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Aim of the study : The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen. Material and methods : Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35–36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger. Results : The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10. Conclusions : The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.

Objective: The goal of this study was to determine the prevalence of C. trachomatis in women diagnosed with infertility attending the Outpatient Clinic of Infertility from Botucatu Medical School, UNESP, Brazil. Patients and Methods: This molecular study enrolled a total of 112 women. Among these patients, 62 presented primary infertility while 50 presented secondary infertility. The criteria for eligibility included women who were: reproductive-aged; no prior report of seroconversion for HIV; no antibiotic or vaginal cream used in the preceding 30 days; and abstinence from sexual intercourse for 72 hours before the visit. The women were submitted to a gynecological examination and cervical samples were collected with an endocervical cytobrush for molecular analysis of C. trachomatis. Results: The prevalence of chlamydial infection was 8% with similar prevalence between primary (8.1%) and secondary (8.0%) infertility. Conclusion: Considering the asymptomatic nature of chlamydial infection and its association with tubal factor infertility, there is a pressing need to incorporate the screening of C. trachomatis infection as part of the routine investigation for infertility. The early diagnostic by screening can minimize complications and reduce Public Health costs with Assisted Reproductive Technology.

Made available in DSpace on 2014-10-01T13:08:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-12-01Bitstream added on 2014-10-01T14:03:04Z : No. of bitstreams: 1 S0100-72032013001200006.pdf: 518995 bytes, checksum: 0c294c02ea0d4b9caf0317f0aba30e3c (MD5) OBJETIVO: Avaliar a contribuição do hiperandrogenismo para o desenvolvimento da síndrome metabólica (SM) em mulheres obesas com ou sem Síndrome dos Ovários Policísticos (SOP). MÉTODOS: Estudo transversal retrospectivo no qual foram incluídas 60 mulheres obesas com fenótipo clássico da SOP - Consenso de Rotterdam - e 70 obesas sem SOP. A SM foi diagnosticada pelos critérios do NCEP-ATP III. A obesidade foi definida pelo índice de massa corpórea e o hirsutismo, pelo Índice de Ferriman-Gallwey (IFG). As dosagens realizadas foram: testosterona total, sulfato de dehidroepiandrosterona (SDHEA), insulina e glicose, colesterol total, HDL e triglicerídios. A resistência insulínica (RI) foi avaliada pelo HOMA-IR e pelo índice de sensibilidade à insulina de Matsuda e De Fronzo. A analise estatística foi realizada com o teste t de Student, teste do χ² e análise de regressão logística multivariada (p0,05). CONCLUSÃO: Mulheres obesas com SOP apresentam maior frequência de SM quando comparadas às obesas não SOP. O hiperandrogenismo não mostrou influência nesse grupo de mulheres estudadas. PURPOSE: To assess the contribution of hyperandrogenism to the development of metabolic syndrome (MetS) in obese women with polycystic ovary syndrome (PCOS). METHODS: Retrospective cross-sectional study conducted on 60 obese women with classic PCOS phenotype - Rotterdam Consensus - and 70 non-PCOS obese women. MetS was diagnosed by the NCEP-ATP III criteria and obesity was defined by body mass index. The Ferriman-Gallwey score (mFG) was used to evaluate hirsutism. The following measurements were performed: total testosterone, dehydroepiandrosterone sulfate (DHEA-S), glucose and insulin, total cholesterol, HDL, and triglycerides. Insulin resistance was measured using the HOMA-IR and insulin sensitivity index of Matsuda and De Fronzo (ISI). Statistical analysis was performed using the Student's t-test, χ² test and multivariate logistic regression analysis (p0.05). CONCLUSION: Obese women with PCOS have a higher frequency of metabolic syndrome than non-PCOS obese women, and hyperandrogenism does not contribute to the development of metabolic syndrome in this group of women. Universidade Federal do Paraná Departamento de Tocoginecologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Programa de Pós-Graduação em Ginecologia, Obstetrícia e Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Instituto de Biociências Departamento de Bioestatística Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Programa de Pós-Graduação em Ginecologia, Obstetrícia e Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Instituto de Biociências Departamento de Bioestatística

The aim of this study was to evaluate inflammatory response in chronic anovulating infertility women undergoing intracytoplasmic sperm injection. Thirteen infertile women with chronic anovulation and 23 normally ovulating women were prospectively evaluated. N-acetylglucosaminidase (NAG), myeloperoxidase (MPO), monocyte chemoattractant protein 1 (MCP-1), and C-reactive protein (CRP) concentrations were evaluated in serum and follicular fluid. Women with chronic anovulation presented higher NAG and MPO activity in follicular fluid when compared with normally ovulating women. Serum MPO activity was higher in the control group compared to the chronic anovulation group. Both serum and follicular fluid CRP concentrations were higher in women with chronic anovulation in comparison with the control group. Higher MCP-1 follicular fluid concentrations and serum levels of CRP were associated with the occurrence of ovarian hyperstimulation syndrome. Patients with chronic anovulation exhibited significantly higher follicle macrophage/neutrophil activation as well as unspecific inflammatory response by comparison with normally ovulating women.

The analysis of p53 protein in cervical carcinoma correlated with clinical and prognostic factors was performed in a retrospective study with p53 expression detection by immunohistochemical technique. 120 slides of patients with squamous cell cancer at the Gynecologic Oncology Clinic and stored in the Department of Pathological Anatom at the School of Medicine of Botucatu were used. Age, ethnicity, parity, smoking habit, oral contraceptive use, age at first intercourse, histology, stage, treatment, and follow-up were the cofactors associated with p53 positivity. Fisher’s exact tests were carried out to analyze associations between p53 and variables, with p < 0.05 as the significant level. The study revealed a 43.3% frequency of patients with stage II disease and p53 positive rate with p = 0.001, and 64.2% frequency with p = 0.024 of Correlação de fatores clínicos e prognósticos proteína p53 no colo uterino. patients whose first intercourse occurred between the ages of 15 and 20. These findings show the correlation between stage II disease and age at fir st intercourse with p53 positive in invasive cervical cancer. Fisher's exact test revelead these cofactors to be statistically significant and there was no association between the protein p53 with others prognostic and analyzed cofactors. The prognostic value of p53 in cervical cancer had been examined, with the conclusion that p53 is correlated to unfavorable prognosis.

