Variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey

Fundamento: la infertilidad femenina es un término utilizado para referirse a una mujer que no ha podido quedar embarazada después de haberlo intentado por lo menos en un año al mantener relaciones sexuales desprotegidas. Objetivo: caracterizar algunas variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Hospital Docente Ginecobstétrico Provincial Ana Betancourt Mora de Camagüey durante el año 2021. El universo estuvo constituido por 304 pacientes con diagnóstico de infertilidad. Las variables estudiadas incluyeron: grupo etáreo, tipo de infertilidad, municipio de origen, tasa de incidencia, nivel educacional, hábitos tóxicos, factores de riesgo y antecedentes personales. Los datos se expresaron en números y porcientos. Resultados: el 30,9 % correspondió al grupo etáreo de 30 a 34 años, procedentes en su mayoría del municipio Camagüey (43,5 %), mientras Céspedes alcanzó la mayor tasa de incidencia (13,8 %) por cada 1000 mujeres con rango de edad que pudieran ser admitidas en el programa. Un porciento elevado tenía estudios universitarios (45,4 %) y preuniversitarios (24,3 %), predominó el consumo de café (24,0 %) y tabaco (14,5 %) como hábitos tóxicos; así como enfermedades de trasmisión sexual (24,7 %) y el uso de anticonceptivo (21,1 %). La obesidad (13,5 %) resultó ser el principal antecedente personal. Conclusiones: la infertilidad femenina está determinada por varios factores, incluidos los epidemiológicos, como los hábitos tóxicos, el estado nutricional, los antecedentes personales, entre otros, en su mayoría modificables, que pueden ser tratados desde la Atención Primaria de Salud.

Background: female infertility is a term used to refer to a woman who has not been able to get pregnant after trying for at least a year by having unprotected sexual intercourse. Objective: to characterize some socio-epidemiological variables of female infertility in Camagüey province. Methods: a descriptive, cross-sectional study was carried out at the Ana Betancourt Mora Camagüey Provincial Gynecobstetric Teaching Hospital during the year 2021. The universe consisted of 304 patients diagnosed with infertility. The variables studied included: age group, type of infertility, municipality of origin, incidence rate, educational level, toxic habits, risk factors, and personal history. Data were expressed in numbers and percentages. Results: 30.9 % corresponded to the age group of 30 to 34 years, coming mostly from the Camagüey municipality (43.5 %), while Cespedes reached the highest incidence rate (13.8 %) per 1000 women with age range that could be admitted to the program. A high percentage had university studies (45.4 %) and pre-university studies (24.3 %), the consumption of coffee (24.0 %) and tobacco (14.5 %) predominated as toxic habits; as well as sexually transmitted diseases (24.7 %) and the use of contraception (21.1 %). Obesity (13.5 %) turned out to be the main personal history. Conclusions: female infertility is determined by several factors, including epidemiological ones, such as toxic habits, nutritional status, personal history, among others, mostly modifiable, which can be treated from Primary Health

Dolor pélvico crónico en mujeres / Chronic pelvic pain in women

RESUMEN Fundamento: el dolor pélvico crónico es un problema ginecológico frecuente en las mujeres de edad fértil. Se define como el dolor no cíclico que persiste durante seis meses o más, localizado en la pelvis, en la porción infra umbilical de la pared abdominal anterior, en la región lumbosacra o en la región glútea lo que provoca discapacidad funcional. Las mujeres en edad fértil, son sin lugar a duda el grupo etario fundamental para la salud global y de las futuras generaciones. Muchas mujeres acuden a consulta de Ginecología por presentar dolor pelviano crónico y al realizarles la historia clínica, se observan problemas de fertilidad. Objetivo: caracterizar el comportamiento del dolor pélvico crónico de causa ginecológica en pacientes en edad fértil. Métodos: se realizó un estudio observacional, descriptivo, transversal. La población de estudio estuvo constituida por 123 mujeres con diagnóstico de dolor pélvico crónico de causa ginecológica y en edad fértil, que fueron atendidas en consulta de Ginecología en el Hospital Docente Clínico Quirúrgico Comandante Manuel Fajardo Rivero de Villa Clara durante el período comprendido entre el 1ro de septiembre de 2017 al 30 de septiembre de 2019. Resultados: las mujeres en el estudio eran adultas. La principal causa del dolor fue la endometriosis. La mayoría eran multíparas y presentaron infertilidad. Conclusiones: la mayoría de las pacientes con dolor pélvico crónico en edad fértil eran adultas. La principal causa del dolor pélvico crónico fue la endometriosis, seguido de las adherencias. La mayoría de las mujeres eran multíparas y presentaron infertilidad.

ABSTRACT Background: chronic pelvic pain is a frequent gynecological problem in women of childbearing age. It is defined as non-cyclical pain that persists for six months or more, located in the pelvis, in the infra-umbilical portion of the anterior abdominal wall, in the lumbosacral region or in the gluteal region, causing functional disability. Women of childbearing age are without a doubt the fundamental age group for global health and for future generations. Many women come to the gynecology clinic for having chronic pelvic pain and when the medical history is done, a high incidence of fertility problems is observed. Objective: to characterize the behavior of chronic pelvic pain of gynecological cause in patients of childbearing age. Methods: an observational, descriptive, cross-sectional study was carried out. The study population consisted of 123 patients with a diagnosis of chronic pelvic pain of gynecological cause and of childbearing age, which weretreated in a gynecology consultation at the Comandante Manuel Fajardo Rivero Teaching Clinical Hospital of Villa Clara during the period from September 1st, 2017 to September 30th, 2019. Results: the women in the study were adults. The main cause of pain was endometriosis. Most of the women were multiparous and had infertility. Conclusions: most of the patients with chronic pelvic pain in childbearing age were adults. The main cause of chronic pelvic pain was endometriosis, followed by adhesions. Most of the women were multiparous and had infertility.

