Is there any association between vitamin D levels and polycystic ovary syndrome (PCOS) phenotypes?

ABSTRACT Objective The aim of this study was to assess the serum vitamin D level in a retrospective study in women with polycystic ovary syndrome (PCOS), according to the different phenotypes of the disease. Subjects and methods In this retrospective study, the records of 351 infertile women who were diagnosed with PCOS were examined, and 200 of them were enrolled in the study randomly in 4 PCOS phenotypes. Fifty normal ovulatory women with the history of male factor were selected as the control group. Parameters, including age, infertility duration, body mass index (BMI), hormone profile, as well as the serum vitamin D level were compared among the 4 phenotypes, with the P-value ≤ 0.05 considered statistically significant. Results The findings showed a higher serum vitamin D level in the control group than in PCOS patients, which was statistically significant (P < 0.001). In addition, there was no significant difference in the serum vitamin D level among the four phenotypes of PCOS. Conclusions No significant difference was found in the serum vitamin D level of the different phenotypes of PCOS. Further studies with larger sample sizes are recommended to be done to establish the role of the serum vitamin D level in PCOS patients.

Highly prevalence of vitamin D deficiency among Brazilian women of reproductive age

ABSTRACT Objective Vitamin D has several metabolic functions and possible reproductive functions. This study aimed to determine the prevalence of vitamin D deficiency among Brazilian women of reproductive age, and to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and infertility causes. Subjects and methods This retrospective cross-sectional study evaluated data from a private Brazilian assisted reproduction center that were collected between January 1 and May 5, 2012. Serum 25(OH)D concentrations were measured and compared for infertile and fertile women. Concentrations of 25(OH)D that were < 20 ng/mL were defined as deficiency and concentrations of 21-30 ng/mL were defined as hypovitaminosis D. Results Among the 369 evaluated women, 81.1% exhibited hypovitaminosis D and 32.0% exhibited deficiency. The infertile and control patients did not exhibit any significant differences in the prevalence of vitamin D deficiency (30.2% vs. 35%, respectively; p = 0.33) or in the mean 25(OH)D concentrations (24.3 ± 7.9 ng/mL vs. 23.8 ± 8.7 ng/mL, respectively; p = 0.51). Furthermore, there were no significant differences in the mean 25(OH)D concentrations among subgroups of patients with single infertility factors, or between these subgroups and the control group. Conclusions A high proportion of Brazilian women of reproductive age exhibited vitamin D deficiency, regardless of their fertility status. Thus, it may be useful to evaluate this population for vitamin D deficiency, although future studies are needed to determine whether this deficiency might affect the outcomes of treatments for infertility.

Hyper - prolactinemiea in subfertile women

To determine the frequency of Hyperprolactinemia in subfertile women presenting to Nishtar Hospital Multan. Case series study. This study was carried out in Gynae and Obst. Outpatient Department and Gynae and Obst. Units of Nishtar Hospital, Multan from Oct. 2009 to March 2010. A total of 111 Patients with subfertility were selected which were fulfilling inclusion criteria. The prevalence of HPR in subfertile women at Nishtar Hospital Multan is 31.53%, and it is more common in women with primary subfertility i.e. 23.42% than in secondary subfertility where it is 8.10%. It is concluded that hyperprolactinemia [HPR] leads to anovulation which is a main cause of subfertility, more common among women with primary subfertility than secondary subfertility

What Number of Oocytes Is Appropriate for Defining Poor Ovarian Response?

PURPOSE: This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). MATERIALS AND METHODS: A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. RESULTS: The 25th percentile of the distribution corresponded to total oocytes 5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes < or =2 or mature oocyte < or =1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was < or =0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes < or =2 or mature oocyte < or =1 in a previous cycle or a serum AMH level of < or =0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. CONCLUSION: We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.

What Number of Oocytes Is Appropriate for Defining Poor Ovarian Response?

PURPOSE: This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). MATERIALS AND METHODS: A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. RESULTS: The 25th percentile of the distribution corresponded to total oocytes 5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes < or =2 or mature oocyte < or =1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was < or =0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes < or =2 or mature oocyte < or =1 in a previous cycle or a serum AMH level of < or =0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. CONCLUSION: We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.

