Oocyte Cryopreservation in Women with Ovarian Endometriosis.

Ovarian endometriosis is a gynecological condition that is closely associated with infertility-from its pathogenesis to treatment modalities, this condition presents a challenge both for patients and clinicians alike when seeking conception, due to low AMH levels, peritoneal inflammation, and the inadvertent removal of healthy ovarian parenchyma at surgery. In fact, around half of endometriosis patients seeking fertility require tertiary-level assisted reproduction techniques to achieve a live birth. Oocyte cryopreservation, a procedure initially designed for oncology patients, has emerged over recent years as a very promising treatment strategy for patients who have been diagnosed with ovarian endometriosis in order to preserve their fertility and obtain a live birth at a later stage in their lives. Counseling patients about oocyte preservation techniques at an early stage in the diagnosis, ideally before the age of 35 and especially prior to any surgical treatment, provides an excellent opportunity to discuss future fertility and the benefits associated with oocyte cryopreservation.

The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis.

To investigate the impact of uterine adenomyosis on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) clinical outcomes and also to evaluate the impact of gonadotropin-releasing hormone agonist (GnRHa) and surgical treatments. Infertile women with adenomyosis undergoing conventional IVF or ICSI were compared with women without adenomyosis. Fertility outcomes were evaluated in two patients with adenomyosis untreated and treated surgically or medically therapy. The review protocol was registered in PROSPERO (CRD42020214586). We consider the live birth rate (LBR) as the primary outcome. The analysis showed that women with adenomyosis had lower LBR (OR 0.59, 95% CI 0.37-0.92, p = 0.02), clinical pregnancy rate (OR 0.66, 95% CI 0.48-0.90), and ongoing pregnancy rate (OR 0.43, 95% CI 0.21-0.88) compared to those without adenomyosis, and miscarriage rate was higher in women with adenomyosis (OR 2.11, 95% CI 1.33-3.33). Surgical treatment increases natural conception in women with adenomyosis although the paucity of data (only two studies), and conversely, treatment with GnRHa does not increase the IVF outcomes. Women with adenomyosis have decreased IVF clinical outcomes. Pretreatment with the use of long-term GnRHa could not be beneficial, even though only three studies were included in the meta-analysis. The major part of the studies has not divided focal and diffuse adenomyosis, and this represents a relevant source of bias: studies conducted with standardized diagnostic criteria for adenomyosis are still needed to determine if the different clinical presentations of such condition could compromise IVF outcomes.

Práticas estéticas e corporais: criação e produção de subjetividade na atenção psicossocial / Aesthetic and body practices: creation and production of subjectivity in psychosocial care

RESUMO Práticas estéticas e corporais têm ocupado um lugar significativo na atenção psicossocial, no contexto da Reforma Psiquiátrica brasileira. Propostas que inventam outras formas de produção de saúde e de subjetividade, associadas à participação social, têm valorizado a diversidade de formas de expressão em saúde mental e a diferença nas formas de existência. Com o intuito de estudar essas práticas e criar um campo de comunicação e produção coletiva de suas singularidades e seu plano comum, um grupo de pesquisadores se reuniu no Programa de Pós-graduação em Psicologia da Universidade Estadual Paulista e desenvolveu pesquisas articuladas ao projeto 'Práticas estéticas e corporais na atenção psicossocial: processos de criação e produção de subjetividade'. Nessas pesquisas, foram exploradas as relações entre arte e saúde mental, a produção das políticas públicas relacionadas ao campo, o desenvolvimento das práticas clínicas, artísticas e culturais e a formulação de conceitos e perspectivas teóricas que sustentem essas práticas. Neste texto, serão apresentadas, brevemente, as políticas públicas de saúde e cultura que foram desenvolvidas no Brasil nos últimos 30 anos, sua articulação intersetorial e algumas experiências práticas nesse campo, que temos desenvolvido e pesquisado.

ABSTRACT Aesthetic and body practices have played a significant role in psychosocial care, in the context of the Brazilian Psychiatric Reform. Proposals that invent other ways of producing health and subjectivity, associated with social participation, have valued the diversity of expression in mental health and the difference in forms of existence. In order to study these practices and create a field of communication and collective production of their singularities and their common plan, a group of researchers met in the Graduate Program in Psychology at Universidade Estadual Paulista, creating the line of research 'Aesthetic and body practices in the psychosocial care: processes of creation and production of subjectivity'. In the inquiries developed, the relations between art and mental health, the production of public policies related to the field, the development of clinical, artistic and cultural practices and the formulation of concepts and theoretical perspectives that support these practices were explored. In this paper, the health and culture public policies that have been developed in Brazil in the last 30 years, their intersectoral articulation and some practical experiences in this field, which we have developed and researched, will be briefly presented.