Caracterización clínico-epidemiológica de la mujer infértil / Epidemiological-clinical characterization of infertile women

RESUMEN Fundamento: la infertilidad es la incapacidad para tener hijos, pero con posibilidad de embarazo que no llega a término. En el mundo existen 187 millones de parejas afectadas. Objetivo: caracterizar las mujeres atendidas en la consulta municipal de infertilidad. Métodos: se realizó un estudio descriptivo observacional y retrospectivo en Policlínico Docente Emilio Daudin Bueno, de la provincia Guantánamo, durante el periodo enero de 2017 a junio de 2020. El universo estuvo constituido por las 128 mujeres infértiles de 19-39 años atendidas en consulta. Fueron evaluadas variables cualitativas y cuantitativas. La información de cada variable estudiada se obtuvo de las historias clínicas de las pacientes atendidas en consulta. Resultados: predominaron las féminas de 25-29 años con infertilidad secundaria; las infecciones genitales como factor causal predominante, seguido de los antecedentes obstétricos desfavorables y en la mayoría de las pacientes el peso saludable como evaluación nutricional. Se pudo percibir que del total de las pacientes, en algunas existió algún grado de aumento del peso corporal. Conclusiones: la consulta de infertilidad cumple el objetivo de lograr la concepción de las féminas según las causas que impiden la misma, la actuación de cada profesional de la salud al incorporar los conocimientos necesarios a emplear en su adecuado seguimiento, permitirá concretarlo desde la Atención Primaria de Salud.

ABSTRACT Background: infertility is the inability to have children, but with the possibility of pregnancy, which does not reach term. There are one hundred and eighty-seven million affected couples in the world. Objective: to characterize women treated in the municipal consultation of infertility. Methods: an observational and retrospective descriptive study was carried out in Emilio Daudinot Bueno Docent Polyclinic, Guantánamo, during the period January 2017 to June 2020. The universe was made up of 128 infertile women who met the inclusion criteria: 19-39 years old, seen in infertility consultation and fulfill the concept of infertility. Qualitative and quantitative variables were evaluated. The primary data was obtained from the medical records of the patients seen. Results: females aged 25-29 years with secondary infertility predominated; genital infections as the predominant cause factor, followed by unfavorable obstetric history and, in most patients, healthy weight as a nutritional assessment. It was possible to perceive that of the total number of patients, in some there was some degree of increase in body weight. Conclusions: the infertility consultation fulfills the objective of achieving the conception of women by attenuating the causes that prevent it, the performance of each health professional by incorporating the necessary knowledge to be used in its adequate follow-up, will allow specifying it from Primary Care of health.

Miomectomía múltiple por vía abdominal / Multiple abdominal myomectomy

RESUMEN Se presentaron dos pacientes a las cuales se les realizó una miomectomía en los meses de enero y marzo de 2017, en la localidad de Luanda, Angola. Ambas fueron atendidas en la consulta de Ginecología por: aumento de volumen del abdomen, sangramiento genital durante la menstruación y fuera de ella, síntomas compresivos caracterizados por urgencia miccional y estreñimiento, además de infertilidad. Se les realizaron: exámenes de laboratorio, ultrasonido ginecológico y renal, así como histerosalpingografía. Después del análisis de estos exámenes se les diagnosticó una miomatosis uterina múltiple; fueron remitidas al salón de operaciones con previo consentimiento informado y se les practicó una miomectomía múltiple sin complicaciones transoperatorias. Se conservó el útero en ambas pacientes, las cuales tuvieron una recuperación postoperatoria satisfactoria. Una de estas pacientes logró un embarazo cinco meses después de la cirugía.

ABSTRACT We present two patients who had a myomectomy in January and March 2017, in Luanda, Angola. Both were treated in the Gynecology consultation due to increased abdominal volume, genital bleeding during and between periods, compressive symptoms characterized by urinary urgency, constipation and infertility. Laboratory tests, gynecological and renal ultrasound, as well as hysterosalpingography were performed. After the analysis of these tests, they were diagnosed with multiple uterine myomas, referred to the operating room with prior informed consent and underwent a multiple myomectomy without transoperative complications. The uterus was preserved in both patients, who had a satisfactory postoperative recovery. One of these patients got pregnant five months after surgery.

Infertilidad e hipotiroidismo subclínico / Infertility and subclinical hypothyroidism

RESUMEN Fundamento: la infertilidad adquiere cada día mayor auge en las sociedades desarrolladas, la misma se define como la incapacidad para procrear después de un año de vida sexual activa no protegida por algún tipo de contracepción, el hipotiroidismo que se define como la hiposecreción de hormonas por la glándula tiroides se relaciona con problemas ovulatorios, de implantación, infertilidad abortos y complicaciones durante el embarazo. Objetivo: identificar la presencia de hipotiroidismo subclínico en mujeres con infertilidad. Métodos: se realizó un estudio transversal y descriptivo en pacientes atendidas en el servicio de reproducción asistida de la provincia Pinar del Río, desde el 1ro enero de 2017 hasta el 30 junio de 2019. Los datos se obtuvieron de las historias clínicas. Para el análisis de la información se utilizó el sistema estadístico SPSS (versión 22.0), se confeccionó una base de datos en Excel 2010, se aplicó análisis univariado de carácter descriptivo, se utilizaron estadígrafos descriptivos como la distribución de frecuencias absoluta y relativa. Se utilizaron las pruebas T de Student para datos cuantitativos y Chi cuadrado para datos cualitativos, ambas con un nivel de significancia del 95 % (p < 0,05). Resultados: la mayor parte de las mujeres tenían infertilidad secundaria. El hipotiroidismo subclínico resultó más frecuente en la infertilidad secundaria. Los valores medios de hormona estimulante de la tiroides resultaron mayores en mujeres con infertilidad primaria, quienes presentaron de manera significativa niveles menores de triyodotironina en suero, la mitad tuvo un tiempo de infertilidad entre dos y cinco años. Predominó el sobrepeso. Conclusiones: se encontró mayor prevalencia de hipotiroidismo subclínico entre las mujeres con infertilidad secundaria.

