Sperm Selection for micro TESE-ICSI in Non-Obstructive Azoospermia, a Case Report.

TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represents a technique to attain pregnancy in couples with non-obstructive azoospermia (NOA) and other unlikely situations. Because of the poor pregnancy outcomes obtained by this procedure, we need new sperm selection techniques to improve the livebirth rate of NOA patients. Here we describe a successful micro TESE-ICSI cycle performed with sperm selected through high magnification and polarized light microscopy in a couple with two previous ICSI failures.

Effect of hormone therapy on postural balance in postmenopausal women.

OBJECTIVE: The aim of this study was to analyze the effects of hormone therapy (HT) on postural balance in postmenopausal women and its association with risk of falls. METHODS: In this cross-sectional study, a total of 225 Brazilian postmenopausal women aged 45 to 75 years were included and divided into two groups: HT users (n = 102) and nonusers (n = 123). HT users were women who had continuously taken HT throughout the preceding 6 months, whereas nonusers received no such therapy during the same period. Women with amenorrhea for more than 12 months and aged 45 years or older were included. Those with neurological or musculoskeletal disorders, vestibulopathies, uncorrected visual deficit, or drug use that could affect balance were excluded. Histories of falls (previous 24 mo) as well as clinical and anthropometric characteristics were analyzed. Postural balance was assessed through stabilometry (computerized force platform), Romberg test, and crouching test. Statistical analysis included the median test, χ test, Spearman correlation coefficient, and logistic regression method (odds ratio). RESULTS: Women users of HT were younger (53.0 vs 57.0 y) and with a shorter time since menopause (5.5 vs 10.0 y) than nonusers (P < 0.05). No anthropometric differences were observed. The number of women who had experienced falls was significantly lower among HT users than nonusers: 51 vs 88 falls, respectively (P < 0.05), and presented an adjusted risk of falls of 0.49 (95% CI, 0.27-0.88) times lower than the nonusers group. For the stabilometric parameters, HT users showed significantly lower amplitude in body oscillation (latero-lateral and antero-posterior) and a smaller oscillation area compared with nonusers (P < 0.05). There was no significant correlation between the Romberg test and fall rate (P > 0.05). In the crouching test, 47.1% of the participants showed an adequate level of muscle strength in lower limbs without differences between the groups (P > 0.05). CONCLUSIONS: Postmenopausal women using HT showed lower frequency of falls and a better performance in stabilometric parameters than did nonusers.

Evaluation of postural balance in postmenopausal women and its relationship with bone mineral density--a cross sectional study.

BACKGROUND: Low bone mineral density (BMD) and falls are common problems encountered in the postmenopausal women. The purpose was to evaluate the association between postural balance and BMD in postmenopausal women and its relation to risk for falls. METHODS: In this cross-sectional study, 225 women in amenorrhea > 12 months and age ≥ 45 years were included and divided, according to BMD, in T-score values > -2.0 SD (n = 140) and ≤ -2 SD (n = 85). Those with neurological or musculoskeletal disorders, history of vestibulopathies, uncorrected visual deficit or drug use that could affect balance were excluded. History of falls (last 24 months), clinical and anthropometric characteristics were evaluated. Postural balance was assessed by stabilometry (force platform). For statistical analysis were used Wilcoxon's Test, Chi-Square Test and logistic regression method for fall risk (Odds Ratio-OR). RESULTS: Patients with BMD > -2.0 SD were younger, with shorter time since menopause, and showed higher BMI as compared to those with low BMD (≤ -2 SD) (p < 0.05). It was observed that 57.8% of the participants reported fall episodes without significant difference distribution between the groups (p = 0.055). No differences were found from the comparison between the groups (p > 0.05) for stabilometric parameters. Risk for falls increased with age (OR 1.07; CI 95% 1.01-1.13), current smoking (OR 2.19; CI 95% 1.22-3.21) and corrected visual deficit (OR 9.06; CI 95% 1.14-4.09). In contrast, hormone therapy (HT) use was significantly associated with reduced risk for falls (OR 0.48; CI 95% 0.26-0.88). CONCLUSIONS: In postmenopausal women, BMD did not show association with postural balance or risk for falls. Age, smoking and corrected visual deficit were clinical indicators of risk for falls whereas HT use showed to be a protective factor.

