[LH-FSH ratio and Polycystic Ovary Syndrome: A forgotten test?]. / Proporción LH-FSH y síndrome de ovario poliquístico: ¿prueba olvidada o no útil?

OBJECTIVE: To identify the predictive value of LH-FSH ratio in the Polycystic Ovary Syndrome diagnosis and to evaluate its role according PCOS phenotypes. MATERIAL AND METHOD: A descriptive, comparative, observational, prospective study of PCOS patients and its controls. All participants received a questionnaire and underwent a physical and transvaginal ultrasound examination. Blood samples were also collected for analysis of metabolic markers and hormones. PCOS was diagnosed according to Rotterdam criteria. RESULTS: A total of 267 women were included into the study. PCOS was diagnosed in 162 patients. There was statistical difference in: HOMA, 1.43 ± 1.06, 2.09 ± 1.96; Total Testosterone, 0.31 ± 0.14, 0.41 ± 0.19; and free Androgen index, 1.17 ± 1.30, 1.69 ± 1.18; for control and PCOS group, respectively. FSH, 6.55 ± 2.43 in controls and 5.30 ± 1.66 in PCOS patients (p = 0.001); LH, 4.34 ± 2.12 controls, 6.36 ± 4.61 PCOS patients (p = 0.001). LH-FSH ratio was 0.71 ± 0.39 for control group and 1.25 ± 0.85 in PCOS group, p = 0.001. A correlation was observed between LH-FSH ratio and total antral follicle count (p < 0.001) and with insulin resistance (p = 0.022). CONCLUSION: LH-FSH ratio, although it is a valuable test, it is not diagnostic of PCOS. A correlation was found with LH-FSH ratio and insulin resistance but we must not forget about its association with hyperandrogenism.

Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients.

In 2007, a previously uninfected kidney transplant recipient tested positive for human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) infection. Clinical information of the organ donor and the recipients was collected by medical record review. Sera from recipients and donor were tested for serologic and nucleic acid-based markers of HIV and HCV infection, and isolates were compared for genetic relatedness. Routine donor serologic screening for HIV and HCV infection was negative; the donor's only known risk factor for HIV was having sex with another man. Four organs (two kidneys, liver and heart) were transplanted to four recipients. Nucleic acid testing (NAT) of donor sera and posttransplant sera from all recipients were positive for HIV and HCV. HIV nucleotide sequences were indistinguishable between the donor and four recipients, and HCV subgenomic sequences clustered closely together. Two patients subsequently died and the transplanted organs failed in the other two patients. This is the first recognized cotransmission of HIV and HCV from an organ donor to transplant recipients. Routine posttransplant HIV and HCV serological testing and NAT of recipients of organs from donors with suspected risk factors should be considered as routine practice.

[Culture of blastocysts using sequential media]. / Cultivo de blastocistos con medios secuenciales.

The advantages of cultivating human pre-embryos to the stage of blastocites, are well known. The use of media of culture sequential, without the backing of somatic cells, is new. The objective was to cultivate human pre-embryos to the stage of blastocyte to the determine the recuperation indexes, implantation index and pregnancy index in patients subjected to FIVT/TE or ICSI. Once obtained the ovules of patients were injected/inseminated to latter be cultivated for 72 hours using P1 medium at 10% of SSS under mineral oil for, latter, be transferred to a complex medium for blastocites culture for 48 hours, and finally be transferred. Thirteen were included (9 of FIV and 4 of ICSI) obtaining 205 ovules; fertilized 143 and 131 had cellular division. One hundred and twenty one pre-embryos were cultivated to blastocyst stage, from which, 53 reached that stage (43.8%); transferring 28 and freezing 25. In average, 2.1 blastocysts were transferred by patient. There were four pregnancies and one alive newborn, at term for an index of implantation of 14.2% and a pregnancy index of 30.7%. The study shows our initial experience, which demonstrated and acceptable idea of recuperation of blastocysts and pregnancies.

Fragmentación del ADN espermático: situación actual / Sperm DNA fragmentation: Current research

Resumen OBJETIVO: Revisar los mecanismos responsables de la fragmentación del ADN espermático y sus métodos de análisis, la definición de fragmentación del ADN y las características que hacen al espermatozoide único y diferente de las demás células. Discutir la trascendencia de las técnicas actuales para evaluar la fragmentación del ADN espermático, su utilidad y aplicación clínica. Emitir recomendaciones de práctica clínica según lo que el grupo considera el mejor abordaje en este tema. METODOLOGIA: Búsqueda bibliográfica en las bases de datos: Medline, Pubmed, Pubmed Central y Google Scholar con las palabras clave: fragmentación del ADN, fragmentación del ADN espermático, fragmentación del ADN espermático humano y pruebas de fragmentación del ADN. RESULTADOS: Se seleccionaron 143 artículos con adecuada metodología, claridad y relevancia clínica y se encontraron 16 metanálisis, de los que se seleccionaron 5 por su metodología y claridad en los resultados. CONCLUSIÓN: La integridad del genoma paterno es decisiva para conseguir un recién nacido sano. Las técnicas actuales están lejos de la perfección en términos de predictibilidad, selección y resultados. Sin embargo, las nuevas tecnologías pueden aportar información faltante para dilucidar el papel de las pruebas de fragmentación del ADN espermático en el laboratorio de reproducción asistida.

