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Study question Are there differences between patients classified according to the Poseidon criteria regarding IVF sucess rates? Summary answer POSEIDON groups differ from each other. Woman's age, more than the ovarian reserve, is the main factor of poor prognosis in IVF cycles. What is known already Poor ovarian response to stimulation in an IVF cycle has an estimated incidence of 9-24%. The criteria used to characterize this group of patients are heterogeneous, making it difficult to address risk factors, to determine prognosis and to propose novel treatment options. The most used diagnostic criteria are the Bologna criteria and more recently the Poseidon classification. Study design, size, duration An observational, retrospective cohort study, based on 558 ART cycles performed between 2015 and 2018 at a single center in Brazil. Participants/materials, setting, methods Group division was acording to POSEIDON criteria: groups 1A (n = 15), 1B (n = 19), 2A(n = 48), 2B (n = 59), 3 (n = 17) and 4 (n = 50). Two control groups were stablished for comparison purposes: C1 with no previous poor response, normal ovarian reserve and women's age < 35 years (n = 157) and C2 with women's age ≥ 35 years (n = 193). Data was obteined from clinical records and analyzed with SPSS program. Main results and the role of chance Groups 3, 4 and 2A of Poseidon had less oocytes recovered (p Limitations, reasons for caution Retrospective and observational study. Wider implications of the findings The findings of this study play a role in improving patients counselling. The results are encouraging for young women with normal reserve and a previous bad response, since they weren't found to have poor outcomes in a new cycle. Woman's age should be the main criteria to determine patient prognosis. Trial registration number not applicable

Context: Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. Objective: We evaluated fertility treatment and pregnancy outcomes in five women with childhood-onset combined pituitary hormone deficiencies (CPHD). Patients and Methods: Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). Results: All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Conclusion: Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients., Adequate hormonal replacement, including GH, prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD.

Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (− 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-β) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP). Concerning the ER-β SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p

Background Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-α) gene with PPT dysfunction. Methods A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-α gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism. Results The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-α gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55–2.33). Conclusions The XbaI SNP in the ERα gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.

The genesis of the endometrial polyp is as yet unclear. There is evidence that the polyp is related to the inflammatory process and that it interacts with the cyclooxygenase-2 (COX-2) enzyme.To review the influence of COX-2 on the postmenopausal endometrial polyp.A systematic review was made of the Medline, Embase, and Cochrane databases, covering the years of 2001-2014. The inclusion criteria were: experimental studies with immunohistological analysis of COX-2 in endometrial polyps; women; hysteroscopic and surgical evaluation; and studies with comparisons between the endometrial polyp and other tissues (normal endometrium, adjacent endometrium, and other uterine diseases). The exclusion criteria were: polyps in other organs; genetic polymorphisms; endometrial cancer exclusively; abnormal uterine bleeding unrelated to polyps. The search key words (taken from the Medical Subject Headings - MeSH) were endometrial polyp and cyclooxygenase-2.Seven of ten articles were selected. Results showed positive COX-2 expression in the glandular epithelium of the polyps, and expression was more intense when the polyp was malignant. However, there was a study which did not find any difference between polyps and the normal endometrium, and there was another which compared polyps in menacme with postmenopausal polyps.There is no consensus in the literature as to the participation of COX-2 in the development of benign and/or malignant endometrial polyps. In all of the studies, COX-2 was present in the postmenopausal polyps and with greater intensity in the malignant ones.

