Utilidad de un esquema combinado de FSH + LH recombinantes versus FSH recombinante sola en ciclos de fertilización in vitro / Recombinant FSH versus recombinant FSH + LH during GnRH antagonist ovarian stimulation for in vitro fertilization

Resumen OBJETIVO: comparar el efecto de añadir LH recombinante a ciclos de estimulación para reproducción asistida versus ciclos solo estimulados con FSH recombinante (FSHr). MATERIALES Y MÉTODOS: estudio retrospectivo, comparativo, observacional y transversal de ciclos de fertilización in vitro efectuados en el Centro Mexicano de Fertilidad del CEPAM divididos en dos grupos, según el tipo de gonadotropina administrada. RESULTADOS: se estudiaron 529 ciclos en los que el desarrollo folicular y la cantidad de ovocitos fueron mayores en el grupo estimulado solo con FSHr. Sin embargo, el porcentaje de ovocitos en metafase II fue mayor en el grupo con LHr. La tasa de embarazo fue mayor en el grupo estimulado con LHr. CONCLUSION: la ventaja de añadir LHr a ciclos de estimulación en reproducción asistida se refleja en mayores tasas de embarazo.

Abstract OBJECTIVE: To evaluate the effect of adding recombinant LH to IVF GnRH cycles compared to recombinant FSH stimulated cycles. MATERIALS AND METHODS: A retrospective, observational, cross-sectional study of 486 cycles of in vitro fertilization was done in the Centro Mexicano de Fertilidad of CEPAM (Hospital Angeles Lomas). We included 529 cases where it was used a stimulation protocol GnRH antagonist flexible scheme and analyzed depending on the utilized gonadotropin scheme. RESULTS: 529 cycles were studied in which the follicular development and the number of oocytes were higher in the group stimulated with FSHr alone. However, the percentage of oocytes in metaphase II was higher in the group with LHr. The pregnancy rate was higher in the group stimulated with LHr. CONCLUSION: There is a benefit of adding rLH to IVF GnRH antagonist stimulation protocols resulting in higher pregnancy rates.

Percepción de la fertilidad en mujeres en edad reproductiva, según su edad / Fertility perception in reproductive women´s according to their age

Resumen OBJETIVO: evaluar la percepción de fertilidad, los factores de riesgo asociados con la infertilidad y el deseo de tener hijos en un grupo de mujeres en edad reproductiva. MATERIALES Y MÉTODOS: encuesta de características demográficas, salud reproductiva, estilo de vida y creencias de conductas de riesgo asociadas con la infertilidad. Los resultados se tabularon en una tabla de Excel y se analizaron las variables según la edad. RESULTADOS: se obtuvieron 245 respuestas pero se excluyeron dos por datos incompletos. La población de estudio se dividió en 7 grupos, según su edad. El 67% de quienes respondieron la encuesta fueron mujeres de 25-34 años, que abarcó el periodo más fértil. La escolaridad promedio fue de licenciatura y 55% eran casadas. El 69.1% de las encuestadas tenía un empleo y el nivel socioeconómico predominante fue clase media. El 65% de las mujeres utilizó algún método anticonceptivo; 91% de las mujeres desea tener hijos y 88.4% que no tienen se visualizan con ellos. Se consideró la mejor edad para iniciar la maternidad entre 25-29 años y una edad límite para poder embarazarse sin dificultad entre 30-34 años. A mejor y mayor conocimiento de la fertilidad femenina de las encuestadas, éstas consideraron la menor edad como la opción óptima para lograr el embarazo. CONCLUSION: el conocimiento de la fertilidad favorece una toma de decisiones adecuada acerca del futuro reproductivo y evita conductas que llevan a la disminución de la posibilidad de embarazo.

Abstract OBJECTIVE: To evaluate self-perception of women about fertility, risk factors for infertility and reproductive desire of a group of women in reproductive age MATERIAL AND METHODS: This is a transversal study including 245 women of reproductive age. Data were collected by a survey asking about demographic factors, reproductive health, lifestyle and beliefs about fertility. Data were analyzed by age group. RESULTS: Age group with the most answers were 30-34 years, 91% desires motherhood and 65% has a method for family planning. There was an inverse relation between the best age considered to have children and the age of the surveyed women. Older women considered age as a prognostic factor for pregnancy. Informed women considered a younger age to have babies than non-informed. CONCLUSION: Fertility knowledge favours an adequate decision taking about reproductive future.