Universidade Federal de Minas Gerais (UFMG), Dept Gynecol & Obstet, Sch Med, BR-30130100 Belo Horizonte, MG, Brazil

The analysis of p53 protein in cervical carcinoma correlated with clinical and prognostic factors was performed in a retrospective study with p53 expression detection by immunohistochemical technique. 120 slides of patients with squamous cell cancer at the Gynecologic Oncology Clinic and stored in the Department of Pathological Anatom at the School of Medicine of Botucatu were used. Age, ethnicity, parity, smoking habit, oral contraceptive use, age at first intercourse, histology, stage, treatment, and follow-up were the cofactors associated with p53 positivity. Fisher’s exact tests were carried out to analyze associations between p53 and variables, with p < 0.05 as the significant level. The study revealed a 43.3% frequency of patients with stage II disease and p53 positive rate with p = 0.001, and 64.2% frequency with p = 0.024 of patients whose first intercourse occurred between the ages of 15 and 20. These findings show the correlation between stage II disease and age at first intercourse with p53 positive in invasive cervical cancer. Fisher's exact test revelead these cofactors to be statistically significant and there was no association between the protein p53 with others prognostic and analyzed cofactors. The prognostic value of p53 in cervical cancer had been examined, with the conclusion that p53 is correlated to unfavorable prognosis.

Summary The aim of this investigation was to determine the presence of abnormal sperm chromatin packaging in spermatozoa with large nuclear vacuoles (LNV) selected via high magnification by analysing the pattern of chromomycin A3 (CMA3) staining. A prospective observational study was designed to analyse semen samples obtained from 66 men undergoing infertility diagnosis and treatment. The numbers of cells with normal (dull yellow staining of the sperm head/CMA3-negative) and abnormal (bright yellow fluorescence of the sperm head/CMA3-positive) chromatin packaging were determined on slides with normal and LNV spermatozoa. The presence of bright yellow fluorescence (CMA3-positive) was significantly higher (p

Purpose: to compare the efficacy of recombinant LH supplementation for controlled ovarian stimulation in recombinant FSH and GnRH-agonist protocol. Methods: Search strategies included on-line surveys of databases. The fixed effects model was used for odds ratio and effect size (weighted mean difference). Four trials fulfilled the inclusion criteria. Results: a fewer days of stimulation (p

OBJECTIVE This study evaluated the augmentation of venlafaxine with hormone therapy in the treatment of postmenopausal depression. The hormones evaluated were estrogen (0.625 mg) in combination with medroxyprogesterone acetate (2.5 mg) and methyltestosterone (2.5 mg). DESIGN Seventy-two menopausal women (mean age: 53.6 +/- 4.27 years) diagnosed with depression (Montgomery-Asberg Depression Rating Scale [MADRS] scores > or = 20) were treated with venlafaxine and one of the following hormone therapy combinations, in a double-blind regimen: estrogen + medroxyprogesterone + methyltestosterone (group 1, n = 20); estrogen + medroxyprogesterone acetate (group 2, n = 20); methyltestosterone only (group 3, n = 16); and no hormone therapy (group 4, n = 16). Study duration was 24 weeks. Primary efficacy outcome was remission according to the MADRS, whereas secondary efficacy measures included the Clinical Global Impression (CGI), Blatt-Kupperman Index, and Women's Health Questionnaire (WHQ). RESULTS Forty-eight patients completed the study. All groups showed significant improvement from baseline. Group 3 demonstrated significant improvement on the MADRS compared with placebo (group 4) at weeks 20 (P = 0.048) and 24 (P = 0.030); effect size 8.04 (0.83; 15.26) (P = 0.029), but also had the highest dropout rate. Groups 1 and 3 had significant CGI improvement rates compared with placebo: 42.23% (P = 0.012) and 44.45% (P = 0.08), respectively. There were no differences in the WHQ or BKI scores among the groups. CONCLUSIONS Methyltestosterone 2.5 mg had the highest effect size compared with placebo, but the high dropout rate prevented its efficacy from being determined. Estrogen plus medroxyprogesterone, combined with methyltestosterone or otherwise, demonstrated a trend toward increased efficacy of venlafaxine. Further larger-scale clinical trials are needed to elucidate the findings of this pilot study.

A hiperprolactinemia é o distúrbio endócrino mais freqüente do eixo hipotálamo-hipofisário, observado em mulheres na idade reprodutiva. Caracteriza-se pela elevação consistente dos valores plasmáticos de prolactina. A regulação da produção da prolactina dá-se por meio da ação inibitória de um neurotransmissor, a dopamina. As manifestações clínicas são distúrbios do ciclo menstrual, amenorréia, galactorréia, infertilidade e diminuição da libido. Entretanto, sintomas psicológicos, especialmente ansiedade e depressão, têm sido associados à hiperprolactinemia. Contudo, há poucos estudos clínicos publicados sobre o tema. O papel da prolactina na patogênese dos distúrbios psiquiátricos pode refletir ação direta sobre o sistema nervoso central, efeito indireto por meio dos hormônios gonadais ou constituir fatores independentes, resultantes da depleção de dopamina. Assim, detectada a prevalência de distúrbios psiquiátricos em pacientes com hiperprolactinemia, conclui-se pela necessidade de maior número de pesquisas que investiguem as bases da possível inter-relação entre os estados hiperprolactinêmicos e o psiquismo.Hyperprolactinemia is the most frequent endocrine disorder of the hypothalamus-hypophysis axis observed in women of reproductive age. It is characterized by elevated serum prolactin levels. Prolactin production is regulated by the inhibitory action of a neurotransmitter, dopamine. Clinical manifestations include irregular menstrual cycle, amenorrhea, galactorrhea, infertility and libido decrease, but psychological symptoms, especially anxiety and depression, have also been associated with hyperprolactinemia. Nonetheless, few studies about this condition are available. In the pathogenesis of psychiatric disorders, prolactin may have either a direct action on the central nerve system or an indirect effect via gonadal hormones or function as independent factors as a result of dopamine depletion. Thus, since the prevalence of psychiatric disorders in patients with hyperprolactinemia was detected, it was concluded that further studies are necessary to investigate the basis of a potential relationship between both hyperprolactinemic and psychiatric conditions.