Serum leptin levels in obese infertile men and women

The present study was designed to evaluate the relationship between serum leptin and infertility in obese young and old men and women. The groups of infertile obese men [n=66] and women [n=30] compared with control obese fertile men [n=60] and women [n=30] with same ages to find the contribution of serum leptin level in causation of fertility. The results revealed that serum leptin were significantly raised in infertile male and female with p<0.001. BMI was also found to be significantly higher [p<0.001] in infertile men and women. Moreover a strong positive correlation was found between BMI and leptin level, and serum leptin and age in both fertile and infertile men and women. The values of correlation coefficients between serum leptin and BMI, and serum leptin and age are statistically significant [r=0.3-0.6, p<0.01-p<0.05]. This study has concluded that obesity is associated with infertility in men and women. Sex hormonal imbalance may also be associated BMI and serum leptin in infertility. However further studies are required to determine the exact match by which enhanced BMI and serum leptin levels to female and male infertility

Organochlorine compound levels in fertile and infertile women from Rio de Janeiro, Brazil / Níveis de substâncias organocloradas em mulheres férteis e inférteis do Rio de Janeiro, Brasil

OBJECTIVE: The aim of the study was quantify organochlorine compounds in women seeking for infertility treatment (n = 15) and in spontaneously pregnant ones (n = 21). MATERIALS AND METHODS: A questionnaire was applied regarding lifestyle, occupational and reproductive history. Blood samples were collected from both groups. RESULTS: From the pesticides studied, pp'DDE was detected in 100% of infertile women, at higher mean levels than in pregnant women (3.02 mcg/L vs. 0.88 mcg/L; p = 0.001; power of 69%), without correlation with the etiology of infertility. Levels of the polychlorinated biphenyls (PCBs) were low, with positive samples in 100% in the infertile women for PCBs 138, 153, 180, while in pregnant women, they were 85.7% for congeners 138 and 153. Only PCB180 showed significance, with frequency of 71.4% (p = 0.019). CONCLUSIONS: The risk factors for female infertility were: age, consumption of untreated water and of canned foods. Exposure to the most prevalent organochlorine compounds described in literature was confirmed in the study, indicating that pp'DDE may adversely influence female fertility.

OBJETIVO: O estudo teve como objetivo quantificar as substâncias organocloradas em mulheres buscando tratamento para infertilidade (n = 15) e que espontaneamente engravidaram (n = 21). MATERIAIS E MÉTODOS: Foi aplicado questionário considerando estilo de vida, história ocupacional e reprodutiva. Amostras de sangue foram obtidas em ambos os grupos. RESULTADOS: Dos pesticidas, pp'DDE foi detectado em 100% das inférteis, com níveis maiores que nas grávidas (3,02 mcg/L vs. 0,88 mcg/L; p = 0,001; poder 69%), sem correlação na etiologia da infertilidade. Os níveis de detecção das bifenilas policloradas (PCBs) foram baixos, com 100% de positividade das amostras nas inférteis para os PCBs 138, 153, 180, e de 85,7% nas grávidas para os congêneres 138 e 153. Apenas PCB180 mostrou significância na frequência de 71,4% (p = 0,019). CONCLUSÕES: Os fatores de risco para infertilidade feminina foram: idade, consumo de água não tratada e alimentos enlatados. A exposição aos organoclorados mais prevalentes descritos na literatura foi confirmada no estudo, indicando que pp'DDE pode influenciar adversamente a fertilidade feminina.

El hábito de fumar se asocia a baja concentración plasmática de hormona antimülleriana en mujeres infértiles / Effects of smoking on plasma antimüllerian hormone concentrations among infertile women