Factores de riesgo asociados con el aumento de progesterona el día de la aplicación de hCG en protocolos de estimulación con un antagonista para fertilización in vitro / Risk factors associated with increased progesterone on the day of hCG application in stimulation protocols with an antagonist for in vitro fertilization

Resumen ANTECEDENTES: se ha reportado el efecto adverso de la elevación prematura de las concentraciones de progesterona durante la fase folicular de un ciclo de fertilización in vitro. Hasta el momento no existen estudios que evalúen los factores de riesgo asociados con esta elevación. OBJETIVO: evaluar los factores de riesgo asociados con la elevación prematura de las concentraciones de progesterona durante la fase folicular en ciclos de estimulación ovárica para fertilización in vitro con un fármaco antagonista en esquema flexible. MATERIALES Y METODOS: estudio retrospectivo, observacional y transversal de ciclos de fertilización in vitro, efectuado en el Centro Mexicano de Fertilidad del CEPAM, de enero de 2009 a febrero de 2014. Criterios de inclusión: pacientes que recibieron un protocolo de estimulación ovárica con un antagonista de GnRH en esquema flexible. RESULTADOS: se analizaron 469 ciclos de fertilización in vitro. Las principales variables relacionadas con las concentraciones de progesterona el día de la aplicación de hCG fueron: IMC (r=-0.96), estradiol basal (r=0.94), edad de la mujer (r= -0.7) y pico máximo de estradiol (r=0.89). No se encontró correlación con las concentraciones de FSH y LH basales, ni con la dosis total de gonadotropinas. CONCLUSION: las pacientes de menor edad e IMC, además de concentraciones basales elevadas y pico máximo de estradiol suelen tener concentraciones altas de progesterona el día de la aplicación de hCG.

Abstract BACKGROUND: It is well known that premature luteinization has a deletereous efecto on the outcome of IVF cycles however there are no reports that evaluate associated risk factor. OBJECTIVE: To evaluate factors associated to premature luteinization during folicular phase of IVF cycles under antagonist stimulation protocol. MATERIAL AND METHODS: This is a comparative, retrospective, observational study. 469 IVF flexible-antagonist protocol cycles were included from January 2009 to February 2014. RESULTS: We registered 469 IVF cycles. The IMC, basal estradiol, age and estradiol on trigger date showed correlation with premature luteinization. There were no association with basal FSH and LH nor total gonadotropin dose. CONCLUSION: Lowe age and IMC and higher estradio levels are associated to a higer level of progesterone on trigger date.

Comparación de la tasa de embarazo con embriones desvitrificados transferidos por ciclo natural vs ciclo con preparación endometrial / Comparison of pregnancy rate for embryos transferred in natural cycle vs cycles with endometrial preparation

Resumen OBJETIVO: comparar la tasa de embarazo en ciclos de transferencia de embriones vitrificados versus ciclos naturales y con preparación endometrial. MATERIALES Y MÉTODOS: estudio comparativo, observacional y retrospectivo efectuado mediante la revisión de expedientes clínicos de procedimientos de fertilización in vitro efectuados entre enero de 2010 y diciembre de 2013. Los casos se dividieron en dos grupos: ciclo natural y preparación endometrial. Se analizaron las variables de edad, IMC, FSH, LH y estradiol al inicio del ciclo, progesterona el día del inicio del soporte lúteo, LH, y estradiol el día de transferencia, supervivencia embrionaria, número de embriones transferidos, calidad embrionaria y tasa de embarazo. Posterior al análisis principal los grupos se dividieron, nuevamente, de acuerdo con la calidad embrionaria. RESULTADOS: se revisaron 951 expedientes clínicos en los que se identificaron y analizaron 75 ciclos que reunieron los criterios de inclusión. No se encontraron diferencias en porcentaje de supervivencia embrionaria o número de embriones transferidos, ni en la tasa de embarazo entre los grupos. En el grupo con embriones de calidad regular se observó una diferencia significativa en las tasas de embarazo en transferencia en ciclo natural (15%) versus ciclos con preparación endometrial (33.3%) con una p significativa de 0.02. CONCLUSIONES: cuando la calidad embrionaria es regular, la tasa de embarazo es mayor que cuando la transferencia se efectúa en un ciclo con preparación endometrial.

