Alteraciones citogenéticas en pacientes con diagnóstico de infertilidad en Lima, Perú / Cytogenetic abnormalities in patients with infertility diagnosis in Lima, Peru

INTRODUCCIÓN: La infertilidad es una enfermedad multicausal y el componente genético representa uno de sus principales eventos. Si bien la distribución de la infertilidad puede variar entre poblaciones, las parejas de los países con bajos y medianos ingresos pueden verse más afectadas por la infertilidad, con una proporción de alteraciones citogenéticas aún no esclarecidas. OBJETIVO: Evaluar la frecuencia de alteraciones citogenéticas y su correlación con el número de abortos en pacientes peruanas con diagnóstico de infertilidad. MÉTODO: Se realizó un estudio de corte transversal en 400 pacientes de 18 a 60 años, de ambos sexos, con diagnóstico de infertilidad. Se registraron las características clínicas disponibles durante el examen genético y el análisis citogenético convencional fue con bandeo GTG en muestras de sangre periférica. El análisis de correlación se realizó con la prueba de Spearman. RESULTADOS: Del total, 389 pacientes cumplieron los criterios de inclusión, y de estos, 169 (43,44%) tuvieron reportes de abortos (promedio: 2,25, rango: 1-7). Hallamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas (p < 0,000). Reportamos 25/289 (6,43%) alteraciones cromosómicas, de las que 11/25 (44%) fueron heterocromatinas constitutivas y 6/25 (24%) fueron translocaciones reciprocas. Las alteraciones citogenéticas más frecuentes fueron 16qh+ y 9qh+ (ambas con un 16%), y afectaron a 17 (68%) varones. CONCLUSIONES: Existe una moderada frecuencia de alteraciones citogenéticas en pacientes peruanos con diagnóstico de infertilidad, y las alteraciones más frecuentes fueron heterocromatina constitutivas. Además, evidenciamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas.

INTRODUCTION: Infertility is a multicausal disease and the genetic component represents one of its main events. Although the distribution of infertility may vary between populations, couples in low-and-middle-income countries may be more affected by infertility with a proportion of cytogenetic alterations still unclear. OBJECTIVE: To evaluate the frequency of cytogenetic alterations and their correlation with the number of abortions in Peruvian patients with a diagnosis of infertility. METHOD: A cross-sectional study was carried out in 400 patients between 18 and 60 years-old, of both genders with a diagnosis of infertility. The clinical characteristics available during the genetic examination were recorded and the conventional cytogenetic analysis was with GTG banding in peripheral blood samples. The correlation analysis was performed with the Spearman test. RESULTS: Of the total 389 patients who met the inclusion criteria, of these 169 (43.44%) patients had reports of abortions (mean: 2.25, range: 1-7). We found a significant correlation between the number of abortions and cytogenetic alterations (p < 0.000). We report 25/289 (6.43%) chromosomal alterations, where 11/25 (44%) were constitutive heterochromatin, and 6/25 (24%) were reciprocal translocations. The most frequent cytogenetic alterations were 16qh + and 9qh + (both 16%), and affected 17 (68%) men. CONCLUSIONS: There is a moderate frequency of cytogenetic alterations in Peruvian patients diagnosed with infertility, where the most frequent alterations were constitutive heterochromatin. Furthermore, we evidenced a significant correlation between the number of abortions and cytogenetic alterations.

Hormona antimülleriana como marcador de respuesta ovárica en pacientes tratadas por fertilización in vitro / Anti-Müllerian hormone as a marker of ovarian response in patients treated with in vitro fertilization

