Effect of day 5 or 6 blastocyst embryo transfer on pregnancy outcomes in euthyroid women undergoing IVF: A single centre retrospective cohort.

OBJECTIVE: This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect gestational outcomes in euthyroid women undergoing in vitro fertilisation. METHODS: Of 428 women who underwent in vitro fertilisation assessed in this retrospective cohort study, 212 (49.5%) underwent embryo transfer on day 5 of blastulation and 216 (50.5%) on day 6. Dichotomization based on anti-thyroid peroxidase antibodies status was also performed, with 370 (86.4%) women testing negative and 58 (13.6%) testing positive. Clinical and hormonal data and rates of clinical pregnancy, miscarriage, and live births were compared between the groups. RESULTS: When evaluating gestational outcomes based on the day of blastulation, a statistically significant difference was observed in clinical pregnancy rates [51.4% (day 5) vs. 40.7% (day 6); p=0.033]. However, there was no significant difference in the relative frequencies of miscarriages (p=1.000), live births (p=1.000), or preterm births (p=1.000). Using Cramer's V test, a weak association was found between the day of blastulation and clinical pregnancy outcomes (V2=10.7%; p=0.027). There were no statistically significant differences between the anti-thyroid peroxidase antibodies-negative and -positive groups in terms of clinical pregnancy rates (p=0.396), miscarriages (p=0.129), and live births (p=0.129). CONCLUSIONS: Higher rates of clinical pregnancy were observed in women who underwent embryo transfers performed on day 5 compared to those on day 6. However, no effect was observed with gestational outcomes. Further, anti-thyroid peroxidase antibody positivity did not have a statistically significant impact on gestational outcomes.

Effect of thyroid function on assisted reproduction outcomes in euthyroid infertile women: A single center retrospective data analysis and a systematic review and meta-analysis.

Background: The influence of thyroid-stimulating hormone (TSH) on gestational outcomes have been studied and checked whether differing TSH levels are relevant on human reproduction outcomes. International guidelines recommend TSH values <2.5 mIU/L in women trying to conceive, since values above this level are related to a higher frequency of adverse reproductive outcomes. This study aimed to evaluate whether TSH values correlate with different gestational outcomes in euthyroid infertile women without autoimmune thyroid disease. Methods: A retrospective cohort study was conducted involving 256 women who underwent in vitro fertilization (IVF) treatment. The participants were divided into two groups: TSH 0.5-2.49 mIU/L (n=211) and TSH 2.5-4.5 mIU/L (n=45). The clinical data, hormonal profiles and reproductive outcomes were compared between groups. Additionally, a systematic review with meta-analysis following the PRISMA protocol was carried out in PubMed/MEDLINE, EMBASE, and SciELO, with no time or language restrictions, for articles comparing TSH groups named "low TSH" (<2,5 mIU/L) and "high TSH" (≥2.5 mIU/L). A meta-analysis of proportions was performed with pooled estimates expressed as relative risk (RR) of events and a random effects model. Results: Age, BMI, free thyroxine levels (FT4) hormonal profile and IVF outcomes were not different between groups, neither gestational outcomes (p=0.982). Also, no difference was observed when the TSH and FT4 levels were compared between patients with positive or negative gestational outcomes (p=0.27 and p=0.376). Regarding the systematic review with meta-analysis, 17 studies from 2006 to 2022 were included, and added by this original retrospective research comprising 13.247 women undergoing IVF. When comparing the proportions of clinical pregnancy between the TSH groups, no significant difference was found (RR 0.93, 95% CI 0.80-1.08), with high between studies heterogeneity (I²: 87%; τ2: 0.0544; p<0.01). The number of deliveries was not significantly different between groups, despite a trend towards higher frequency in the high-TSH group (RR 0.96, 95% CI 0.90-1.02). Conclusion: Variation in TSH levels within the normal range was not associated with pregnancy and delivery rates in women, without autoimmune thyroid disease, who underwent IVF treatment. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42022306967.

Evaluation of levels of cortisol in saliva using electro-chemical luminescence in low-risk and high-risk pregnancies / Avaliação do cortisol salivar por electroquimioluminecência em gestantes de baixo e de alto risco

OBJECTIVES: to compare the levels of cortisol (cortisolemia refers to the level of cortisol in blood) in women with a high-risk pregnancy compared with those with a low-risk pregnancy, by way of evaluation of levels of cortisol in saliva, using the electrochemical luminescence technique (ECL). METHODS: 38 women aged between 17 and 40 years in the third trimester of pregnancy were divided in two groups: 20 low-risk pregnancies and 18 high-risk ones. Cortisol in saliva was collected at midnight and measured using ECL. The mean levels of cortisol in saliva in the two groups were compared using the Kruskal-Wallis test. RESULTS: the mean systolic and diastolic pressure was normal in both groups. The levels of cortisol in the saliva of women with high-risk pregnancies was significantly higher than those for the low-risk pregnancy group (20.2 (±21,1) nmol/L vs 11.4(±16.2) nmol/L; p=0.007). CONCLUSIONS: a high risk pregnancy involves higher levels of cortisol than a low-risk one. The levels of cortisol in saliva, as measured using ECL, can be used to identify hypercortisolism in pregnancy.

OBJETIVOS: comparar os níveis de cortisol em mulheres com gravidez de alto risco em relação às gestantes de baixo risco, por meio da avaliação do cortisol salivar utilizando a técnica da electroquimioluminescência (EQL). MÉTODOS: foram estudadas 38 mulheres de 17a 40 anos de idade, no terceiro trimestre de gestação, divididas em dois grupos: 20 gestantes de baixo risco e 18 gestantes de alto risco. O cortisol salivar foi coletado à meia-noite e medido através da EQL. As médias do cortisol salivar foram comparadas entre os dois grupos de gestantes através do teste de Kruskal-Wallis. RESULTADOS: a média das pressões sistólica e diastólica foi normal nos dois grupos. O cortisol salivar das gestantes de alto risco foi significativamente mais elevado do que das gestantes baixo risco: (20,2 (±21,1) nmol/L vs 11,4(±16,2) nmol/L; p=0,007). CONCLUSÕES: a gestação de alto risco cursa com níveis mais elevados de cortisol quando comparada à gestação de baixo risco. O cortisol salivar, medido pelo EQL mostrou-se promissor para identificar o hipercortisolismo na gestação.

Sequestração Pulmonar intralobar / Intralobar sequestration of the lung

A autora relata um caso de seqüestração pulmonar, cujo diagnóstico foi estabelecido após suspeita radiográfica; enfatiza a importância desta anomalia congênita pelas dificuldades do seu diagnóstico, que só é realizado quando já se conhece e se pensa nela; revisa a literatura acerca do tema em foco, abordando todos os aspectos diagnósticos, momento em que tangenciam a imagenologia e, por fim, tece considerações sobre a abordagem terapêutica da mesma