ABSTRACT Background: infertility acquires a growing boom in developed societies, it is considered as the inability to procreate after a year of active sexual life not protected by some type of contraception; the hypothyroidism that is defined as the hyposcretion of hormones by the thyroid gland is related to ovulatory problems, implantation, infertility, abortions and complications during pregnancy. Objective: to identify the presence of subclinical hypothyroidism in women with infertility. Methods: a cross-sectional and descriptive study was carried out on patients treated in the assisted reproduction service of the Province of Pinar del Río, in the period from January 1st, 2017 to June 30th, 2019. Data were obtained from the medical records. For the analysis of the information, the statistical system SPSS (version 22.0) was used, a database was created in Excel 2010, descriptive univariated analysis was applied, descriptive statistics were used as the absolute and relative frequency distribution. The Student's T test was used for quantitative data and Chi square for qualitative data, both with a level of significance of 95% (p<0.05). Results: most of the women had secondary infertility. Subclinical hypothyroidism was more frequent in secondary infertility. The average values ​​of thyroid stimulating hormone were higher in women with primary infertility who presented significantly lower levels of serum triiodothyronine, half had an infertility time between two and five years. Overweight predominated. Conclusions: A higher prevalence of subclinical hypothyroidism was found among women with secondary infertility.

Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura / Protocol for the management of infertile couples with catgut implantation in acupuncture points

RESUMEN Introducción: en la mujer, el hallazgo inmediato más importante en los estudios de infertilidad es la ausencia de ovulación y aunque en su tratamiento existen alternativas, aún son ineficaces debido a limitaciones diagnósticas y terapéuticas. En las causas masculinas, las alteraciones idiopáticas de la calidad del semen predominan, son más frecuentes la astenozoospermia y oligozoospermia, asociado al diagnóstico de varicocele. Las razones por las cuales el potencial de fertilidad no siempre se mejora después de tratamiento quirúrgico oportuno y adecuado del varicocele, están todavía en estudio, y los tratamientos convencionales propuestos son costosos y no siempre efectivos. Objetivo: elaborar un protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura. Desarrollo: se analizaron temáticas sobre la atención a la mujer con ciclos anovulatorios y a hombres infértiles después del tratamiento quirúrgico del varicocele y con infertilidad idiopática y los tratamientos tradicionales propuestos. Se generaron preguntas científicas para confeccionar el protocolo. Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura que incluye: profesionales a quienes va dirigido, población diana, recursos necesarios, equipo de trabajo, papel de los miembros del equipo, secuencia de actuación, modo de realización, ventajas, desventajas y contraindicaciones de la implantación de catgut, diferenciación y tratamiento en cada caso según el diagnóstico tradicional chino e indicadores de evaluación. Conclusiones: la modalidad terapéutica propuesta, es una alternativa inocua y poco costosa que contribuye a mejorar la fecundidad y la natalidad de la pareja infértil.

ABSTRACT Introduction: in women, the most important immediate finding in infertility studies is the nonexistence of ovulation and although there are alternatives in their treatment, they are still ineffective due to diagnostic and therapeutic limitations. In male causes, idiopathic alterations in semen quality predominate, the most frequent being asthenozoospermia and oligozoospermia associated with the diagnosis of varicocele. The reasons why fertility potential is not always improved after timely and adequate surgical treatment of varicocele are still under study, and the proposed conventional treatments are expensive and not always effective. Objective: to elaborate a protocol for the management of the infertile couples with catgut implantation in acupuncture points. Development: topics regarding this protocol were analyzed on the care of women with anovulatory cycles and infertile men after surgical treatment of varicocele along with idiopathic infertility as well as the proposed traditional treatments, generating scientific questions to draw up the protocol. The protocol for the management of infertile couples with implantation of catgut in acupuncture points includes: professionals to whom it is directed, target population, necessary resources, teamwork, role of team members, sequence of action, approach for its implementation, advantages, disadvantages and contraindications concerning the implantation of catgut, differentiation and treatment in each case according to the traditional Chinese diagnosis and assessment indicators. Conclusions: the proposed therapeutic modality is an innocuous and inexpensive alternative that contributes to the improvement of fertility and birth rate in the infertile couples.

Hipotiroidismo asociado con infertilidad en mujeres en edad reproductiva / Hypothyroidism associated with infertility in women in reproductive age

Resumen: OBJETIVO: Revisar la bibliografía más reciente para valorar y sintetizar los aspectos más importantes relacionados con las repercusiones del hipotiroidismo y su asociación con infertilidad en la mujer en edad reproductiva. METODOLOGÍA: Estudio de investigación documental consistente en la búsqueda en las bases electrónicas de PubMed y Google Scholar (1993-2018) con las palabras clave: hipotiroidismo subclínico, hipotiroidismo, disfunción tiroidea, hipofunción tiroidea, enfermedad de tiroides subclínica, pérdida de embarazo, aborto y embarazo; escritos en español e inglés y estudios retrospectivos publicados en libros de texto. RESULTADOS: Se incluyeron 39 documentos y se seleccionaron los de mayor relevancia científica y epidemiológica. El hipotiroidismo afecta a las mujeres en edad reproductiva con prevalencia de 0.4-0.5% para el evidente y 2-8% para el subclínico, este último puede resultar en infertilidad femenina y pobres desenlaces reproductivos. CONCLUSIÓN: El hipotiroidismo es una enfermedad que afecta más a las mujeres que a los hombres, con mayor incidencia en la etapa fértil. El diagnóstico y tratamiento oportuno mejoran el pronóstico de la fertilidad, embarazo y vida del recién nacido.