Objective In an attempt to clarify the clonality and genetic relationships that are involved in the tumorigenesis of uterine leiomyomas, we used a total of 43 multiple leiomyomas from 14 patients and analyzed the allelic status with 15 microsatellite markers and X chromosome inactivation analysis. Study design We have used a set of 15 microsatellite polymorphism markers mapped on 3q, 7p, 11, and 15q by automated analysis. The X chromosome inactivation was evaluated by the methylation status of the X-linked androgen receptor gene. Results Loss of heterozygosity analysis showed a different pattern in 7 of the 8 cases with allelic loss for at least 1 of 15 microsatellite markers that were analyzed. A similar loss of heterozygosity findings at 7p22-15 was detected in 3 samples from the same patient. X chromosome inactivation analysis demonstrated the same inactivated allele in all tumors of the 9 of 12 informative patients; different inactivation patterns were observed in 3 cases. Conclusion Our data support the concept that uterine leiomyomas are derived from a single cell but are generated independently in the uterus. Loss of heterozygosity findings at 7p22-15 are consistent with previous data that suggested the relevance of chromosomal aberrations at 7p that were involved in individual uterine leiomyomas.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:31Z No. of bitstreams: 1 S0100-72032005000800006.pdf: 43714 bytes, checksum: e00cde0b491e3a1049e37ca4e50ddf0a (MD5) Made available in DSpace on 2013-08-22T18:50:31Z (GMT). No. of bitstreams: 1 S0100-72032005000800006.pdf: 43714 bytes, checksum: e00cde0b491e3a1049e37ca4e50ddf0a (MD5) Previous issue date: 2005-08-01 Made available in DSpace on 2013-09-30T19:41:32Z (GMT). No. of bitstreams: 2 S0100-72032005000800006.pdf: 43714 bytes, checksum: e00cde0b491e3a1049e37ca4e50ddf0a (MD5) S0100-72032005000800006.pdf.txt: 28585 bytes, checksum: b19be25144dbe3459e9a0634acdbd31e (MD5) Previous issue date: 2005-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:10:57Z No. of bitstreams: 2 S0100-72032005000800006.pdf: 43714 bytes, checksum: e00cde0b491e3a1049e37ca4e50ddf0a (MD5) S0100-72032005000800006.pdf.txt: 28585 bytes, checksum: b19be25144dbe3459e9a0634acdbd31e (MD5) Made available in DSpace on 2014-05-20T15:10:57Z (GMT). No. of bitstreams: 2 S0100-72032005000800006.pdf: 43714 bytes, checksum: e00cde0b491e3a1049e37ca4e50ddf0a (MD5) S0100-72032005000800006.pdf.txt: 28585 bytes, checksum: b19be25144dbe3459e9a0634acdbd31e (MD5) Previous issue date: 2005-08-01 OBJETIVO: avaliar a prevalência do hipotiroidismo subclínico e suas repercussões sobre o perfil lipídico e a densidade mineral óssea (DMO) em mulheres na pós-menopausa. Métodos: trata-se de estudo transversal com recuperação de dados de prontuários de pacientes acompanhadas em ambulatório de climatério. Critérios de inclusão: mulheres na pós-menopausa com dosagem do hormônio estimulador da tiróide (TSH) e de tiroxina livre (T4-L). Critérios de exclusão: hipertiroidismo e carcinoma de tiróide. Considerou-se hipotiroidismo subclínico valores de TSH superiores a 5,0 mUI/mL e T4-L normal. Foram selecionadas 320 pacientes (idade 55,2±6,4 anos) divididas em 3 grupos: função tiroideana normal (n=208), hipotiroidismo subclínico (n=53) e hipotiroidismo clínico sob tratamento (n=59). Foram analisados dados clínicos, uso de terapia hormonal, índice de massa corpórea (IMC=kg/m²), perfil lipídico (colesterol total, HDL, LDL, triglicerídeos) e DMO da coluna lombar e fêmur. Na análise estatística, as diferenças entre as médias dos grupos foram comparadas utilizando-se a análise de variância (ANOVA). Para múltipla comparação, assumindo que a variância era diferente entre os grupos, utilizou-se o método de Tukey. RESULTADOS: o hipotiroidismo subclínico foi diagnosticado em 16,1% dos casos. Os grupos foram homogêneos quanto às características clínicas, IMC e perfil lipídico e uso de terapêutica hormonal. Nas pacientes com hipotiroidismo subclínico ou clínico encontrou-se menor freqüência de osteopenia na coluna lombar e fêmur quando comparadas às eutiroidianas (p5.0 mIU/ml and normal T4-L were considered to be subclinical hypothyroidism. The 329 selected women (55.2±6.4 years) were divided into three groups: normal thyroid function (control) (n=208), subclinical hypothyroidism (n=53) and clinical hypothyroidism under treatment (n=59). Clinical data, hormonal therapy use, body mass index (BMI=kg/m²), lipid profile (total cholesterol, HDL, LDL, triglycerides) and BMD of lumbar column and femur were obtained. RESULTS: subclinical hypothyroidism was diagnosed in 16.1% of the cases. The groups were homogeneous regarding clinical features, BMI or lipidic profile. BMD in lumbar column and femur was lower in subclinical and clinical hypothyroidism than in euthyroidism (p

Uterine leiomyomas are extremely common, benign, smooth muscle tumors that represent a significant public health problem. Although there have been few molecular studies of uterine leiomyomas, most of them have reported a very low frequency of loss of heterozygosity (LOH) in different regions of the genome. The detection of LOH has been used to identify genomic regions that harbor tumor suppressor genes and to characterize different tumor types. We have used a set of 15 microsatellite polymorphism markers to examine the frequency of allele loss in a panel of 64 human uterine leiomyomas matched to normal DNAs. The markers were chosen from regions involved in losses identified by comparative genomic hybridization in a subset of uterine leiomyomas described in a previous report. DNA from tumors and normal tissue was amplified by the polymerase chain reaction and subsequently analyzed using an ABI Prism 377 DNA automated sequencer. The frequency of LOH observed was low, except for the markers D15S87 (15q26.3), D7S493 (7p15.3), and D7S517 (7p22.2). No changes in microsatellite size were detected in our samples. These results provide useful clues for identifying putative tumor suppressor genes associated with a subset of uterine leiomyomas. (c) 2004 Wiley-Liss, Inc.

The objective of the present study was to determine the importance of the site of embryo transfer (upper or lower half endometrial cavity) on implantation and clinical pregnancy rates.A total of 400 transfers guided by ultrasound were randomly assigned to two groups according to the distance between the uterine fundus and the catheter tip at the time of embryo placement. Group I (n = 200) consisted of transfers corresponding to a distance of50% of the endometrial cavity length (ECL), i.e. transfer in upper half of the cavity; and group II (n = 200) consisted of transfers corresponding to a distance ofor = 50%, of the ECL, i.e. transfer in lower half of cavity. The Student's t-test, Mann-Whitney test and Fisher's exact test were used where appropriate.The general characteristics of the study population and the main transfer cycle characteristics had an equal distribution (P0.05) between groups I and II. No significant difference in implantation or pregnancy rates was observed between groups I and II.The implantation or pregnancy rates were similar whether the embryos were deposited in the upper or lower half of the endometrial cavity.

