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1.
J Assist Reprod Genet ; 39(8): 1917-1926, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35759063

RESUMO

PURPOSE: Adequate androgen levels are necessary for regular follicular growth, progression beyond the pre-antral stage, and prevention of follicular atresia. The main purpose of this study was to investigate whether baseline androgen levels had a predictive value on stimulation outcomes in IVF cycles. The secondary purpose was to compare the possible predictive value of androgens with that of already known markers. METHODS: The study included 91 infertile patients aged 30-45 years awaiting the first IVF cycle. All women underwent the same stimulation protocol and the same starting dose of recombinant FSH. As stimulation outcomes, the number of follicles recruited, estradiol and progesterone levels on the day of trigger, the total dose of gonadotropins administered, and the number of oocytes collected were recorded. Multiple linear regression and multivariate logistic regression were used to evaluate the significant predictive value of the variables for response to controlled ovarian stimulation (COS). By studying the reliability of different markers, an attempt was made to develop a single index with the highest predictive value. RESULTS: Pearson's correlation revealed a statistically significant inverse correlation between oocytes collected and age (r = - 0.333, p < 0.001) and a positive correlation with AMH (anti-müllerian hormone) (r = 0.360, p < 0.001), antral follicle count (AFC) (r = 0.639, p < 0.001), and androstenedione (Δ4-A) (r = 0.359, p < 0.001). No significant correlation was reported with FSH (r = - 0.133, p = 0.207) and total testosterone (r = 0.180, p = 0.088). In COS good responders, the G-index (= AMH ng/mL*AFC/Δ4-A ng/dL) revealed a significantly higher level (p < 0.001) than AMH, AFC, and Δ4-A alone. CONCLUSION: Baseline serum Δ4-A, presumably crucial for ensuring a regular follicular growth, is a reliable marker of ovarian response to stimulation. Since the ovarian capacity to respond to gonadotropins does not depend exclusively on the presence of follicles, we suggest a new index, the G-index, able to contemplate both the ovarian reserve and the Δ4-A level.


Assuntos
Reserva Ovariana , Androgênios , Androstenodiona , Hormônio Antimülleriano , Feminino , Fertilização in vitro/métodos , Hormônio Foliculoestimulante , Atresia Folicular , Gonadotropinas , Humanos , Folículo Ovariano/fisiologia , Ovário , Indução da Ovulação/métodos , Reprodutibilidade dos Testes
2.
Reprod Sci ; 28(12): 3466-3472, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33939166

RESUMO

"Add-on" procedures are actively promoted on some fertility clinic websites as proven means to improve IVF success rates, especially for couples with repeated implantation/IVF failures. However, the actual contribution of these interventions to live birth rates remains inconclusive. At present, little is known about the type and quality of the information provided on the IVF clinics' websites regarding the merits of "add-ons." A systematic evaluation of the quality of information on "add-on" procedures in fertility clinic websites was performed using 10-criteria structured questionnaire. We included English language websites that presented in the Google.com search engine after typing the following key-words:"endometrial scratching"(ES), "intralipid infusions"(ILI), "assisted hatching"(AHA), "PGT-A," or "PGS". In total, 254 websites were evaluated. In most cases, an accurate description of the "add-on" procedures was provided (78.8%). However, only a minority (12%) reported their undetermined effectiveness. The use of PGT-A was more often encouraged (52.8%) than ES (23.6%) and AHA (16%). The cost was infrequently presented (6.9%). Scientific references were only rarely provided for ILI, versus 12.7% for ES, 4.0% for AHA, and 5.6% for PGT-A. The information entry date was often missing. None of the websites reported the clinic's pregnancy-rate following the "add-on" procedures. Information on "add-ons" available to patients from IVF clinic websites is often inaccurate. This could perpetuate false myths among infertile patients about these procedures and raises concern regarding possible commercial bias. It is imperative that IVF clinic websites will better communicate the associated risks and uncertainties of "add-ons" to prospective patients.