Abstract OBJECTIVE: Compare pregnancy rates of thawed embryo transfer between natural cycle and endometrial preparation. MATERIALS AND METHODS: This is a comparative, retrospective, observational study. 951 medical files where reviewed in the from January 2010 to January 2014. 75 files met with the inclusion criteria. The cycle where divided into two groups. The first group, thawed embryos where transferred during a natural cycle without any hormonal therapy. The second group, thawed embryos where transferred to a prepared endometrium with GnRH agonist and exogenous estrogen. Two embryos where transferred if the patient had two or more viable thawed embryos and one in all other cases. Variables analyzed in both groups where, age, body mass index, FSH, LH, and estrogen at the beginning of the cycle, progesterone on the day of initiating luteal support, LH and estradiol the day of embryo transfer, post-thaw embryo survival rate, number of embryos transferred, embryo quality and pregnancy rate. Groups where then divided according to the embryo quality forming a good quality cohort and a regular quality cohort. In both groups transfers during a natural cycle where compared with embryo transfer to a prepared endometrium. RESULTS: There was no difference observed in embryo survival or number of embryos transferred between both groups. Embryo quality was statistically better in the group with prepared endometrium. There was no statistical significant difference in pregnancy rate between the two groups. In cycles with good quality embryos there was no statistical difference in pregnancy rate when embryos where transferred during a natural cycle versus those transferred to a prepared endometrium. In cycles with regular quality embryos there was a statistical significant difference in pregnancy rate. Pregnancy rate for thawed-embryo transfer during a natural cycle was 15% and 33.3% when the transfer was to a prepared endometrium (p = 0.02). CONCLUSION: Endometrial preparation increases de pregnancy rate when regular quality thawed-embryos are transferred.

Embarazo a término posterior a ruptura hepática secundaria a síndrome de HELLP / Term pregnancy after hepatic rupture secondary to HELLP syndrome

Resumen ANTECEDENTES: La ruptura hepática es una complicación inusual, pero potencialmente mortal, que sucede en 1 de cada 100,000 a 250,000 embarazos. La mortalidad materna se ha reportado en 86% de los casos. En las pacientes con síndrome de HELLP debe considerarse que la manifestación de un hematoma hepático puede culminar en ruptura hepática y muerte. CASO CLINICO: Paciente de 46 años de edad, con antecedente de embarazo gemelar doble, bicorial, biamniótico de 36.5 semanas y preeclampsia severa, posterior a ruptura hepática por síndrome de HELLP y muerte de ambos fetos. El último embarazo evolucionó sin problemas y finalizó en cesárea en la semana 37, sin complicaciones materno-fetales, por lo que fue dada de alta del hospital al tercer día y posteriormente evolucionó sin incidentes. CONCLUSIONES: La atención médica multidisciplinaria y la infraestructura hospitalaria permitieron que la paciente no perdiera la vida debido a la ruptura hepática y hemorragia grave. La hipertensión durante el embarazo es una de las principales causas de muerte materna en todo el mundo; por tanto, es importante concientizar a las pacientes para que acudan a control prenatal regularmente y orientarlas acerca de la hipertensión y sus complicaciones. Los ginecoobstetras deben considerar que la ruptura hepática es una complicación muy grave, con consecuencias fatales para la madre y el feto.

Abstract BACKGROUND: Hepatic rupture is a potentially fatal rare complication, which is diagnosed in 1 of each 100,000 to 250 000 pregnancies. Maternal mortality has been reported in up to 86% of the patients. In cases where there has been a diagnosis of HELLP syndrome, the presence of a hepatic hematoma has to be suspected since it could lead to a hepatic rupture and eventually death. CLINICAL CASE: 46 year old female in late stage of pregnancy, following a hepatic rupture caused by HELLP syndrome and fetal demise of both fetuses in previous twin pregnancy. Her last pregnancy being of normal evolution, having been submitted to cesarean section without complications on her 37th week of gestation, and discharged on her third post-operative day showing a good evolution. CONCLUSION: The multidisciplinary medical attention given to the patient, as well as the hospital infrastructure, allowed the patient to be kept in good health despite the hepatic rupture and hemorrhage presented. It is important to remember that one of the leading causes of maternal death around the world is hypertension during pregnancy. Therefore, patients have to be made conscious of the significance and importance of attending prenatal care on a regular basis and be given information on hypertension and its complications. Additionally, it is important that obstetricians keep in mind that although this is a rare complication, it can lead to a fatal outcome when presented.