The influence of endometrial cavity length (ECL) on implantation and pregnancy rates after 400 embryo transfers was studied prospectively in a population with the indication of IVF/intracytoplasmic sperm injection (ICSI). The tip of the transfer catheter was placed above or below the half point of the ECL in a randomized manner. Two analyses were performed: (i) absolute position (AP); embryo transfers were divided into three groups according to the distance between the end of the fundal endometrial surface and the catheter tip (DTC - distance tip catheter): AP1 (n = 212), 10-15 mm; AP2 (n = 158), 16-20 mm; and AP3 (n = 30),or =21 mm. (ii) relative position (RP)--embryo transfers were divided into four groups according to their RP [RP = (DTC/ECL) x 100]: RP1 (n = 23),or =40%; RP2 (n = 177), 41-50%; RP3 (n = 117), 51-60%; and RP4 (n = 83),or =61%. Analysis based on relative distance revealed significantly higher implantation and pregnancy rates (P0.05) in more central areas of the ECL. However, analysis based on absolute position did not reveal any difference. In conclusion, the present results demonstrated that implantation and pregnancy rates are influenced by the site of embryo transfer, with better results being obtained when the catheter tip is positioned close to the middle area of the endometrial cavity. In this respect, previous analysis of the ECL is the fundamental step in establishing the ideal site for embryo transfers.

Purpose: The objective of this study was to determine if the zona thinning (ZT) technique improved the rates of implantation and clinical pregnancy for patients aged ≥38 years submitted to an ICSI program.

h Abstract Objective. The purpose of this study was to assess the cervicovaginal levels of proinflammatory cytokines in women with Chlamydia trachomatis (CT) infection in the presence of bacterial vaginosis (BV) and normal flora and to compare with those negative for CT. Materials and Methods. In this cross-sectional study, nonpregnant women were enrolled at 2 outpatient clinics and at 1 primary medical care unit in Sao Paulo State, Brazil. Cervicovaginal samples from 256 women with BV, of which 68 (26.6%) had concomitant CT infection and 188 (73.4%) wereCT-negative,weremeasuredforinterleukin-1A (IL-1A), IL-6, and IL-8 by enzyme-linked immunosorbent assay. A matching number of samples from women with normal flora, CT-positive (n = 68) and negative (n = 188), were evaluated as control. Cytokine levels were compared by Mann-Whitney test and differences were considered sig- nificant at p G.05. Results. In CT-negative women, IL-1A was increased in BV (p G.001) when compared to normal flora, while the levels of IL-6 and IL8 were unchanged. The presence of CT infection was not associated with differences on cytokine levels in women with normal flora. However, women with BV had higher levels of IL-1A (p = .02), IL-6 (p = .02), and IL-8 (p = .03) in the presence of CT when compared to those who tested negative for CT. Conclusions. Detection of endocervical CT is associated with increased cervicovaginal IL-1A, IL-6, and IL-8 levels in women with concomitant BV but not in those with normal flora. h

To assess the contribution of hyperandrogenism to the development of metabolic syndrome (MetS) in obese women with polycystic ovary syndrome (PCOS).Retrospective cross-sectional study conducted on 60 obese women with classic PCOS phenotype - Rotterdam Consensus - and 70 non-PCOS obese women. MetS was diagnosed by the NCEP-ATP III criteria and obesity was defined by body mass index. The Ferriman-Gallwey score (mFG) was used to evaluate hirsutism. The following measurements were performed: total testosterone, dehydroepiandrosterone sulfate (DHEA-S), glucose and insulin, total cholesterol, HDL, and triglycerides. Insulin resistance was measured using the HOMA-IR and insulin sensitivity index of Matsuda and De Fronzo (ISI). Statistical analysis was performed using the Student's t-test, χ² test and multivariate logistic regression analysis (p0.05).Obese women with PCOS had significantly higher mFG (15.4 ± 6.1), waist circunference (105.6 ± 11.4 cm), DHEA-S (200.8 ± 109.2 µg/dL), testosterone (135.8 ± 71.4 ng/dL), and HOMA-IR (8.4 ± 8.5) values and lower ISI values (2.0 ± 1.8) than non-obese PCOS women (3.2 ± 2.1; 101.4 ± 9.2 cm; 155.0 ± 92.7 µg/dL; 50.0 ± 18.2 ng/dL; 5.1 ± 4.7 and 3.3 ± 2.7, respectively) (p0.05). The frequency of MetS was higher in PCOS obese (75%) than non-PCOS obese (52.8%) women (p=0.015). Multivariate analysis did not reveal the contribution of the variables IFG, testosterone, and DHEAS to the development of MetS (p0.05).Obese women with PCOS have a higher frequency of metabolic syndrome than non-PCOS obese women, and hyperandrogenism does not contribute to the development of metabolic syndrome in this group of women.

Made available in DSpace on 2014-12-03T13:10:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-10-22Bitstream added on 2014-12-03T13:23:08Z : No. of bitstreams: 1 WOS000326242800001.pdf: 282617 bytes, checksum: fb6540008c7a954d9d146e16337518dc (MD5) Background: Intrauterine insemination (IUI) is widely used to treat infertility, and its adequate indication is important to obtain good pregnancy rates. To assess which couples could benefit from IUI, this study aimed to evaluate whether sperm motility using a discontinuous gradient of different densities and incubation in CO2 in normospermic individuals is able to predict pregnancy.Methods: A total of 175 couples underwent 175 IUI cycles. The inclusion criteria for women were as follows: 35 years old or younger (age range: from 27 to 35 years) with normal fallopian tubes; endometriosis grades I-II; unexplained infertility; nonhyperandrogenic ovulatory dysfunction. Men with normal seminal parameters were also included. All patients underwent ovarian stimulation with clomiphene citrate and human hMG or r-FSH. When one or (at most) three follicles measuring 18 to 20 mm were observed, hCG (5000 UI) or r-hCG (250 mcg) was administered and IUI performed 36-40 h after hCG. Sperm processing was performed using a discontinuous concentration gradient. A 20 microliters aliquot was incubated for 24 h at 37 degrees C in 5% CO2 following a total progressive motility analysis. The Mann-Whitney and Chi-square tests, as well as a ROC curve were used to determine the cutoff value for motility.Results: Of the 175 couples, 52 (in 52 IUI cycles) achieved clinical pregnancies (CP rate per cycle: 29.7%). The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001). The comparison of progressive motility after processing and 24 h after incubation between these two groups indicated that progressive motility 24 h after incubation was higher in the pregnancy group. The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001). The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.Conclusions: We concluded that the sperm motility of normospermic individuals 24 h after incubation at 37 degrees C in 5% CO2, with a cutoff value of 56.5%, is predictive of IUI success. Ctr Human Reprod Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, Brazil Sao Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynaecol & Obstet, Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Bioestat, Botucatu, SP, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, SP, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, SP, Brazil GERAR Fertil Clin, Recife, PE, Brazil Sao Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynaecol & Obstet, Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Bioestat, Botucatu, SP, Brazil