The use of combined oral contraceptives is widespread among hypertensive women despite being associated with increased cardiovascular risk. Contraceptives containing drospirenone, which has antimineralocorticoid properties, may have a positive or neutral effect on neurohumoral activation and metabolic homeostasis of hypertensive women at reproductive age.ObjectivesTo evaluate the effect of combined oral contraceptive containing drospirenone+ethinylestradiol on the systemic blood pressure, metabolic variables and neurohumoral axis in hypertensive women in reproductive age.DesignProspective controlled trial with 56 hypertensive women allocated in two groups: 30 volunteers under oral combined contraceptive use and 26 volunteers using non-hormonal contraceptive methods. Subjects were tested before the introduction of the contraceptive method and 6 months after its use. For data acquisition, we used continuous non-invasive beat-to-beat blood pressure curve recordings and, for the biochemical and hormonal analyses two blood samples were obtained. Student's t test was used to determine differences between groups and moments and p

Objective To analyze the diagnostic accuracy of two- (2D) and three- (3D) dimensional saline contrast sonohysterography (SCSH) in the detection of endometrial polyps and submucosal uterine leiomyomas in women of reproductive age with abnormal uterine bleeding compared with gold standard hysteroscopy. Methods A systematic review of diagnostic studies that compared 2D- and/or 3D-SCSH with hysteroscopy and anatomopathology was conducted according to PRISMA and SEDATE recommendations. The databases MEDLINE, EMBASE and The Cochrane Library were searched electronically using specific terms with no restriction on language or publication year. Quality assessment of included studies was performed using the QUADAS-2 tool. Meta-analysis was performed with the Meta-DiSk program and data presented as forest plots and summary receiver–operating characteristics (SROC) curves. Pooled sensitivity, specificity and positive (LR+) and negative (LR–) likelihood ratios of SCSH in the detection of uterine cavity abnormalities were calculated. Results A total of 1398 citations were identified and five studies were included in the systematic review and meta-analysis. Pooled sensitivity and specificity of 2D-SCSH in detecting endometrial polyps were 93% (95% CI, 89–96%) and 81% (95% CI, 76–86%), respectively, with pooled LR+ of 5.41 (95% CI, 2.60–11.28) and LR– of 0.10 (95% CI, 0.06–0.17). In the detection of submucosal uterine leiomyomas, pooled sensitivity and specificity were 94% (95% CI, 89–97%) and 81% (95% CI, 76–86%), respectively, with pooled LR+ of 4.25 (95% CI, 2.20–8.21) and LR– of 0.11 (95% CI, 0.05–0.22). 2D-SCSH had good accuracy in detecting endometrial polyps and submucosal uterine leiomyomas, with areas under the SROC curves of 0.97 ± 0.02 and 0.97 ± 0.03, respectively. Studies that analyzed the diagnostic accuracy of 3D-SCSH could not be compared due to high heterogeneity related to menopausal status, type of technique used and primary outcome being investigation of infertility. Conclusions 2D-SCSH proved to be a highly sensitive method for detection of endometrial polyps and submucosal uterine leiomyomas, making it a potential first-line diagnostic method in the work-up for women with abnormal uterine bleeding. More studies are needed on 3D-SCSH in women of reproductive age. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Low-density lipoprotein (LDL) receptors are overexpressed in most neoplastic cell lines and provide a mechanism for the internalization and concentration of drug-laden nanoemulsions that bind to these receptors. The aim of the present study was to determine whether the administration of standard chemotherapeutic schemes can alter the expression of LDL and LDL receptor-related protein 1 (LRP-1) receptors in breast carcinoma. Fragments of tumoral and normal breast tissue from 16 consecutive volunteer women with breast cancer in stage II or III were obtained from biopsies before the beginning of neoadjuvant chemotherapy and after chemotherapy, from fragments excised during mastectomy. Tissues were analyzed by immunohistochemistry for both receptors. Because complete response to treatment was achieved in 4 patients, only the tumors from 12 were analyzed. Before chemotherapy, there was overexpression of LDL receptor in the tumoral tissue compared to normal breast tissue in 8 of these patients. LRP-1 receptor overexpression was observed in tumors of 4 patients. After chemotherapy, expression of both receptors decreased in the tumors of 6 patients, increased in 4 and was unchanged in 2. Nonetheless, even when chemotherapy reduced receptors expression, the expression was still above normal. The fact that chemotherapy does not impair LDL receptors expression supports the use of drug carrier systems that target neoplastic cells by the LDL receptor endocytic pathway in patients on conventional chemotherapy.

