Severity of Problems (DRSP) was filled out for two months (PMS diagnosis), a nutritional assessment was carried out based on twelve food intake records (for two menstrual cycles) to quantify food intake. RESULTS: Of the 69 participants analyzed, 35 experienced PMS and 34 did not experience PMS. For participants with PMS, calorie and carbohydrate intake was higher during LP than in FP (p = 0.004 and p = 0.003, respectively), whereas these changes were not observed in participants without PMS (p > 0.05). There were interactions between the groups and the MC phases (LP and FP) for the intake of calories (p = 0.028) and carbohydrates (p = 0.001). There was a marginal negative relationship between the levels of ghrelin and calorie intake in FP (rS = -0.314, p = 0.066) in the PMS group and a negative relationship between the levels of ghrelin and leptin in LP (rS = -0.490, p = 0.004) in the group without PMS. CONCLUSIONS: These results indicated a higher calorie and carbohydrate intake during LP in participants with PMS, in addition to the hypothesis that the roles of ghrelin and leptin in energy regulation may be different in participants with PMS compared to those without PMS.

Sleep quality and excessive daytime sleepiness in women with Premenstrual Syndrome.

OBJECTIVE: Examine the relationship between Premenstrual Syndrome (PMS) and sleep in different menstrual cycle phases. METHODS: Case-control survey conducted at the Primary Care Service and Clinical Research Center at Hospital de Clínicas de Porto Alegre with women aged between 18 and 45 years old. Women filled the Brazilian version of the Premenstrual Symptoms Screen Tool (PSST) for the screening of PMS; participants with positive screening completed the Daily Record of Severity of Problems (DRSP) to confirm PMS diagnosis. We applied the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) Brazilian versions in the luteal phase (LP) and follicular phase (FP). RESULTS AND CONCLUSION: 69 women were characterized with PMS and 52 without PMS. The risk of poor sleep quality (SQ) was two times higher in women with PMS (p = .006; OR = 3.057; IC95% 1.44-6.45). An interaction between no PMS and LP was found in ESS (p = .014; generalized estimating equation - GEE - adjusted for multiple comparisons by the Bonferroni test and adjusted by age); besides that, women with PMS had greater scores in ESS (p = .022; GEE adjusted by age).

Premenstrual Syndrome and Female Sexual Function.

PURPOSE: To examine the relationship between Premenstrual Syndrome (PMS) and female sexual function (FSF) with the luteal (LP) and follicular phases (FP). METHOD: We performed a cross-sectional survey using the Female Sexual Function Index (FSFI) questionnaire in the LP and FP. We used the Brazilian's version of the Premenstrual Symptoms Screen Tool (PSST) and the Daily Record of Severity of Problems (DRSP) for diagnosis of PMS. RESULTS: There was no difference in the FSF between groups in both cycle phases. We found an association between LP and worst scores on FSFI. CONCLUSION: PMS does not affect FSF.

Premenstrual syndrome diagnosis: A comparative study between the daily record of severity of problems (DRSP) and the premenstrual symptoms screening tool (PSST) / Diagnóstico de síndrome pré-menstrual: um estudo comparativo entre o relato diário da gravidade dos problemas (DRSP) e o instrumento de rastreamento de sintomas pré-menstruais (PSST)

Abstract Objective To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. Methods A cross-sectional study with 127 women (20 45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. Results Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. Conclusion The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

Resumo Objetivo Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). Métodos Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. Resultados Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). Conclusão O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

Selection of developmentally competent human oocytes aspirated during cesarean section.

PURPOSE: To evaluate the efficiency/safety of Brilliant Cresyl Blue (BCB) staining as a selection method of developmentally competent immature human oocytes. MATERIALS AND METHODS: Immature oocytes of 32 pregnant women were recovered during cesarean section (CS). After retrieval, 92 oocytes were randomly divided into two groups: control (directly disposed to in vitro maturation - IVM) and treated - exposed to BCB 26 µM during 60 min. After staining, the treated group was classified as cytoplasm coloration, BCB positive (blue) or negative (colorless), and then disposed to IVM. Nuclear status was checked after 24 and 48 h of IVM. Nuclear maturation (polar body extrusion), meiosis resumption (absence of germinal vesicle) and degeneration rates were evaluated among the three groups (control, BCB positive and BCB negative) using Generalized Estimating Equations, followed by Bonferroni's correction for multiple comparisons. RESULTS: Nuclear maturation was higher in BCB positive compared to BCB negative, after 24 and 48 h of IVM (p = .004 and p = .032). The control group was equal to BCB positive. There was no difference among groups analyzing meiosis resumption and degeneration rates. CONCLUSION: The BCB test can be a good marker in pre-selection procedures of developmentally competent human oocytes aspirated during CS.

Premenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST).

OBJECTIVE: To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. METHODS: A cross-sectional study with 127 women (20-45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. RESULTS: Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. CONCLUSION: The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

OBJETIVO: Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). MéTODOS: Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. RESULTADOS: Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). CONCLUSãO: O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

Safety of brilliant cresyl blue staining protocols on human granulosa and cumulus cells.

The selection of human immature oocytes destined for in vitro maturation (IVM) is performed according to their cumulus-oocyte complex (COC) morphology. In animal models, oocyte pre-selection with brilliant cresyl blue (BCB) staining improves fertilization and blastocyst rates and even increases the number of calves born. As the granulosa cells and cumulus cells (GCs and CCs) have a close relationship with the oocyte and are available in in vitro fertilization (IVF) programs, applying BCB staining to these cells may help to elucidate whether BCB shows toxicity to human oocytes and to determine the safest protocol for this dye. GCs and CCs were isolated from 24 patients who underwent controlled ovarian stimulation. After 48 h, cells were exposed to: Dulbecco's Modified Eagle Medium (DMEM) with or without phenol red, DPBS and mDPBS for 60 min; 13, 20 and 26 µM BCB for 60 min; and 60, 90 or 120 min to 13 µM BCB. Cellular viability was tested using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) and trypan blue assays. The 20 and 26 µM BCB exposures resulted in lower cell viability, similar to when cells were exposed to BCB for 90 or 120 min. GCs and CCs viabilities were equal among control group and 13 µM BCB group after 60 min. BCB staining was not toxic to GCs and CCs when the regime of 13 µM BCB for 60 min was used. Due to the close molecular/biochemical relationship between these cells and the gamete, we propose that it is unlikely that the use of BCB could interfere with the viability/health of human oocytes.