Abstract: OBJECTIVE: To review the most recent bibliography to assess and synthesize the most important aspects in relation to the repercussions of hypothyroidism and its association with infertility in women of reproductive age. METHODOLOGY: Documentary research study carried out based on the search in PubMed and Google Scholar; from the years 1993 to 2018 with the keywords: subclinical hypothyroidism, hypothyroidism, thyroid dysfunction, thyroid hypofunction, subclinical thyroid disease, pregnancy loss, abortion and pregnancy in Spanish and English and retrospective study in textbooks. RESULTS: 39 documents were included, selecting the ones with the highest scientific and epidemiological relevance. Hypothyroidism affects women of reproductive age with a prevalence of 0.4-0.5% for the obvious and 2-8% for the subclinical, the latter can result in female infertility and poor reproductive results. CONCLUSION: Hypothyroidism is a pathology that affects women, with a higher incidence in the fertile stage. A timely diagnosis and treatment improve the prognosis of fertility, pregnancy and life of the newborn.

Association of obesity and anovulatory infertility / Associação entre obesidade e infertilidade anovulatória

ABSTRACT Objective To verify the association of obesity and infertility related to anovulatory issues. Methods This case-control study was carried out with 52 women, aged 20 to 38 years, divided into two groups (infertile − cases − and fertile − control), seen at outpatient clinics, in the period from April to December, 2017. Results We found significant evidence that obesity negatively affects women's fertility (p=0.017). The group of infertile women was 7.5-fold more likely to be obese than fertile women. Conclusion Strategies that encourage weight control are indicated for women with chronic anovulation, due to hight metabolic activity of adipose tissue.

RESUMO Objetivo Verificar em mulheres a associação entre obesidade e infertilidade relacionada a questões anovulatórias. Métodos Estudo de caso-controle com 52 mulheres, de 20 a 38 anos, divididas em dois grupos (mulheres inférteis − casos − e férteis − controles), atendidas em ambulatórios, no período de abril a dezembro de 2017. Resultados Verificou-se evidência significativa de que a obesidade afeta negativamente na fertilidade das mulheres (p=0,017). O grupo de mulheres inférteis teve 7,5 vezes mais chances de serem obesas quando comparadas às mulheres férteis. Conclusão Estratégias que estimulem o controle do peso são indicadas para mulheres com anovulação crônica devido à elevada atividade metabólica do tecido adiposo.

Caracterización de mujeres con infertilidad de causa endocrina / Characterization of Women with Endocrine Infertility

RESUMEN Fundamento: existe un incremento de la infertilidad en las parejas y las causas endocrinas femeninas están entre las primeras responsables. Objetivo: describir el comportamiento de la infertilidad femenina de causa endocrina en pacientes estudiadas en el Centro Territorial de Reproducción Humana de Cienfuegos. Método: se realizó un estudio descriptivo, de serie de casos en el que se incluyeron a todas las mujeres que se atendieron por infertilidad de causa endocrina desde enero de 2012 hasta enero de 2013. Las variables analizadas fueron: edad, antecedentes patológicos personales, tipo de sangrado, historia obstétrica, valoración nutricional, hirsutismo, bocio, galactorrea, acantosis nigricans, tiempo de infertilidad, tipo de infertilidad. Se creó una base de datos, con ayuda del programa SPSS con el que se realizó el procesamiento para su posterior análisis. Se aplicó la estadística descriptiva, frecuencias y porcientos. Resultados: el grupo de edad que predominó fue el de 30 a 34 años y el 9,4 % de las féminas tenían antecedentes patológicos personales de obesidad, casi la mitad presentaron oligomenorrea, un 33,6 % de ellas presentaron sobrepeso y se detectó que en el examen físico un 34,3 % de las pacientes presentaron acantosis nigricans. El mayor número de mujeres acudieron con un tiempo de infertilidad menor de 3 años para un 50,4 %. Un 66,4 % presentó infertilidad secundaria y según el diagnóstico endocrino la hiperprolactinemia fue la más representativa con el 38,7 %. Conclusiones: la infertilidad de causa endocrina se presentó principalmente en mujeres con sobrepeso, con un tiempo de infertilidad de tipo secundaria menor de 3 años y la hiperprolactinemia fue la más representativa.

ABSTRACT Foundation: there is an increase in couple infertility and female endocrine causes are among the main reasons. Objective: to describe the behavior of endocrine female infertility in patients studied at the Territorial Center for Human Reproduction of Cienfuegos. Method: a descriptive series of case studies was conducted in which all women treated for endocrine infertility from January 2012 to January 2013 were included. The variables analyzed were age, personal pathological history, type of bleeding, obstetric history, nutritional assessment, hirsutism, goiter, galactorrhea, acanthosis nigricans, time and type of infertility. A database, using SPSS program was created and processed for further analysis. Descriptive statistics, frequencies and percentages were applied. Results: the predominant age group was 30 to 34 years old and 9.4 % had a personal pathological history of obesity, almost half had oligomenorrhea 33.6 % of them were overweight and on physical examination 34.3 % of the patients showed acanthosis nigricans. The largest number of women attended with less than 3-year infertility was 50.4 %. Secondary infertility was 66.4 % and according to the endocrine diagnosis, hyperprolactinemia was the most representative with 38.7 %. Conclusions: endocrine infertility occurred mainly in overweight women; with a secondary, less than 3-year time infertility and hyperprolactinemia was the most representative.

The role of laparoscopy in the propaedeutics of gynecological diagnosis

Abstract Purpose: To evaluate agreement between pre- and post-laparoscopy gynecological diagnosis in order to demonstrate the rationality of this minimally invasive technique use in gynecological propaedeutics. Methods: Retrospective chart review study conducted between March 2010 and October 2016 based on a convenience sample. 315 patients undergoing surgical laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were compared by the diagnosis agreement test considering the proportions of events. Results: Laparoscopy contributed to diagnosis in 59.6% of infertility cases (P>0.05), in 93.7% of chronic pelvic pain of undetermined origin (P<0.01) and conclusively elucidated the diagnosis of acute abdomen and the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05). Conclusion: The use of laparoscopy considerably contributed to diagnostic elucidation, especially in cases of undetermined chronic pelvic pain.