Background: Smoking may hamperfemale fertility, probably modifying ovarian reserve. Antimüllerian hormone (AMH) is an accurate marker for ovarian reserve. Aim: To look for an association between smoking status and plasma AMH concentration. Patients and Methods: A cohort of 141 infertile women in a university setting in Santiago, Chile was studied. Demographic and smoking data, including the number of cigarettes smoked during the last week, were collected. A blood sample was obtained and kept frozen until determination of AMH by ELISA and follicle stimulating hormone (FSH) and estradiol at day three of the menstrual cycle, by radioimmunoanalysis. Results: Thirty two participants smoked (23%). There were no significant differences in age, parity, body mass index, causes of infertility and day three FSH and estradiol between smokers and nonsmokers. According to a regression analysis, there was a significant decrease in AMH concentration with age and active cigarette smoking. A drop in AMH of -0.189 ng/mL with a unitary change in age and a decrease of -2.29 ng/mL when everything else remains constant, except the smoking status, were established (p < 0.001 and r2 = 0.134). However, no dose response was observed when the number of cigarettes smoked during the last week were introduced in the model. Furthermore, no significant association ofplasma AMH with day three plasma FSH and estradiol concentrations was observed. Conclusions: Cigarette smoking is associated with decreased AMHplasma concentrations among infertile women. However there was no dose response relationship. The mechanisms underlying this association are unknown and further investigation is required.

Anticardiolipin antibodies and lupus anticoagulants among women undergoing in vitro fertilization in Jamaica / Anticuerpos anticardiolipinas y anticoagulantes lúpicos entre mujeres a las que se les realiza FIV en Jamaica

OBJECTIVE: The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica. METHODS: A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patient's hospital record, between March 2000 and March 2010, was collected and the relevant data extracted. RESULTS: The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787). CONCLUSION: The prevalence of positive aCL and/or lA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.

OBJETIVO: Los objetivos de este estudio fueron evaluar el efecto del anticuerpo anticardiolipina (aCL) y el anticoagulante lúpico (LA) sobre el resultado de los ciclos de la fertilización en vitro (FIV), así como determinar la prevalencia de estos anticuerpos en mujeres estériles que buscan tratamiento de FIV en Jamaica. MÉTODOS: Se realizó un estudio de cohorte para determinar si el tamizaje de pacientes para detectar el anticuerpo anticardiolipina y el anticoagulante lúpico tenía un impacto significativo en el resultado del proceso de FIV. Se obtuvieron las historias clínicas hospitalarias de cada una de las pacientes, entre marzo de 2000 y marzo de 2010, y se extrajeron los datos pertinentes. RESULTADOS: La prevalencia de aCL en esta cohorte de mujeres jamaicanas fue 3.88% moderada/alta positiva, 0.68% positiva baja, y aquellas con resultados negativos de aCL, 95.4%. La prevalencia de mujeres con resultados de anticoagulante lúpico positivos fue 4.1%, y 0.9% de las mujeres resultaron positivas con respecto tanto al LA como al aCL. De las pacientes que fueron positivas al LA y/o al aCL, ocho de cada 30 pacientes (26.7%) tuvieron una prueba de embarazo positiva, en comparación con 61 de cada 181 pacientes (33.7%) negativas al LA y/o al aCL (p = 0.5787). CONCLUSIÓN: La prevalencia de resultados positivos en relación con anticuerpos anticardiolipinas y/o anticoagulantes lúpicos en mujeres estériles que buscan FIV en Jamaica es 7.76%. La presencia de estos anticuerpos no afectó la tasa de embarazo de estas mujeres, ni mostró un aumento de riesgo de la cancelación del ciclo FIV, o riesgo de síndrome de hiperestimulación ovárica. El tamizaje en busca de estos anticuerpos en mujeres que buscan tratamiento de FIV, no está justificado.

[NK, T and B lymphocyte populations in infertile women]

Many different factors and problems can cause infertility. This study carried out to compare NK, T and B lymphocyte populations in peripheral blood of fertile and infertile women. In this case-control study 30 infertile women and 15 non pregnant women participated. The non pregnant women had a history of at least two alive children as a control group. The monoclonal antibodies and flowcytometry were used for evaluation of T cell subpopulations [CD3, CD4, CD8], B cells [CD22] and NK cells [CD56] in fertile and infertile women. NK cells [CD56] significantly increased in infertile women compared with control groups [P=0.009] and T lymphocytes CD3, CD4 significantly reduced in infertile women compared with fertile women [P=0.013, P=0.004, respectively]. CD4/CD8 ratio reduced in infertile women compared with fertile women [P=0.05]. There was no difference in B cells and CD8 T cells in infertile women compared with controls. This study showed that NK cells increase and CD4 T lymphocytes reduce in infertile women. Our results suggest the immunological alterations may be related to infertility