[Risk factors for osteoporosis in postmenopausal women from southeast Brazilian]. / Fatores de risco para osteoporose em mulheres na pós-menopausa do sudeste brasileiro.

PURPOSE: To evaluate bone mineral density (BMD) and their risk factors associated with postmenopausal osteoporosis. METHODS: A cross-sectional clinical study was performed on 431 women (aged 40-75 years). INCLUSION CRITERIA: amenorrhea > 12 months and age > 45 years or, bilateral oophorectomy > 40 years with BMD values (T-score of lumbar spine/femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30 min/5 times/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI = weight/height²). The χ2 test and the logistic regression method (Odds Ratio--OR) were used to determine osteoporosis risk. RESULTS: According to WHO criteria, 106 (24.6%) women showed osteoporosis (T-score < -2.5 DP), 188 (43.6%) osteopenia (-1.0/-2.4 DP), and 137 (31.8%) were normal (> -1.0 DP). Osteoporosis was detected in 12% of women aged 40-49 years, in 21.8% of women aged 50-59 years and in 45.7% of women aged > 60 years (p < 0.001). Osteoporosis occurred in 11.8% of women with a menopause period < 5 years, in 29.4% with a menopause period from 6 to 10 years, and in 41% of women with a menopause period > 10 years (p < 0.001). Of the women with early menopause, 80% showed osteopenia/osteoporosis (p = 0.03), and of those with BMI < 20 kg/m², 50% were osteoporotic (p < 0.001). The risk for osteoporosis detection increased with age (OR = 1.1; CI 95% = 1.0-1.1), time of menopause (OR = 1.1; CI 95% = 1.0-1.1), smoking (OR = 1.9; CI 95% = 1.2-3.2), RA (OR = 3.6; CI 95% = 1.3-9.6) and maternal fracture history (OR = 2.1; CI 95% = 1.1-3.0) (p < 0.05). In contrast, HT use (OR = 0.3; 95% CI = 0.2-0.6) and high BMI (OR = 0.9; 95% CI = 0.8-0.9) reduced the risk (p < 0.05). CONCLUSION: In postmenopausal women, age, time of menopause, smoking and maternal history of fracture were clinical indicators of risk for osteoporosis, whereas HT use and high BMI proved to be protective factors.

Fatores de risco para osteoporose em mulheres na pós-menopausa do sudeste brasileiro / Risk factors for osteoporosis in postmenopausal women from southeast Brazilian

OBJETIVO: Avaliar a densidade mineral óssea (DMO) e os fatores de risco associados à osteoporose na pós-menopausa. MÉTODOS: Estudo clínico transversal com 431 mulheres (idade 40 - 75 anos). Foram incluídas mulheres com: amenorréia >12 meses e idade >45 anos ou, ooforectomia bilateral >40 anos, com DMO (escore T de coluna lombar/colo de fêmur) pelo DEXA dos últimos 12 meses. Fatores de risco avaliados: idade, idade e tempo de menopausa, tabagismo, atividade física (30 min/5 vezes/ semana), artrite reumatoide (AR), uso de corticoterapia e de terapia hormonal (TH), fratura prévia, fratura materna de quadril e índice de massa corpórea (IMC=peso/altura²). Foram empregodos teste do χ² e método de regressão logística no risco (Odds Ratio - OR) para osteoporose. RESULTADOS: Pelos critérios da Organização Mundial da Saúde, 106 (24,6 por cento) mulheres apresentavam osteoporose (escore T <-2,5DP), 188 (43,6 por cento) osteopenia (-1,0/-2,4DP) e 137 (31,8 por cento) eram normais (>-1,0DP). Foi detectada osteoporose em 12 por cento das mulheres com idade entre 40 e 49anos, em 21,8 por cento no grupo de 50 a 59 anos e 45,7 por cento nas mulheres com idade >60anos (p<0,001). Osteoporose ocorreu em 11,8 por cento com tempo de menopausa <5 anos, 29,4 por cento de 6 - 10 anos, e 41 por cento >10anos (p<0,001). Naquelas com idade da menopausa <40 anos, 80 por cento apresentaram osteopenia/osteoporose (p=0,03) e com IMC<20kg/m², 50 por cento osteoporóticas (p<0,001). O risco de detectar osteoporose aumentou com a idade (OR=1,1; IC95 por cento=1,0-1,1), tempo de menopausa (OR=1,0; IC95 por cento=1,0-1,1), tabagismo atual (OR=2,1; IC95 por cento=1,2-3,8), AR (OR=3,6; IC95 por cento=1,3-9,6) e história materna de fratura de quadril (OR=2,1; IC95 por cento=1,1-3,0) (p<0,05). Contrariamente, o uso de TH (OR=0,49; IC95 por cento=0,3-0,9) e elevado IMC (OR=0,9; IC95 por cento=0,8-0,9) reduziram o risco de detecção da osteoporose (p<0,05)...

