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1.
J Assist Reprod Genet ; 41(6): 1577-1584, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38676842

RESUMO

PURPOSE: This study aims to evaluate whether the clinical outcomes of cycles with frozen embryo transfer (FET) in hormonal replacement treatment supplemented with dydrogesterone (DYD) following detection of low circulating levels of progesterone (P4) were comparable to the results of cycles with otherwise normal serum P4 values. METHODS: Extended analyses of a retrospective cohort that included FET cycles performed between July 2019 and March 2022 after a cycle of artificial endometrial preparation using valerate-estradiol and micronized vaginal P4 (400 mg twice daily). Whenever the serum P4 value was considered low on the morning of the planned transfer, 10 mg of DYD three times a day was added as a supplement. Only single-embryo transfers of a blastocyst were considered. The primary endpoint was live birth rate. RESULTS: Five-hundred thirty-five FET cycles were analyzed, of which 136 (25.4%) underwent treatment with DYD. There were 337 pregnancies (63%), 207 live births (38.6%), and 130 miscarriages (38.5%). The P4 values could be modeled by a gamma distribution, with a mean of 14.5 ng/ml and a standard deviation of 1.95 ng/ml. The variables female age on the day of FET, ethnicity, and weight were associated with a variation in the serum P4 values. There were no differences in the results between cycles with or without the indication for DYD supplementation. CONCLUSIONS: Live birth rate did not vary significantly in females with low and normal serum P4 levels on the day of FET when DYD was used as rescue therapy.


Assuntos
Coeficiente de Natalidade , Criopreservação , Didrogesterona , Transferência Embrionária , Nascido Vivo , Taxa de Gravidez , Progesterona , Humanos , Didrogesterona/administração & dosagem , Didrogesterona/uso terapêutico , Feminino , Progesterona/sangue , Gravidez , Transferência Embrionária/métodos , Adulto , Criopreservação/métodos , Nascido Vivo/epidemiologia , Estudos Retrospectivos , Fertilização in vitro/métodos , Blastocisto/metabolismo , Blastocisto/efeitos dos fármacos , Progestinas/administração & dosagem , Progestinas/uso terapêutico
2.
Rev Bras Ginecol Obstet ; 44(10): 930-937, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36446559

RESUMO

OBJECTIVE: To determine whether a rescue strategy using dydrogesterone (DYD) could improve the outcomes of frozen embryo transfer cycles (FET) with low progesterone (P4) levels on the day of a blastocyst transfer. METHODS: Retrospective cohort study including FET cycles performed between July 2019 and October 2020 following an artificial endometrial preparation cycle using estradiol valerate and micronized vaginal P4 (400 mg twice daily). Whenever the serum P4 value was below 10 ng/mL on the morning of the planned transfer, DYD 10 mg three times a day was added as supplementation. The primary endpoint was ongoing pregnancy beyond 10 weeks. The sample was subdivided into two groups according to serum P4 on the day of FET: low (< 10 ng/mL, with DYD supplementation) or normal (above 10 ng/mL). We performed linear or logistic generalized estimating equations (GEE), as appropriate. RESULTS: We analyzed 304 FET cycles from 241 couples, 11.8% (n = 36) of which had serum P4 below 10 ng/mL on the FET day. Baseline clinical data of patients was comparable between the study groups.Overall, 191 cycles (62.8%) had a biochemical pregnancy, of which 131 (44,1%) were ongoing pregnancies, with a 29,8% miscarriage rate. We found no statistically significant differences in the hCG positive (63 vs 64%) or ongoing pregnancy rates (50 vs 43,3%) between those FETs with low or normal serum P4 values, even after multivariable logistic regression modelling. CONCLUSION: Our results indicate that DYD 10 mg three times a day administered in women who perform FET with P4 serum levels < 10 ng/mL, allows this group to have pregnancy rates beyond 12 weeks at least as good as those with serum levels above 10 ng/mL.