To identify aspects of health in postmenopausal Brazilian women using a health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late postmenopausal symptoms.A prospective cohort was formed with 69 postmenopausal women; they were divided into groups corresponding to early (n = 32) and late postmenopause (n = 37) through gynecological and clinical evaluations. We administered the Kuppermann-Blatt Menopausal Index and the Women's Health Questionnaire before and after health education instructions.The average age for the onset of menopause was 47.9 years (n = 69). Fifty women (72.5%) in this study had completed their primary education, 78.3% (n = 54) performed manual labor, and 60.9% (n = 42) showed concomitant chronic illnesses. After attending a series of health-related presentations, the mean weight of the women was reduced by 3.54% in early postmenopausal women (p0.001) and by 2.06% in the late postmenopausal group (p0.001). The mean abdominal circumference was reduced by 1.75% (p0.001) in the early postmenopausal group. In addition, the total score in the Kuppermann-Blatt Menopausal Index decreased by 34.38% in the early and by 33.33% in the late postmenopausal groups. According to the Women's Health Questionnaire, there was a decrease in the domain Depressive mood by 0.839 to 0.700 (p0.001) in the early and by 0.814 to 0.648 (p0.001) in the late postmenopausal groups.Regardless of improving menopausal symptoms and anthropometric parameters, the effects of the multidisciplinary team activities in early postmenopausal women may be similar to those in late postmenopausal women.

Ovulation induction (OI) is a cornerstone of human assisted reproduction treatments (ART). Current OI protocols are based on the human follicular dynamics model known as propitious moment theory (PMT), by which follicles continuously grow from the primordial pool without any pattern, and follicular fate depend on the occurrence of a gonadotropin surge. Recently, a new paradigm of human follicular dynamics called follicular waves was revealed using sequential ultrasound examination of 1 interovulatory interval. Instead of random growth, follicles develop in coordinated groups or waves, occurring 2 to 3 times during an interovulatory interval. Follicular waves are common in several other mono-ovulatory species, like equines and bovines. In fact, this model was applied to the development of several OI protocols in veterinary medicine, especially in cows. It has been shown that synchronization of OI with the emergence of a follicular wave increases substantially success rates in animals, even with single embryo transfer. Veterinarians have already developed mechanisms to control wave emergence through mechanical or chemical ablation of the dominant follicle or corpus luteum. Considering the follicular dynamics similarities between humans and bovines regarding the follicular wave phenomenon, we hypothesize that synchronization of follicular wave emergence with ovarian stimulation produces more competent oocytes and embryos and will enhance ART efficiency in humans. At the end of this article, we propose 2 theoretical approaches to induce the emergence of a follicular wave in women: (1) a mechanical strategy by aspiration of the dominant follicle and (2) a pharmacological strategy by administering estradiol and progesterone.

To clarify whether the metabolism of triglyceride-rich lipoproteins and lipid transfer to high-density lipoprotein (HDL) are altered in patients with polycystic ovary syndrome (PCOS).Case-control study.Endocrinology clinics.Eight normal-weight (NW) and 15 obese (Ob) patients with PCOS were compared with 10 NW and 10 Ob women without PCOS paired for age and body mass index.Determination of triglyceride-rich lipoprotein metabolism and lipid transfer to HDL.Participants were injected triglyceride-rich emulsions labeled with (14)C-cholesteryl esters and (3)H-triglycerides and the fractional clearance rate (FCR, in min(-1)) of labels was determined. Lipid transfer from artificial nanoemulsions to HDL was performed by incubating radioactively labeled lipid nanoemulsions with plasma during 1 hour, followed by radioactive counting of HDL-containing supernatant after chemical precipitation.Lipolysis estimated by triglyceride FCR was equal in PCOS groups (NW = 0.043 +/- 0.032, Ob = 0.033 +/- 0.009) and respective controls (NW = 0.039 +/- 0.015, Ob = 0.044 +/- 0.019). However, the remnant removal as estimated by cholesteryl ester FCR was reduced in both PCOS groups (NW = 0.005 +/- 0.006, Ob = 0.005 +/- 0.005) compared with controls (NW = 0.016 +/- 0.006, Ob = 0.011 +/- 0.072). Lipid transfer rates were not different among groups, but triglyceride transfer rates were positively correlated with homeostasis model assessment estimate of insulin resistance in PCOS.PCOS patients showed decreased removal of atherogenic remnants even when fasting glucose was100 mg/dL. This reinforces the usefulness of the measures taken to prevent cardiovascular events in PCOS patients.

