O hormônio antimulleriano e a reserva ovariana: uma revisão integrativa da literatura / The anti-mullerian hormone and the ovarian reserve: an integrative literature review

O hormônio antimulleriano é secretado pelas células da granulosa dos folículos que estão em desenvolvimento no ovário. Por meio da sua dosagem, é possível avaliar a reserva ovariana. A mulher tem seu número máximo de oócitos no perío- do fetal, mas, conforme o tempo passa, existe uma queda do número de células germinativas. Desse modo, para mulheres que têm o desejo de engravidar, a dosa- gem de hormônios e a avaliação da reserva ovariana podem ajudar no processo. O objetivo do estudo foi encontrar evidências na literatura que comprovem que o hormônio antimulleriano é o melhor marcador da reserva ovariana. Para isso, foi realizada uma revisão integrativa, classificada como qualitativa; a busca de da- dos foi realizada no PubMed, utilizando a seguinte palavra-chave: "hormônio anti- mulleriano (HAM)". Foram encontrados oito artigos que abordavam diretamente o tema, e há evidências que corroboram a hipótese de que o hormônio antimulleria- no é um bom marcador da reserva ovariana, sendo necessários mais estudos para determinar a sua superioridade.

The anti-mullerian hormone is secreted by the granulosa cells of follicles that are developing in the ovary. Though its dosage is possible to evaluate the ovarian re- serve. Women have their maximum number of oocytes in the fetal period, but there is a decrease in the number of germinative cells as time goes by. Thus, women that desire to get pregnant can have hormones dosed and the ovarian reserve evalua- ted to help them with this process. The objective of this study was to find evidence in the literature that proves that the anti-mullerian hormone is the best marker of ovarian reserve. For this purpose, an integrative review was conducted, using the key word: "anti-mullerian hormone (AMH)". Eight articles were found on the subject and there is evidence that proves the hypothesis of the anti-mullerian hormone as a good marker, however more studies are needed to determine its superiority.

The importance of genetic research in cases of severe male factor infertility: A case of 46,XX testicular disorder of sex development.

46,XX testicular disorder of sex development is a rare syndrome characterized by an inconsistency between genotype and phenotype. Affected individuals present variant genitalia between male and ambiguous, non-functional testicles, non-obstructive azoospermia, generally accompanied by hypergonadotropic hypogonadism, a condition known for high levels of gonadotrophic hormones. In some cases, disorders of sexual development are diagnosed during puberty. However, a significant number of individuals show physical characteristics common to males that are not clinically suspicious. As a result, patients with the condition may remain undiagnosed. Many individuals with the condition are diagnosed as adults, due to infertility. The present study discusses the case of an individual who underwent karyotyping for sterility and was found to be a 46,XX male. Despite having a female karyotype, the presence of the sex-determining region Y gene explains the manifestation of masculine secondary sex characteristics. This report highlights the importance of genetic evaluation, considering that carriers may present significant complications resulting from the disorder. Based on correct diagnosis, it is possible to improve a carrier's quality of life through multidisciplinary approaches and help them achieve pregnancy through assisted reproductive technology treatments.

Serous adenocarcinoma of the ovary diagnosed during ultrasound evaluation for fertility preservation.

Breast cancer is the most common malignant tumor in women of reproductive age, and fertility preservation counseling is now an integral part of the initial management of these patients. This article reports the case of a 33-year-old woman diagnosed with breast cancer and referred for oncofertility counseling before her treatment. Despite a previous negative cancer workup, a transvaginal ultrasound scan, performed for antral follicle count as part of the initial ovarian reserve assessment, revealed a synchronous ovarian adenocarcinoma. A BRCA1 mutation was confirmed weeks later. This report highlights the role of transvaginal ultrasound in the initial evaluation and reviews the risks associated with fertility preservation in breast cancer patients.

Fertilization outcome, embryo development and birth after unstimulated IVM.

BACKGROUND/PURPOSES: A common observation in oocyte in vitro maturation (IVM) cycles is poor embryo quality. However, no study was dedicated to assess zygote and early cleavage embryo quality in IVM cycles. The objective of this study is to analyze fertilization outcome, embryo development and the resulting pregnancy and births in unstimulated IVM cycles. METHODS: IVM oocytes were collected 36 h post hCG and matured in vitro for 28-30 h. All oocytes were inseminated by ICSI. Resulting zygotes and embryos were assessed on day-1, 2 and 3, when transfers were made. RESULTS: The overall oocyte maturation and fertilization rates were 63% and 62%, respectively. Abnormal fertilization rate was 27%. [corrected] Ninety five and 14.6% of the 2Pn zygotes reached the 2-cell and 8-cell stage at day-2 and day-3, respectively. Embryo quality assessment on day-3 at transfer revealed that only 9% of the embryos were of very good quality. Most embryos showed developmental delay. An average of 3.29 embryos were transferred per patient resulting in implantation and clinical gestation rates of 16% and 32%, respectively. Overall 14 healthy babies were born and there is one ongoing pregnancy. CONCLUSION: Results show a significant rate of abnormal fertilization and poor embryo quality after IVM, which is reflected in a higher than average number of embryos being transferred. However, pregnancy, implantation and birth rates are reasonably high and allow us to consider IVM a valuable approach for the treatment of infertility in PCO or PCOS patients.