OBJETIVO: Determinar se uma estratégia de resgate usando didrogesterona (DYD) pode melhorar os resultados dos ciclos de transferência de embriões congelados (TEC) com baixos níveis de progesterona (P4) no dia de uma transferência de blastocisto. MéTODOS: Estudo de coorte retrospectivo que incluiu ciclos TEC realizados entre julho de 2019 e outubro de 2020 após um ciclo de preparação endometrial artificial usando valerato de estradiol e P4 vaginal micronizado (400 mg duas vezes ao dia). Sempre que o valor de P4 sérico estava abaixo de 10 ng/mL na manhã da transferência planejada, adicionou-se 10 mg de DYD tri-diário como suplementação. O desfecho primário foi gravidez evolutiva após 10 semanas. A amostra foi subdividida em dois grupos de acordo com o P4 sérico no dia da TEC: baixo (< 10 ng/mL, com suplementação de DYD) ou normal (acima de 10 ng/mL). Realizamos equações de estimativa generalizada linear ou logística (GEE), conforme apropriado. RESULTADOS: Analisaram-se 304 ciclos de FET de 241 casais, dos quais 11,8% (n = 36) tinham valores de P4 sérico abaixo de 10 ng/mL no dia da TEC. Os dados clínicos e demográficos dos pacientes eram comparáveis entre os grupos.Globalmente, 191 ciclos (62,8%) tiveram uma gravidez bioquímica, dos quais 131 (44,1%) foram gestações em curso, com uma taxa de aborto espontâneo de 29,8%. Não encontramos diferenças estatisticamente significativas na taxa de gravidez bioquímica (63 vs. 64%) ou nas taxas de gravidez evolutiva (50 vs. 43,3%) entre TEC com valores séricos de P4 baixos ou normais, mesmo após modelação com regressão logística multivariável. CONCLUSãO: Nossos resultados indicam que a suplementação com DYD 10 mg três vezes ao dia em mulheres com níveis séricos de P4 abaixo de 10 ng/mL em ciclos de TEC substituídos parecem conseguir resultados pelo menos tão bons como nos ciclos com valores superiores para taxas de gravidez em curso além de 12 semanas.


Assuntos
Didrogesterona , Progesterona , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Transferência Embrionária , Taxa de Gravidez
3.
Rev. bras. ginecol. obstet ; 44(10): 930-937, Oct. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1423266

RESUMO

Abstract Objective To determine whether a rescue strategy using dydrogesterone (DYD) could improve the outcomes of frozen embryo transfer cycles (FET) with low progesterone (P4) levels on the day of a blastocyst transfer. Methods Retrospective cohort study including FET cycles performed between July 2019 and October 2020 following an artificial endometrial preparation cycle using estradiol valerate and micronized vaginal P4 (400 mg twice daily). Whenever the serum P4 value was below 10 ng/mL on the morning of the planned transfer, DYD 10 mg three times a day was added as supplementation. The primary endpoint was ongoing pregnancy beyond 10 weeks. The sample was subdivided into two groups according to serum P4 on the day of FET: low (< 10 ng/mL, with DYD supplementation) or normal (above 10 ng/mL). We performed linear or logistic generalized estimating equations (GEE), as appropriate. Results We analyzed 304 FET cycles from 241 couples, 11.8% (n = 36) of which had serum P4 below 10 ng/mL on the FET day. Baseline clinical data of patients was comparable between the study groups. Overall, 191 cycles (62.8%) had a biochemical pregnancy, of which 131 (44,1%) were ongoing pregnancies, with a 29,8% miscarriage rate. We found no statistically significant differences in the hCG positive (63 vs 64%) or ongoing pregnancy rates (50 vs 43,3%) between those FETs with low or normal serum P4 values, even after multivariable logistic regression modelling. Conclusion Our results indicate that DYD 10 mg three times a day administered in women who perform FET with P4 serum levels < 10 ng/mL, allows this group to have pregnancy rates beyond 12 weeks at least as good as those with serum levels above 10 ng/mL.