Introducción: La infertilidad afecta al 15 por ciento de las parejas en edad fértil, de las que aproximadamente 4-8 por ciento requerirán técnicas de reproducción asistida de alta tecnología. Con la incorporación de la mujer a la vida laboral y la consiguiente postergación de la maternidad es posible el aumento de la infertilidad. La hormona antimülleriana en la mujer se produce por las células de la granulosa. Esta regula el reclutamiento de folículos, su crecimiento y previene el agotamiento folicular, por lo que constituye una importante herramienta en los protocolos de inducción de la ovulación. Objetivo: Evaluar los niveles de la hormona antimülleriana como marcador de respuesta ovárica en pacientes tratadas por fertilización in vitro. Método: Se realizó un estudio descriptivo, observacional y de corte transversal en la consulta protocolizada de Reproducción Asistida del Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el periodo comprendido de abril 2017 hasta abril 2019. La muestra quedó conformada por 137 mujeres que participaron en esta consulta. Se empleó estadística descriptiva e inferencial. Resultados: La edad promedio de las pacientes fue de 33,1 ± 7,4 años. Predominó la concentración sérica normal de la hormona antimülleriana en mujeres entre 31-35 años (26,3 por ciento), nivel normal de FSH en (39,4 por ciento), recuento de folículos antrales normal (24,1 por ciento), buena calidad ovocitaria (39,4 por ciento), y buena calidad embrionaria (36,5 por ciento). Conclusiones: El nivel sérico de la hormona antimülleriana se asoció significativamente a la edad, la hormona folículo estimulante, el recuento de los folículos antrales, y la calidad ovocitaria y embrionaria(AU)

Introduction: Infertility affects to 15 percent of the couples in childbearing age, and approximately 4-8 percent of them will need high-tech assisted reproduction techniques. With the participation of women in work life and the subsequent delay of maternity, it is possible the increase of infertility. Anti-Müllerian in women is produced by granular cells. These cells control the recruitment of follicles, their growth and prevent follicles exhaustion; therefore, it represents an important tool in the protocols of ovulation induction. Objective: Assess the levels of anti-Müllerian hormone as a marker in the ovarian response in patients treated with in vitro fertilization. Methods: It was conducted a descriptive, observational and cross-sectional study in the consultation of Assisted Reproduction in "Hermanos Ameijeiras" Surgical Clinical Hospital, in the period April, 2017 - April, 2019. The sample was formed by 137 women who attended to this consultation. It was used descriptive and inferential statistics. Results: Average age of the patients was 33,1 ± 7,4 years old. There was predominance of normal serum concentration of anti-Müllerian hormone in women among 31-35 years old (26,3 percent), FSH normal level in (39,4 percent), normal recount of antral follicles (24,1 percent), good oocyte quality (39,4 percent), and good embryonic quality (36,5 percent). Conclusions: The serum level of the anti-Müllerian hormone was significantly associated to age, the follicle-stimulating hormone, the recount of antral follicles, and the oocyte and embryonic quality(AU)

Evaluar el factor masculino mediante un espermograma durante la consulta de infertilidad / Assessing the Male Factor by a Sperm during the Consultation of Infertility

Se considera que la infertilidad se evalúa cuando una mujer no logra embarazarse de su pareja después de 12 meses de coitos regulares sin protección. Este problema afecta a un alto porcentaje de parejas en el mundo. Generalmente, el diagnóstico y tratamiento de la infertilidad se enfoca solo desde el punto de vista femenino por la obvia relación con el embarazo. Sin embargo, con la evidencia existente, el problema debe ser abordado como una alteración entre la pareja(AU)

It is accepted that infertility is evaluated when a woman fails to get pregnant from her partner after 12 months of unprotected regular intercourse, a problem that affects a high percentage of couples in the world. Generally, the diagnosis and treatment of infertility focuses only from the female point of view, due to the obvious relationship with pregnancy. However, with the existing evidence, the problem must be addressed as a couple alteration(AU)

Infertility diagnosis in jaguar (Panthera onca): case report / Diagnóstico de infertilidade em onça pintada (Panthera onca): relato de caso

This work reports one case of infertility in a male jaguar (Panthera onca) aged 21 years and weighing 125 kg. Changes in sperm due to chronic stress, inadequate food handling and reproductive senescence are emphasized.(AU)

O presente trabalho relata um caso de infertilidade em uma onça-pintada (Panthera onca), macho, de 21 anos e 125 kg. São ressaltadas as alterações ocorridas nos espermatozoides, devido a estresse crônico, manejo alimentar inadequado e senescência reprodutiva.(AU)

El modelo de la adaptación ante la infertilidad de la pareja / The model of adaptation to the infertility of the couple

