[Preliminary results of effectiveness of two schemes of controlled ovarian hyperstimulation protocols with recombinant foliculle stimulating hormone in intrauterine insemination cycles]. / Resultados preliminares del estudio de eficacia de dos esquemas de hiperestimulación ovarica controlada con hormona folículo estimulante recombinante en ciclos de inseminación intrauterina.

BACKGROUND: The intrauterine insemination (IUI) is the first line treatment in different infertility situations. OBJECTIVE: To compare the efficacy of two protocols of controlled ovarian hyper stimulation (COHS) with recombinant Follicle Stimulating hormone (rFSH) (75 vs. 150 UI/day) plus IUI, in terms of pregnancy rate, multiple pregnancies, ovarian hyper stimulation syndrome and ovarian stimulation features. MATERIALS AND METHODS: Prospective study, sequential assignment, included 35 patients that had 44 cycles of IUI. They were assigned in to two groups, group 1 that started controlled ovarian hiperestimulation with 75 and 2 with 150 UI/day of recombinant rFSH. RESULTS: We found statistically significant difference between groups in: dose of rFSH, amount of stimulation days, number of mature follicles and estradiol blood levels on the day of use of the GnRHant and hCG injection day. The pregnancy rate between group 1 and 2 were 9.1 vs. 27.2%, respectively. Of the 8 pregnancies, 75% were achieving in group 2. The twin pregnancy rate was 2.2% and there were no cases of OHSS. CONCLUSIONS: Although without significant difference between groups we found a clear trend to achieve a better pregnancy rate with the 150 UI/day protocol without a significant raise in multiple pregnancy rate nor OHSS. The multifollicular development was associated to group 2 seems to be related to the better pregnancy rate achieved by the same group.

[Intrauterine insemination versus programmed intercourse in cycles of controlled ovaric hyperstimulation]. / Inseminación intrauterina versus coito programado en ciclos de hiperestimulación ovárica controlada.

BACKGROUND: Assisted reproduction techniques are used more and more frequently in the treatment of coulples with infertility diagnosis. OBJECTIVE: To analyze the intrauterine insemination (IUI) value in controlled ovarian hyperstimulation cycles (COH). MATERIAL AND METHODS: An analytic, comparative, retrospective and longitudinal case-control study was performed. COH with IUI (group I) or with timed intercourse (TI) (group II) cycles from January 1st 2004 to December 31st 2006 were analyzed. Infertile patients aged between 24 and 42 years (group I) and between 23 and 36 years (group II) were included. The following variables were analyzed: Age, type, etiology and duration of infertility, sperm density and motility after capacitation or seminal analysis, number of total and mature follicles, endometrial thickness, gonadotropin type and dosage, insemination or TI cycle day. Pregnant vs non pregnant and pregnancies in both groups were analyzed. Results were analyzed with the STATA 7.0 and SPSS 12.0 programs. RESULTS: 873 COH+I UI cycles in 539 couples and 246 COH+ TI in 138 patients were analyzed the pregnancy rates per cycle were 13.1% and 5.2% for each group respectively. The mean woman's age was of 32.9 +/- 3.5 and 31.8 +/- 2.7 years for groups I and II respectively. There were significant differences in sperm density in both groups. The remaining variables showed no statistical differences. CONCLUSIONS: IUI versus TI do not seems to be superior with respect to the pregnancy rates in COH cycles.

[Effect of intramural and subserous myomas on in vitro fertilization cycles and their perinatal results]. / Efecto de los miomas intramurales y subserosos en los ciclos de fertilización in vitro y sus resultados perinatales.