Resumo Objetivo Determinar se uma estratégia de resgate usando didrogesterona (DYD) pode melhorar os resultados dos ciclos de transferência de embriões congelados (TEC) com baixos níveis de progesterona (P4) no dia de uma transferência de blastocisto. Métodos Estudo de coorte retrospectivo que incluiu ciclos TEC realizados entre julho de 2019 e outubro de 2020 após um ciclo de preparação endometrial artificial usando valerato de estradiol e P4 vaginal micronizado (400 mg duas vezes ao dia). Sempre que o valor de P4 sérico estava abaixo de 10 ng/mL na manhã da transferência planejada, adicionou-se 10 mg de DYD tri-diário como suplementação. O desfecho primário foi gravidez evolutiva após 10 semanas. A amostra foi subdividida em dois grupos de acordo com o P4 sérico no dia da TEC: baixo (< 10 ng/mL, com suplementação de DYD) ou normal (acima de 10 ng/mL). Realizamos equações de estimativa generalizada linear ou logística (GEE), conforme apropriado. Resultados Analisaram-se 304 ciclos de FET de 241 casais, dos quais 11,8% (n = 36) tinham valores de P4 sérico abaixo de 10 ng/mL no dia da TEC. Os dados clínicos e demográficos dos pacientes eram comparáveis entre os grupos. Globalmente, 191 ciclos (62,8%) tiveram uma gravidez bioquímica, dos quais 131 (44,1%) foram gestações em curso, com uma taxa de aborto espontâneo de 29,8%. Não encontramos diferenças estatisticamente significativas na taxa de gravidez bioquímica (63 vs. 64%) ou nas taxas de gravidez evolutiva (50 vs. 43,3%) entre TEC com valores séricos de P4 baixos ou normais, mesmo após modelação com regressão logística multivariável. Conclusão Nossos resultados indicam que a suplementação com DYD 10 mg três vezes ao dia em mulheres com níveis séricos de P4 abaixo de 10 ng/mL em ciclos de TEC substituídos parecem conseguir resultados pelo menos tão bons como nos ciclos com valores superiores para taxas de gravidez em curso além de 12 semanas.


Assuntos
Humanos , Feminino , Gravidez , Didrogesterona/uso terapêutico , Transferência Embrionária , Fase Luteal
4.
Int J Gynaecol Obstet ; 157(1): 76-84, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34197642

RESUMO

OBJECTIVE: To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. METHODS: Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. RESULTS: Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. CONCLUSION: Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Ruptura Uterina , Feminino , Humanos , Recém-Nascido , Leiomioma/cirurgia , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/cirurgia , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia
5.
Rev Bras Ginecol Obstet ; 43(8): 608-615, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34547795

RESUMO

OBJECTIVE: To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. METHODS: This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were ß human chorionic gonadotropin (ß-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. RESULTS: A total of 140 transfers were included in the analysis: 87 with ß-HCG > 10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%). Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher ß-HCG-positive (72 versus 59%; p > 0.05), lower delivery (26 versus 39%; p > 0.05) and higher miscarriage rates (64 versus 33%; p < 0.01). Comparing the middle quartiles (P25-50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p > 0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p > 0.05) and a lower number of miscarriages (28 versus 45%; p > 0.05). These differences were not statistically significant. CONCLUSION: There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.