Pathways and factors regulated by bone marrow-derived stem cells in human ovarian tissue.

OBJECTIVE: To describe molecular and paracrine signaling changes produced by human bone marrow-derived stem cells (BMDSC) in human ovarian cortex. DESIGN: Experimental study. SETTING: University hospital research laboratories. PATIENT(S): Ovarian cortex from poor responder women (n = 7). ANIMALS: Immunodeficient NOD/SCID female mice (n = 18). INTERVENTION(S): Human ovarian cortex strips were xenografted into ovariectomized NOD/SCID female mice. A week later, mice were infused with phosphate-buffered saline, 1 × 106 BMDSC, or 3 × 105 CD133+ cells via tail vein. Gene expression changes and enriched pathways were assessed by RT2 Profiler Arrays. Several upregulated genes were validated in individual samples by real-time quantitative PCR, and transcriptomic results were reinforced by a proteomic assessment. MAIN OUTCOME MEASURE(S): Gene expression changes, enriched Kyoto Encyclopedia of Genes and Genomes pathways, and paracrine factors. RESULT(S): Seventy-four Kyoto Encyclopedia of Genes and Genomes pathways were upregulated, with the PI3K-Akt signaling pathway the most enriched after BMDSC and CD133 treatments. The greatest transcriptomic changes were seen on day 14 in the BMDSC group, affecting the regulation of paracrine factors such as KITLG, THBS1, SERPINF1, and TIMP2. Proteomics data verified changes in FoxO signaling, actin cytoskeleton remodeling, and apoptosis by BMDSC. CONCLUSION(S): We identified paracrine factors and pathways regulated by BMDSC that may be future targets of treatment for the increasing number of poor responder women. Our findings suggest that BMDSC upregulated soluble factors such as KITLG, THBS1, SERPINF1, and TIMP2 as well as PI3K-Akt signaling and regulation of actin cytoskeleton pathways. The identification of these putative underlying mechanisms informs future experiments aiming to optimizing clinical application of BMDSC.

Therapy with probiotics and synbiotics for polycystic ovarian syndrome: a systematic review and meta-analysis.

OBJECTIVE: Several randomized controlled trials (RCTs) have investigated the use of probiotic/synbiotic in PCOS patients, without clarifying the real use in clinical practice. The aim of this meta-analysis was to evaluate the effectiveness of probiotics and synbiotics on metabolic, hormonal and inflammatory parameters of PCOS. METHODS: Electronic databases (MEDLINE, Scopus, EMBASE, ScienceDirect, The Cochrane Database of Systematic Reviews and ClinicalTrials.gov) were searched from their inception until May 2019. The study protocol was registered in PROSPERO with number CRD42018111534. Randomized controlled trials (RCTs) of PCOS's women undergoing therapy at least 8 weeks with probiotics or synbiotics or without therapy were included. The primary outcomes were changes in anthropometric parameters, glucose/insulin metabolism, lipid profile, sex hormones profile, inflammation markers. RESULTS: 587 patients were included in nine RCT. The administration of probiotic/synbiotic were associated with a significant improvement in FPG, FBI, HOMA I-R, BMI. It also modified Ferriman-Gallway, serum triglycerides, serum testosterone, hs-CRP, NO, TAC, GSH, and MDA. Subgroup analysis of the type of intervention showed that probiotics were associated with greater testosterone and FPG reduction; synbiotics administration resulted in a more pronounced decrease of the FBI. Subgroup analyses on the duration of therapy showed that, probiotic/synbiotic administration had a significantly greater effect on QUICK-I in the case of women with 12-weeks of therapy than in the 8-weeks therapy group. Nevertheless, we did not observe any significant difference was observed in terms of FBI, HOMA-IR, and FPG. CONCLUSIONS: Probiotics and synbiotics seem to either an effect on/influence metabolic, hormonal and inflammatory parameters, or can influence them. Consequently, it could lead to an improvement of fertility in PCOS.