Background Uterine leiomyomas (UL) are mesenchymal benign tumors extremely common that represent a significant public health problem. The deregulation of growth factors and microRNAs (miRNAs), shortening of telomeres, excessive production of disorganized extracellular matrix, loss of heterozygosity and recurrent chromosomal aberrations (including 7q22 deletion and chromossomal rearrangements in 12q15) have been suggested to contribute to the growth of fibroids. HMGA2, mapped to 12q15, is a major regulator of benign tumorigenesis from mesenchyme-derived tissues and stem-cell self-renewal. In UL, HMGA2 overexpression is frequently reported. Recently it has been shown that repression of HMGA2 by microRNA let-7s is a critical molecular regulatory mechanism associated with tumor growth. In this study, it was evaluated three miRNAs mapped to 7q22 (miR-25, miR-93 and miR106b) and miR-let-7a (previously reported as HMGA2 regulator). These findings were compared with gene expression microarray data.

To evaluate the clinical, ultrasonographic, biochemical and metabolic alterations of adolescents with polycystic ovary syndrome (PCOS).Retrospective observational study conducted on 44 adolescents aged 12 to 19 years, diagnosed with PCOS according to the Rotterdam Consensus. Metabolic changes were assessed according to the recommendations of the International Diabetes Federation, considering: waist circumference (WC)90th percentile (10-15 years of age) or80 cm (age16 years), fasting glucose100 mg/dL, triglycerides150 mg/dL, HDL40 mg/dL, and blood pressureHg 130/85 mm.Mean age was 16.7 ± 2.2 years and age at menarche was 11.8 ± 1.4 years. The menstrual irregularity most frequently observed was amenorrhea (72.7%) followed by oligomenorrhea (27.3%); hirsutism was observed in 86.4% and acne in 56.8%. Polycystic ovaries were observed by ultrasound only in 27.3%. Mean BMI was 30.3 ± 6.6 kg/m². According to BMI, 52.3% of adolescents were obese, 13.6% were overweight and 6.8% had a healthy weight. Increased waist circumference (63.6%, 28/44) and the reduction of HDL-C (34.1%, 15/44) were the metabolic changes most frequently observed. Increased triglycerides were observed in 27.3% (12/44) and increased blood pressure and impaired fasting glucose were found in 9.1% (4/44) and 4.5% (2/44) of cases, respectively. Acanthosis nigricans was observed in 52.3% and insulin resistance in 62.8% of the adolescents with PCOS. Metabolic syndrome was identified in six children (13.6%), all of them obese or overweight.In the adolescents with PCOS studied here, menstrual irregularity and hirsutism were the most common clinical manifestations, while the sonographic findings consistent with polycystic ovaries were less prevalent. Obesity associated with insulin resistance predisposes these adolescents to a higher frequency of metabolic disorders.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:28:38Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:32:20Z : No. of bitstreams: 1 2-s2.0-84874582462.pdf: 2646107 bytes, checksum: 198eeb5a410105f90919e96a3ab88e1b (MD5) Made available in DSpace on 2014-05-27T11:28:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-03-04 Background: Uterine Leiomyomas (ULs) are the most common benign tumours affecting women of reproductive age. ULs represent a major problem in public health, as they are the main indication for hysterectomy. Approximately 40-50% of ULs have non-random cytogenetic abnormalities, and half of ULs may have copy number alterations (CNAs). Gene expression microarrays studies have demonstrated that cell proliferation genes act in response to growth factors and steroids. However, only a few genes mapping to CNAs regions were found to be associated with ULs. Methodology: We applied an integrative analysis using genomic and transcriptomic data to identify the pathways and molecular markers associated with ULs. Fifty-one fresh frozen specimens were evaluated by array CGH (JISTIC) and gene expression microarrays (SAM). The CONEXIC algorithm was applied to integrate the data. Principal Findings: The integrated analysis identified the top 30 significant genes (P

Inflammation is as an important factor in ovulation with the active participation of leucocytes and their inflammatory mediators. The present study was performed to compare the activity of the inflammatory enzymes myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) in patients with endometriosis-related infertility and in normally ovulating women undergoing intracytoplasmic sperm injection (ICSI).This prospective study included infertile women undergoing ICSI treatment. These women were divided into two groups: endometriosis anovulation (n = 18) and normally ovulating (n = 20). NAG and MPO activity was evaluated colorimetrically in serum and in follicular fluids obtained at the time of oocyte retrieval.There was a significant correlation between the serum and follicular fluid activities of NAG and MPO (τ = 0.256, P = 0.025; and τ = -0.234, P = 0.041; respectively). Both serum and follicular fluid NAG activities were higher in patients with endometriosis compared to the control group (P0.001). MPO follicular fluid activity was lower in patients with endometriosis compared to normally ovulating women (P = 0.016).Infertile patients with endometriosis show a distinct pattern of serum and follicular fluid macrophage/neutrophil activation compared to normally ovulating women undergoing ICSI, which may reflect the role of immune and inflammatory alterations in endometriosis-related infertility.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:26:24Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:42:09Z : No. of bitstreams: 1 2-s2.0-84859587854.pdf: 160345 bytes, checksum: a24fff4cb85fdbe48e2165b27caa2941 (MD5) Made available in DSpace on 2014-05-27T11:26:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-03-01 PURPOSE: To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS. METHODS: A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose =140 mg/dL and