OBJETIVO: Avaliar se existe alguma relação entre os valores plasmáticos de progesterona no dia da transferência de um blastocisto desvitrificado em ciclos hormonalmente substituídos e a taxa de gravidez, aborto ou nascido vivo. MéTODOS: Estudo observacional, ambispectivo, incluindo todos os ciclos de transferência de blastocistos congelados no nosso departamento, entre maio de 2018 e junho de 2019. Avaliou-se a taxa de gravidez e de nascidos vivos após 24 semanas de gestação. Os grupos foram comparados de acordo com os valores de progesterona plasmáticos dosados no dia da transferência do blastocisto: comparou-se o 1° quartil com os outros e depois os 2° e 3° quartis com o 4°. RESULTADOS: Avaliaram-se 140 transferências: 87 com ß gonadotrofina coriônica humana (ß-HCG) > 10 IU/L (62%), 50 das quais terminaram em nascido vivo (36% do total), enquanto 37 tiveram um aborto (42% das gravidezes). Verificou-se uma tendência para menor número de recém-nascidos nas transferências com níveis de progesterona no 1° quartil (< 10.7ng/mL) (26 versus 39%; p > 0.05) e um maior número de abortos (64 versus 33%; p < 0.01). Comparando o 2° e 3° quartis com o 4°, verificou-se que nos casos em que a progesterona estava acima do percentil 75, apesar de uma taxa de gravidez semelhante (60 versus 57%; p > 0.05), houve uma tendência para uma maior taxa de nascidos vivos (43 versus 31%; p > 0.05) e menor número de abortos (28 versus 45%; p > 0.05) abaixo do percentil 75. Estas diferenças não foram estatisticamente significativas. CONCLUSãO: Não se verificaram diferenças estatisticamente significativas para taxa de gravidez e de nascido vivo. A taxa de aborto foi maior no primeiro quartil.


Assuntos
Gonadotropina Coriônica Humana Subunidade beta , Progesterona , Transferência Embrionária , Feminino , Fertilização in vitro , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
6.
Rev. bras. ginecol. obstet ; 43(8): 608-615, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1351769

RESUMO

Abstract Objective To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. Methods This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. Results A total of 140 transfers were included in the analysis: 87 with β-HCG>10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%).Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p>0.05), lower delivery (26 versus 39%; p>0.05) and higher miscarriage rates (64 versus 33%; p<0.01). Comparing the middle quartiles (P25-50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p>0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p>0.05) and a lower number of miscarriages (28 versus 45%; p>0.05). These differences were not statistically significant. Conclusion There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.


Resumo Objetivo Avaliar se existe alguma relação entre os valores plasmáticos de progesterona no dia da transferência de um blastocisto desvitrificado em ciclos hormonalmente substituídos e a taxa de gravidez, aborto ou nascido vivo. Métodos Estudo observacional, ambispectivo, incluindo todos os ciclos de transferência de blastocistos congelados no nosso departamento, entre maio de 2018 e junho de 2019. Avaliou-se a taxa de gravidez e de nascidos vivos após 24 semanas de gestação. Os grupos foram comparados de acordo com os valores de progesterona plasmáticos dosados no dia da transferência do blastocisto: comparou-se o 1° quartil com os outros e depois os 2° e 3° quartis com o 4°. Resultados Avaliaram-se 140 transferências: 87 com β gonadotrofina coriônica humana (β-HCG)>10 IU/L (62%), 50 das quais terminaram em nascido vivo (36% do total), enquanto 37 tiveram um aborto (42% das gravidezes). Verificou-se uma tendência para menor número de recém-nascidos nas transferências com níveis de progesterona no 1° quartil (<10.7ng/mL) (26 versus 39%; p>0.05) e ummaior número de abortos (64 versus 33%; p<0.01). Comparando o 2° e 3° quartis com o 4°, verificouse que nos casos em que a progesterona estava acima do percentil 75, apesar de uma taxa de gravidez semelhante (60 versus 57%; p>0.05), houve uma tendência para uma maior taxa de nascidos vivos (43 versus 31%; p>0.05) emenor número de abortos (28 versus 45%; p>0.05) abaixo do percentil 75. Estas diferenças não foram estatisticamente significativas. Conclusão Não se verificaram diferenças estatisticamente significativas para taxa de gravidez e de nascido vivo. A taxa de aborto foi maior no primeiro quartil.