Marcadores séricos de estresse oxidativo em mulheres inférteis com endometriose / Serum markers of oxidative stress in infertile women with endometriosis

OBJETIVO: comparar marcadores séricos de estresse oxidativo entre pacientes inférteis com e sem endometriose e avaliar a associação destes marcadores com o estadiamento da doença. MÉTODOS: estudo prospectivo envolvendo a inclusão consecutiva de 112 pacientes inférteis, não-obesas, com idade inferior a 39 anos, divididas em dois grupos: Endometriose (n=48, sendo 26 com endometriose mínima e leve - Estádio I/II e 22 com endometriose moderada e grave - Estádio III/IV) e Controle (n=64, com fator tubário e/ou masculino de infertilidade). Durante a fase folicular precoce do ciclo menstrual, foram coletadas amostras sanguíneas para análise dos níveis séricos de malondialdeído, glutationa e níveis totais de hidroperóxidos, por espectrofotometria e vitamina E, por cromatografia líquida de alto desempenho. Os resultados obtidos foram comparados da seguinte forma: os grupos endometriose versus controle; endometriose estádio I/II e controle, endometriose estádio III/IV e controle e entre os dois subgrupos de endometriose. Em todas as análises, foi considerado o nível de significância de 5 por cento (p<0,05). RESULTADOS: os níveis de vitamina E e glutationa foram mais baixos no soro de mulheres inférteis com endometriose moderada/grave (21,7±6,0 µMol/L e 159,6±77,2 nMol/g proteína, respectivamente) quando comparadas a mulheres com endometriose mínima e leve (28,3±14,4 µMol/L e 199,6±56,1 nMol/g proteína, respectivamente). Os níveis totais de hidroperóxidos foram significativamente mais elevados no grupo endometriose (8,9±1,8 µMol/g proteína) em relação ao Grupo Controle (8,0±2 µMol/g proteína) e nas portadoras de doença III/IV (9,7±2,3 µMol/g proteína) em relação à I/II (8,2±1,0 µMol/g proteína). Não se observou diferença significativa nos níveis séricos de malondialdeído entre os diversos grupos. CONCLUSÕES: foi evidenciada uma associação positiva entre infertilidade relacionada à endometriose, avanço do estadiamento da doença e aumento dos níveis séricos de hidroperóxidos, sugerindo aumento da produção de espécies reativas em portadoras de endometriose. Esses dados, associados à redução dos níveis séricos de vitamina E e glutationa, sugerem a ocorrência de estresse oxidativo sistêmico em portadoras de infertilidade associada à endometriose.

PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5 percent (p<0.05) in all analyses. RESULTS: vitamin E and glutathione levels were lower in the serum of infertile women with moderate/severe endometriosis (21.7±6.0 mMol/L and 159.6±77.2 nMol/g protein, respectively) compared to women with minimal and mild endometriosis (28.3±14.4 mMol/L and 199.6±56.1 nMol/g protein, respectively). Total hydroxyperoxide levels were significantly higher in the endometriosis group (8.9±1.8 µMol/g protein) than in the Control Group (8.0±2 µMol/g protein) and among patients with stage III/IV disease (9.7±2.3 µMol/g protein) compared to patients with stage I/II disease (8.2±1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. CONCLUSIONS: we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.

Marcadores séricos de estresse oxidativo e resultados dos procedimentos de reprodução assistida em pacientes inférteis com síndrome dos ovários policísticos e controles / Serum markers of oxidative stress and assisted reproduction procedures results in infertile patients with polycystic ovary syndrome and controls