The purpose of this study was to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB-1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n = 16, placebo), B (n = 15, tamoxifen, 10 mg), and C (n = 13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fisher's test revealed that tamoxifen significantly reduced MIB-1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p = 0.21). Groups B and C presented a significant increase in progesterone (p = 0.038), estradiol (p < 0.001), and sex hormone binding globulin (p = 0.001) levels. Elevation of serum follicle-stimulating hormone concentration (p = 0.0045) and a fall in prolactin levels (p = 0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.

OBJECTIVE: To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and acanthosis nigricans. DESIGN: Controlled clinical study. SETTING: Tertiary academic medical center. PATIENTS: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. INTERVENTIONS: Morning blood samples in the follicular phase to determine the steroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. MAIN OUTCOME MEASURE: Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. RESULTS: Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. CONCLUSIONS: Patients with PCO, hirsutism and acanthosis nigricans present high levels of insulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.OBJETIVO: Investigar a atividade ovariana antes e após a supressão gonadal com análogo de GnRH em pacientes com síndrome dos ovários policísticos (SOP), hiperandrogenismo, hiperinsulinismo e acantose nigricante. DESENHO: Estudo clínico prospectivo. LOCAL: Centro médico-acadêmico nível terciário. PACIENTES: Seis pacientes com sinais clínicos de SOP, hirsutismo e acantose nigricante. INTERVENÇÕES: Colheita de amostras sanguíneas matinais na fase folicular para determinar os valores séricos de esteróides, curva glicêmica e insulínica, comparando esta última à do grupo controle. Administração por dois meses consecutivos de análogo de GnRH, comparando, nas pacientes do grupo de estudo, os níveis séricos de testosterona livre antes e após a supressão gonadal. PRINCIPAIS DETERMINAÇÕES: Determinação dos níveis séricos de insulina nas pacientes com SOP, hirsutismo e acantose nigricans e avaliar os níveis de testosterona livre antes e após supressão gonadal. RESULTADOS: Os níveis de insulina foram significativamente maiores nas pacientes do grupo de estudo, quando comparados a mulheres normais, durante a curva glicêmica. Também encontramos uma significativa queda nos valores de testosterona livre, após dois meses de supressão gonadal com analógo de GnRH, quando confrontados ao tempo inicial. CONCLUSÕES: Pacientes com SOP, hirsutismo e acantose nigricante apresentam altos níves séricos de insulina, sugerindo uma hiperativação ovariana por este peptídeo, que, entretanto, não é mantida se promovermos o bloqueio gonadotrófico.