Respuesta terapéutica en pacientes con síndrome de ovarios poliquísticos / Therapeutic answer in patients who suffers from polycystic ovary syndrome

Fundamento: el síndrome de ovarios poliquísticos constituye un desorden heterogéneo, endocrino-metabólico; y ha sido reconocido como la principal causa de infertilidad en mujeres en edad reproductiva. Objetivo: determinar la respuesta terapéutica en pacientes con síndrome de ovarios poliquísticos. Métodos: se realizó un estudio observacional descriptivo longitudinal, en la provincia de Camagüey en la consulta de Endocrinología del Hospital Universitario Manuel Ascunce Domenech desde enero de 2013 hasta enero de 2015. El universo estuvo constituido por la totalidad de pacientes diagnosticadas con síndrome de ovarios poliquísticos que asistieron a consulta. Se utilizó estadística descriptiva y los datos fueron recogidos mediante encuesta. Resultados: de las pacientes atendidas todas respondieron al tratamiento, de las evaluadas con el fenotipo normoandrogénico respondieron de manera adecuada. Después de aplicado el tratamiento las pacientes permanecieron con un volumen ovárico superior a los 13 mL con respecto a lo que presentaba al inicio del estudio. Conclusiones: la variación más importante radicó en la reducción de los niveles plasmáticos de testosterona y el aumento de los valores de la progesterona. La combinación terapéutica más empleada fue el higiénico-dietético asociado al uso de metformina.

Background: polycystic ovary syndrome is an heterogeneous disorder; it has been recognized as the main cause of infertility on women during reproductive ages. Objective: to determine the therapeutic answer on patients who suffers from polycystic ovary syndrome in Camaguey during January 2013 to January 2015. Methods: an observational descriptive and longitudinal study was carried out. The universe was sample by all patients who were diagnosed with polycystic ovary syndrome. The data were processed by descriptive statistics. Results: 66, 97 % of patients answered to the treatment and 70, 00 % of patients who had normoandrogenic type answered correctly too. After the treatment 55, 50 % of patients continuous with ovary volume higher than 13 mL. Conclusions: the most important variation were to reduce blood levels of testosterone and to increase blood levels of progesterone. The therapeutic combination more used was hygienic-dietetic changes plus metformina.

Síndrome de hiperestimulación ovárica severo: Informe de caso y revisión de literatura / Severe Ovarian Hyper Stimulation Syndrome: Case Report and Literature Review / Síndrome de hiperestimulação ovárica grave: Relato de caso e revisão da literatura

Introducción: El síndrome de hiperestimulación ovárica severo es la complicación más grave de la estimulación ovárica durante la inducción de la ovulación. Los hallazgos característicos son la presencia de ovarios aumentados de volumen y ascitis en relación a extravasación de líquido por aumento de la permeabilidad capilar, cuya severidad puede llevar a falla respiratoria, renal, colapso hemodinámico y eventos tromboembólicos. Objetivo: Describir un caso clínico de síndrome de hiperestimulación ovárica, junto con una revisión de la literatura sobre la patología, orientada al diagnóstico y tratamiento óptimo de pacientes con estas características clínicas. Presentación del caso: Paciente de 29 años con antecedente de síndrome de ovario poliquístico que presenta síndrome de hiperestimulación ovárica severo como complicación secundaria a estimulación gonadotrófica. El cuadro clínico mostró ovarios aumentados de tamaño en la evaluación sonográfica; anasarca dada por ascitis y derrames pleurales bilaterales e insuficiencia respiratoria tipo distrés respiratorio del adulto. Se realizó paracentesis y se utilizó ventilación mecánica no invasiva, logrando la expansión pulmonar. Discusión: El análisis de este caso se inició siete días después de la administración de gonadotropina, favorecido por las condiciones previas de la paciente, sin complicaciones letales. Conclusiones: La paracentesis puede constituir una opción terapéutica efectiva en el tratamiento de ascitis con compromiso de la función pulmonar. La ventilación mecánica no invasiva es una estrategia para evitar la intubación en estas pacientes lo cual evita los periodos de sedación exhaustivos y el consiguiente riesgo de broncoaspiración. [Urbina-Contreras ZE, Urbina-Echeverry SE,Lamos-Duarte AF, Picón-Jaimes YA. Síndrome de hiperestimulación ovárica severo: Informe de caso y revisión de literatura. MedUNAB 2017; 20(2): 244-251].

Introduction: Severe ovarian hyper stimulation syndrome is the most serious complication of ovarian stimulation during the induction of ovulation. Characteristic findings are the presence of increased ovarian volume and ascites in relation to fluid extravasation due to increased capillary permeability whose severity can lead to respiratory failure, renal failure, and hemodynamic collapse and thromboembolic events. Objective: To describe a clinical case of OHSS, along with a review of the literature on the pathology, aimed at the diagnosis and optimal treatment of patients with these clinical characteristics. Case presentation: A 29-year-old patient with a history of polycystic ovarian syndrome who presented severe Severe ovarian hyper stimulation syndrome as a secondary complication to gonadotrophic stimulation. The clinical profile showed enlarged ovaries in the sonographic test; anasarca due to ascites and bilateral pleural effusions and respiratory failures that belong to a respiratory distress type in this adult patient. Paracentesis was performed and noninvasive mechanical ventilation was used, achieving lung expansion with it. Discussion: The analysis of this case was started seven days after the administration of gonadotropin, favored by the patient's previous conditions, with no lethal complications. Conclusions: Paracentesis may be an effective therapeutic option in the treatment of ascites with compromised lung function. Noninvasive mechanical ventilation is a strategy to avoid intubation in these patients, which avoids the periods of exhaustive sedation and the consequent risk of bronchoaspiration. [Urbina-Contreras ZE, Urbina-Echeverry SE, Lamos-Duarte AF, Picón-Jaimes YA. Severe Ovarian Hyper Stimulation Syndrome: Case Report and Literature Review. MedUNAB 2017; 20(2): 244-251].

