[Peritoneal immune response in endometriosis]. / Respuesta inmune peritoneal en endometriosis.

The systematic analysis of immunity status in the peritoneum of women with endometriosis, is presented. Twenty five patients were studied, distributed as follows: A. Endometriosis, B. Sterility of non identified cause. In all the patients, peritoneal fluid was obtained (PF) during diagnostic laparoscopy, and a sample of peripheral blood was taken simultaneously. Both samples were processed analysis of lymphocytes subpopulations (ALS) by flux cytometry using monoclonal antibodies with reactivity to lymphocytes T total (CD+), lymphocytes B (CD19+), auxiliatory/inductory (CD3+CD4+), suppressor/cytotoxic (CD3+CD8+) and NK (CD3+CD16+ + 56+). The peritoneal ALS of both groups were characterized by a clear lymphocyte B diminution, moderate diminution of activators; a considerable increase of suppressors; altered CD4+/CD8+ relation in favour of suppression and NK diminution when comparing with its own blood compartment. All of these values were identical for both groups, and the only significant difference was found when comparing activated lymphocytes T subpopulation that was lesser in PF of women with endometriosis. This is the only fact that backs up the existence of altered immunity in the peritoneum of these patients, that affects the expression of activated lymphocytes. However, taking as a criterium the rest of subpopulations, in endometriosis as well as in ECNI the microenvironment goes for suppression and they are not distinguishable among them. On other side, it started signal characterization that conditions suppression induction for lymphocytes activation in peritoneal environment of women with endometriosis. Ten samples of PF of patients using peripheral purified lymphocytes by density gradient of voluntary donnors, normal, fertile, were analyzed. Cells were cultivated and stimulated in vitro with concanavaline A in presence of timidine 3H. In experimental holes PF was added at dose-response concentration, and it was evaluated as the difference in synthesis of radioactive ADN against the incubated cells in absence of PF. It was possible to demonstrate the presence of associated factors in PF of patients with endometriosis that inhibit proliferation of lymphocytes stimulated by Con A, and not so in samples of ECNI. With these factors one supposes the presence of soluble signals that condition local immunological suppression.

[Ethical and legal considerations on assisted human reproduction in Mexico]. / Consideraciones éticas y legales sobre la reproducción asistida en México.

Assisted Human Reproduction (AHR) has been one of the most important advances in Ginecology and Obstetrics technology, it has contributed to improve understanding on deeper biological mechanisms of human reproduction. Since Louise Brown's birth, in 1978, in vitro fertilization and Human Embryos Transference (HET) developed by Steptoe and Edwards, became the basis for new AHR methods. Later, writen information has increased, so, it is easy to find a lot of scientific reports in national and international specialized journals. These reports contents not only technological advances, but a lot of ethical thoughts which had showed the necessity for a worldwide legislation.

[Preoperative management of uterine leiomyomatosis using pituitary gonadotropin-releasing hormone analogues]. / Tratamiento médico preoperatorio de leiomiomatosis uterina con análogos de hormona liberadora de gonadotropinas hipofisarias.

Uterine leiomyomatosis shows a frequency from 25 to 30% in reproductive age women. Traditional treatment is hysterectomy or myomectomy independently from fertility wishes of the woman. Its growth has been associated to estrogenic activity. Because of this, several substances have been used to diminish tumour size, pre-operatively. The use of analogues of liberating hormone of hypophysiary gonadotropins (GnRH), given to favor surgical technique, to diminish trans-operative bleeding and to avoid blood transfusions. Clinical efficiency of the use of nafarelin acetate in women with uterine leyomiomatosis, pre-operatively during three months, was studied in this paper. The study was prospective, comparative, blind and with longitudinal measurements. Twenty eight women were included. Group I (n = 13) and Group II (n = 15) control without treatment. Observation units included FSH, LH, E2, BHC, HCT, USG basal, 30, 60, 90 days. Results showed a diminution of more than 80% of the initial uterine volume, and of 30% of the myomas independently measured. Side effects, tolerance and efficacy of the used compound, are mentioned.

[Evidence of antimicrobial activity of the follicular fluid: an evaluation and analytical study of samples obtained in an assisted reproduction program]. / Evidencia de actividad antimicrobiana del líquido folicular: estudio evaluatorio y analítico de muestras obtenidas en un programa de reproducción asistida.