Objetivo: comparar os níveis séricos de cinco marcadores de estresse oxidativo e os resultados de reprodução assistida (RA), entre pacientes com infertilidade por fator tubário e/ou masculino e portadoras de síndrome dos ovários policísticos (SOP). Métodos: foram inclusos 70 pacientes, sendo 58 com infertilidade por fator tubário e/ou masculino e 12 com SOP, que foram submetidas à estimulação ovariana controlada para realização de injeção intracitoplasmática de espermatozoide (ICSI). A coleta de sangue foi realizada entre o terceiro e o quinto dia do ciclo menstrual, no mês anterior à realização da estimulação ovariana. Foram analisados os níveis de malondialdeído, hidroperóxidos, produtos de oxidação proteica, glutationa e vitamina E, pela leitura da absorbância em espectrofotômetro e por cromatografia líquida de alta eficiência (HPLC). Para a análise estatística, utilizou-se o teste t de Student e o teste exato de Fisher. Resultados: entre as pacientes com SOP, foi constatado maior índice de massa corporal, volume ovariano e número de folículos antrais e uma menor dose total utilizada de hormônio folículo estimulante. Não observamos diferença em relação à resposta à estimulação ovariana, aos resultados de RA e aos níveis séricos de malondialdeído, hidroperóxidos, produtos de oxidação proteica, glutationa e vitamina E entre os grupos. Conclusões: no estudo não evidenciamos diferença entre os níveis séricos de marcadores de estresse oxidativo, nem nos resultados de RA, comparando pacientes inférteis não-obesas com SOP e controles. Estes dados sugerem que, neste subgrupo específico de portadoras de SOP, os resultados de RA não estejam comprometidos. Todavia, as interpretações acerca da ação do estresse oxidativo sobre os resultados de RA ainda não estão claras e as implicações reprodutivas do estresse oxidativo precisam ser mais bem avaliadas.

Purpose: to compare the serum levels of five markers of oxidative stress and assisted reproduction (AR) outcomes among infertile patients, with tubal and/or male factor and with polycystic ovary syndrome (PCOS). Methods: 70 patients were included, 58 with tubal and/or male factor infertility and 12 with PCOS, who underwent controlled ovarian stimulation to perform intracytoplasmic sperm injection (ICSI). A blood sample was collected between the third and fifth day of the menstrual cycle in the month prior to ovarian stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein oxidation products, glutathione and vitamin E, by reading the absorbance with a spectrophotometer and by high performance liquid chromatography (HPLC). Data were analyzed statistically by the Student's t-test and Fisher's exact test. Results: significant increases in the body mass index, ovarian volume and number of antral follicles were observed in PCOS patients, as well as the use of a lower total dose of follicle stimulating hormone for these patients. There were no differences in the response to ovarian stimulation, in the results of AR or serum levels of malondialdehyde, hydroperoxides, advanced oxidation protein products, glutathione and vitamin E between groups. Conclusions: the present data did not demonstrate a difference in the levels of serum markers of oxidative stress or in AR results when comparing non-obese infertile patients with PCOS and controls. These data suggest that the results of AR may not be compromised in this specific subgroup of patients with PCOS. However, interpretations of the action of oxidative stress on the results of AR are still not clear and the reproductive implications of oxidative stress need to be better evaluated.

Insulino resistencia en mujeres infértiles / Insulin resistance in infertile women

Antecedentes: La insulino resistencia (IR) es una compleja alteración fisiopatológica, presente en los órganos terminales, de alta prevalencia en mujeres en edad fértil y etapa prepuberal, con reconocida asociación a riesgo cardiovascular e infertilidad. Objetivo: Determinar la frecuencia de IR en mujeres infértiles y los factores de riesgos asociados en mujeres que acuden a la consulta de ginecología de la Maternidad "Dr. Armando Castillo Plaza". Método: Investigación de tipo aplicada y descriptiva, con diseño no experimental, aplicándose la técnica de la observación directa no participante y estructurada, teniendo como instrumento la ficha de trabajo. Resultados: La prevalencia de IR fue de 80 por ciento, con índice de HOMA de 5,4 +/- 2,7. Se identificaron en las mujeres infértiles los siguientes factores de riesgo asociados: hiperandrogenismo/obesidad (OR: 1,51; p<0,001), dislipidemia (OR: 6,53; p<0,001), hipertensión arterial (OR: 8,41; p<0,02), acantosis nigricans (OR: 9,0; p<0,002), acné (OR: 2,65; p< 0,01). Conclusión: Encontramos una alta frecuencia de IR entre las mujeres con infertilidad, la cual puede ser corregida con cambios en los estilos de vida y con intervenciones de baja complejidad para el tratamiento de la infertilidad.