Introdução: O síndrome de hiperestimulação ovárica avançado é a complicação mais grave da estimulação ovariana durante a indução da ovulação. As características achadas são o aumento do volumem dos ovários e ascite em relação ao extravasamento do fluido devido ao aumento da permeabilidade capilar, cuja gravidade pode levar à insuficiência respiratória, insuficiência renal,colapso hemodinâmico e eventos tromboembólicos. Objetivo: Descrever um caso clínico de síndrome de hiperestimulação ovárica avançado, juntamente com uma revisão da literatura sobre a patologia, visando o diagnóstico e tratamento ótimo de pacientes com essas características clínicas. A presentação do caso: Paciente de 29 anos com história de síndrome de ovário policístico que apresenta síndrome de hiperestimulação ovárica avançado como complicação secundária à estimulação gonadotrófica. O quadro clínico mostrou ovários ampliados na avaliação ultra-sonográfica; anasarca devido à ascite e derrames pleurais bilaterais e insuficiência respiratória do tipo insuficiência respiratória do adulto. Foi realizada a paracentese e foi utilizada ventilação mecânica não invasiva, atingindo a expansão pulmonar. Discussão: A análise deste caso começou sete dias após a administração da gonadotrofina, favorecida pelas condições prévias da paciente, sem complicações letais. Conclusões: A paracentese pode constituir uma opção terapêutica efetiva no tratamento de ascite com comprometimento da função pulmonar. Aventilação mecânica não invasiva é uma estratégia para evitar intubação nessas pacientes, o que evita os períodos de sedação exaustiva e o consequente risco de bronco-aspiração. [Urbina-Contreras ZE, Urbina-Echeverry SE, Lamos-Duarte AF, Picón-Jaimes YA. Síndrome de hiperestimulação ovárica grave: Relato de caso e revisão da literatura. MedUNAB 2017; 20(2): 244-251].

Chlamydia e infertilidad: actualidad y desafíos / Chlamydia and infertility: present time and challenges

Fundamento: la infección por chlamydia constituye, en la actualidad, un serio problema de salud, es la causa infecciosa más frecuente que incide sobre la morbilidad reproductiva en la mujer a nivel mundial. Objetivo: identificar la incidencia de chlamydia trachomatis en pacientes con infertilidad, así como el comportamiento de factores epidemiológicos asociados a esta infección. Métodos: se realizó un estudio observacional descriptivo, de junio de 2013 a abril de 2015., con el objetivo de determinar la incidencia de chlamydia trachomatis en pacientes femeninas infértiles que acudieron al laboratorio de Microbiología del Hospital Provincial Saturnino Lora de Santiago de Cuba, a las que se les tomó muestras de la secreción vaginal y endocervical para llevar a cabo el diagnóstico microbiológico. Resultados: la sintomatología más habitual, evidenciada con respecto a las pacientes positivas, fue la secreción vaginal anormal, con relación al nivel de escolaridad y la positividad obtenida, el mayor porcentaje de casos aislados fue entre los profesionales, según aéreas de salud se encontró mayor incidencia en los policlínicos José Martí, Carlos Juan Finlay y Julián Grimau. Conclusiones: la infertilidad fue la causa que más incidió en la población objeto de estudio, se consideró que las características inusuales de las secreciones dificultan el diagnóstico precoz de la infección.

Background: nowadays, chlamydia infection constitutes a serious health problem. It is the most frequent cause that affects. Objective: to identify the incidence of chlamydia trachomatis in patients with infertility, as well as the behavior of epidemiological factors related to this infection. Methods: a descriptive, observational study was conducted to determine the incidence of chlamydia trachomatis in infertile female patients who attended Saturnino Lora hospital, especially Microbiology laboratory. Samples of vaginal and cervical discharge were taken to make the microbiological diagnosis from June 2013 to April 2015. Results: the most frequent symptomatology related to positive patients was abnormal vaginal discharge. According to educational level and the obtained positivity, the highest percentage of isolated cases was among the professionals. With regard to health areas, the incidence was greater in José Martí, Carlos Juan Finlay and Julián Grimau clinics. Conclusions: infertility was the cause that affected the most related to chlamydia trachomatis in the population that was studied. It was considered that unusual characteristics of discharge make early diagnosis of the infection difficult.

Diagnósticos de enfermagem dos domínios autopercepção e enfrentamento/tolerância ao estresse relacionados à infertilidade feminina / Nursing diagnoses of the domains self-perception and coping/tolerance of stress related to female infertility

Objetivou-se caracterizar o perfil de diagnósticos de enfermagem dos domínios Autopercepção e Enfrentamento/Tolerância ao estresse apresentados por mulheres com queixa de infertilidade. Estudo descritivo, quantitativo, realizado com 40 mulheres, em uma unidade de assistência primária à saúde. Dados foram coletados por meio de formulário de entrevista elaborado para esta pesquisa. Identificou-se 20 diagnósticos. Disposição para poder melhorado, Disposição para enfrentamento melhorado, Disposição para resiliência melhorada, Ansiedade e Baixa autoestima situacional apresentaram maior frequência. Os achados revelaram que a infertilidade pode gerar ansiedade e afetar negativamente a autopercepção da mulher. Entretanto, esta clientela demonstrou disposição para otimizar seu nível de bem-estar. A identificação de diagnósticos contribui para o planejamento do cuidado e enriquece a qualidade do atendimento, possibilitando o preparo destas mulheres para a conquista ou não da maternidade, por meio de intervenções de enfermagem individualizadas, incluindo apoio emocional e psicossocial de acordo com a necessidade de cada uma

The objective was to characterize the profile of nursing diagnoses of the domains Self-perception and Coping/Tolerance of stress of women with infertility complaints. A descriptive, quantitative study conducted with 40 women, in a primary health care unit. Data was collected with an interview form created for this study. We identified 20 diagnoses. Improved readiness for power, Improved readiness for coping, Improved readiness for resilience, Anxiety and, Low situational self-esteem presented were more frequent. The findings revealed that infertility can generate anxiety and negatively affect women's self-perception. However, this clientele demonstrated readiness to optimize their wellbeing. Identification of diagnoses contributes with care planning and enriches the quality of assistance, allowing women to be prepared for achieving maternity or not, through individualized nursing interventions, including emotional and psychosocial support according to the need of each one of them.