Due to lack of evidence of infection in patients for ovarian punction for ovular capture, the hypothesis of possible antibacterial action that could exist in follicular fluid, was evaluated. One hundred and ten samples of such fluid, were taken for antibacterial analysis, 37 of which, were studied, as they were the clearest ones and not contaminated. Such samples were obtained from hyperstimulated patients, ready for ovular capture through vagina by ultrasonographic guide. A bacterial inoculum, was prepared, in order to evaluate antimicrobial activity of follicular fluid against E. coli, P. aeruginosa, S. agalactiae, L. monocytogenes and C. albicans. Counting of bacterial colonies, at 2, 4, 6, 12 and 24 hours. Results summary shows bacteriostatic activity in all studied colonies, and E. coli and S. agalactiae seem to be the most sensitive, followed by P. aeruginosa, S. aureus and L. monocytogenes; and still present in C. albicans. It is concluded that follicular fluid has an antibacterial action, probably selective; and that keeping this research line will confirm this finding, and possibly will determine the concerned factors.

[Pyo-ovary as a complication of transvaginal follicular aspiration]. / Pioovario como complicación de aspiración folicular por vía transvaginal.

Patient with primary sterility; antecedent of tubal surgery and damaged tuboperitoneal factor; she was programmed for in vitro fertilization with embryo transference. She had ovarian hyperstimulation with pure FSH and menotropins; follicular aspiration, via vagina with ultrasonographic guidelines. Seven days after, she presented with colic pain at left iliac region a hard, painful mass was found at left iliac region. Uterus deviated to the right, painful to movement; left vaginal cul de sac increased in volume and left adnexal tumor, without limits; left pararectal tumor. Exploratory laparoscopy was done, with pelvic abscess drainage, 10 to 12 cm, and left oophorectomy; the diagnosis was left pyo-ovary. Normal evolution.

[Endometrial aspiration biopsy]. / Biopsia endometrial por aspiración.

The factuality and diagnostic accuracy of aspiration endometrial biopsy with Karman's cannula, as compared with the curetted sample with Novak's cannula, were evaluated. Two hundred and thirty endometrial biopsies, were taken, as part of the study in women with fertility problems, at the Assisted Reproduction Clinic and Sterility Clinic, Instituto Nacional de Perinatología. The samples taken with Karman's cannula, Group I (n = 115); and with Novak's cannula, Group II (n = 115), were compared: procedure's time, pain intensity, quantity and quality of samples, macro and microscopically. In 92.2% of group I, tissue adequate for diagnosis, was obtained, as compared with 84.4% in Group II; likewise, the sample was better quantitatively and qualitatively, in Group I; and required time was less than one minute in 90% in Group I, an 83% in Group II. With the use of Karman's cannula, 20% of the patients had no pain, and 0.9% with the use of Novak's cannula. So, it can be concluded that endometrial aspiration with Karman's is reasonable and reliable in the functional histological diagnosis; it permits the obtention of adequate samples, in quantity and quality, and offering as advantages less pain and more security for the patients.

[The evaluation of the usefulness of ultrasound independent of estradiol as a prognostic criterion for ovular capture and maturity. A comparative double-blind study]. / Evaluación de la utilidad del ultrasonido independiente de estradiol como criterio pronóstico para captura y madurez ovular. Estudio comparativo doblemente ciego.

One hundred and twenty women were studied which had primary or secondary sterility, and underwent into the GIFT or IVF-ET program at the INPer. They were divided in two groups. Group I had 96 women in which only was taken in account the follicular development measured by vaginal ultrasound to decide continuation or cancellation, in this group estradiol serum levels determination was done, but it was not used for decision making; group II had 24 women in which estradiol was taken in account in addition with ultrasound. There were no differences in the number of follicles seen by ultrasound neither in the estradiol serum levels between the groups. Correlation coefficients between follicles seen by ultrasound and retrieved oocytes and mature oocytes, thus partial correlation coefficients for follicles seen by ultrasound plus estradiol serum levels and retrieved oocytes and captured oocytes were higher in group I in all days with the exception of day 10 in which they were similar. By the aforementioned in can be concluded that in this group of patients the ultrasound was the most reliable variable to give a quantitative and qualitative prognostic of oocyte retrieval.