PURPOSE: To evaluate bone mineral density (BMD) and their risk factors associated with postmenopausal osteoporosis. METHODS: A cross-sectional clinical study was performed on 431 women (aged 40 - 75 years). Inclusion criteria: amenorrhea >12 months and age >45 years or, bilateral oophorectomy >40 years with BMD values (T-score of lumbar spine/femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30 min/5 times/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI=weight/height²). The χ2 test and the logistic regression method (Odds Ratio - OR) were used to determine osteoporosis risk. RESULTS: According to WHO criteria, 106 (24.6 percent) women showed osteoporosis (T-score <-2.5 DP), 188 (43.6 percent) osteopenia (-1.0/-2.4 DP), and 137 (31.8 percent) were normal (>-1.0 DP). Osteoporosis was detected in 12 percent of women aged 40 - 49 years, in 21.8 percent of women aged 50 - 59 years and in 45.7 percent of women aged >60 years (p<0.001). Osteoporosis occurred in 11.8 percent of women with a menopause period <5 years, in 29.4 percent with a menopause period from 6 to 10 years, and in 41 percent of women with a menopause period >10 years (p<0.001). Of the women with early menopause, 80 percent showed osteopenia/osteoporosis (p=0.03), and of those with BMI <20 kg/m², 50 percent were osteoporotic (p<0.001). The risk for osteoporosis detection increased with age (OR=1.1; CI95 percent=1.0-1.1), time of menopause (OR=1.1; CI95 percent=1.0-1.1), smoking (OR=1.9; CI95 percent=1.2-3.2), RA (OR=3.6; CI95 percent=1.3-9.6) and maternal fracture history (OR=2.1; CI95 percent=1.1-3.0) (p<0.05). In contrast, HT use (OR=0.3; 95 percentCI=0.2-0.6) and high BMI (OR=0.9; 95 percentCI=0.8-0.9) reduced the risk (p<0.05)...

[Quality of life in postmenopausal women, users and non-users of hormone therapy]. / Qualidade de vida em mulheres na pós-menopausa, usuárias e não usuárias de terapia hormonal.

PURPOSE: to evaluate the quality of life of post-menopause women, users and non-users of hormonal therapy (HT), in a Healthcare Unit in Franca, São Paulo, Brazil. METHODS: a clinical transversal study, carried out with 250 post-menopausal women, with ages from 45 to 70 years old, attended to in Healthcare Units, from September 2007 to August 2008. Participants were divided into two groups: HT users (n=70) and non-users (n=180). Women making continuous HT use for at least six months were considered as users. Sociodemographic and clinical characteristics have been evaluated. Blatt-Kupperman's menopausal index has been applied to assess climacteric symptoms, and the Women's Health Questionnaire (WHQ), to assess their quality of life. Fisher's exact test or chi2 and Mann-Whitney and Kruskal-Wallis's tests have been used for the statistical analysis. RESULTS: no significant difference has been found in the comparison of groups, concerning age, menarche, menopause, parity and body mass index. It has been seen that 67.2% of the women were married, 83.2% had attended primary school and 53.2% were housewives, with no difference between the groups. HT users reported lower frequency of climacteric symptoms (BKMI) with moderate and marked intensity, as compared to non-users (p<0.001). Even though HT users presented lower average score in cognitive deficit (p<0.001), vasomotor symptoms (p=0.04), sleeping problems (p<0.001), attractiveness (p=0.02) from the WHQ, there has been no difference in the total score, as compared to non-users. CONCLUSIONS: post-menopausal women, HT users and non-users, admitted at Healthcare Units, have not presented differences in global quality of life.

