A multicenter clinical study with myo-inositol and alpha-lactalbumin in Mexican and Italian PCOS patients.

OBJECTIVE: This open-label non-randomized clinical study aimed at evaluating the effects of myo-inositol plus alpha-lactalbumin in two groups of PCOS women, treated in Mexico and Italy. Alpha-lactalbumin was used being effective in increasing myo-inositol intestinal absorption. This effect is very useful in greatly reducing the therapeutic failure of myo-inositol in some patients (inositol resistant subjects). PATIENTS AND METHODS: The study involved 34 normal weight or overweight patients (14 in Mexico and 20 in Italy), aged 18 to 40 years, with anovulation and infertility > 1 year and insulin resistance diagnosed by HOMA-Index. Patients were administered orally with 2 g myo-inositol, 50 mg alpha-lactalbumin, and 200 µg of folic acid twice a day for 6 months. Controls were the same patients at t0 (baseline). The primary outcome was HOMA-index decrease after 3 and 6 months of treatment. Other parameters monitored were BMI, progesterone, LH, FSH, total testosterone, free testosterone, androstenedione, total cholesterol, HDL, LDL, triglycerides. RESULTS: Recovery was general, and its relevance was higher when the starting point was further away from the normal range. The most important results were obtained with insulin, HOMA-index, LH, and androstenedione. No significant adverse effects were detected in both groups of patients. CONCLUSIONS: This clinical trial demonstrated for the first time that myo-inositol and alpha-lactalbumin improve important parameters in PCOS patients characterized by different metabolic profiles.

[Prevalence of infections (Chlamydia, Ureaplasma and Mycoplasma) in patients with altered tuboperitoneal factor]. / Prevalencia de infecciones (Chlamydia, Ureaplasma y Mycoplasma) en pacientes con factor tuboperitoneal alterado.

OBJECTIVE: To determine the prevalence of Chlamydia, Ureaplasma and Mycoplasma in patients with peritoneal tubal factor infertility and altered. MATERIAL AND METHODS: A descriptive, observational, retrospec- tive, transversal, infertility patients Juarez Hospital of Mexico 2013 to 2015. Study included patients with infertility diagnosis and detection of antibodies (IgG) by ELISA for Chlamydia and vaginal cultures for Mycoplasma and Ureaplasma, hysterosalpingography and histerolapa- roscopia with chromotubation RESULTS: 46 patients with a mean age of 32.5 years. It was found that 36% were positive for these infections (n = 17): Chlamydia in 8.7% (n = 4), Ureaplasma in 21.7% (n = 10) and Mycoplasma in 6.5% (n = 3). Chlamydia patients and bilateral tubal occlusion (OTB) in 5.8% (n = 1), Ureaplasma and OTB (n = 5) were identified in 29.4% of them with pelvic inflammatory disease (PID) and tubal obstruction Ureaplasma right (OTD) in 5.8% (n = 1), Ureaplasma and tubal patency but with loose adhesions in 5.8% (n = 1) and Mycoplasma with OTB in 11.1% (n = 2), p = 0.425. Hysterosalpingography showed a sensitivity of 59% and specificity of 79%. CONCLUSIONS: Although there was no association of variables, Ureaplasma infection was more common in patients with infertility and tubal damage.

[Frequency and etiology of azoospermia in the study of infertile couples]. / Frecuencia y etiología de azoospermia en el estudio de parejas infértiles.

