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1.
Obstet Gynecol Surv ; 74(1): 33-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30648725

RESUMO

IMPORTANCE: With the increase in patients who identify as transgender, it is crucial that gynecologists are culturally and clinically competent in understanding their unique needs. OBJECTIVE: The aim of this study was to identify the key gynecologic issues facing transgender patients and develop an overarching framework of tools needed to address these issues. EVIDENCE ACQUISITION: A review of the existing literature was undertaken to address the key clinical aspects of care. RESULTS: Various aspects of the gynecologic care of transgender patients, including health maintenance and cancer screening examinations, hormone replacement therapy, hysterectomy and salpingo-oophorectomy, and referral and collaboration with the patient's care team, are outlined. CONCLUSIONS AND RELEVANCE: Transgender patients are more likely to be engaged and seek care if their identity and their needs are understood. While many aspects of transgender health care follow standard practices, there are significant and important differences, including gender-affirming therapies. This article aims to give gynecologists the necessary tools to partner in the care of transgender patients.


Assuntos
Competência Clínica/normas , Ginecologia/métodos , Serviços de Saúde para Pessoas Transgênero , Pessoas Transgênero , Feminino , Ginecologia/normas , Humanos , Masculino , Avaliação das Necessidades/normas , Relações Médico-Paciente
2.
Obstet Gynecol ; 119(5): 1009-16, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22525912

RESUMO

OBJECTIVE: To identify Chlamydia trachomatis antigens associated with tubal factor infertility and acute infection. METHODS: A C trachomatis proteome array was used to compare antibody profiles among women with tubal factor infertility, normal fertility, and acute C trachomatis infection. RESULTS: Thirteen immunodominant antigens reacted with 50% or more sera from all women (n=73). Six C trachomatis antigens were uniquely recognized in women with tubal factor infertility. Combining fragmentation of the six antigens with serum sample dilution, chlamydial antigens HSP60, CT376, CT557, and CT443 could discriminate between women with tubal factor infertility and women with normal fertility with a sensitivity of 63% (95% confidence interval [CI] 0.41-0.77) and specificity of 100% (95% CI 0.91-1), respectively. These antigens were designated as tubal factor infertility-associated antigens. However, these tubal factor antigens were unable to distinguish tubal factor infertility patients from those with acute infection. A combination of CT875 and CT147 distinguished women with acute infection from all other C trachomatis-exposed women with a detection sensitivity of 63% (95% CI 0.41-0.77) and specificity of 100% (95% CI 0.95-1), respectively. Thus, CT875 and CT147 were designated as acute infection-associated antigens. CONCLUSION: A sequential screening of antibodies against panels of C trachomatis antigens can be used to identify women with tubal factor infertility and acute C trachomatis infection. LEVEL OF EVIDENCE: II.


Assuntos
Anticorpos Antibacterianos/sangue , Antígenos de Bactérias , Proteínas de Bactérias , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/imunologia , Infertilidade Feminina/diagnóstico , Doença Aguda , Adulto , Biomarcadores/sangue , Infecções por Chlamydia/sangue , Infecções por Chlamydia/microbiologia , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/microbiologia , Análise Serial de Proteínas , Proteoma , Sensibilidade e Especificidade
3.
Fertil Steril ; 97(5): 1129-35.e1, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22365076

RESUMO

OBJECTIVE: To investigate the expression and regulation of colony-stimulating factor 1 (CSF-1) and its receptor, C-FMS, in endometriosis. DESIGN: In vivo and vitro study. SETTING: University-based academic medical center. PATIENT(S): Reproductive-age women undergoing surgery for benign conditions. INTERVENTION(S): Peritoneal and endometrial tissue samples were obtained. MAIN OUTCOME MEASURE(S): CSF-1 and C-FMS expression. RESULT(S): Significantly higher CSF-1 levels were found in peritoneal fluid of patients with endometriosis compared with control subjects. Ectopic endometriotic tissue had 3.5-fold and 1.7-fold increases in CSF-1 and C-FMS expression, respectively, compared with eutopic tissue. Coculture of endometrial cells from either established cell lines or patient samples with peritoneal mesothelial cells (PMCs) led to increased expression of CSF-1 and C-FMS. A higher but nonsignificant increase in levels of C-FMS and CSF-1 was found in cocultures of endometrial epithelial cells from patients with endometriosis compared with those without endometriosis. CONCLUSION(S): Increased CSF-1 levels may contribute to endometriosis lesion formation and progression. Elevation in CSF-1 after coculture of endometrial cells with PMCs suggests that endometrial tissue may be a source of peritoneal CSF-1. Increased C-FMS expression in endometrial cells from women with endometriosis cocultured with PMCs suggests that endometrial tissue involved in lesion formation is highly responsive to CSF-1 signaling.


Assuntos
Endometriose/imunologia , Endométrio/imunologia , Fator Estimulador de Colônias de Macrófagos/metabolismo , Receptor de Fator Estimulador de Colônias de Macrófagos/metabolismo , Centros Médicos Acadêmicos , Líquido Ascítico/imunologia , Comunicação Celular , Células Cultivadas , Técnicas de Cocultura , Endometriose/genética , Endometriose/patologia , Endométrio/patologia , Células Epiteliais/imunologia , Células Epiteliais/patologia , Feminino , Humanos , Fator Estimulador de Colônias de Macrófagos/genética , Peritônio/imunologia , Peritônio/patologia , Receptor de Fator Estimulador de Colônias de Macrófagos/genética , Células Estromais/imunologia , Células Estromais/patologia , Texas , Regulação para Cima
4.
Fertil Steril ; 96(2): 505-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21719003

RESUMO

The predictive value of serum beta hCG level for fetal cardiac motion and pregnancy outcome after IVF was evaluated. The serum hCG level 12 days after ET is a useful predictor of subsequent presence of fetal cardiac activity and live birth and may assist clinicians in counseling patients regarding their IVF outcome.


Assuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Aconselhamento , Fertilização in vitro , Infertilidade/tratamento farmacológico , Biomarcadores/sangue , Transferência Embrionária , Feminino , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Infertilidade/sangue , Nascido Vivo , Valor Preditivo dos Testes , Gravidez , Curva ROC , Estudos Retrospectivos , Texas , Resultado do Tratamento , Ultrassonografia Pré-Natal , Regulação para Cima
5.
Fertil Steril ; 96(3): 715-21, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21742324

RESUMO

OBJECTIVE: To identify Chlamydia trachomatis antigens that can be used to differentially diagnose tubal factor infertility in comparison with previously reported heat shock protein 60. DESIGN: In vitro study. SETTING: Academic medical center. PATIENT(S): Infertile women with and without tubal pathology diagnosed laparoscopically. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Antibody responses to C. trachomatis in infertile women with or without tubal pathologies using a C. trachomatis genome-wide proteome array. RESULT(S): Comparison of the antibody profiles revealed 30 C. trachomatis antigens that were preferentially recognized in women with tubal factor infertility, with a detection sensitivity and specificity of 80.6% and 56.5%, respectively, 10 of which showed 100% specificity. A combination of CT443 and CT381 antigens yielded the highest detection sensitivity (67.7%) while maintaining 100% specificity. CONCLUSION(S): These findings have demonstrated that antibodies to CT443 and CT381, when used in combination, have higher sensitivity and specificity in predicting tubal factor infertility than other indicators for tubal factor infertility, such as heat shock protein 60 antibodies (35.5%, 100%) or hysterosalpingogram (65%, 83%). Using a panel of C. trachomatis antigens to serologically diagnose tubal factor infertility can save the patients from undertaking expensive and invasive procedures for determining tubal pathology and choosing treatment plans.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/genética , Chlamydia trachomatis/genética , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/microbiologia , Adulto , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/genética , Antígenos de Bactérias/imunologia , Proteínas da Membrana Bacteriana Externa/genética , Proteínas da Membrana Bacteriana Externa/imunologia , Chaperonina 60/genética , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/imunologia , Tubas Uterinas/microbiologia , Tubas Uterinas/patologia , Feminino , Estudo de Associação Genômica Ampla , Células HeLa , Humanos , Histerossalpingografia , Infertilidade Feminina/epidemiologia , Laparoscopia , Proteômica , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Adulto Jovem
6.
Fertil Steril ; 95(8): 2735-7, 2011 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-21549369

RESUMO

The in vitro fertilization (IVF) outcomes, including clinical intrauterine gestation rate and live birth rate, between Hispanic and non-Hispanic white women were compared, and there were no differences. Hispanics were more likely to have a diagnosis of tubal factor infertility, whereas non-Hispanic white women were more likely to have endometriosis as their infertility diagnosis.


Assuntos
Fertilização in vitro/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Infertilidade Feminina/terapia , Nascido Vivo/etnologia , Taxa de Gravidez/etnologia , População Branca/estatística & dados numéricos , Adulto , Distribuição de Qui-Quadrado , Endometriose/complicações , Endometriose/etnologia , Feminino , Fertilização in vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etnologia , Infertilidade Feminina/etiologia , Gravidez , Complicações na Gravidez/etnologia , Medição de Risco , Fatores de Risco , Texas/epidemiologia , Fatores de Tempo , Resultado do Tratamento
7.
Am J Obstet Gynecol ; 203(5): 494.e7-494.e14, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20643392

RESUMO

OBJECTIVE: The objective of the study was to assess antibodies against Chlamydia trachomatis heat shock proteins (HSP) in patients with tubal factor infertility (TFI), infertility controls (IFC), and fertile controls (FC). HSPs assist organisms in surviving caustic environments such as heat. STUDY DESIGN: Twenty-one TFI, 15 IFC, and 29 FC patients were enrolled after laparoscopic tubal assessment. The titers of antibodies against C trachomatis organisms and 14 chlamydial HSPs were compared among the 3 groups. RESULTS: TFI patients developed significantly higher levels of antibodies against C trachomatis and specifically recognizing chlamydial HSP60 and caseinolytic protease (Clp) P, a subunit of the ATP-dependent Clp protease complex involved in the degradation of abnormal proteins. CONCLUSION: In addition to confirming high titers of antibodies against C trachomatis organisms and HSP60 in TFI patients, we identified a novel link of TFI with anti-ClpP antibodies. These findings may provide useful information for developing a noninvasive screening test for TFI and constructing subunit anti-C trachomatis vaccines.


Assuntos
Anticorpos Antibacterianos/imunologia , Chaperonina 60/imunologia , Chlamydia trachomatis/imunologia , Endopeptidases/imunologia , Doenças das Tubas Uterinas/imunologia , Infertilidade Feminina/imunologia , Western Blotting , Células Cultivadas , Distribuição de Qui-Quadrado , Infecções por Chlamydia/imunologia , Infecções por Chlamydia/microbiologia , Ensaio de Imunoadsorção Enzimática , Doenças das Tubas Uterinas/microbiologia , Feminino , Células HeLa , Humanos , Infertilidade Feminina/microbiologia
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