[The clinical study of male infertility]. / Estudio clínico de la infertilidad masculina.

Male infertility study requires systematization of clinical and paraclinical diagnostic procedures and the knowledge of frontier techniques to analyze functional capacity of human spermatozoon. The application of the various methods of assisted reproduction in male infertility treatment, should be judged with a good criterion in order to offer maximal benefit and least risk. New methods to handle gametes and standardization of existing ones, could, in the future, offer better alternatives in male infertility treatment.

[The effect of the early administration of progesterone on egg recovery, fertilization and pregnancy in an institutional fertilization in vitro program]. / Efecto de la administración temprana de progesterona sobre la tasa de captura ovular, fertilización y embarazo en un programa institucional de fertilización in vitro.

39 patients which underwent an IVF-ET procedure at the INPer were divided in two groups. To one of them, progesterone was administered since the day of oocyte retrieval (group I), whereas the other group received progesterone 48 hours before hCG administration (group II). There were no statistical differences between the groups in the parameters analysed before the oocyte retrieval. There were statistical differences between the groups in progesterone levels in the day of oocyte retrieval in favour of group II, and in fertilization rate and transfer rate for group I. There were no valuable differences between the groups in pregnancy rate.

[Biological process in patients having been impregnated through GIFT or IVF-ET. Clinical experience]. / Comportamiento biológico en pacientes que lograron embarazo por GIFT o FIVTE. Experiencia institucional.

There were analyzed in a retrospective way the results of pre-retrieval hormonal levels as well as the number of retrieved oocytes, mature oocytes and transferred embryos in three groups of patients (2 GIFT, 1 IVF-ET) which achieved a pregnancy, and were matched with groups with no pregnancy. There were no statistically significant differences in most of the analyzed parameters, by the aforementioned we can suppose that pregnancy depends of endometrial quality and in this moment we are not able to modify it satisfactorily.

[Index of cells obtainable from semen: indicator of fertility?]. / Indice de células recuperables del semen: indicador de fertilidad?

It has been recognized that semen analysis is not a sensible nor a specific tool for detecting infertility in the male. Its predictive value is limited by the subjectivity of manual analysis, a high variability of semen parameters in fertile men and lack of correlation between sperm characteristics and fertility indexes. In this paper we present evidence supporting the concept that calculating an index of potentially fertile cells from data obtained in a regular semen analysis might be useful for predicting fertility in the male.

[The functional ovarian reserve in assisted reproduction. A clinical dilemma]. / Reserva ovárica funcional en reproducción asistida. Dilema clínico.

The response to supraphysiological ovarian stimulation in Assisted Reproduction (particularly FIV-TE and GIFT) may be very heterogeneous, despite the fact that selected patients have clinical and paraclinical characteristics very homogeneous. Highly significant differences, were found, in two groups of patients with similar clinical characteristics, who were stimulated with the same scheme. Group I (Adequate response = 22 patients) and Group II (Inadequate response = 13 patients), regarding to basal seric levels of FSH (P = 0.007) and to quality of follicular response (P = 0.000). These results suggest that quality of response to supraphysiological ovarian stimulation, may reflect a "Functional ovarian reserve" and that this can be predicted (partially) with basal seric levels of FSH; but, may be, the inadequate response, paradoxical to certain point, would not represent an ovarian failure or a resistant ovarian syndrome, incipient or transitory during the reproductive age?

[Quantification of deoxyribonucleic acid and collagen as biological markers in uterine leiomyoma]. / Cuantificación de ácido desoxirribonucléico y colágena como marcadores bioquímicos de leiomiomatosis uterina.

The uterine leiomyomas (UL) are tumors compound by smooth muscle connective tissue. Growth depends mainly of two basic mechanisms: hypertrophy of myometrial cells and connective tissue deposit. The quantification of the basic elements of the tumor permits to try its application as biochemical markers of disease, auxiliary diagnostic criteria, or in medical therapeutical monitorization, alternative that lately has become very important. In the present study 33 patients are included, in two groups. Group I women with uterine leiomyomatosis (n = 17) and Group II (n = 16) without UL. A prospective, double blind, transversal of cases and control study. Connective tissue concentration was evaluated based on collagen determination. The evaluation of muscular tissue was done by desoxyribonucleic acid (DNA) measurement. The results showed a significant increase in connective tissue concentration (until 500%) and a significant diminution of cellularity (DNA) in women with UL, as compared with control group. The main biochemical and clinical implications of these findings, are commented upon.

