[Prevalence of chromosomal alterations in infertile patients studied in a clinic of assisted reproduction]. / Prevalencia de alteraciones cromosómicas en pacientes infértiles estudiadas en una clínica de reproducción asistida.

BACKGROUND: Chromosomal abnormalities are a frequent cause of infertility. There is not consensus if should be included in the work-up of infertile couple. OBJECTIVE: to evaluate the prevalence of chromosomal abnormalities in our population of infertile couple and support the cytogenetic exam in the initial protocol. PATIENTS AND METHODS: Retrospective study of 787 infertile patients divided in five groups, to whom a cytogenetic exam was performed between January 2004 and April 2007. RESULTS: The prevalence of general chromosomal abnormalities was 12.5% (98/787). We found a 14.8% (34/229) with severe male factor, 14.3% (2/14) with premature ovarian failure, 12.3% (20/162) with recurrent pregnancy loss, 8% (9/112) idiopathic infertility and 12.2% (33/270) associated with other causes. The major alterations correspond to trisomies, translocations, and 9 chromosome markers. CONCLUSIONS: The results of this study are consistent with those reported in the literature which are associated with a greater prevalence of chromosomal abnormalities in infertile couples compared with the general population, this findings show the importance of consider the cytogenetic study in the initial diagnosis protocol of infertile couple.

[Antiphospholipid syndrome and human reproduction]. / Síndrome antifosfolipídico y reproducción humana.

Recurrent pregnancy loss is secondary to multiple illnesses. An important cause sometimes undiagnosed is the antiphospholipid syndrome, an autoimmune disease with various clinical alterations (miscarriage, hypertensive disorders, preterm delivery, vascular thrombosis, intrauterine retard growth, death intrauterine, abruption placentae). There are major and minor clinical criteria and precise indications that guide the physician to its recognition. Antibodies related with the syndrome are anticardiolipin and lupic anticoagulant, but other phospholipids seems to be implicated on this pathology and its participation on trombotic events is even unknown. Opportune diagnosis is of vital importance for fetomaternal morbidity and mortality. The repercussions are important during gestational stage, but effects c an persist o r even appear during the puerperium, predisposing t o trombotic events. The antiphospholipid s yndrome th at accompanies gestation, requires of efficient valuation and a special treatment, with a narrow prenatal surveillance. The best therapy for reproductive future which has less undesirable effects, is with heparin and acetylsalicylic acid administration; prednisone (steroids) is used in cases of active illness. The current knowledge about this disease makes possible that a pregnancy at term can be achieved with the least as possible number of complications.

[Mechanism of action of insulin sensitizer agents in the treatment of polycystic ovarian syndrome]. / Mecanismos de acción de los agentes sensibilizantes de insulina en el tratamiento del sindrome de ovario poliquístico.

Polycystic ovarian disease (PCOD) is the most important endocrine abnormality that affects women in reproductive age. It is characterized by chronic anovulation and hyperandrogenemia probably secondary to insulin resistance. Hence insulin sensitizers agents had been used in PCOD. Metformin is a biguanide used in the treatment of PCOD via decrease of hepatic gluconeogenesis and insulinemia; improvement peripheral glucose utilization, oxidative glucose metabolism, nonoxidative glucose metabolism and intracellular glucose transport. Such effects, when this drug is administered alone during 3 to 6 months, increase sex hormone binding globulin (SHBG), reduce free androgens index and hirsutism, decrease insulin resistance, and regulate menses in 60 to 70% of cases. Thiazolidinodiones are drugs that decrease insulin resistance in the liver with hepatic glucose production. Their mechanism of action is through the peroxisome proliferator-activated receptors gamma (PPAR-gamma), that help to decrease plasmatic concentrations of free fatty acids, pre and postprandial glucose, insulin, triglycerides, increased HDL cholesterol and decreased LDL, menses return to normality, with improvement of ovulation and decreased hirsutism. It seems that by modulation and attenuation of insulin resistance, hypoglucemic agents such as metfomin and thiazolidinodiones can be used effectively to treat anovulation, infertility and hyperandrogenemia.