Objective The objective of this paper is to evaluate ovarian reserve in primary antiphospholipid syndrome (PAPS) women and the association between ovarian reserve tests and clinical and laboratorial parameters, and anti-corpus luteum antibody (anti-CoL). Methods We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded because of association with other autoimmune diseases ( n = 42), contraindication or unwillingness to stop hormonal contraceptive ( n = 21), current pregnancy or breastfeeding ( n = 3) and previous ovarian surgery ( n = 1). Therefore, a cross-sectional study was conducted in 18 PAPS patients and 24 healthy women. They were evaluated at early follicular phase with measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) and sonographic antral follicle count (AFC). Serum measurement of anti-CoL was determined by immunoblot analysis. All analyses were performed after at least six months from the last intake of hormonal contraceptive and resumption of menstruation. Results The mean age was comparable in PAPS and controls (33.0 ± 5.0 vs. 30.4 ± 7.0 years; p = 0.19). Regarding ovarian reserve tests, the frequencies of low AFC (≤10) (56% vs. 22%, p = 0.04) and very low AFC (≤5) (37% vs. 9%, p = 0.04) were significantly higher in PAPS patients than controls. Trends of higher frequencies of reduced (Conclusion Women suffering from PAPS possessed reduced ovarian reserve, with prevalence greater than 50%.

Endometriosis, defined as the presence of endometrial glands and/or stroma outside the uterine cavity, is an estrogen-dependent disease that affects about 10% of reproductive age women. Theories to explain the etiology of endometriosis abound. These include the alteration of epithelial cells on peritoneal surface, metaplasia of embryonic remnants of the mullerian ducts, immune system abnormalities, and the dissemination of endometrial cells through the circulation or lymphatic system, as well as retrograde menstruation, the hypothesis currently favored for the development of endometriosis. Angiogenesis, the development of new capillaries from pre-existing blood vessels, has been proposed as a key mechanism in the pathogenesis of endometriosis. Again from an etiological perspective, the formation of endometriotic implants requires ectopic fixation and proliferation of endometrial stroma and glands. The process of invasive insertion of endometriotic tissues involves the degradation of the extracellular matrix, and altered expression of matrix metalloproteinases (MMPs) in the eutopic and ectopic endometrium. Considering the antiproliferative, antiangiogenic, antioxidant, anti-inflammatory properties and matrix metalloproteinase activity inhibition of statins and the original studies addressing the possible mechanisms of action in endometriosis, the aim of this systematic review was to synthesize the research conducted to date in order to propose statins as possible and effective tools for controlling this disease.

Between July 1992 and May 1999 twenty-four patients were submitted to neovaginoplasty by the Abbe McIndoe Technique using an expander ` Ž mold. The age varied from 14 to 31 years average . 18.4 years . The time of hospitalization varied Ž . from 8 to 11 days average 9.2 days . Ž . Twenty patients 20 24 83.3% were diagnosed with Rokitansky Mayer Kuster Syndrome, Ž . three 3 24 12.5% had Testicular FeminizaŽ . tion Syndrome, and one patient 1 24 4.1% had a post-traumatic deformity. The vaginometry prior to surgery varied between 0 and 2.5 cm

Objective To determine the impact of menopause on lipid transfer from donor lipoproteins to high-density lipoproteins (HDLs)—a process that is related to the protective function of HDL—and the size of HDL particles. Method Plasma from 22 premenopausal and 18 postmenopausal nonobese, normolipidemic women paired for age (40–50 years) was incubated in an artificial nanoemulsion labeled with radioactive lipids. Then the HDL fraction was assessed for radioactivity; the percentage of radioactive lipids transferred from the nanoemulsion to HDL was determined; and the size of HDL particles was measured by laser light scattering. Results There were no differences between the 2 groups in serum concentration of HDL cholesterol (61 ± 12 mg/dL vs 61 ± 14 mg/dL) or apolipoprotein A1 (1.5 ± 0.3 g/L vs 1.5 ± 0.2 g/L); lipid transfer to HDL; or size of HDL particles (8.8 ± 0.8 vs 9.0 ± 0.5 nm). Conclusion Menopause was not found to affect HDL cholesterol plasma concentration, lipid transfer to HDL, or size of HDL particles in normolipidemic nonobese women.