Desfecho reprodutivo após septoplastia histeroscópica: estudo retrospectivo / Reproductive outcomes after hysteroscopic septoplasty: a retrospective study

OBJETIVO: Avaliar os resultados reprodutivos após septoplastia histeroscópica. MÉTODOS: Estudo retrospetivo observacional por meio de análise dos registos clínicos de 28 mulheres com antecedentes de infertilidade ou de abortos recorrentes, submetidas à septoplastia histeroscópica. Para a avaliação do desfecho reprodutivo foram consultados os registos informáticos dos Cuidados de Saúde Primários e do nosso Centro Hospitalar, no período compreendido entre a septoplastia e a primeira gravidez ou o presente. Os outcomes primários foram a taxa de gravidez, de recém-nascidos e de abortos após septoplastia. O septo uterino foi diagnosticado por ecografia 2D ou 3D e classificado de acordo com a classificação da American Fertility Society. A septoplastia foi realizada na fase folicular do ciclo menstrual, com recurso da energia monopolar, bipolar e/ou microtesoura. Os programas Microsoft Excel e SPSS versão 17 foram utilizados para comparação do desfecho reprodutivo prévio e posterior à septoplastia. Foi utilizado o teste exato de Fisher, considerando significado estatístico quando p<0,05. RESULTADOS: Foi realizada septoplastia histeroscópica em 20 doentes (72%) com infertilidade secundária e 8 (28%) com infertilidade primária, tendo sido necessária segunda intervenção para remoção completa do septo em 5 casos (18%). Ocorreu um caso perfuração uterina minor. Após septoplastia histeroscópica, 64% das mulheres engravidaram, obtendo-se uma taxa de nados vivos de 48%; gravidez tubária de 4%; e 19% das doentes tiveram abortos espontâneos. CONCLUSÕES: Os resultados do presente estudo estão de acordo com o descrito na literatura, tendo-se obtido uma melhoria significativa dos desfechos reprodutivos, com uma redução da taxa de aborto espontâneo de cinco vezes após a septoplastia histeroscópica. .

PURPOSE: To assess the reproductive outcomes after hysteroscopic septoplasty. METHODS: A retrospective observational study was performed with analysis of the medical records of 28 women with infertility or recurrent abortions undergoing hysteroscopic septoplasty. To evaluate reproductive outcomes we consulted the medical records of our hospital and of primary health care units between septoplasty and the present or first pregnancy. Primary outcomes were pregnancy rate, newborns, and abortions after septoplasty. Uterine septum was diagnosed by 2D or 3D ultrasound and classified according to the American Fertility Society. All procedures were performed in the follicular phase of the menstrual cycle using monopolar or bipolar energy and/or microscissors. To compare the reproductive outcomes before and after septoplasty we used Microsoft Excel and SPSS version 17. Fisher's exact test was considered statistically significant if p<0.05. RESULTS: Hysteroscopic septoplasty was performed in 20 patients (72%) with secondary infertility and in 8 patients (28%) with primary infertility. The septum was incompletely removed during the first hysteroscopy in 5 cases (18%), which required a second surgery. One case was complicated with minor uterine perforation. After hysteroscopic septoplasty, 64% of women became pregnant and 48% live neonates were delivered; 4% of the patients had a tubal pregnancy; and 19% had miscarriages. CONCLUSIONS: The results of this study are consistent with those described in the literature. Patients obtained a significant improvement of reproductive outcomes with a fivefold reduction in miscarriage rate after hysteroscopic septoplasty. .

Calidad de vida relacionada con la salud en mujeres con ovario poliquístico / Health-related Quality of Life in Women with Polycystic Ovary Syndrome

El síndrome de ovario poliquístico es la alteración endocrino-metabólica que más frecuentemente afecta a las mujeres en edad reproductiva. Sus síntomas y signos característicos son las irregularidades menstruales, amenorrea, acné, hirsutismo, obesidad e infertilidad. El síndrome de ovario poliquístico tiene implicaciones significativas para la salud a largo plazo, que pueden conducir a morbilidad psicológica y a una calidad de vida disminuida. Este artículo revisa la literatura actual en relación con el síndrome de ovario poliquístico y la calidad de vida relacionada con la salud, y evalúa cómo algunas manifestaciones clínicas del síndrome de ovario poliquístico afectan la calidad de vida de las mujeres que lo padecen.

Polycystic ovary syndrome is the most frequent endocrine and metabolic disorder in women of reproductive age. Its characteristic signs and symptoms are menstrual irregularities, amenorrhea, acne, hirsutism, obesity and infertility. Polycystic ovary syndrome has major effects on long-term health, which can lead to psychological morbidity and decreased quality of life. This paper reviews the current literature on polycystic ovary syndrome and health-related quality of life; in addition, it assesses how some clinical manifestations of polycystic ovary syndrome affect the quality of life of women who suffer this disorder.

RISK OF INFERTILITY IN PATIENTS WITH CELIAC DISEASE: a meta-analysis of observational studies / Risco de infertilidade em pacientes com doença celíaca: uma meta-análise de estudos observacionais

Context Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. Objectives We seek to determine the relationship between celiac disease and infertility. Methods Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. Results The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. Conclusions Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients. .