Qualidade de vida em mulheres na pós-menopausa, usuárias e não usuárias de terapia hormonal / Quality of life in postmenopausal women, users and non-users of hormone therapy

OBJETIVO: avaliar a qualidade de vida (QV) de mulheres na pós-menopausa usuárias e São Paulo. MÉTODOS: foi conduzido estudo clínico transversal, com 250 mulheres na pós-menopausa, idade entre 45 a 70 anos, atendidas em uma Unidade Básica de Saúde (UBS), de setembro de 2007 a agosto de 2008. As participantes foram divididas em dois grupos: usuárias de terapia hormonal (TH, n=70) e não usuárias (n=180). Consideraram-se como usuárias de TH aquelas que faziam uso contínuo dessa terapia há pelo menos seis meses. Foram avaliadas as características sociodemográficas e clínicas. Aplicou-se o Índice Menopausal de Blatt e Kupperman (IMBK), para avaliar a intensidade dos sintomas climatéricos, e o Questionário de Saúde da Mulher (QSM), para a avaliação da QV. A análise estatística foi realizada pelo teste do χ2 ou exato de Fisher, teste de Mann-Whitney e de Kruskal-Wallis. RESULTADOS: não foram encontradas diferenças significativas na comparação entre os grupos quanto à idade, menarca, menopausa, paridade e índice massa corpórea. Observou-se que 67,2% eram casadas, 83,2% com ensino fundamental e 53,2% se ocupavam com os trabalhos domésticos, não diferindo entre os grupos. As usuárias de TH relataram menor frequência de sintomas climatéricos (IMBK) de intensidade moderada e acentuada, comparadas a não usuárias (p<0,001). Na avaliação do QSM, verificou-se, entre as usuárias de TH, menor escore médio quanto ao déficit cognitivo (p<0,001), sintomas vasomotores (p=0,04), problemas com o sono (p<0,001) e atratividade (p=0,02), contudo, sem diferença no escore total quando comparadas a não usuárias. CONCLUSÕES: as mulheres na pós-menopausa usuárias e não usuárias de TH, atendidas em UBS, não apresentaram diferenças na QV global.

PURPOSE: to evaluate the quality of life of post-menopause women, users and non-users of hormonal therapy (HT), in a Healthcare Unit in Franca, São Paulo, Brazil. METHODS: a clinical transversal study, carried out with 250 post-menopausal women, with ages from 45 to 70 years old, attended to in Healthcare Units, from September 2007 to August 2008. Participants were divided into two groups: HT users (n=70) and non-users (n=180). Women making continuous HT use for at least six months were considered as users. Sociodemographic and clinical characteristics have been evaluated. Blatt-Kupperman’s menopausal index has been applied to assess climacteric symptoms, and the Women’s Health Questionnaire (WHQ), to assess their quality of life. Fisher’s exact test or χ2 and Mann-Whitney and Kruskal-Wallis’s tests have been used for the statistical analysis. RESULTS: no significant difference has been found in the comparison of groups, concerning age, menarche, menopause, parity and body mass index. It has been seen that 67.2% of the women were married, 83.2% had attended primary school and 53.2% were housewives, with no difference between the groups. HT users reported lower frequency of climacteric symptoms (BKMI) with moderate and marked intensity, as compared to non-users (p<0.001). Even though HT users presented lower average score in cognitive deficit (p<0.001), vasomotor symptoms (p=0.04), sleeping problems (p<0.001), attractiveness (p=0.02) from the WHQ, there has been no difference in the total score, as compared to non-users. CONCLUSIONS: post-menopausal women, HT users and non-users, admitted at Healthcare Units, have not presented differences in global quality of life.