Assuntos
Clínicas de Fertilização/normas , Gastos em Saúde/normas , Infertilidade/terapia , Internet/normas , Educação de Pacientes como Assunto/normas , Técnicas de Reprodução Assistida/normas , Coeficiente de Natalidade , Feminino , Clínicas de Fertilização/economia , Humanos , Infertilidade/economia , Disseminação de Informação/métodos , Educação de Pacientes como Assunto/métodos , Gravidez , Técnicas de Reprodução Assistida/economia
3.
Reprod Sci ; 28(4): 1026-1030, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33469877

RESUMO

To describe a rare case of unilateral massive hydrothorax after controlled ovarian stimulation for IVF and to analyze the diagnostic complexities in a patient lacking both risk factors and typical features of ovarian hyperstimulation syndrome (OHSS). We present a case of a 35-year-old woman suffering from primary infertility due to a severe male factor. Admitted to hospital for dyspnea, the patient initially underwent a thoracentesis. Later, due to the recurrence of massive hydrothorax, permanent pleural drainage was placed. Recognized as a severe manifestation of the OHSS, it was treated by pleural drainage, hydration, albumin perfusion, and management of the intercurrent pregnancy, up to improvement in clinical and hematological laboratory parameters and resolution of pleural effusion and respiratory symptoms. A total of 42 l of pleural fluid was drained during the 40 days of hospitalization. Since the pathogenesis of isolated acute hydrothorax in ovarian stimulation probably lies in the presence of anatomical defects of the diaphragm, this may justify that the relationship between this pathology and the OHSS risk factors may be less close. Massive pleural effusion may exceptionally be the only clinical presentation of OHSS. A high index of suspicion is necessary to make the correct diagnosis and to promptly administer treatment.


Assuntos
Fertilização in vitro/efeitos adversos , Hidrotórax/diagnóstico , Síndrome de Hiperestimulação Ovariana/diagnóstico , Derrame Pleural/diagnóstico , Adulto , Feminino , Humanos , Hidrotórax/etiologia , Síndrome de Hiperestimulação Ovariana/etiologia , Derrame Pleural/etiologia
4.
Front Psychol ; 11: 586873, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33391106

RESUMO

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the methodological guidelines of Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: (i) dealing with infertile patients and their specificities, (ii) performing assisted reproductive technology (ART), (iii) being part of a team. These themes related to participants experiencing: (i) difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as "particular patients" and men as poorly involved in the process; (ii) difficulties in dealing with a complex procedure in which errors are not allowed (as reported by embryologists), with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; (iii) being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients' overpersistence (rather than just dropout) represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers' own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts.

5.
J Psychosom Obstet Gynaecol ; 39(2): 128-137, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28385114

RESUMO

OBJECTIVE: To investigate the association between polycystic ovary syndrome (PCOS) and psychological disturbances, including anger. To analyze whether the biochemical/phenotypical features of PCOS play a role in the type and severity of psychological disorders. MATERIAL AND METHODS: This case-control study included 30 PCOS patients meeting NIH criteria and 30 non-PCOS women referring to Reproductive Medicine Unit for infertility. Complete clinical and biochemical screening and the self-reported psychological data [Symptom Check List 90-R (SCL-90-R); Short-Form Health Survey 36 (SF-36); and State-Trait Anger Expression Inventory-2 (STAXI-2)] were collected. Statistical analyses were performed with SPSS-21. RESULTS: Compared with control women, women with PCOS reported significantly higher scores on SCL-90-R scales of somatization, anxiety, hostility, psychoticism, overall psychological distress and a number of symptoms. At STAXI-2, patients with PCOS scored higher in trait-anger and in the outward expression of anger, while lower in outward anger-control; PCOS patients had significantly lower scores on SF-36 scales of physical functioning and bodily pain. Hirsutism was directly associated with anxiety. Regarding the associations between phenotypical/biochemical features and psychological distress in PCOS patients, results showed that waist-to-hip ratio is inversely related to anxiety, psychoticism, hostility and to the indexes of psychological distress; such inverse relationship was also seen between plasmatic levels of testosterone and trait-anger, and between total cholesterol and hostility. CONCLUSIONS: Results were consistent with the previous literature on the well-being of PCOS women (in particular for anxiety and quality of life [QoL]) but failed to find evidence for depression. The relationship between psychological distress and the features of the syndrome highlighted the role of hirsutism. With respect to hyperandrogenemia, our data rejected its involvement in the elevated negative mood states and affects. Adopting an interdisciplinary approach in the PCOS patients' care, anger showed to be common and deserves major consideration.


Assuntos
Ira/fisiologia , Hirsutismo , Síndrome do Ovário Policístico , Qualidade de Vida/psicologia , Fatores Socioeconômicos , Estresse Psicológico , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Estudos de Casos e Controles , Depressão/etiologia , Depressão/psicologia , Feminino , Hirsutismo/etiologia , Hirsutismo/metabolismo , Hirsutismo/psicologia , Humanos , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/metabolismo , Síndrome do Ovário Policístico/fisiopatologia , Síndrome do Ovário Policístico/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
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