Contexto A doença celíaca é uma doença auto imune do intestino delgado associada a manifestações extra-intestinais, tais como distúrbios reprodutivos. A relação entre a doença celíaca e a infertilidade foi previamente avaliada, com resultados conflitantes. Objetivos Procuramos determinar a relação entre a doença celíaca e a infertilidade. Métodos Utilizou-se dados extraídos de estudos de projeto de caso-controle ou coorte de 1966 à dezembro de 2013 utilizando o MEDLINE-Pubmed, EMBASE, LILACS e Cochrane Library. Foram analisados dois tipos de ensaios: os que avaliam o risco de infertilidade em pacientes com doença celíaca já diagnosticados e, os que avaliam a prevalência da doença celíaca não diagnosticada em indivíduos com diagnóstico de infertilidade. Resultados A busca resultou em 413 estudos potencialmente relevantes para a revisão, 12 dos quais foram finalmente incluídos para análise. Foi encontrada uma associação significativa entre as mulheres com diagnóstico de infertilidade e doença celíaca não diagnosticada [TR 3,09 (IC 95% 1,74-5,49)]. Ao considerar esses estudos avaliando a ocorrência de infertilidade em pacientes com doença celíaca já diagnosticada, não foi encontrada diferença entre os pacientes com doença celíaca e controles [TR 0,99 (0,86-1,13)]. Conclusões A falta de diagnóstico para a doença celíaca é um fator de risco para a infertilidade. As mulheres que procuram o conselho médico para esta condição particular, devem ser examinados para a doença celíaca. A adoção de uma dieta sem glúten pode ter um impacto positivo sobre a fertilidade neste grupo de pacientes. .

Prevalência de Chlamydia trachomatis em mulheres submetidas à fertilização assistida em Goiânia / Prevalence of Chlamydia trachomatis in women undergoing assisted reproduction in Goiânia

Objetivo: identificar dentre as mulheres que recorrem à fertilização assistida as que têm positividade para sorologia de Chlamydia trachomatis. Método: estudo retrospectivo, do tipo transversal. As informações foram obtidas por meio da avaliação de prontuários de pacientes. Para que o estudo fosse concluído foi necessária uma amostra de 120 prontuários. A coleta foi feita com a seleção da primeira paciente de cada mês, a exclusão da segunda, a seleção da terceira e assim consecutivamente, para constituir uma amostra significativa de forma aleatória. Por meio da análise dos prontuários foram verificados os critérios de inclusão e exclusão. Resultados: a frequência de infecção por Chlamydia trachomatis foi de 39% e uma paciente apresentou as duas sorologias positivas. A maior incidência de IgG positivo foi na faixa entre 36 e 39 anos. Conclusão: a prevalência de sorologia positiva para Chlamydia trachomatis foi de 40%. É importante o desenvolvimento de ações assistenciais e educacionais contínuas para o cuidado com a saúde, principalmente o rastreamento em mulheres jovens, para controle da disseminação e prevenção de sequelas das doenças sexualmente transmissíveis.

Objective: identify among women using assisted fertilization those with seropositivity for Chlamydia trachomatis. Method: was a retrospective, cross-sectional. Data were collected through evaluation of patient records, the required sample was 120 charts. The collection was made by selecting the first patient of each month and was performed after a jump from a patient, with a close third to be analyzed, and so on, constitute a significant sample randomly without giving preferences. Through the analysis of the records were checked for inclusion and exclusion criteria. Results: the frequency of Chlamydia trachomatis infection was 39%, one patient had two positive tests. The highest incidence of positive IgG was aged between 36-39 years. Conclusion: the prevalence of positive serology for Chlamydia trachomatis was 40%. It is important to develop actions and continuing educational assistance for health care, especially in screening young women for controlling the spread and prevention of sequelae of sexually transmitted diseases.

Endométrio na janela de implantação em mulheres com síndrome dos ovários policísticos / Endometrium in women with polycystic ovary syndrome during the window of implantation

O endométrio humano é submetido a uma complexa série de mudanças proliferativas e secretórias em cada ciclo menstrual e exibe somente pequeno período de receptividade, conhecido como "janela de implantação", necessário para a nidação do blastocisto no útero. O processo da implantação ocorre de forma sequencial, levando ao estabelecimento da gravidez. Alterações morfofuncionais durante este período podem impedir ou dificultar a implantação. Por este motivo, o estudo do endométrio nesta fase é importante para o aprimoramento de terapias que possam interferir nos mecanismos envolvidos na interção materno-embrionária. Várias doenças ginecológicas, incluindo a síndrome dos ovários policísticos (SOP), estão associadas à diminuição da fecundidade e da receptividade uterinas. Apesar de recentes avanços nas técnicas de reprodução assistida, permitindo a seleção de embriões de alta qualidade, a taxa de implantação continua baixa e não tem aumentado suficientemente nas últimas décadas. O presente artigo tem como objetivo revisar os aspectos endometriais da "janela de implantação" em mulheres com a síndrome dos ovários policísticos, focando especialmente as moléculas de adesão. Para tanto, nos valemos da análise de 105 artigos publicados em revistas indexadas no PUBMED nos últimos 50 anos (até maio de 2011). Como conclusão, a receptividade endometrial parece ser o maior fator limitante no estabelecimento da gestação em grande número de doenças ginecológicas, incluindo a SOP, e o tratamento para melhorar as taxas de implantação possivelmente será nessa direção.

The human endometrium undergoes to a complex series of prolifertive and secretory changes in each menstrual cycle and displays only a short period of receptivity, known as the "window of implantation", necessary for the implantation of the blastocyst in the uterus. The implantation process occurs in a sequential manner, leading to the establishment of pregnancy. Morphofunctional changes during this period may prevent or hinder the implantation. For this reason, the study of the endometrium at this stage is important for the improvement of therapies that may interfere with the mechanisms involved in maternal-embryonic interaction. Several gynecological disorders, including polycystic ovary syndrome (PCOS), are associated with decreased fertility and uterine receptivity. In spite of recent advances in assisted reproduction techniques, allowing the selection of high quality embryos, the implantation rate remains low and has not increased enough in recent decades. This article aims at reviewing the endometrial aspects of the "window of implantation" in women with polycystic ovary syndrome, focusing mainly on adhesion molecules. For that purpose, we analyzed 105 articles published in journals indexed in PubMed in the last 50 years (up to May 2011). In conclusion, the endometrial receptivity seems to be the major limiting factor for the establishment of pregnancy in a large number of gynecological diseases, including PCOS, and treatment to improve implantation rates is likely to be taken towards this direction.