Abstract OBJECTIVE: To review the mechanisms responsible for sperm DNA fragmentation and its methods of analysis. This includes a briefly review about the definition of DNA fragmentation; what characteristics make the sperm unique and different from other cells. We also give a discussion about the impact of the current techniques to evaluate sperm DNA fragmentation and its utility and clinical application. Lastly, there are practice recommendations regarding what our group considers to be the best approach for this subject. METHODOLOGY: Bibliographic search in the databases: Medline, Pubmed, Pubmed Central and Google Scholar with the keywords: DNA fragmentation, sperm DNA fragmentation, fragmentation of human sperm DNA and DNA fragmentation tests. CONCLUSION: The integrity of the paternal genome is of crucial importance to reach our goal of a healthy newborn. Current techniques are far from perfect in terms of predictability, selection and results. New technologies may give us the information missing in order to elucidate the role of sperm DNA fragmentation tests in the assisted reproduction lab.

Mioinositol en combinación con D-chiro-inositol: resultados preliminares en el tratamiento de primera línea de pacientes con síndrome de ovario poliquístico / Myoinositol plus D-chiro-inositol: Preliminary results as first line management in PCOS

Resumen OBJETIVO: Evaluar el efecto de la combinación de mioinositol y D-chiro-inositol en el perfil metabólico y endocrino de mujeres con síndrome de ovario poliquístico. MATERIALES Y MÉTODOS: Estudio experimental, prospectivo y longitudinal efectuado en pacientes con diagnóstico de síndrome de ovario poliquístico (criterios de Rotterdam) sin tratamiento o intervención previa. Diariamente se administraron, por vía oral, 2000 mg de mioinositol y 400 mg de D-chiro-inositol, durante 90 días. Se evalúan y comparan el perfil clínico y metabólico de cada paciente antes y después de la intervención. RESULTADOS: Se estudiaron 61 pacientes con síndrome de ovario poliquístico, con una diferencia estadísticamente significativa en los valores de la escala Ferriman-Gallwey (6.06 ± 2.0 y 5.57 ± 1.1; p = 0.003 pre y postratamiento, respectivamente); volumen ovárico izquierdo (7.76 ± 3.2 y 7.18 ± 2.3; p = 0.005, pre y postratamiento, respectivamente). La cuenta de folículos antrales del ovario izquierdo fue de 10.65 ± 6.4 y 10.20 ± 5.7; p=0.029 pre y postratamiento, respectivamente. La cuenta de folículos antrales del ovario derecho fue: 12.11 ± 6.5 y 11.75 ± 6.1; p=0.048 pre y postratamiento, respectivamente. Hubo mejoría en los valores del HOMA (1.85 ± 1.0 y 1.67 ± 0.7; p=0.015 pre y postratamiento, respectivamente. En la proporción LH-FSH: 1.13 ± 0.8 y 0.99 ± 0.6; p=0.018 pre y postratamiento, respectivamente. CONCLUSIÓN: Los resultados del estudio muestran un efecto positivo de la administración combinada de mioinositol y D-chiro-inositol en el perfil clínico y metabólico de pacientes con síndrome de ovario poliquístico. La mejora en las concentraciones séricas de andrógenos, de la proporción LH-FSH y la regularización de los ciclos menstruales puede contribuir al aumento de la fertilidad en pacientes con síndrome de ovario poliquístico y factor ovárico.

Abstract OBJECTIVE: To assess the effect of a combined therapy with myoino-sitol (MI) and D-chiro-inositol (DCI) in Polycystic Ovary Syndrome (PCOS) patients. MATERIALS AND METHODS: An experimental, prospective, longitudinal study. It includes patients with PCOS diagnostic (by Rotterdam criteria) that have not received any form of therapy or management for the syndrome. All patients received an oral daily administration of MI and DCI for 90 days. Clinic and metabolic profiles are assessed pre and postreatment. RESULTS: Sixty-one patients are included and we observed an improvement in Ferriman-Gallwey scale (6.06 ± 2.0 y 5.57 ± 1.1; p=0.003, pre-and postreatment, respectively); left ovary volume (7.76 ± 3.2 y 7.18 ± 2.3; p=0.005, pre and postreatment, respectively). Left ovary antral follicle count (10.65 ± 6.4 y 10.20 ± 5.7; p=0.029, pre and postreatment, respectively) and right ovary antral follicle count (12.11 ± 6.5 y 11.75 ± 6.1, p=0.048, pre and postreatment, respectively). There is also an improvement in HOMA (1.85 ± 1.0 y 1.67 ± 0.7, p=0.015, pre and postreatment, respectively) and LH/FSH ratio (1.13 ± 0.8 y 0.99 ± 0.6, p=0.018 pre and post treatment, respectively). CONCLUSION: We observed a positive effect with the combined administration of MI and DCI in clinic and metabolic profile of PCOS patients. Improvement in androgen profile, LH/FSH ratio and restoring menstrual cycles, may have a positive effect over the infertility caused by an anovulatory factor.