Introducción: los modelos conceptuales constituyen un marco de referencia para la práctica de enfermería y para tratar a la pareja infértil, el modelo de la adaptación de Sor Callixta Roy permite que los profesionales utilicen como herramienta el "Proceso de Atención de Enfermería" para ofrecer un cuidado de excelencia. OBJETIVO: diseñar la propuesta de actuación de enfermería ante parejas infértiles a través del modelo de la adaptación de Sor Callixta Roy. MÉTODOS: estudio descriptivo y retrospectivo con las parejas tratadas en el "Centro territorial de atención a la pareja infértil" de la provincia de Cienfuegos tributarias de fertilización invitro. La muestra fue de 92 mujeres. RESULTADOS: predominó el grupo de mujeres de 36 a 40 años (35,9 por ciento), en cuanto a la edad en que iniciaron las relaciones sexuales el 39,1 por ciento lo hizo antes de los 14 años, aunque predominó el grupo entre 15 y 19 años. El grupo de 36 a 40 años fue el que refirió mayor número de parejas sexuales. El 52,2 por ciento se realizó al menos una interrupción provocada, el grupo entre 36 y 40 años fue el que más incurrió con 18,5 por ciento y hubo algunas que utilizaron este proceder tres veces o más como método anticonceptivo. El 16,3 por ciento de las mujeres nunca logró un embarazo en su vida reproductiva; el 78,2 por ciento, entre 1 y 3. En el 18,4 por ciento fue diagnosticada la clamidia y en el 23,9 por ciento otras infecciones. Solo el 6,5 por ciento de las mujeres no tenían dificultades para la reproducción por lo que el problema era de causa masculina. CONCLUSIONES: predominaron los factores de riesgo para las infecciones de transmisión sexual, así como un gran número de abortos provocados(AU)

INTRODUCTION: the conceptual models constitute a reference mark for the nursery practice and to treat the infertile couple. The model of adaptation of Sor Callixta Roy allows that the professionals use the "Process of nursery Care" as a tool to offer an excellence care. OBJECTIVE: to design the proposal of Nursery Care to infertile couples through the model of the adaptation of Sor Callixta Roy. METHOD: descriptive and retrospective study with the couples tried in the territorial "Center of Care to the infertile couple" of Cienfuegos tributaries to fertilization invitro; from a universe of 251 couples was selected a sample of 92 (36.6 percent) histories charts with the aleatory simple method whose were taken to a form the necessary variables. The datas were processed with SPSS version 15.0 and the results are shown in charts. RESULTS: the risk factors prevail for the infections of sexual transmission as well as the carrying out of great number of induced miscarriages which constitute causes of infertility. Other factors are evidence that allow to confirm that many cases can be avoided and the great mayority can solve their situation. CONCLUSIONS: the risk factors prevail for the infections of sexual transmission as well as the carrying out of great number of induced miscarriages which constitute causes of infertility(AU)

Terapia de parejas e infertilidad / Couples therapy and infertility

La infertilidad de la pareja ha tenido un gran peso dentro de los aspectos bio-médicos y la parte emocional ha sido poco cuidada. Tras la resolución de la Sala IV en Costa Rica en el año 2000, sobre la prohibición de la fertilización in vitro, muchas de estas parejas se vieron afectadas a nivel psicológico y el presente artículo pretende describir lo que la Terapia de Pareja de un modelo sistémico, encontró como manifestaciones de sufrimiento por la doble pérdida que estas parejas han vivido.

Infertility in Mazandaran province - north of Iran: an etiological study

The prevalence and etiology of infertility are not similar in different parts of the world. There are only few reports of this topic in Iran. This study was conducted to determine the clinical patterns and major causes of infertility in Mazandaran province in north of Iran. The medical records of 3734 consecutive couples attending two infertility clinics in Mazandaran province, from 2003 to 2008, were reviewed. The couples had not had a viable birth after at least 1 year of unprotected intercourse and were fully investigated. Of the entire samples, 78.7% had primary infertility and 21.3% had secondary infertility. The mean duration of infertility in couples was 5.7 +/- 4 years. The etiology of infertility in couples revealed; male factor in 38.9%, female factor in 34.7%, combined factors in 14.6% and undetermined cause in 11.8%. In this study, delayed attendance of infertile couples to the infertility clinic was found. Therefore, there is a need to revise public health program on infertility to focus on the education and prevention of infertility and its risk factors