Since the 1995 publication of the first report on uterine fibroid embolization (UFE), injecting small particles in the uterine arteries has been associated not only with pain but also with such conditions as menorrhagia, dysmenorrhea, infection, and bulkrelated symptoms [1]. Leiomyomas located close to or inside the endometrium have a higher risk of becoming infected after UFE; and because treatment with antibiotics is not always sufficient when infection occurs, a surgical intervention can be needed. A 35-year-old woman, gravida 0, presented with pelvic pressure and vaginal discharge. Although she had undergone myomectomy in 2003, a pelvic ultrasonographic examination showed a dominant intramural leiomyoma 107×85×78 mm in volume 6 months before the UFE. Three months before presenting to the hospital, polyvinyl alcohol particles 500 to 710 μm in diameter (Ivalon; Cook, Bloomington, IN) were used to embolize each uterine artery via the bilateral femoral access approach. Following UFE she developed fever, her pelvic pain increased, and laboratory studies revealed an elevated white blood cell count. A vaginal examination revealed a purulent bloody discharge without cervical dilatation. However, on another visit 5 days later, a fibroid was in the process of being expelled through the cervix. Magnetic resonance imaging showed a dominant submucosal fibroid 102×83×69 mm in volume and a cervical dilatation of 3 cm. Perfusion of the surrounding myometrium was preserved (Fig. 1). After the patient was sedated, her fibroid was removed by twisting its stalk. Expulsion of leiomyomas after UFE has been reported in the literature, and some investigators have suggested that submucosal leiomyomasmaybeassociatedwithan increased risk of infection [2]. Patients may present with symptoms ranging from cramping to pain with or without evidence of infection, and with vaginal discharge and passage of tissue fragments. Surgical evacuation of infarcted fibroid tissue may be necessary in patients who do not respond to supportive treatment, and in those who are not able to pass the fibroid tissue on their own [3]. Submucosal uterine fibroids occasionally prolapse into the vagina and even the vulvar region. If this tissue does not pass spontaneously, dilation and curettage of the uterus might become necessary. The present case demonstrates that the evacuation of a fibroid as large as 130 mm in diameter can occur spontaneously without any complications.

UNLABELLED This paper is based on a Cochrane review published in The Cochrane Library, issue 4, 2002 (see www.CochraneLibrary.net for information) with permission from The Cochrane Collaboration. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review. BACKGROUND GnRH agonists have been widely used in cycles of IVF. There are two types of GnRH agonist administration that can be used to lead to hypophysis desensitization in IVF cycles in the long protocol: one consisting of daily low doses of GnRH agonist and the other the administration of analogues in higher, long-acting doses (depot). The objective of this study is to compare the use of a single long-acting depot dose with that of daily GnRH agonist doses in IVF cycles. METHODS Relevant randomized controlled trials were identified by electronic search of the following databases: MEDLINE, EMBASE, LILACS (Latin American and Caribbean Center on Health Sciences Information) and the Cochrane Controlled Trials Register. Six studies, with a total of 552 women, were included and analysed. RESULTS The studies do not indicate that there is a statistically significant difference between the use of depot GnRH agonist and of daily GnRH agonist in the primary outcome, clinical pregnancy rates per woman [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.65-1.37]. However, there was sufficient evidence showing that the use of depot GnRH agonist for pituitary desensitization in IVF cycles increased the number of gonadotrophin ampoules [weighted mean difference (WMD) 3.30, 95% CI 1.27-5.34] and the duration of the ovarian stimulation (WMD 0.56, 95% CI 0.31-0.81), as compared with the use of daily GnRH agonist. CONCLUSIONS Although we recognize that the clinical pregnancy rates per woman are not the ideal primary outcome, we found no evidence of differences between the long protocols using depot or daily GnRH agonist for IVF cycles. However, the use of depot GnRH agonist is associated with increased requirements for gonadotrophins and a longer time needed for ovarian stimulation. If these differences could be shown to translate into economic benefit, depot GnRH agonist would increase the overall costs of IVF treatment.