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:26:24Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:47:37Z : No. of bitstreams: 1 2-s2.0-84859569822.pdf: 147395 bytes, checksum: f6fa5ba4e5a12693a3376cebc6a40b6d (MD5) Made available in DSpace on 2014-05-27T11:26:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-03-01 PURPOSE: To compare the diagnostic accuracy of sonohysterography (HSN) and conventional transvaginal ultrasound (USG) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (ART). METHODS: Comparative cross-sectional study with 120 infertile women candidate to ART, assisted at Centro de Reprodução Assistida (CRA) of Hospital Regional da Asa Sul (HRAS), Brasília-DF, from August 2009 to November 2010. Sonohysterography was performed with saline solution infusion in a close system. The sonohysterography finding was compared to previous USG results. The uterine cavity was considered abnormal whenthe endometrium was found to be thicker than expectedduring the menstrual cycle and whenan endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. The statistical analysis was doneusing absolute frequencies, percentage values and the χ 2, with the level of significance set at5%. RESULTS:HSN revealed that 92 (76.7%) infertile women candidate to ARThad anormal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%). Serviço de Reprodução Humana da Unidade de Ginecologia e Obstetrícia do Hospital Regional da Asa Sul-HRAS Secretaria de Estado de Saúde do Distrito Federal-SES/DF, Brasília (DF) Curso de Medicina da Universidade Católica de Brasília-UCB, Brasília (DF) Programa de Pós-Graduação em Ginecologia, Obstetrícia e Mastologia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista úlio de Mesquita Filho-UNESP, Botucatu (SP) Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista Júlio de Mesquita Filho-UNESP, Botucatu (SP) Trabalho realizado no Serviço de Reprodução Humana-SRH Hospital Regional da Asa Sul-HRAS Secretaria de Estado de Saúde do Distrito Federal-SES/DF, Brasília (DF) Programa de Pós-Graduação em Ginecologia, Obstetrícia e Mastologia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista úlio de Mesquita Filho-UNESP, Botucatu (SP) Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista Júlio de Mesquita Filho-UNESP, Botucatu (SP)

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:35Z No. of bitstreams: 1 S0100-72032012000200006.pdf: 198368 bytes, checksum: da2a174175e38786e478f4a4e381f38f (MD5) Made available in DSpace on 2013-08-22T18:50:35Z (GMT). No. of bitstreams: 1 S0100-72032012000200006.pdf: 198368 bytes, checksum: da2a174175e38786e478f4a4e381f38f (MD5) Previous issue date: 2012-02-01 Made available in DSpace on 2013-09-30T18:21:02Z (GMT). No. of bitstreams: 2 S0100-72032012000200006.pdf: 198368 bytes, checksum: da2a174175e38786e478f4a4e381f38f (MD5) S0100-72032012000200006.pdf.txt: 31608 bytes, checksum: 96996fad334abbcf598b776703a3c63d (MD5) Previous issue date: 2012-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:50Z No. of bitstreams: 2 S0100-72032012000200006.pdf: 198368 bytes, checksum: da2a174175e38786e478f4a4e381f38f (MD5) S0100-72032012000200006.pdf.txt: 31608 bytes, checksum: 96996fad334abbcf598b776703a3c63d (MD5) Made available in DSpace on 2014-05-20T13:35:50Z (GMT). No. of bitstreams: 2 S0100-72032012000200006.pdf: 198368 bytes, checksum: da2a174175e38786e478f4a4e381f38f (MD5) S0100-72032012000200006.pdf.txt: 31608 bytes, checksum: 96996fad334abbcf598b776703a3c63d (MD5) Previous issue date: 2012-02-01 OBJETIVO: Analisar a prevalência de resistência à insulina de acordo com diferentes medidas antropométricas e bioquímicas em mulheres com síndrome dos ovários policísticos. MÉTODOS: Foram analisadas, retrospectivamente, 189 pacientes com síndrome dos ovários policísticos. O diagnóstico de resistência à insulina foi obtido utilizando-se insulinemia, HOMA-IR, QUICKI, índice de sensibilidade à insulina e relação glicemia/insulina. Foram utilizados o índice de massa corpórea e o lipid accumulation product. Para análise dos resultados, aplicou-se a estatística descritiva, a ANOVA, o pós-teste de Tukey e a correlação de Pearson. RESULTADOS: As pacientes apresentaram média de idade de 24,9±5,2 e de índice de massa corpórea de 31,8±7,6. O percentual de pacientes obesas foi de 57,14%. Dentre os métodos de investigação de resistência à insulina, o índice de sensibilidade à insulina foi a técnica que mais detectou (56,4%) a presença de resistência à insulina nas mulheres com síndrome dos ovários policísticos. em 87% das pacientes obesas, detectou-se a resistência à insulina. A relação glicemia/insulinemia de jejum e o índice de sensibilidade à insulina apresentaram correlação forte com o lipid accumulation product. CONCLUSÃO: A prevalência de resistência à insulina variou de acordo com o método utilizado e foi maior quanto maior o índice de massa corpórea. O lipid accumulation product também está relacionado à resistência à insulina. PURPOSE: To analyze the prevalence of insulin resistance, according to different biochemical and anthropometric measurements in women with polycystic ovary syndrome. METHODS: A total of 189 patients with polycystic ovary syndrome were retrospectively analyzed. Insulin resistance diagnosis was performed using fasting insulin, HOMA-IR, QUICKI, insulin sensibility index and glucose/fasting insulin ratio. Body mass index and lipid accumulation product were used. Data were analyzed statistically by descriptive statistics, ANOVA, Tukey post-test, and Pearson's correlation. RESULTS: The polycystic ovary syndrome patients had a mean age of 24.9±5.2 and a mean body mass index of 31.8±7.6. The percentage of obese patients was 57.14%. Among the methods of insulin resistance investigation, the insulin sensibility index was the technique that most detected (56.4%) the presence of insulin resistance in women with polycystic ovary syndrome. The insulin resistance was detected in 87% of obese patients. The fasting glucose/fasting insulin ratio and insulin sensibility index were strongly correlated with lipid accumulation product. CONCLUSION: The prevalence of insulin resistance varied according to the method used, and it was greater the higher the body mass index. Lipid accumulation product was also related to insulin resistance. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Universidade Federal de Uberlândia (UFU) Departamento de Tocoginecologia Universidade Federal do Rio Grande do Norte (UFRN) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte (UFRN) Departamento de Tocoginecologia Universidade Estadual Paulista Júlio de Mesquita Filho Departamento de Clínica Médica Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia e Obstetrícia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Universidade Estadual Paulista Júlio de Mesquita Filho Departamento de Clínica Médica Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia e Obstetrícia

To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS.A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose140 mg/dL and200 mg/dL), and the diagnosis of DM-2 was obtained by both the oral glucose tolerance test (DM: 120 minutes for plasma glucose200 mg/dL) and fasting glucose using the criteria of the American Diabetes Association (impaired fasting glucose: fasting plasma glucose100 and126 mg/dL; DM: fasting glucose126 mg/dL). A logistic regression model for repeated measures was applied to compare the oral glucose tolerance test with fasting plasma glucose. ANOVA followed by the Tukey test was used for the analysis of the clinical and biochemical characteristics of patients with and without GI and/or DM-2. A p0.05 was considered statistically significant.PCOS patients had a mean age of 24.8±6.3, and body mass index (BMI) of 18.3 to 54.9 kg/m² (32.5±7.6). The percentage of obese patients was 64%, the percentage of overweight patients was 18.6% and 17.4% had healthy weight. The oral glucose tolerance test identified 14 cases of DM-2 (5.7%), while fasting glucose detected only three cases (1.2%), and the frequency of these disorders was higher with increasing age and BMI.The results of this study demonstrate the superiority of the oral glucose tolerance test in relation to fasting glucose in diagnosing DM-2 in young women with PCOS and should be performed in these patients.