Pattern of semen fluid abnormalities in male partners of infertile couples in Khartoum, Sudan

Normal semen is a mixture of spermatozoa suspended in secretions from the testis and epididymis, which at the time of ejaculation, are combined with secretions from the prostate, seminal vesicles, and pulbourethral glands. Many factors affect the quantity and quality of semen parameters such as cigarette smoking, excessive exercise and alcohol consumption. The objectives of the study were to determine the pattern of semen fluid abnormalities [volume of the ejaculate, sperm concentration, sperm motility, sperm morphology] in male partners of infertile couples in Khartoum, Sudan. This was a descriptive study, 100 records of couples who attended Sudan Assisted Reproduction Centre in Khartoum seeking fertility treatment from July - December 2008 were reviewed for the volume of the ejaculate, the concentration of the sperms, the motility and the morphology. Semen production was obtained in the centre or at home after 3-7 days of abstinence from intercourse. Production of semen was by masturbation in a sterile container. Evaluation of samples was made by a qualified andrology technician. Statistics was done by the computer using SPSS soft ware. Results showed that 41.5%, 53.9%, 3.1%, and 1.5% of men had a volume of < 2, 2-4, 5-7 and >8 ml respectively. 25%, 37% and 38% had normal, oligozoospermia and azoospermia respectively. As regards motility, 27.4% had normal motility 62.9% had sluggish motility and 9.7% their sperms were immotile. There were only 1.8% of men who had normal morphology. The study concluded that, few men had sperm profile that was consistent with reference values with regard to volume, concentration, motility and morphology. Morphology showed the least normality. Results showed that no subject in the cohort fulfilled the full criteria of normozoospermia

Avaliação da cavidade uterina com histerossonografia, uma revisão / Assessment of uterine cavity with sonohysterography, a review

A histerossonografia foi descrita pela primeira vez há três décadas. A infusãode solução salina na cavidade uterina favorece sua exploração e proporciona excelente visualização da anatomia e do interior da cavidade do útero melhor do que com ultrassonografia transvaginal convencional. Para verificar o papel atual da histerossonografia na avaliação da cavidade uterina de mulheres com sangramento uterino anormal e assintomática, foi realizado revisão bibliográfica de estudos que compararam a histerossonografia com a ultrassonografia transvaginal ou histeroscopia diagnóstica ambulatorial. Para isso, pesquisou-se estudos relevantes em bases de dados eletrônicas Medline/PubMed, SciELO/LILACS. A histerossonografia é procedimento ambulatorial, “não invasivo”, de melhor custo-benefício, com melhor sensibilidade e especificidade na identificação de anomalias uterinas, causando desconforto mínimo ecom baixo índice de complicações. Foi objeto de revisões, não existindo mais dúvidas quanto a sua acurácia. Pode-se concluir que a histerossonografia ferramenta útil na propedêuticade avaliação da cavidade uterina de mulheres sintomáticas comsangramento uterino anormal, infertilidade e perdas gestacionais repetidas, falhas de implantação embrionária em programas com técnicas de reprodução assistida / fertilização in vitro e naquelas com qualquer alteração uterina intra ou extracavitária na ultrassonografia transvaginal. Portanto, está indicada como método de avaliação inicial da cavidade uterina antes de indicar histeroscopia diagnóstica.

Sonohysterography was firstly described three decades ago. The saline solution infusion into the uterine cavity favors its use and provides excellent visualization of the anatomy and the inner cavity of the uterusbetter than the conventional transvaginal sonography. To check the current role of sonohysterography in the uterine cavityassessment in women with abnormal uterine bleeding and asymptomatic, a literature review comparing sonohysterograph with conventional transvaginal sonography and/or ambulatory diagnostic hysteroscopy was carried out. To this end, relevant studies were researched in electronic databases Medline/PubMed, SciELO/LILACS.The sonohysterography is an ambulatory procedure, non-invasive, better cost-benefit, better sensitivity and specificity to identify uterine abnormalities, causing minimal discomfort and low complications rate. It was subject to revision which there is no more doubt about its accuracy.It can be concluded that the sonohysterography is a useful tool in the propedeutics to assess uterine cavity of symptomatic patients with abnormal uterine bleeding, infertility, recurrent miscarriages, and embryonicimplantation failures in assisted reproduction treatment / in vitrofertilization and in any other intra and extra uterine cavity alteration.Hence, conventional transvaginal sonography is indicated as an initialmethod of assessment of the uterine cavity previously to ambulatorydiagnostic hysteroscopy.

