Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study.

OBJECTIVE: The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy. MATERIALS AND METHODS: This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated. RESULTS: There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences. CONCLUSIONS: The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments.The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.

[Assisted Reproductive Technology in Female Transplant Recipients: Experience of a Reproductive Medicine Unit and Literature Review]. / Procriação Assistida em Mulheres Transplantadas: Experiência de uma Unidade de Medicina da Reprodução e Revisão da Literatura.

Diseases in end stage typically occur with hypothalamic-pituitary-ovarian axis disorders, with consequent anovulation and infertility. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplantedwomen are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented.

Doenças em estádio terminal cursam tipicamente com distúrbios do eixo hipotálamo-hipófise-ovário, com consequente anovulação e infertilidade. A transplantação de órgãos sólidos aumentou a sobrevida e melhorou a capacidade reprodutiva das mulheres com este tipo de patologia. Embora a adopção seja uma possibilidade, a mulher transplantada infértil tem direito à sua autodeterminação reprodutiva com recurso a técnicas de procriação medicamente assistida. As gravidezes em mulheres transplantadas são de alto risco, mas não parece existir evidência de diferenças no desfecho obstétrico e neonatal nas grávidas transplantadas sujeitas a procriação assistida, comparativamente a gravidezes espontâneas. A utilização de técnicas de procriação assistida em mulheres transplantadas constitui um desafio médico, ético e psicossocial, cuja abordagem deve ser multidisciplinar, para assegurar o sucesso reprodutivo sem comprometer a função do órgão transplantado ou a saúde materna, permitindo o nascimento de uma criança saudável. A literatura existente mantém-se escassa. São apresentados três casos clínicos.

First transplantation of cryopreserved ovarian tissue in Portugal, stored for 10 years: an unexpected indication.

Ovarian tissue cryopreservation represents a valid strategy to preserve ovarian function in patients with a high risk of premature ovarian failure. We present a case of ovarian tissue cryopreservation carried out in an 18-year-old woman after a laparotomy for left adnexal mass with left adnexectomy. Congenital absence of the right ovary was observed during surgery. To preserve fertility, rescue cryopreservation of ovarian tissue was carried out under extreme conditions (without adopting the standard published protocol, not yet available at our centre). Ten years later, transplantation of cryopreserved ovarian tissue was carried out and, shortly after it, restoration of ovarian function was confirmed.

Late-onset postpartum hemorrhage from placental bed subinvolution: a case report.

BACKGROUND: Placental bed subinvolution is an underestimated cause of severe, late-onset postpartum hemorrhage. CASE: A case of placental bed subinvolution caused abnormal uterine bleeding in the late postpartum period. Because of difficulties in establishing the diagnosis, massive, intractable and life-threatening uterine hemorrhage occurred, leading to hysterectomy. CONCLUSION: Early recognition of placental bed subinvolution allows the use of treatment options capable of preserving the uterus and subsequent fertility.

A randomised study of GnRH antagonist (cetrorelix) versus agonist (busereline) for controlled ovarian stimulation: effect on safety and efficacy.

OBJECTIVE: To assess safety and efficacy of cetrorelix utilisation in controlled ovarian stimulation (COS). STUDY DESIGN: Phase III, randomized, single center study of 131 patients undergoing COS and IVF with or without ICSI, in a University affiliated Hospital. Sixty-six patients were allocated to the protocol with antagonist and 65 to the agonist protocol arm. The Student's t-test, the Mann-Whitney test and the chi-square test were applied as required, using SPSS for Windows with a two-sided 5% significance level. RESULTS: The mean (+/-S.D.) duration of stimulation was 9.5+/-1.7 days in the antagonist group and 10.6+/-2.1 days in the agonist group (P=0.02). The mean (+/-S.D.) duration of suppression was 4.6+/-1.3 days in the antagonist group and 27.3+/-5.2 days in the agonist group (P<0.0001). No significant differences were noted in other outcome measures: amount of rFSH required, estradiol level on hCG day, number of follicles>or=15 mm and endometrial thickness on oocyte retrieval day, number of oocytes retrieved, fertilization rate and number of OHS cases. Clinical pregnancy rates per-attempt and per-transfer were 15.1% and 17.0% in the antagonist group and 16.9% and 20.0% in the agonist group (P=0.79 and 0.71, respectively). CONCLUSIONS: GnRH antagonists are an effective, safe and well tolerated alternative to agonists for COS.

[Newborns from assisted reproductive technology at the Hospital de São João]. / Recém-nascidos de reprodução medicamente assistida.

Over the last 20 years, assisted reproductive technology has been increasingly used. Ever since the first newborn resulting from artificial insemination, over two centuries ago, thousands more children were born resulting from these techniques. In Portugal, assisted reproductive technology began in 1985 at the Hospital de São João (HSJ). Although the success of these techniques is often judge by the pregnancy rate, occasionally by the birth rate, the most important issue of this evaluation should be the neonatal health. A retrospective study to evaluate the use of assisted reproductive technology at the HSJ, as well as the occurrence of complications during pregnancy and the evolution of the newborns in the neonatal period, during the period between 1999 and 2003, was undertaken. A hundred and thirty-eight pregnant women were included, which stands for about 1% of the total number of pregnant women at the HSJ in the period in question, with an average of age 32.2 +/- 4.1 and of infertility 6.2 +/- 3.8 years. The number of attempts for a successful pregnancy was 2.7 +/- 2.1. The most used technique was intracytoplasmatic sperm injection. Eighteen percent of the pregnancies resulted in abortion. The incidence of multiple pregnancies was 30%. A hundred and fifty-six infants were born, which stands for about 1% of the total number of births at the HSJ in the period in question, with a gestational age of 36.4 +/- 3 weeks and weight at birth of 2674.5 +/- 761.4 g. The incidence of preterm birth was 41%. Seventy-eight percent of the newborns had a good neonatal outcome, whereas the other 22% were admitted to a neonatal intensive care unit for an average period of 17 days. The most frequent neonatal morbidity was respiratory. One newborn died. Despite the need for several attempts of assisted reproductive technology, pregnancy complications, neonatal morbidity and mortality, the use of these techniques allowed for most couples to overcome their infertility problem.