Assuntos
Humanos , Feminino , Gravidez , Progesterona , Gonadotropina Coriônica Humana Subunidade beta , Fertilização in vitro , Estudos Retrospectivos , Taxa de Gravidez , Transferência Embrionária
7.
JBRA Assist Reprod ; 23(4): 402-407, 2019 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-31361435

RESUMO

OBJECTIVES: To find a pretreatment predictor for achieving a live birth. Assisted reproduction technology with IVF/ICSI is the ultimate chance for some couples to conceive a child. The expectations are high and it is important to give them a realistic perspective about the chances of achieving a live birth. METHODS: A retrospective cohort study of all IVF/ICSI cycles performed in our center between 2012 and 2016. We considered only those cycles with a live birth delivery after 24 weeks, or cycles with no surplus embryos left. The following data was evaluated: AMH; AFC; age; BMI; previous diagnosis; type of treatment; number of previous deliveries; ethnicity, smoking status. Univariate and multivariate analysis were used to examine the association of live birth with baseline patient characteristics. We determined the odds-ratio for all the statistically significant variables (p<0.05), in a multivariate model. The results are presented according to the predictors founded. RESULTS: 739 cycles were evaluated: 9.1% were canceled; 10.2% did not have oocytes; 15.6% did not have D2 embryos; 31.4% achieved a live birth. The univariate analysis revealed statistically significant differences regarding AMH, AFC and women's age between couples with and without a live birth (p<0.001), and the cause of infertility. We found no association with live births in other variables. These variables were categorized and used in a multivariate analysis. CONCLUSION: Age, AMH, AFC and cause, when sub-classified, are independently associated with the results of an IVF/ICSI treatment. These results enable couples to face real expectations in their particular scenario.


Assuntos
Coeficiente de Natalidade , Fertilização in vitro , Infertilidade/terapia , Nascido Vivo , Injeções de Esperma Intracitoplásmicas , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Folículo Ovariano , Indução da Ovulação/métodos , Paridade , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Adulto Jovem
8.
Int J Fertil Steril ; 13(1): 83-85, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30644250

RESUMO

Müllerian anomalies are very common, and a frequent cause of infertility. The most used classification system until now, proposed by the American Society for Reproductive Medicine in 1988, categorizes comprehensively uterine anomalies but fails to classify defects of the cervix or vagina. This is based on a developmental theory that postulates that müllerian duct fusion is unidirectional, beginning caudally and extending cranially, which does not account for isolated cervical or vaginal defects. More recently, the European Society of Human Reproduction and Embryology has developed a consensus, which allows for independent cervical anomalies. We present a case of a 39-year-old woman with secondary infertility, found to have a cervical duplication in an anteroposterior disposition, which puts into question the principles of embryology formerly known, but supports the theory that development happens in a segmentary fashion.

9.
Reprod. clim ; 31(1): 55-61, 2016. tab
Artigo em Português | LILACS | ID: lil-788738

RESUMO

O câncer não é incomum nem incurável: 85% dos doentes com menos de 45 anos diagnosticados nos EUA em 2002 sobreviveram mais de 10 anos. As maiores taxas de sobrevivência verificam‐se nos doentes jovens com câncer da mama, testicular e hematológico. Contudo, é para tratar estes tumores que são usados os fármacos mais gonadotóxicos, assim como doenças hematológicas e autoimunes também requerem terapêuticas potencialmente lesivas para as gônadas para o seu controle. O comité ético da Sociedade Americana de Medicina da Reprodução considera que “existem fortes argumentos para a preservação da fertilidade em doentes jovens com cânceres tratáveis”. Cabe ao médico assistente (oncologista, hematologista, cirurgião, internista) decidir o tratamento do paciente e considerar: o risco de falência ovárica/testicular; o prognóstico e o timing para iniciar tratamentos. Por outro lado, ao especialista em medicina da reprodução cabe desenvolver estratégias para preservar gâmetas/embriões de acordo com idade, tempo disponível até início do tratamento, tipo de câncer, status marital e risco de infertilidade com a terapêutica proposta. A colaboração contínua entre esses especialistas, incluindo os doentes e os parceiros, é a chave para a tomada de decisões que permitam a preservação da função reprodutiva após controle da doença de base.