Polycystic ovary syndrome (PCOS) is an endocrinopathy associated with infertility, diabetes and cardiovascular events. This study aimed to correlate polymorphisms of genes involved in the biosynthesis and metabolism of steroids and insulin action (CYP17A1, CYP19A1, AR, ESR1, ESR2, INSR, IGF2 and PAI1) with clinical and biochemical parameters of PCOS. DNA was extracted from peripheral blood samples obtained from 117 PCOS and 105 healthy women. The PAI1 insertion/deletion (-675 ins/delG) polymorphism (rs1799768) was genotyped by PCR-SSCP. CYP19A1 [TTTA](n), AR [CAG](n), ESR1 [TA](n), and ESR2 [CA](n) genes were evaluated by PCR-based GeneScan analysis, while CYP17A1 5'UTR (rs743572), INSR 1058 CT (rs1799817), and IGF2 3'UTR GA (rs680) polymorphisms were evaluated by PCR-RFLP. The results showed a prevalence of PAI1 4G5G+4G4G genotypes in PCOS (p = 0.025). Younger PCOS women showed a predominance of CT+TT, GA+AA and 4G5G+4G4G genotypes of INSR, IGF2, and PAI1 (p = 0.0499, p = 0.0300, p = 0.0350, respectively). AR shorter alleles (≤ 20 repeats) were significantly associated with higher serum levels of total testosterone (TT, p = 0.0086). In conclusion, PAI1 polymorphism seems to be associated with the risk of PCOS development. Younger PCOS women had specific genotypes of INSR, IGF2 and PAI1 genes. AR shorter alleles can be associated with higher serum levels of TT in PCOS patients.

To compare the diagnostic accuracy of sonohysterography (HSN) and conventional transvaginal ultrasound (USG) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (ART).Comparative cross-sectional study with 120 infertile women candidate to ART, assisted at Centro de Reprodução Assistida (CRA) of Hospital Regional da Asa Sul (HRAS), Brasília - DF, from August 2009 to November 2010. Sonohysterography was performed with saline solution infusion in a close system. The sonohysterography finding was compared to previous USG results. The uterine cavity was considered abnormal when the endometrium was found to be thicker than expected during the menstrual cycle and when an endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. The statistical analysis was done using absolute frequencies, percentage values and the χ², with the level of significance set at 5%.HSN revealed that 92 (76.7%) infertile women candidate to ART had a normal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%), 9 cases of abnormal shape of the uterine cavity (7.5%), 6 submucous myomas (5%), 4 cases of inadequate endometrial thickness for the menstrual cycle phase (3.3%), and 2 cases of uterine septum (1.7%); 5 women presented more than one abnormality (4.2%). While USG showed alteration in the cavity only in 5 (4.2%) women, the sonohysterography confirmed 4 out of the 5 abnormalities shown by USG and detected an abnormal uterine cavity in 24 other women, who had not been detected by USG. This means that sonohysterography was able to detect more abnormalities in the uterine cavity than USG, with a statistically significant difference (p=0.002).The sonohysterography was more accurate than USG in the assessment of the uterine cavity of this cohort of infertile women candidate to ART. The sonohysterography can be easily incorporated into the investigation of these women and contribute to reducing embryo implantation failures.

Made available in DSpace on 2013-08-28T14:13:18Z (GMT). No. of bitstreams: 1 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) Made available in DSpace on 2013-09-30T18:20:33Z (GMT). No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Previous issue date: 2009-04-23 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:34Z No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Made available in DSpace on 2014-05-20T13:35:34Z (GMT). No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Previous issue date: 2009-04-23 Background: It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates.Methods: Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria.Results: When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (P = 0.96; OR = 0.99, 95% CI 0.78, 1.25). on the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (P < 0.0001; OR: 2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%).Conclusion: Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment. Ctr Human Reprod Prof Franco Jr, São Paulo, Brazil São Paulo State Univ UNESP, Dept Obstet & Gynecol, Botucatu Med Sch, São Paulo, Brazil São Paulo State Univ UNESP, Dept Obstet & Gynecol, Botucatu Med Sch, São Paulo, Brazil

The objective of this meta-analysis was to investigate the influence of meiotic spindle visualization in human oocytes on intracytoplasmic sperm injection (ICSI) outcomes. Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and Ovid). The fixed effect was used for odds ratio. Ten trials fulfilled the inclusion criteria comparing in-vitro and clinical ICSI outcomes with or without visualization of meiotic spindle in fresh and in-vivo matured oocytes. According to the meta-analysis, the results showed statistically significant higher fertilization rate (P < 0.0001) when the meiotic spindle was viewed than when it was not. Moreover, the percentage of pro-nuclear-stage embryos with good morphology (P = 0.003), cleavage rate (P < 0.0001), percentage of day-3 top-quality embryos (P = 0.003) and percentage of embryos that reached the blastocyst stage (P < 0.0001) were statistically significantly better among embryos derived from oocytes in which meiotic spindle was viewed compared with those in which meiotic spindle was not observed. However, these differences were not observed in the clinical pregnancy or implantation rates. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. However, additional controlled trials are needed to further confirm these results.