Dichorionic twins and monochorionic triplets after the transfer of two blastocysts.

PURPOSE: To describe a unique case of MZ dichorionic twins and MZ monochorionic triplets in a quintuplet gestation after intracytoplasmatic sperm injection (ICSI) and blastocyst transfer. METHODS: Case report. A 24-year-old woman underwent ICSI and received two blastocysts transferred. A quintuplet gestation was established .Transvaginal ultrasonography was performed sequentially during early pregnancy. RESULTS: Three intrauterine gestational sacs were revealed at about 5th week. At the 7th week, five gestational sacs presenting heart beats were detected and a quintuplet pregnancy consisting of two monozygotic (MZ) dichorionic twins and three MZ monochorionic triplets was determined. At the 10th week, a single gestational sac with heart beats was detected. The prenatal course was uneventful. A healthy baby was born at 36th week. CONCLUSION: Few other reports have described the occurrence of a quintuplet gestation after the transfer of two blastocysts generated by ICSI. Our case is unique in that the two blastocysts underwent two different splitting processes, which occurred possibly at a similar time giving rise to MZ dichorionic twins and MZ monochorionic triplets.

[Spontaneous pregnancies after ovarian puncture for in vitro maturation in women with the polycystic ovary syndrome]. / Gestações espontâneas após punção ovariana para maturação in vitro em mulheres com síndrome dos ovários policísticos.

PURPOSE: to report three cases of spontaneous gestation in women with polycystic ovarian syndrome (PCOS), that occurred in the months subsequent to transvaginal oocyte retrieval for in vitro maturation (IVM). METHODS: three infertile patients with PCOS, submitted to oocytes' IVM without previous ovarian stimulation, were included in the study. During the procedure of oocytes' collection, each ovary was drilled from four to eight times. RESULTS: none of the patients got pregnant with the IVM technique. Evaluating the cases' follow-up, in seven months after the procedure, the three patients got pregnant without the help of techniques of assisted reproduction, which resulted in three births. CONCLUSIONS: the multiple drillings in the ovary of these patients with PCOS, during the process to collect oocytes, may have contributed to their pregnancy in the months following the procedure.

Gestações espontâneas após punção ovariana para maturação in vitro em mulheres com síndrome dos ovários policísticos / Spontaneous pregnancies after ovarian puncture for in vitro maturation in women with the polycystic ovary syndrome

OBJETIVO: relatar três casos de gestações espontâneas em portadoras da síndrome dos ovários policísticos (SOP) que ocorreram nos meses subsequentes à realização de punção ovariana transvaginal para captação oocitária para a maturação in vitro. MÉTODOS: foram incluídas no estudo três pacientes inférteis portadoras de SOP submetidas à maturação in vitro dos oócitos sem estimulação ovariana prévia. Durante o procedimento da coleta dos oócitos, cada ovário foi perfurado de quatro a oito vezes. RESULTADO: nenhuma paciente engravidou com a técnica da maturação in vitro. Avaliando o seguimento dos casos, em sete meses após o procedimento, as três pacientes engravidaram sem o auxílio de técnicas de reprodução assistida, resultando em três nascimentos. CONCLUSÕES: as múltiplas perfurações nos ovários destas pacientes portadoras da SOP, durante o procedimento de coleta dos oócitos, podem ter contribuído para a obtenção da gestação nos meses subsequentes ao procedimento.

PURPOSE: to report three cases of spontaneous gestation in women with polycystic ovarian syndrome (PCOS), that occurred in the months subsequent to transvaginal oocyte retrieval for in vitro maturation (IVM). METHODS: three infertile patients with PCOS, submitted to oocytes' IVM without previous ovarian stimulation, were included in the study. During the procedure of oocytes' collection, each ovary was drilled from four to eight times. RESULTS: none of the patients got pregnant with the IVM technique. Evaluating the cases' follow-up, in seven months after the procedure, the three patients got pregnant without the help of techniques of assisted reproduction, which resulted in three births. CONCLUSIONS: the multiple drillings in the ovary of these patients with PCOS, during the process to collect oocytes, may have contributed to their pregnancy in the months following the procedure.

A aplicação clínica de maturação in vitro de oócitos humanos (IVM) / The clinical use of human oocyte in vitro maturation (IVM)

A coleta de oócitos imaturos, a partir de ovários não estimulados em combinação com a maturação in vitro de oócitos (lVM) e fertilização in vitro é uma técnica de reprodução assistida que tem recebido crescente interesse nos últimos anos. O objetivo desta revisão é fazer um levantamento do estado da arte da maturação in vitro de oócitos humanos, particulamente em ciclos não estimulados e enfatizar o potencial desta metodologia dentre as técnicas de reprodução assistida.