Cancer is not unusual neither incurable: in USA 85% of patients under 45 years diagnosed in 2002 survived more than 10 years. The highest survival rates occur in young patients with breast, testicular and hematologic cancer. However, these tumors are treated with drugs wich most affect fertility and there is evidence that the discussion of preserving fertility is of great importance. Moreover, hematologic and autoimmune diseases may also require the use of potentially gonadotoxic drugs for their control. The ethics committee of the American Society for Reproductive Medicine believes that “there are strong arguments for the preservation of fertility in young patients with treatable cancers”. It is up to the physician (oncologist, hematologist, surgeon, internist) to decide the best treatment to the patient evaluating the risk of ovarian/testicular failure; the prognosis and the timing to start treatments. Moreover, the specialist in reproductive medicine should develop strategies to preserve gametes/embryos according to: age; time to treatment; type of cancer; marital status and risk of infertility, with the proposed therapy. The ongoing collaboration between these specialists, including patients and partners in the discussion, is the key to making decisions that allow the preservation of reproductive function after control of the primary disease.


Assuntos
Humanos , Masculino , Feminino , Preservação da Fertilidade , Fertilidade , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Neoplasias/terapia
10.
Reprod. clim ; 31(3): 134-142, 2016. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-881002

RESUMO

Introdução: Múltiplos estudos sugerem que os valores de ß-hCG e de progesterona podem ser bons preditores de gravidez. Objetivo: Investigar o potencial dos valores de ß-hCG e progesterona na previsão de gravidez evolutiva e de gravidez gemelar, 14 dias após punção ovocitária em ciclos FIV/ICSI, e estabelecer um modelo de previsão. Métodos: Estudo retrospetivo de ciclos com punção e transferência de embriões a fresco entre maio/2011 e setembro/2015. Os grupos definidos foram: sem gravidez; gravidez não evolutiva; gravidez evolutiva (única ou gemelar). A análise estatística considerou = 5%. Para avaliar a capacidade de prever gravidez evolutiva e gravidez gemelar recorreu-se a um modelo de análise multivariada e usou-se um processo de regressão logística binária. Recorreu-se às curvas ROC para avaliar a capacidade do valor de ß-hCG e progesterona na distinção entre gravidez não evolutiva e evolutiva. Resultados: Verificaram-se 149 casos: sem gravidez 11,4%, gravidez não evolutiva 24,8%, gravidez evolutiva 63,8% (83 única, 12 gemelares). Com exceção dos valores de progesterona e ß-hCG, não se verificaram diferenças estatisticamente significativas entre as variáveis do grupo gravidez não evolutiva e evolutiva (ß-HCG: 38,9 vs 159 UI/L; progesterona: 20,4 vs 60 ng/mL). Na comparac¸ão entre gravidez única e gemelar, apenas o valor de ß-hCG foi estatisticamente significativo (ß-HCG: 147 vs 331 UI/L). Quando o valor de progesterona é ≥ 25, a probabilidade de gravidez é 5,4 vezes superior (IC95%, 1,18-24,8). Na regressão logística para gravidez gemelar apenas o valor de ß-hCG foi estatisticamente significativo. Conclusão: Uma avaliação única de progesterona e ß-hCG, 14 dias após punção, tem um bom valor preditivo de gravidez evolutiva, porém com capacidade limitada para discriminar entre gravidez única e gemelar.(AU)