Diagnóstico de la infertilidad: estudio de la pareja infértil / Infertility diagnosis: basic workup for the infertile couple

El estudio de una pareja infértil se debe efectuar luego de un año sin lograr un embarazo y debe ser simultáneo en ambos miembros de ella. Se debe lograr establecer la disponibilidad y adecuada funcionalidad de gametos femeninos, gametos masculinos y del tracto genital femenino. Luego de la historia clínica y examen físico se debe solicitar exámenes complementarios en forma sistemática, expedita y respetando una buena relación costo-efectividad, siempre en un orden creciente de complejidad.

The basic evaluation of the infertile couple must be initiated, in both partners simultaneously, when failing to conceive after one year of regular unprotected intercourse. An adequate availability and functionality of female gametes, male gametes and female genital tract must be established. After an accurate clinical history and physical examination, subsequent complimentary tests should be performed in a systematic, expeditious, and cost-effective manner with initial emphasis on the least invasive methods.

Hysterosalpingographic Findings in Patients with Infertility in South Eastern Nigeria

Background:Hysterosalpingography (HSG) is still an integral part of gynecological evaluation of infertile couple and its value has not been underestimated in moderngynecological practice; especially in developing countries. The study aims to evaluate the findings at HSG in patients presenting with infertility at the Ebonyi State University Teaching Hospital;Abakaliki; Southeastern Nigeria. A retrospective analysis of 100 consecutive HSG results of patients presenting with infertility was done between January 2005-April 2008. Their clinical records and radiological findings were analyzed for demographic data; and cervical; uterine and tubal; pathology. Results: The commonest age group was between 25 -34 years. Sixty-five percent presented with secondary infertility while 35presented with secondary infertility. Hysterosalpingographic findings were abnormal in 80of patients (primary infertility 20and secondary infertility 60). Bilateral tubal blockage and bilateral fimbrial adhesion were the commonest tubal factor abnormalities while intracavitary mass impression and cervical synechia were the commonest findings for uterine and cervical factor abnormalities respectively. Conclusion:Tubal blockage and tubal factor infertility are still common among infertile couples. This may probably be due to chronic pelvic inflammatory disease or pelvic infection following sexually transmitted infections; mismanaged pregnancies and septic abortions; as most of the patients presented with secondary infertility. Measures to prevent the occurrence of these infections are highlighted

Fallo ovárico prematuro / Premature ovarian failure

El fallo ovárico prematuro (FOP) se trata de un trastorno que se manifiesta en forma de amenorrea a una edad precoz, antes de los 40 años, traduciéndose en un cese de la función ovárica, tanto de la función hormonal como genésica. No tan solo hablamos de una causa de esterilidad, sino también de un estado de hipoestrogenismo con sus efectos secundarios...

Ultrassonografia tridimensional em reprodução humana / Tridimensional ultrasonography in human reproduction

A ultrassonografi a é um recurso imprescindível em Medicina Reprodutiva, seja na área diagnóstica como na terapêutica. A avaliação do útero e dos ovários, o acompanhamento do ciclo ovariano, natural ou estimulado, e os procedimentos cirúrgicos, como a aspiração de cistos, aspiração folicular, transferência de embriões e avaliação prognóstica da implantação, representam algumas das situações nas quais o papel da ultrassonografia pode ser considerado, nos dias de hoje, insubstituível. Atualmente, conta-se com um novo recurso nesta área, representado pela ultrassonografia tridimensional, em particular associada à doplerfluxometria. Inúmeras publicações recentes evidenciam que a ultrassonografia tridimensional tem melhorado os conhecimentos sobre a foliculogênese e a receptividade endometrial. A determinação mais acurada do número de folículos antrais, do volume ovariano, da avaliação do fluxo sanguíneo ovariano e do volume endometrial representam métodos eficazes e não invasivos para o diagnóstico e prognóstico da infertilidade conjugal e seu tratamento com técnicas de reprodução assistida.