[Evaluation of semen parameters in long term cryopreserved samples for over 10 years]. / Evaluación de los parámetros seminales en muestras criopreservadas por más de 10 años.

BACKGROUND: Sperm samples subjected to cryopreservation are vulnerable, reflecting changes in membrane integrity, mobility and DNA. OBJECTIVE: To assess the rate of DNA fragmentation, sperm mobility and recovery viability in capacitated semen samples after cryopreservation for over 10 years. MATERIAL AND METHOD: Longitudinal, prospective, observational study of 19 seminal samples cryopreserved for more than 10 years, in a mexican fertility center. The sample was divided into 4 groups: Group CX (Surgery), Group IVF (in vitro fertilization), OAT Group (Oligo- astheno-teratozoospermia) and QX Group (Chemotherapy), in order to compare variables such as: recovery in mobility, DNA fragmentation index and sperm viability. Continuous variables were designated as means ± SD, and categorical variables as frequencies and percentages. JMP-V9 program was used. RESULTS: There is no difference in storage time and initial volume. The concentration, total mobility, total motile cells and morphology in OAT group are different from the rest. There is difference in initial morphology of the tail, showing more altered parameters in CX and IVF groups. In the CX, FIV and OAT Groups was achieving a mobility recovery of 27.34%, 30.02% and 55.24% respectively. The QX group presented no change. By analyzing the viability only OAT group presented < 50% intact sperm. For DNA fragmentation CX Groups and IVF showed the lowest rate (3.5.± 2.5 and 3.5 ± 3.01 respectively) compared with OAT Groups and QX (9.8 ± 0.2 and 12, 17 ± 3.9). CONCLUSION: It is possible to store semen samples for a long period of time, retrieving suitable viability sperm useful for assisted reproduction techniques.

[Gamete laboratory. Determining factors of success in in-vitro fertilization]. / Laboratorio de gametos. Factores determinantes de éxito en fertilización in vitro.

The objective was to evaluate the gamete laboratory parameters that can to determine the possibility of achieving pregnancy in in vitro fertilization (IVF). A prospective study was carried in 196 patients undergone to conventional and oocyte donation IVF. After the evaluation of oocytes, embryos and the pregnancies was established that postmature oocytes were more frequently retrieved from patients that did not get pregnant. A good embryo morphology and principally the transfer of 4-cell embryos are common events in IVF. However, there were not significant difference in embryo parameters, number of blastomeres and embryo quality, between pregnant and not pregnant patients. In conclusion, it appear that bad oocyte quality has a negative effect over the possibility of achieving pregnancy. The number of blastomeres and embryo quality were not predictive of the possibility to get pregnant.

[Ovarian volume as a predictive factor of ovarian reserve in response to exogenous stimulation with gonadotropins and its correlation with ovum/embryo development in FIVTE/ICSI results]. / Estudio del volumen ovárico como factor predictivo de reserva ovular en respuesta a la estimulación exógena con gonadotropinas y su correlación con el desarrollo óvulo/embrionario en los resultados de FIVTE/ICSI.

UNLABELLED: The evaluation of ovarian reserve in regard to the exogenous response elicited by gonadotropines is directly related to the interconnection of diverse intrafollicular factors involved in ovum components, and thus, to a better embryonic development, which will be reflected in the pregnancy ratios of assisted reproduction programs. A series of markers have been proposed in order to dynamically evaluate the ovarian response: hormone determinations (FSH, E2, FSH:LH index), biochemical factors (inhibine-B), intrafolicular (cytokines, leptin), neuromodulators (GNRH test), and so forth. However, none has shown a specific sensitivity in order to accurately determine the best treatment depending on the values they provide. OBJECTIVE: To evaluate the capacity of ovarian response on the basis of ovarian volume determination. Two groups of patients were studied: group 1 (n = 19) with a basal ovarian volume smaller than 3 cm3, and group 2 (n = 21), those with a volume greater than 3 cm3. Patients in group 2 showed a better response to ovarian stimulation, as well as the collection of better quality ovarian, increased fertilization, segmentation and pregnancy ratios and a lower cancellation index as compared to group 1. It can be concluded that patients with an ovarian volume lower than 3 cm3 on the day before the stimulation will present a poor response to exogenous gonadotropins, thus, this variable must be considered as a marker of ovarian follicular response.