Background: Insulin resistance (IR) is a complex physiopathological alteration, present in the terminal organs, of high prevalence in women in fertile age and prepuberal stage, with recognized cardiovascular risk association and infertility. Objective: To determine the frequency of IR in infertile women and factors of risks associated in the patients which going to consultation of gynecology of the Maternity "Dr. Armando Castillo Plaza". Method: An applied and descriptive investigation was realised, with nonexperimental design, being applied the technique of the nonparticipant and structured direct observation, having as instrument the work card. Results: The prevalence of IR was 80 percent, with HOMA index of 5.4 +/- 2.7. In infertile women were identified the following risk factors: increased serum androgens/obesity (OR: 1.51; p<0.001), dyslipidemia (OR: 6.53; p<0.001), arterial hypertension (OR: 8.41; p<0.02), acanthosis nigricans (OR: 9.0; p<0.002), and acne (OR: 2.65; p<0.01). Conclusion: We found a high frequency of IR between the infertile women, which can be corrected with changes in the life styles and low complexity interventions for the treatment of the infertility.

Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente / Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH) basal (U/L), entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC) foi calculado conforme a fórmula de Quetelet [peso (kg)/estatura (cm²)]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3), o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.

PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed, through the basal (U/L) follicle stimulating hormone (FSH), between the third and fifth days of the cycle, 12 months after the surgery. The body mass index (BMI) was calculated according to Quetelet's formula [weight (kg)/height(cm²)]. The Mann-Whitney non-parametric U test was used to compare the variables "age", "BMI" and "basal SFH" between the groups. RESULTS: there was no significant difference between the groups about age and BMI. Concerning basal FSH, in the group of patients with severe endometriosis, the average value was 7.0 U/L, while in the Control Group, it was 5.6 U/L (p=0.3), what demonstrates that the difference between the two groups was not significant. CONCLUSIONS: the surgery did not affect the ovarian reserve of patients with severe ovarian endometriosis.

Status of serum leptin levels in females with infertility

To assess serum leptin levels in infertile females referred to a tertiary care hospital in Pakistan. A case control study was carried out at Shifa College of Medicine/Shifa International Hospital Islamabad, Pakistan from January 2005 to August 2005. Serum leptin levels of 44 infertile females were compared with 44 age matched fertile female controls. The results revealed that serum leptin levels were significantly raised in infertile women [69.7 +/- 40.2ng/ml] as compared to fertile controls [41.1 +/- 27.3ng/ml] with p=0.000. Mean body mass index BMI was also found to be significantly higher in infertile women [27.2 +/- 6.8kg/m2] as compared to fertile females [24.1 +/- 5.2kg/m2] with p-value of 0.019. Moreover, a strong positive correlation was found between BMI and leptin levels as leptin levels increased with increase in BMI. Mean leptin levels in overweight women were significantly higher [81.4 +/- 32.4ng/ml] as compared to normal weight women [30.6 +/- 20.6ng/ml] with p=0.000. The present study has indicated that overweight accompanied by hyperleptinemia is associated with infertility in females. However, further studies are required to determine the exact mechanism by which enhanced body mass and serum leptin levels lead to female infertility

Disturbances in the serum progesterone levels during the luteal phase

The major cause of female infertility is the disturbance of the hormones of hypothalamic-pituitary-gonadal axis and progesterone is a major component of this axis. The present study was carried out to determine the incidence of luteal phase defect of progesterone in a group of 150 regularly menstruating female subjects. Luteal phase defect to progesterone was seen in 43.3% patients, 40% having fairly low level of progesterone and 3.3% exhibiting higher levels

Role of progesterone estimation in infertility

This study was conducted on 50 subjects [30 infertile and 20 fertile] taken from Sir Ganga Ram and Lady Aitchison Hospitals, Lahore and hormonal assays carried out at PGMI, Lahore. The infertile subjects were between 18-35 years of age and were married for more than 2 years. The results showed that 18 out of 30 infertile patients [64%] had luteal phase deficiency [LPD] and 12 out of 30 [56%] had normal progesterone levels. It was thus concluded that estimation of serum progesterone levels in infertile subjects is simple, easy but important investigation. It determines the presence of L.P.D or otherwise. This assay is closely correlated to endometrial biopsy results and therefore can be used as an alternate non-invasive procedure in the work up of infertility

Seroprevalence of Chalmydia trachomatis infection amongst patients with pelvic inflammatory diseases and infertility.