Introduction: Multiple studies suggest that the amount of ß-hCG and progesterone can be good predictors of pregnancy. Objective: To investigate the potential of ß-hCG and progesterone values in predicting evolutive pregnancy and twin pregnancy, 14 days after oocyte puncture in IVF/ICSI cycles, establishing a predictive model. Methods: A retrospective study of cycles with the use of a puncture and fresh embryo transfer between May/2011 and September/2015. The defined groups were: with no pregnancy; without evolutive pregnancy; and with evolutive (single or twin) pregnancy. Statistical analysis considered = 5%. To assess the ability to predict evolutive pregnancy and twin pregnancy, a multivariate analysis model was carried out, with the use of a binary logistic regression process. ROC curves were used to evaluate the ability of ß-hCG and progesterone values in differentiating between non-evolutive and evolutive pregnancy. Results: 149 cases were found: no pregnancy 11.4%, without evolutive pregnancy 24.8%, with evolutive pregnancy 63.8% (83 single, 12 twins). Excluding progesterone and ß-hCG values, there were no statistically significant differences between the variables of non-evolutive and evolutive pregnancy groups (ß-HCG: 38.9 vs. 159 IU/L, progesterone: 20.4 vs. 60ng/mL). In a comparison between single and twin pregnancies, only the amount of ß-hCG was statistically significant (ß-HCG: 147 vs. 331 IU/L). When progesterone value is >25, the probability of pregnancy is 5.4 times greater (95% CI, 1.18-24.8). In a logistic regression for twin pregnancies, only ß-hCG value was statistically significant. Conclusion: A single assessment of progesterone and ß-hCG values 14 days after the puncture has a good predictive value of evolutive pregnancy, but with limited ability to discriminate between single and twin pregnancies.(AU)


Assuntos
Humanos , Feminino , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Fertilização in vitro/métodos , Gravidez de Gêmeos/estatística & dados numéricos , Progesterona/sangue
11.
Rev. bras. ginecol. obstet ; 30(12): 620-625, dez. 2008. tab
Artigo em Português | LILACS | ID: lil-506649

RESUMO

OBJETIVO: comparar parto e seguimento de gravidez entre grávidas adolescentes e não-adolescentes que pariram num hospital terciário da região de Lisboa (Portugal). MÉTODOS: estudo retrospectivo com 10.656 partos. Foram avaliados: seguimento da gravidez, idade gestacional no parto, tipo de parto, necessidade de episiotomia e lacerações graves, índice de Apgar no quinto minuto e peso ao nascer. As grávidas foram divididas em dois grupos, acima e abaixo dos 20 anos. O grupo abaixo dos 20 anos foi depois subdividido entre grávidas com menos ou mais de 16 anos. Foi usado o teste do χ2 para análise estatística. RESULTADOS: as adolescentes tiveram pior seguimento: primeira consulta após as 12 semanas (46,4 versus 26,3 por cento) e menos de quatro consultas (8,1 versus 3,1 por cento), menos distocia (21,5 versus 35,1 por cento), menos cesarianas (10,6 versus 20,7 por cento) e menor necessidade de indução do trabalho de parto (16,5 versus 26,5 por cento). Não houve diferença significativa para idade gestacional no parto e taxa de recém-nascidos de baixo peso. Entre adolescentes, as menores de 16 anos tiveram mais recém-nascidos de baixo peso (12 versus 7,4 por cento) e mais partos entre 34 e 37 semanas (10,8 versus 4,2 por cento). CONCLUSÕES: num hospital com serviço dedicado a grávidas adolescentes com apoio social e psicológico, apesar de pior seguimento pré-natal vigilância, o seu desempenho não foi pior. Uma atenção especial deve, no entanto, ser dada a grávidas abaixo dos 16 anos.


PURPOSE: to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). METHODS: retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The χ2 test has been used for statistical analysis. RESULTS: adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3 percent) and less than four appointments (8.1 versus 3.1 percent), less dystocia (21.5 versus 35.1 percent), less caesarian sections (10.6 versus 20.7 percent), and lower need for inducing labor (16.5 versus 26.5 percent). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4 percent) and more deliveries between 34 and 37 weeks (10.8 versus 4.2 percent). CONCLUSIONS: in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.