[Changes in preovulatory molecular relationship between estradiol and progesterone in patients undergoing controlled ovarian hyperstimulation. Can they be used for the evaluation of ovarian reserve?]. / Cambios en la relación molecular preovulatoria entre estradiol y progesterona en pacientes sometidas a hiperestimulación ovárica controlada. Pueden usarse como evaluación de la reserva ovárica?

The objective was to evaluate if the preovulatory molecular ratio between progesterone and estradiol has age-dependent changes in patients undergone controlled ovarian hyperstimulation. Were studied 180 cycles of conventional in vitro fertilization. Patients were divided in three groups: Group 1 (age less than 30 years; n = 40), group 2 (age between 30 and 35 years; n = 82), and group 3 (age between 36 and 40 years; n = 58). Leuprolide acetate was used in all cases. Molecular progesterone/estradiol ratio was calculate with the following formula: [Serum progesterone (ng/mL) x 3180 (SI x 10(3) divided by serum estradiol (pg/mL) x 3.671 (SI)]. In patients with age more than 38.5 years there was positive correlation between preovulatory progesterone and estradiol (R = 0.55, R2 = 0.30). There were significant difference in molecular progesterone/estradiol ratio between group 1 compared to group 2 (P less than 0.001), group 1 compared to group 3 (P less than 0.0001), as soon as group 1 compared to group 2 plus group 3 (P less than 0.0001). It is concluded that molecular progesterone/estradiol ratio decreases before any endocrino evidence of ovarian aging. The value of this putative test of ovarian reserve is discussed.

[Changes in preovulatory molecular progesterone/estradiol ratio in patients treated with controlled ovarian hyperstimulation. Can they be used in the assessment of ovarian reserve?]. / Cambios en la relación molecular preovulatoria entre estradiol y progesterona en pacientes sometidas a hiperestimulación ovárica controlada. Pueden usarse como evaluación de la reserva ovárica?

The objective was to evaluate if the preovulatory molecular ratio between progesterone and estradiol has age-dependent changes in patients undergoing controlled ovarian hyperstimulation. There were 180 cycles of conventional in vitro fertilization which were studied. Patients were divided in three groups: Group 1 (age less than 30 years; n = 40), group 2 (age between 30 and 35 years; n = 82), and group 3 (age between 36 and 40 years; n = 58). Leuprolide acetate was used in all cases. Molecular progesterone/estradiol ratio was calculated with the following formula: [Serum progesterone (ng/mL) x 3180 (Sl x 10(3)) + serum estradiol (pg/mL) x 3.671 (Sl)]. In patients older than 38.5 years there was positive correlation between preovulatory progesterone and estradiol (R = 0.55, R2 = 0.30). There were significant difference in molecular progesterone/estradiol ratio between group 1 compared to group 2 (P less than 0.001), group 1 compared to group 3 (P less than 0.0001), as well as group 1 compared to group 2 plus group 3 (P less than 0.0001). It is concluded that molecular progesterone/estradiol ratio decreases before any endocrine evidence of ovarian aging. The value of this putative test of ovarian reserve is discussed.

[Diagnosis and treatment of the male factor in the age of intracytoplasmic sperm injection]. / El diagnóstico y tratamiento del factor masculino en la era del ICSI.

Currently, we are witnesses of the Assisted Reproductive techniques; advances reproductive goals have been reached with the Intracytoplasmic Sperm Injection (ICSI) in patients with male factor. However, micromanipulation techniques allowed the reproductive solution without an etiologic and/or physiopathologic diagnosis. The andrologic workup of the dynamic and functional sperm characteristics with the endocrine and urologic evaluation should be performed into the infertility management.

[Effect of intrafollicular interleukin-6 levels on the secretion of estradiol and progesterone in patients treated with in vitro fertilization and embryo transfer]. / Efecto de los niveles de interleucina-6 intrafolicular en la secreción de estradiol y progesterona de pacientes tratadas con fertilización in vitro y transferencia de embriones.