Chlamydia trachomatis (C. trachomatis) is a common cause of pelvic inflammatory disease in female population. This infection can be diagnosed both by culture and serology. The present study evaluated the seroprevalence of chlamydial infection in patients with pelvic inflammatory disease (ND) and infertility and in control population of healthy normal females. The seroprevalence was found to be 82.7% in patients and 32% in controls by Enzyme Linked Immuno Sorbent Assay (ELISA) for any one or more class of antichlamydial antibodies (IgG/IgM/ IgA). The study demonstrates the importance of serology to monitor trends of chlamydial infections in women with PID and infertility.

effect of age, type and duration of infertility on prolactin concentration in the serum of hyperprolactinemic infertile women

Physiological prolactin level is necessary for normal GnRH secretion and necessary for the maintenance of Inteal function. High prolactin secretion may interfere with the ovulation through inhibition of gonadotropin secretion and with the function of corpus luteum as demonstrated by short luteal phase and decrease progesterone. The objectives of this study were to 1] determine the upper normal value of prolactin hormone in Iraqi women and its range; 2] study the effect of age, type and duration of infertility on prolactin concentration. One hundred forty seven hyperprolactinemic infertile women were enrolled in this study. Those were compared with 125 control women. Serum prolactin hormone were estimated in cycle day 2, 12 and 21. The present study showed that the prolactin level in the serum of hyperprolactinemic infertile patients were significantly higher compared to control group in regard to the age of patients, duration, and type of infertility. There were no significant differences in the level of prolactin hormone between primary and secondary infertile patients. The upper limit for normal prolactin value in small sample Iraqi women was 20ng/ml with a range between 5-9 and 20 ng/ml. Age has a significant effect on prolactin concentration in infertile hyperprolactinemic women. Prolactin increased with increasing the duration of infertility

Exposición al plomo y su relación con el tiempo requerido para embarazo / Lead exposure and time to pregnancy

OBJETIVO: Determinar los efectos de la exposición al plomo relacionados con el tiempo requerido para embarazo. MATERIAL Y MÉTODOS: Entre 1997 y 2001 se realizó un estudio en 142 mujeres residentes en la Ciudad de México, participantes en un estudio de cohorte para evaluar diversos efectos del plomo sobre la salud reproductiva. Se realizaron mediciones de plomo en sangre y en hueso a cada una de las participantes en el momento de ingresar al estudio, y se obtuvo información relativa a la exposición y otras variables de interés a través de un cuestionario. A cada una de las participantes se les siguió hasta el momento en que se embarazaron, o bien, hasta el tiempo de término del estudio, con el propósito de determinar la asociación entre la exposición al plomo y el tiempo requerido para quedar embarazada. El análisis estadístico se llevó a cabo utilizando curvas de Kaplan-Meier y modelos de riesgos proporcionales de Cox. RESULTADOS: Del total de mujeres que iniciaron el estudio se embarazaron 42, de las cuales 34 lo lograron antes del primer año de seguimiento y ocho posteriormente. Las medias de las concentraciones de plomo en sangre fueron de 9.3 æg/dl; en rótula y tibia fueron de 16.0 y 11.0 æg Pb/g de hueso mineral, respectivamente. No se detectaron diferencias en los niveles de plomo en sangre respecto al tiempo que durante el estudio requirió la mujer para embarazarse en el primer año; no obstante, se encontró que en las mujeres con plomo en sangre por encima de 10 æg/dl el riesgo de no embarazo fue cinco veces mayor [IC 95 por ciento (1.9-19.1)] después de un año de seguimiento, comparado con aquellas mujeres con plomo en sangre por debajo de 10 æg/dl. CONCLUSIONES: La exposición a concentraciones altas de plomo puede ser un factor de riesgo importante en el tiempo requerido para que una mujer quede embarazada, principalmente en aquellas que siendo fértiles tienen periodos mayores de un año buscando un embarazo.