Assuntos
Adolescente , Feminino , Humanos , Recém-Nascido , Gravidez , Gravidez na Adolescência , Resultado da Gravidez , Estudos Retrospectivos
12.
Acta Med Port ; 21(5): 483-8, 2008.
Artigo em Português | MEDLINE | ID: mdl-19187691

RESUMO

OBJECTIVE: To evaluate the diagnostic accuracy of hysteroscopy at our unit for postmenopausal bleeding, specially concerning proliferative lesions. METHODS: We analyzed the results of 335 hysteroscopies that were done during the last 8 years in our hysteroscopic unit and we compared the hysteroscopic diagnosis with the biopsy result done during the procedure. Data were group according to pathologic findings in three groups normal, proliferative lesions and benign lesions. Data were analyzed by direct comparison. Sensitivity and specificity were calculated, Kappa index was used to access the inter-rater reliability, and likelihood ratio and the post test probability were used to analyze the true value of hysteroscopy. RESULTS: Women were aged between 36 and 88 years, with an average of 61,5. Histological diagnosis was atrophy in 42,1% patients, polyps in 43,3%, sub-mucous fibromioma in 5%, hyperplasic lesions in 9,6%, half of them being carcinomas. Overall Kappa index for the 3 groups was 0,831 which is in line with excellent agreement. Concerning proliferative lesions (hyperplasia + carcinoma vs carcinoma alone) and comparing to histology, sensitivity was 78,1% vs 81,3%; specificity 95,7% vs 98,7%. The positive likelihood ratio was 18,2 vs 64,8 and the negative likelihood ratio was 0,23 vs 0,19. The probability post positive test was 66% vs 76% and the probability post negative test was 2,4% vs 0,95%. No cases of carcinoma were identified among the 129 women diagnosed as having atrophy. However 3,9% of all the lesions regarded as being polyps at the hysteroscopy proved to be proliferative lesions at hysteroscopy. CONCLUSION: Hysteroscopy at our unit is a highly accurate procedure concerning post menopausal endometrial bleeding, with its results being in line with the literature. Diagnosing atrophy or excluding a proliferative lesion by the observer was highly predictive of a negative carcinoma in the histology. Using this argument whenever a proliferative lesion was excluded, only 1 in 302 hysteroscopies hid a carcinoma. Polyps should be regarded as possible proliferative lesions. Despite this result we believe a biopsy should always be undertaken no matter the observer's diagnosis.


Assuntos
Histeroscopia , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Reprodutibilidade dos Testes , Estudos Retrospectivos
13.
Rev Bras Ginecol Obstet ; 30(12): 620-5, 2008 Dec.
Artigo em Português | MEDLINE | ID: mdl-19219344

RESUMO

PURPOSE: to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). METHODS: retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The chi2 test has been used for statistical analysis. RESULTS: adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3%) and less than four appointments (8.1 versus 3.1%), less dystocia (21.5 versus 35.1%), less caesarian sections (10.6 versus 20.7%), and lower need for inducing labor (16.5 versus 26.5%). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4%) and more deliveries between 34 and 37 weeks (10.8 versus 4.2%). CONCLUSIONS: in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.


Assuntos
Resultado da Gravidez , Gravidez na Adolescência , Adolescente , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
14.
Acta Med Port ; 17(4): 329-34, 2004.
Artigo em Português | MEDLINE | ID: mdl-15941560

RESUMO

Thyroid associated ophthalmopathy is an uncommon disease, characterized by a diffuse inflammation of the orbit in a bilateral and asymmetric pattern, causing proptosis and swelling of the eyelids and conjuntiva. In 90% of the patients it is associated with Graves' disease, however it may occur with hipothyroidism or even without thyroid disease. During its course spontaneous remission or exacerbations are common, evolving independently from the thyroid disease, most often without serious complications for the patient, being blindness the worse of them, in 1% of the cases. The cause is still misunderstood but it is thought to be the result of an immune system disorder with the production of auto-antibodies directed against retro-bulbar fibroblasts and thyroid. Therapeutics is still a controversial matter. The balance between benefits and medication adverse effects is still to be made.


Assuntos
Oftalmopatias/etiologia , Doença de Graves/complicações , Feminino , Humanos , Pessoa de Meia-Idade
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