Uterine leiomyomas are common, benign, smooth muscle tumors representing a significant public health problem. The aim of this study was to investigate CYP17A1, CYP19, and androgen (AR) polymorphisms, their relative risks for uterine leiomyomas and possible associations with clinical parameters.Uterine leiomyoma tissues and blood samples were obtained from 87 patients, as were peripheral blood samples from 68 control women. Clinical data were recorded in both groups. The CYP17A1 (rs743572) polymorphism was analyzed by PCR-RFLP, and the CYP19 [TTTA](n) repeat and AR [CAG](n) repeat were analyzed using PCR-based GeneScan analysis. AR loss of heterozygosity (LOH) and microsatellite instability were also evaluated, while samples exhibiting LOH were analyzed for X inactivation.Clinical parameters related to disease development did not differ between cases and controls. CYP17A1 A2/A2 genotype was prevalent in non-white women. CYP17A1, CYP19, and AR genotypes and alleles did not differ between groups. However, alleles presenting [TTTA](7) repeats in intron 4 of CYP19 were more frequent in the control group (p=0.0550). Shorter and longer [CAG](n) repeat alleles of AR were exclusive to the leiomyoma group. The LOH assay showed allele losses at AR locus in four informative tumors and X chromosome inactivation analysis revealed that these tumors retained the active allele.The overall lack of association between uterine leiomyomas with polymorphisms involved in steroidogenesis or steroid metabolism is consistent with the hypothesis that these polymorphisms do not substantially contribute to the development of these tumors.

The objective was to investigate the influence of age on sperm DNA damage. Semen samples were collected from 508 men in an unselected group of couples attending infertility investigation and treatment. DNA fragmentation in spermatozoa was measured by TdT (terminal deoxynucleotidyl transferase)-mediated dUTP nick-end labelling (TUNEL) assay; at least 200 spermatozoa in randomly selected areas of microscope slides were evaluated using a fluorescent microscope and the percentage of TUNEL positive spermatozoa was determined. The number of cells with red fluorescence (TUNEL positive) was expressed as a percentage of the total sample [DNA fragmentation index (DFI)]. Age was treated as a continuous variable for regression and correlation analysis. The following male age groups were used: Group I:or =35 years, Group II: 36-39 years, and Group III:or =40 years. DFI was significantly lower in Group I than in Group II (P = 0.034) or III (P = 0.022). There was no difference in DFI between Groups II and III. In addition, regression analysis demonstrated a significant increase in sperm DFI with age (P = 0.02). TUNEL assay clearly demonstrates an increase in sperm DNA damage with age.

A hiperprolactinemia é o distúrbio endócrino mais freqüente do eixo hipotálamo-hipofisário, observado em mulheres na idade reprodutiva. Caracteriza-se pela elevação consistente dos valores plasmáticos de prolactina. A regulação da produção da prolactina dá-se por meio da ação inibitória de um neurotransmissor, a dopamina. As manifestações clínicas são distúrbios do ciclo menstrual, amenorréia, galactorréia, infertilidade e diminuição da libido. Entretanto, sintomas psicológicos, especialmente ansiedade e depressão, têm sido associados à hiperprolactinemia. Contudo, há poucos estudos clínicos publicados sobre o tema. O papel da prolactina na patogênese dos distúrbios psiquiátricos pode refletir ação direta sobre o sistema nervoso central, efeito indireto por meio dos hormônios gonadais ou constituir fatores independentes, resultantes da depleção de dopamina. Assim, detectada a prevalência de distúrbios psiquiátricos em pacientes com hiperprolactinemia, conclui-se pela necessidade de maior número de pesquisas que investiguem as bases da possível inter-relação entre os estados hiperprolactinêmicos e o psiquismo. Hyperprolactinemia is the most frequent endocrine disorder of the hypothalamus-hypophysis axis observed in women of reproductive age. It is characterized by elevated serum prolactin levels. Prolactin production is regulated by the inhibitory action of a neurotransmitter, dopamine. Clinical manifestations include irregular menstrual cycle, amenorrhea, galactorrhea, infertility and libido decrease, but psychological symptoms, especially anxiety and depression, have also been associated with hyperprolactinemia. Nonetheless, few studies about this condition are available. In the pathogenesis of psychiatric disorders, prolactin may have either a direct action on the central nerve system or an indirect effect via gonadal hormones or function as independent factors as a result of dopamine depletion. Thus, since the prevalence of psychiatric disorders in patients with hyperprolactinemia was detected, it was concluded that further studies are necessary to investigate the basis of a potential relationship between both hyperprolactinemic and psychiatric conditions.

Made available in DSpace on 2022-04-28T19:56:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-01-01 Objective. The purpose of this study was to evaluate the effect of total abdominal hysterectomy on ovarian blood supply using transvaginal color Doppler ultrasonography in women of reproductive age. Methods. This prospective study included 61 women aged 40 years or younger who were divided into 2 groups: group 1, comprising 31 patients who underwent total abdominal hysterectomy (TAH); and group 2, comprising 30 women with no abnormalities. Inclusion criteria included normal ovarian function at baseline, with basal follicle-stimulating hormone levels of less than 15 mUl/mL, normal body weight, no tobacco use, and no history of laparotomy or ovarian disease. Ovarian arterial blood supply by determination of the pulsatility index (PI) on Doppler analysis and ovarian volume on transvaginal ultrasonography were assessed at baseline and at 6 and 12 postoperative months. The Student t test, profile analysis, and Friedman and Mann-Whitney tests were used in the statistical analysis of data. Results. Statistical analysis of baseline data revealed that both groups were homogeneous. At months 6 and 12, greater ovarian volumes and lower Pl values were observed in patients who underwent TAH (P < .05). By the end of the study, in 8 of the 31 patients who underwent TAH (25.5%), benign ovarian cysts were observed. In the control group, all the parameters studied remained unchanged. Conclusions. The reduced PI values observed on Doppler ultrasonography suggested a decrease in the resistance flow in the ovarian arteries in women of reproductive age who underwent TAH. Dept. of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, São Paulo Dept. of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, Rubião Júnior, Botucatu, São Paulo, 18618-970 Dept. of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, São Paulo Dept. of Gynecology and Obstetrics Botucatu Medical School São Paulo State University, Rubião Júnior, Botucatu, São Paulo, 18618-970

To determine whether the use of ultrasound (US) to guide embryo transfer (ET) in a population previously defined as likely to have easy transfer would change the implantation and pregnancy rates in an ICSI program.A total of 100 patients identified as likely to have easy transfer after mock transfer were divided into two groups: Group I, US-guided ET (N = 50) and Group II, ET without the aid of US (N = 50).Implantation and pregnancy rates were similar (p = 0.51, p = 0.29) for Group I (19.6%, 42%) and Group II (16.3%, 30%), as also was the abortion rate (p = 0.55) (Group I: 1/21; Group II: 2/15).As long as previous mock transfers are routinely performed during a cycle preceding assisted reproduction and the clinician considers transfer to be easy, ultrasound does not benefit the process of embryo transfer.