OBJECTIVE: To evaluate the effect of intramural and subserous myomas in in vitro fertilization cycles, as well as its perinatal results. TYPE OF STUDY: Cases and controls. MATERIAL AND METHODS: All the IVF cycles between October 1999 and December 2004 were included. The variables of size and type of myomas, as well as variables of IVF cycles, implantation and pregnancy rates, and perinatal results were analyzed. We calculated the chi-square test to analyze the relationship between myomas and pregnancy. The t-Student test was used to establish the difference in the average between both groups regarding the studied variables. In the logistic regression analysis we controlled confusing variables. RESULTS: We analyzed 431 cycles made in 364 patients divided into two groups: study cases (with myomas-65 cycles) and control cases (without myomas-366 cycles). Age was two years older in the study group (35.7 vs 33.5, p < 0.001). There was no difference in: duration, type of infertility, days of stimulation, gonadotrophin dose, total and mature follicles, and fertilization and implantation rates. We only observed a difference in the recovered oocytes (8.0 vs 9.7, p = 0.027). The pregnancy, abortion and live-born children rates were of 20.0 vs 23.2, 46.1 vs 29.4, and 46.1 vs 58.8%, respectively (study and control groups; p > 0.05). Logistic regression showed that myomas do not affect the possibility of getting pregnant. CONCLUSION: Intramural and subserous myomas < 5 cm do not seem to have an effect in the IVF cycles nor in its perinatal results. In women with myomas < 5 cm that no dot distortion the uterine cavity it is questionable the usefulness of a myomectomy prior to IVF cycles.

[Prognostic factors of pregnancy in intrauterine insemination]. / Factores pronóstico de embarazo en inseminación intrauterina.

BACKGROUND: The artificial insemination is the introduction of spermatozoa in the feminine genital tract without carrying out sexual contact and with the purpose of obtaining the pregnancy. The insemination intrauterine has improved its rate of success thanks to the technological advances and the best knowledge of human reproductive physiology. OBJECTIVES: To evaluate the prognostic factors for the pregnancy success and calculate the cumulative rate per cycle in IUI (intrauterine insemination). PATIENTS AND METHODS: This study was descriptive, retrospective, analytic, and longitudinal. The cycles of IUI were analyzed from January 1st 2003 to December 31st 2005. Couples 24-41 years old with primary and secondary infertility were included. The following variables were studied: age of participant, type of infertility, length of infertility, aetiology, postcapacitation sperm density and motility, number of follicles, endometrial thickness, and the cycle number in which the IUI was performed. Patients carried out a protocol of ovarian stimulation and follicular follow up. The results were analyzed with 11.0 SPSS, continuous variables were analyzed and reported as means +/- SD with univariate logistic regression to determine statistic significance. Categoric variables were reported in frequencies and percentages. ROC curves were calculated to determine optimal cutting points. RESULTS: 668 cycles were analyzed in 391 couples. The pregnancy rate per cycle and couple was of 13.0 and 21.7% respectively. Means +/- SD patient age was 33.5 +/- 3.4 years old. The three variables with p < 0.05 were: the infertility duration, sperm motility and the cycle number in which IUI was performed. No statistical significance was found in the remaining variables. CONCLUSIONS: The greatest success in IUI will be achieved with infertility of 4 years or less, with sperm motility of 77.6% and in the first two cycles of treatment.

[Perinatal results in pregnancies obtained with embryo transfer in vitro fertilization: a case-control study]. / Resultados perinatales de embarazos por fertilización in vitro con transferencia de embriones (FIVTE): un estudio de casos y controles.