UNLABELLED: One out of ten couples seek some kind of treatment for infertility of which males are infertile between 30-50%. Azoospermia has been reported in the range of 10 to 20% of cases. MATERIAL AND METHODS: We reviewed 331 cases seen at the clinic of Reproductive Biology of the Hospital Juárez de México, SSA, from January 1993 through February 2000. 66 patients were found with azoospermia (19.93%). Studies performed were: seminogram, testicular and transrectal ultrasonography, cariotype, deferentovesiculography and testicular biopsy. Radioimmunoassay of gonadotropins (FSH, LH) and testosterone was also practiced. RESULTS: Twelve patients (18.18%) were excluded either for desertion or incompletion of studies. The etiology of azoospermia of remainder 54 cases was: secretory (85.19%) of which 41.3% was idiopathic, 10.9% had germ cells aplasia, 10.9% varichocele, 10.9% Klinefelter syndrome. Secondary secreting azoospermia was found in two cases with Kallman's syndrome one patient had excretory and 7 obstructive azoospermia. CONCLUSIONS: Azoospermia was diagnosed in 19.93% (n = 54) with a mean age of 30 years. 85.19% had primary secretory azoospermia with FSH & LH hypergonadotropism in 85.8 and 56.4% respectively (p < 0.05). Obstructive azoospermia was seen in 12.96% and only one case (1.85%) presented excretory azoospermia.

[Correlation of 2 formulae to estimate insulin resistance]. / Correlación de dos fórmulas para calcular insulinorresistencia.

UNLABELLED: Insulin resistance (IR) is a central metabolic alteration with impact in human reproduction giving rise to hyperandrogenism, infertility, acanthosis, perimenopausal autoimmunity, obesity, hypertension, diabetes and dyslipidemias. Hence the estimation of insulin resistance is of clinical importance and we seeked to evaluate the correlation between two formulas (formula 1: glucose/insulin; formula 2: glucose x insulin/22.5) for its assessment. MATERIAL AND METHODS: Glucose and insulin was measured to 66 females (age 18-66 years) in whom IR was suspected. RESULTS: Mean age of patients was 23.9 +/- SD 10.9 year. IR was detected through the formulas used in 74%; the correlation coefficient (Pearson) was inversely proportional with both formulas (r = -460; p < 0.02). More than 50% of patients with IR had family background of IR, 81% were obese and 74% had a waist-hip index > 0.85 (central obesity or android), 52% hypercholesterolemia, 56% hypertriglyceridemia, 71% inverse relation of HDL/LDL, 45% had infertility, 71% hyperandrogenism, 65% polycystic ovaries and 4% presented diabetes. CONCLUSIONS: Through the use of two arithmetical formulas we determined the presence of IR in 73% of patients studied albeit with proclivity to IR; the correlation between the two formulas was significant. A high association of obesity, infertility, hyperandorogenism and dyslipidemias with IR was also observed.

[Familial pituitary tumor with somatotropic compromise]. / Tumor hipofisario familiar de compromiso somatomamotrópico.

Pituitary adenoma, familiar type, with apparent affection over the involved somatomammotropin of secretion of growth hormone and prolactin, with dominant autosomic transmission, is described for the first time. It was seen that a couple of members without demonstrable tumour, showed clinical data (phenotype) of acromegaly. On investigation of histocompatibility antigens it was observed that the patients with tumour and other symptomatic ones, but without tumour, shared the same haplotypes, and so is very possible that investigation of HLA antigens in patients with pituitary tumour, contributes to better identify its nature and frequency.

Effect of insuflated Nafarelin (D-Nal-6-GnRH) upon uterine leiomyomata.

A nasal spray containing the GnRH analog Nafarelin (D-Nal-6-GnRH) was used to treat 20 patients of reproductive age with clinical and ultrasonographic diagnosis of uterine leiomyomata. Nafarelin showed a high index of efficacy (approximately 65%) in decreasing the volume of myomas. The collateral effects observed were scarce; among these were predominant a decrease of libido and vasomotor symptoms. Although bone pain was not referred, the impact upon osteodensity was not assessed. The effect upon pituitary gonadotropin production as well as that of sexual steroids by GnRH was practically null, and one patient became pregnant. Nonetheless, those symptoms associated with the use of Nafarelin were apparently due to a moderate hypoestrogenism, despite not being substantiated in the laboratory studies. With such disparity, we assume it was given by the route of administration of nasal Nafarelin, which is known to have erratic effects due to limitations in its absorption. Thus, far from being a disadvantage it could be useful in regimes of long term therapy (1-2 years) to avoid the impact of estrogen shortage upon bone turnover. We conclude that Nafarelin through insuflation was highly effective for decreasing the size of uterine leiomyomata.