The objective was to evaluate the relationship between follicular fluid levels of Interleukin-6 (IL-6) and the seric concentrations of estradiol and progesterone during controlled ovarian hyper-stimulation. The levels of IL-6 were measured in follicular fluid of 15 patients undergone to in vitro fertilization and embryo transfer and correlated with the values of seric estradiol and progesterone. There were a negative correlation between follicular levels of IL-6 and either estradiol and progesterone. Four patients achieved pregnancy following embryo transfer (pregnancy rate 26.6%), one of them aborted. As conclusion, the increased levels of IL-6 may be a reaction to controlled ovarian hyper-stimulation and probably a protective response. According to the reduction of estradiol, there may be a subtle reduction in aromatase action by effect of IL-6 and other cytokines.

[Effect of blood concentrations of preovulatory estradiol on the quality of eggs and pre-embryos in patients treated with fertilization in vitro]. / Efecto de las concentraciones séricas de estradiol preovulatorio en la calidad de óvulos y preembriones en pacientes tratadas con fertilización in vitro.

The objective was to investigate if the preovulatory estradiol concentrations obtained during controlled ovarian hyperstimulation (COH) have effect on reproductive outcome. The study included a total of 198 in vitro fertilization (IVF) cycles. Patients were divided into four groups according to serum preovulatory estradiol concentrations. In low responder patients was observed significantly decreased oocyte and preembryo quality compared with normal or high responders (P < 0.01). In this work high response do not have effect on IVF outcome. The clinical results indicate that low estradiol levels the day of hCG administration are apparently correlated with poor oocyte and embryo quality.

[From theory to clinical practice: recombinant FSH in daily practice]. / De la teoría a la clínica: la FSH recombinante en la práctica cotidiana.

The purpose of the present study is to determine the efficacy of induction ovulation with recombinant FSH in patients treated with in vitro fertilization and embryo transfer (IVF-ET) and basic assisted reproductive techniques (ART). One hundred seven cycles were analyzed. The patients were divided in two groups: Group 1, treated with IVF (n = 12) and group 2, treated with basic ART (n = 95). Only recombinant FSH was utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, were administered when one or more dominant follicles with diameter > or = 18 mm were presents; oocyte retrieval was performed 34 hour, while intrauterine insemination was practiced at 36 hours after the hCG injection. The pregnancy rate per IVF cycle was 25.0%, and 16.4% for basic ART. It is concluded that ovulation induction with recombinant FSH is a good and efficient alternative for both variations of ART.

[Spontaneous and assisted reproduction-associated heterotopic pregnancy. The clinical characteristics]. / Embarazo heterotópico espontáneo y asociado con reproducción asistida. Características clínicas.

Heterotopic pregnancy is an uncommon obstetric entity with variegated symptomatology. The objective of this report is to describe the clinical findings of the two varieties of heterotopic pregnancy, spontaneous an related with Assisted Reproduction Techniques (ART). Three cases of heterotopic pregnancy are described, two spontaneous and one occurred after in vitro fertilization and embryo transfer (IVF-ET). The two former culminated in miscarriage of intrauterine pregnancy and tubal rupture; and the late obscured for the ovarian hyperstimulation syndrome which prevented accurate ultrasonographic diagnosis. The clinical presentation and key differences are discussed.

[New concepts in the induction of ovulation. A logarithmic assessment of estradiol production during controlled ovarian hyperstimulation for fertilization in vitro]. / Nuevos conceptos en inducción de la ovulación. Una evaluación logarítmica de la producción de estradiol durante la hiperestimulación ovárica controlada para fertilización in vitro.

The objective was to evaluate the exponential response of serum estradiol to controlled ovarian hyperstimulation (COH) in an in vitro fertilization-embryo transfer (IVF-ET) program through measurement of logarithm of serum estradiol area under the curve (LOG-OUC). One hundred three patients undergone conventional IVF-ET with pituitary suppression were studied. For to calculate the LOG-AUC estradiol, trapezoidal formula and ten-fold logarithm definitions were employed. The estradiol synthesis have notorious logarithmic changes during all COH. There was significant difference between estradiol AUC for initial and final phases of controlled ovarian hyperstimulation. As conclusion LOG-AUC of estradiol can be used for to evaluate the ovarian response to superovulation, its prognostic value for following IVF-ET intent is discussed.