BACKGROUND: In 1978 the first successfull birth by in vitro fertilization took place and this assisted reproduction technique became alternative of treatment in the couples with infertility that had not obtained pregnancy with conventional treatments. The conditions of clinical treatment and laboratory improved, which were in greater number of pregnancies. In 1985 the first study was published that showed adverse perinatal results in pregnancies obtained with fertilization in vitro. Some researchers attributed these results to the increase in the number of multiple pregnancies, pregnant patients older than 35 years, and to the antecedents of infertility. OBJECTIVE: To compare the perinatal outcomes of pregnancies obtained by in vitro IVFET vs spontaneous pregnancies. PATIENTS AND METHODS: A retrospective, case-control study. All pregnancies obtained after IVF ET from October 1st 1999 to November 30th 2004 were compared with a control group of naturally conceived pregnancies and matched by maternal age and the number of fetus. Data concerning obstetric complications and perinatal outcomes were recorded and matched with their control. RESULTS: We analyzed 26 vs 52 singleton, 10 vs 20 twins, 5 vs 5 triplet pregnancies, there were no controls for the quadruplet and quintuplet pregnancies. The mean gestational age at delivery and Capurro score in the singleton pregnancies were 37.8 vs 38.8 y 38.2 vs 39.4 weeks for the study and control groups respectively (p < 0.05), the female sex was more frequent in singleton pregnancies obtained by FIVTE (p < 0.05). There were no statistically significant difference in the premature rupture of membranes, preterm labor, preeclampsia, gestational diabetes, placenta accreta, preterm delivery and low birth weight. The mean birth weight of the pregnancies obtained by IVF were of 2,962.8, 2,100 and 1,532 g for singleton, twin, and triplet respectively. A higher incidence of preterm delivery was found in twin pregnancies but it was not statistically significant. CONCLUSIONS: The rates of adverse perinatal outcomes of the pregnancies after IVF were not higher than pregnancies conceived spontaneously. Twin pregnancies have a greater risk to cause preterm delivery not related to the IVFET procedure.

[Perinatal result of an institutional assisted reproduction program]. / Resultado perinatal de un programa de reproducción asistida institucional.

BACKGROUND: Assisted reproductive technology manipulates masculine gametes, embryos and implantation. It also aids the known or unknown factor of sterility without having the base problem correction as a target. In vitro fertilization and embryo transfer are among these techniques. OBJECTIVE: To describe the overall outcome and the final perinatal offspring after in vitro fertilization cycle in an institutional third level hospital. MATERIALS AND METHODS: IVF cycles were retrospectively analyzed from October 1999 to May 2004. Several variables were described like: age, fertilization rate, implantation and pregnancy rate, fetal status, time of gestation during labor, miscarriage follicle-stimulating hormone rate and take-home baby rate. Patients underwent hypophyseal supression with GnRH analog, using a long luteal phase protocol and stimulated with recombinant FSH. Overall data is expressed as average +/- standard deviation and percentage. RESULTS: 365 cycles were analyzed in 314 patients, average age was of 34 +/- 3.7 years, tubal factor was diagnosed in 63.3%, fertilization rate was of 60.4%, implantation rate of 37.1%, per transfer pregnancy rate of 25.1%, per transfer live born rate of 21.7%, multiple pregnancy rate of 29.3%, miscarriage rate of 28% and ectopic pregnancy rate of 4.8%. In 87.8% of the cases caesarean operation was made; multiple pregnancy offspring weighted more than 1250 g in 70% of them; 70.5% was born after 32 weeks of pregnancy; 90% was born live and with good prognosis. Glucose metabolism alterations were the most frequent maternal complication. CONCLUSION: Although the results obtained were similar to those of assisted reproduction centers, it suggests improving multiple pregnancy rate and abortion rate.

[Estrogen role in the luteal phase support in in vitro fertilization with embryo transfer cycles]. / Papel de los estrógenos en el soporte de la fase lútea en ciclos de fertilización in vitro con transferencia de embriones.

OBJECTIVE: To evaluate the effectiveness of estradiol administration for luteal phase support and to describe the progesterone and estradiol behavior in vitro fertilization-embryo transfer luteal phase. MATERIAL AND METHODS: Patients undergoing in vitro fertilization-embryo transfer with controlled ovarian hyperstimulation and using gonadotropin releasing hormone agonist. They were divided at random into two groups: group 1 would receive progesterone alone, and group 2 would take estrogen and progesterone. Serum concentrations of estradiol and progesterone were measured on days 7 and 14 post-embryo transfer. RESULTS: We examined 52 patients; 24 received progesterone alone and 28 took estrogen and progesterone. Significantly higher estradiol and progesterone concentrations on day 14 were found in pregnant women. It was not on day 7. A significant increment of estrogen was found in the estrogen and progesterone group. Progesterone did not increase significantly. Pregnancy rate was the same in both groups. CONCLUSIONS: For patients undergoing in vitro fertilization-embryo transfer, the addition of estradiol to the progesterone support regimen does not have beneficial effects in terms of pregnancy rate. On day 7 neither progesterone nor estradiol are good predictors of pregnancy.