[GnRH-agonists in gynecology II]. / Agonistas de GnRH en ginecología II.

The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted reproduction, Uterine leiomyomas, Endometriosis, Polycystic ovarian syndrome, Precocious puberty, Premenstrual tension syndrome and breast cancer.

[GnRH-agonists in gynecology I]. / Agonistas de GnRH en ginecología I.

The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted Reproduction, Uterine leiomyomas, Endometriosis, Polycystic Ovarian Syndrome, Precosious Puberty, Premenstrual Tension Syndrome and Breast Cancer.

[Laparoscopy-hysteroscopy at the National Institute of Perinatology]. / Laparoscopia-histeroscopia en el Instituto Nacional de Perinatología.

Seventy five patients were studied. They underwent diagnostic laparoscopy-hysteroscopy. All of them had hysterography. This study was conducted at Biology of Reproduction Department of Instituto Nacional de Perinatología. Laparoscopy-hysteroscopy showed better results to obtain diagnostic and therapeutic information, than the other methods separately without significately increase in surgery time and without complications.

[Presentation of a mathematics formula of duplicated times of estradiol predictive for ovular harvesting]. / Presentación de una fórmula matemática de tiempos de duplicación de estradiol pronóstica para captura ovular.

30 patients were studied, that were included in the IVF program of the INPer. The estradiol response was studied and was correlated with the number of retrieved oocytes. The previously known E2 values considered as indicative for cancellation did no were observed in this series, and there are proposed new ones, also prognostic criterion for oocyte retrieval are proposed.

[Multifactorial analysis of the blood levels of LH, FSH and estradiol in relation to ovular harvesting rates, fertilization and segmentation in patients undergoing assisted reproduction (GIFT-FIVTE)]. / Análisis multifactorial de los niveles séricos de LH, FSH y Estradiol en relación a las tasas de captura ovular, fertilización y segmentación en pacientes de reproducción asistida (GIFT-FIVTE).

This study shows that there is certain tendency to asssign more value to the observation of follicular growth by ultrasound than to hormonal levels "per se". However, the appreciation of growth is only part of the phenomenon of development and ovarian maturity, for that, surveillance with hormonal monitor of ovarian response keeps with a most important role in Assisted Reproduction Clinica. The basal levels, mainly of FSH and in a less degree LH, inversely correlate with the amount of retrieved ovocytes. Estradiol values should be interpreted with a fixed point of reference, as the day of HCG administration, and a direct relation is seen between estradiol levels and captured ovocytes; however, is of highest usefulness to value the conduct of estradiol level, with the knowledge that the prognosis for good capture rates improves with ascending values and above 700 pg in the day of HCG administration.

[The mouse test. Correlation between the segmentation of murine embryos and the fertilization and segmentation of human ovocytes and pre-embryos]. / La prueba de ratón. Correlación entre la segmentación de embriones murinos y la fertilización y segmentación de ovocitos y pre-embriones humanos.

The "mouse test" resulted to be an indispensable requisite in order to do, with security, although not complete, the serum selection, to use in the extracorporal phase of FIVTE. Because of the observations it is considered that it should be tried to addition the culture medium with good quality sera; which is evident with a 90% rate, or more, of segmentation in the embryonic system of mouse, of two cells.

Human amniotic fluid modulation of collagenase production in cultured fibroblasts. A model of fetal membrane rupture.

The participation of a mechanical factor as the only cause of rupture of fetal membranes during normal labor or premature rupture has been criticized, and the involvement of an enzymatic mechanism has been proposed. In this study we analyzed the effect of human amniotic fluids at different gestational ages on the collagenase synthesis of cultured fibroblasts. Our results show that term amniotic fluids are capable of inducing the synthesis of collagenase and other proteases in fibroblasts, as revealed by selective increases in collagenase activity and in immunoreactive collagenase. Nonterm amniotic fluids failed to do the same. This phenomenon is proposed as a model for studying the collagen degradation of fetal membranes during term gestation.