Effect of body mass index and follicular synchrony in the ovarian response to ovulation induction with menotropins.

OBJECTIVE: To determine the correlation between body mass index, follicular synchrony, and pregnancy rate in a controlled ovarian hyperstimulation program with menotropins. SUBJECTS AND METHODS: Seventy-nine hyperstimulation cycles were evaluated. Transvaginal ultrasonographic control was performed and 10,000 IU of human chorionic gonadotropin were administered when the dominant follicle reached a diameter > 16 mm. In order to evaluate the follicular response, the ovarian synchrony factor was used (# follicles > or =16 mm/# follicles > 10 mm). For the statistical analysis, linear correlation and chi-square tests were used. RESULTS: When patients had a normal body mass index there was a positive correlation ( r = .52) between body mass index (kg/m(1.5)) and the ovarian synchrony factor. Weight deficiency and obesity had a deleterious effect on the ovarian response ( r = -.47 and r = -.77, respectively). There was a significant difference in the number of pregnancies in patients with ideal weight in relationship to the subgroup with weight deficit. CONCLUSIONS: An adequate body constitution increases the possibilities of achieving success in ovulation induction programs; on the other hand, weight disturbances have a deleterious effect on ovulation.

[Clinical evaluation of patients submitted to open vs conventional gynecologic laparoscopy]. / Evaluación clínica de pacientes sometidas a laparoscopia ginecológica con técnica abierta versus laparoscopia convencional.

The objective was to comparate the clinical evolution and rates of complications for open and conventional gynecological laparoscopy. Were studied the cases of 253 patients divided in two groups: Group 1 (n = 106) patients treated with open laparoscopy, and group 2 (n = 147) patients managed with conventional surgery. The major indication for performing laparoscopy was infertility management. There were not early or I ate complications of trocar insertion or operative laparoscopy in the group 1. However, in group 2 there were four complications (P < 0.05), two related with needle or trocar insertion. As conclusion, in the studied group open laparoscopy can to eliminate the risks of blind insufflation and trocar insertion observed in the classifical technique, is a safe and efficacious method to treat several gynecological pathologies.

[Heterotopic pregnancy with intrauterine dizygotic twins following embryo transfer in the blastocyst phase]. / Embarazo heterotópico con gestación intrauterina dicigótica después de transferencia de embriones en etapa de blastocisto.

Ectopic pregnancy is a common complication of in vitro fertilization and embryo transfer (IVF-ET). On other hand, heterotopic pregnancy complicates 1-2% of all IVF-ET pregnancies. Tubal damage as reason for treatment and multiple embryo transfer might predispose patients to this complication. We present a successful treated case of an infertile patient that developed simultaneous twin intra- and single extra- uterine pregnancy after blastocyst-stage embryo transfer. In IVF-ET patients presence of an intrauterine gestation not exclude the possibility of a concomitant extrauterine pregnancy. Awareness of the possibility of heterotopic pregnancy after IVF-ET plays an important role in the successful treatment of this reproductive complication. Transfer of good quality embryos can be a risk factor to develop heterotopic pregnancy.

[Efficacy of simultaneous use of cryopreserved semen, controlled ovarian hyperstimulation and intrauterine insemination in the treatment of sterility caused by hypergonadotropic azoospermia]. / Eficacia del uso simultáneo de semen criopreservado, hiperestimulación ovárica controlada e inseminaciones intrauterinas para el tratamiento de la esterilidad causada por azoospermia hipergonadotrópica.

The purpose of the present study is to determine the efficacy of an artificial intrauterine insemination program with frozen donor sperm and controlled ovarian hyperstimulation as an alternative therapy for infertility cause by hypergonadotropic azoospermia. Two hundred forty three insemination cycles with frozen donor sperm were analyzed. Clomiphene citrate, pure FSH, recombinant FSH or human menopausal gonadotropins were utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, was administered when one or more dominant follicles with diameter > or = 16 mm were present; intrauterine insemination was performed 36 hours after the hCG injection. The pregnancy rate per cycle was 19.9%, and the cumulative pregnancy rate was 59.3%. It is concluded that intrauterine insemination with frozen donor sperm and ovulation induction is a good alternative for male factor infertility with no available treatment.