Diagnóstico prenatal en 350 amniocentesis / Prenatal diagnosis in 350 amniocentesis

Se realizaron 350 amniocentesis entre marzo de 1988 y marzo de 1991, como parte del programa de diagnóstico prenatal del Instituto Nacional de Perinatología. El diagnóstico citogenético se obtuvo en 348 casos (99.4%), de los cuales 10 (2.9%), fueron cromosómicamente anormales: Síndrome de Down, Síndrome de Edwards, (2) Síndrome de Turner, (1) Síndrome de Klinefelter (1) e inestabilidad cromosómica. (1) además se identificó un feto portador de translocación robertsoniana, dos portadores de translocaciones recíprocas balanceadas y tres más presentaron mosaicismo verdadero. En el grupo de pacientes estudiadas por indicación diferente de riesgo para cromosopatía, se observó un feto femenino afectado por hiperplasia suprarrenal congénita. En dos casos se observó pérdida fetal posiblemente atribuible al procedimiento por lo que la tasa de aborto fue de 0.57%.(au)

Caracterización de un modelo in vitro para el estudio de las propiedades invasivas del trofoblasto / Characterization of an in vitro model of the invasive properties of the trophoblast

Se analizó la probable utilidad del cultivo de biopsias de vellosidades coriales humanas del primer trimestre, como un modelo de estudio de las propiedades invasivas del trofoblasto. Para definir el evento desde el punto de vista bioquímico, se buscaron diferentes marcadores del fenómeno que incluyó la identificación de actividades enzimáticas que permiten el fenómeno invasivo. Fue posible demostrar que las células derivadas del cultivo de las biopsias liberan activamente al medio de cultivo proteasas neutras dentro de las que se identificó con ensayos específicos a colagenasa y gelatinasa. También fue posible identificar, usando una técnica de gel/sustrato, a otras proteasas que no han sido caracterizadas. La expresión de todas estas enzimas, dirigidas contra componentes de la matriz extracelular uterina, permite el uso de este modelo para estudiar los mecanismos de regulación de su síntesis y actividad, y así, caracterizar desde el punto de vista molecular el evento invasivo.

El diagnóstico y la decisión quirúrgica en el embarazo ectópico: un análisis probabilístico / The diagnosis and surgical decision in ectopic pregnancy: a probabilistic analysis

Se destaca la problemática que representa el diagnóstico del embarazo ectópico antes de que se presente el cuadro agudo o establezca su forma organizada, con énfasis en las diferentes tasas de morbimortalidad y pronóstico de fertilidad, cuando se ofrece a la enferma la oportunidad del tratamiento óptimo. Se muestra un análisis probabilístico calculado por microcomputadora con base en el teorema de Bayes de cómo se comportan 10 indicadores clínicos en focados de manera aislada y en conjunto en el diagnóstico diferencial del embarazo tubario y amenaza de aborto, cuerpo lúteo hemorrágico, enfermedad inflamatoria pélvica, apendicitis y tumor de ovario estudiados de manera retrospectiva en población seleccionada. Se ponen de manifiesto los alcances y limitaciones del modelo como un sistema que ayuda al médico a tomar decisiones en la práctica clínica diaria y en su formación, al hacer explícito el método sobre la manera como se debe seleccionar, ordenar y capturar los datos y sobre todo el análisis de la experiencia al procesar la información clínica. Este primer intento del autor, pretende adquirir la experiencia necesaria para el desarrollo de esta tecnología en la resolución de problemas específicos de la especialidad. Por otro lado el trabajo marca un esfuerzo preliminar en el diseño de metodología útil para el diagnóstico automatizado que, aun cuando por el momento se encuentra restringido a muy pocos centros de trabajo, promete expectativas interesantes en el ejercicio de la medicina.