Introduction: In the present study, our aim was to identify differentially expressed genes involved in estrogen actions at the endometrium level in rats. Methods: Thirty adult rats were ovariectomized four days prior to drug administration for 48 days. Rats were divided in 2 groups: I, control and II, conjugated equine estrogens (CCE). Total RNA was isolated from uterus, and differential expression was analyzed by array technology and RT-PCR. Results: A total of 32 candidate genes were shown to be up-regulated or downregulated in groups I or II. Among them, differential expression was already confirmed by RT-PCR for IGFBP5, S12, c-kit, and VEGF, genes whose expression was up regulated during CCE therapy, and casein kinase 11 and serine kinase expression was the same level in both groups. Conclusion: We have demonstrated that cDNA array represents a powerful approach to identify key molecules in the estrogens therapy. A number of the candidates reported here should provide new markers that may contribute to the detection of target estrogen receptor. This information may also aid the development of new approaches to therapeutic intervention.

The aim of this study was to assess the impact of the postmenopausal period on clinical and urodynamic parameters and on the mobility of the bladder neck in continent women and in women with stress urinary incontinence. Fifty-seven postmenopausal women were studied: 30 were continent and 27 had stress urinary incontinence. They were subdivided according to postmenopausal stage into groups A (5 years) and B (5 years). Five years was a good marker to separate those women with mild and severe estrogen deficiency. Fifteen premenopausal incontinent women were selected for bladder neck ultrasound as controls. All underwent history, general physical and gynecologic examinations, LH and FSH determinations, type 1 urine and uroculture, circadian voiding diary, cotton-swab test, bladder neck ultrasound and urodynamic investigations. Analysis of the voiding diaries revealed a higher frequency of daytime micturition in both groups of incontinent patients than in the continent ones. Increased bladder neck mobility was also found, both in the cotton-swab test and an ultrasound, in group A and an ultrasound in the premenopausal incontinent women. Urodynamic investigation showed decreased bladder capacity at the first micturition urge, as well as decreased urinary volume in the group A patients compared to the continent ones. Decreased urethral closure maximum pressure was also found in group B patients in relation to the continent ones. We concluded that the effect of hypoestrogenism, manifested postmenopause, causes changes in the lower urinary tract of women, particularly those who are incontinent.

INTRODUÇÃO: a violência doméstica e, particularmente, a sexual pode implicar em maior ocorrência de comorbidades no climatério. OBJETIVO: avaliar as repercussões no climatério da violência domestica e sexual. MÉTODO: estudo transversal em 124 mulheres menopausadas, entre 40 e 65 anos, que sofreram violência doméstica e/ou sexual, e um grupo controle (mulheres na menopausa que não sofreram violência n=120). As expostas à violência foram divididas em três grupos: 1-violência sofrida na infância e/ou adolescência, 2-fase adulta, 3-ambas as fases, e aplicou-se questionário sobre violência doméstica e sexual. Correlacionou-se a intensidade dos sintomas climatéricos medido pelo Índice Menopausal de Kupperman (IK), tipo de violência sofrida, fase da vida exposta à violência, comorbidades apresentadas no climatério e percepções da mulher sobre a forma com que os diversos profissionais acolheram ou não nos eventos traumáticos. No grupo controle avaliamos IK e numero de comorbidades. RESULTADOS: aquelas que sofreram violência na infância/adolescência apresentam media de 5,1 comorbidades; na fase adulta 4,6; e em ambas as fases 4,4, com mediana de 5,0 em todas as fases; sem violência (controle) 2,8. As que sofreram violência sexual apresentam mais comorbidades em relação aquelas que sofreram outros tipos de violência. Houve associações significativas entre ter sofrido qualquer tipo de violência em ambas às fases e IK grave e ter sofrido violência sexual em qualquer fase da vida, e IK no mínimo moderado. CONCLUSÃO: mulheres que sofreram violência doméstica e sexual apresentam mais comorbidades e IK elevado em relação ao grupo controle.