Ultrasonography is essential in diagnostic and therapeutic areas of reproductive medicine. The uterus and ovaries assessment, monitoring natural or stimulated ovarian cycle and surgical procedures, such as ovarian cysts aspiration, follicular aspiration, embryo transfer and prognostic evaluation of ultrasonography implementation are situations in which ultrasonography role can be considered still without substitute. Recent technological advances in ultrasound have enabled software and transducers to be developed which generate three-dimensional images, allowing new diagnostic perspectives.

Impact of demographic and psychosocial factors on hysterosalpingography pain and discomfort

Background: Hysterosalpingography (HSG) is an important diagnostic procedure in the investigation of infertility. It is the radiographic delineation of uterine and tubal cavities and is part of the diagnostic evaluation of conjugal infertility.1 This diagnostic procedure is associated with high levels of anxiety, pain and stress from various causes. This study was designed to investigate the impact of demographic and psychosocial factors on HSG pain and discomfort. Method: One hundred hysterosalpingography referrals were recruited for this study. Verbal detector scales were used to assess pain perception, Likert scales were used to assess the psychosocial variables, while visual analogue scales were used to assess discomfort. Pearson's correlations were conducted. Tests were two-tailed, with p < 0.05 indicating statistical significance. Results: Some of the patients (34%) indicated that the administration of analgesics prior to the procedure reduced the pain and discomfort associated with the procedure. Mean ± standard deviation of pain and discomfort were 2.82 ± 0.77 and 6.36 ± 2.19 respectively. Age correlated signifi cantly with pain perception (r = -0.22, P < 0.05), while pain correlated signifi cantly with perception of discomfort(r = -0.46, P < 0.05). Conclusion: Age signifi cantly correlated with pain. This is a factor that could be harnessed for clinical use

Avaliação da qualidade de vida de pacientes portadoras de endometriose após inserção do Sistema Intra-Uterino Liberador de Levonorgestrel (SIU-LNg) / Assessment of quality of life of patients suffering from endometriosis after insertion of Intra-Uterine System Levonorgestrel-releasing (LNG-IUS)

Objetivos: Avaliar a qualidade de vida das mulheres com endometriose através da aplicação de um questionário estruturado, antes e após a inserção do SIU-LNg durante seis meses de seguimento. Métodos: Foi realizada uma pesquisa clínica, observacional, descritiva e prospectiva do tipo Estudo de Casos onde foram acompanhadas mulheres com endometriose associada à dor pélvica, através da aplicação de questionários, desde o momento da inserção do SIU-LNg. Resultados: Foram entrevistadas 10 portadoras, cujo perfil neste estudo, é de uma mulher entre 20-30 anos, casada, com curso superior. O padrão menstrual predominante, antes da inserção do SIU-LNg, era de ciclos regulares, duração de 6 ou mais dias e fluxo menstrual regular. Todas sofriam de sintomas pré-menstruais ou menstruais, sendo os principais dismenorréia, irritabilidade, depressão e cefaléia. O padrão menstrual após o SIU-LNg foi de diminuição do fluxo na maioria das pacientes (“spotting”). O efeito adverso mais freqüente no primeiro mês após a inserção foi a dismenorréia, com significativa melhora a partir do segundo mês. Houve apenas uma descontinuação do seguimento por sangramento irregular contínuo e dor. Conclusão: Em relação aos aspectos da qualidade de vida, houve melhora importante de sintomas depressivos, irritabilidade, incapacidade para eventos sociais, trabalho, estudo, perda de apetite, sono e vida sexual. As usuárias do SIU-LNg e portadoras de endometriose deste estudo apresentaram melhora na qualidade de vida e a atribuíram ao uso do método.

Objective: To assess the quality of life of women with endometriosis by the application of a structured questionnaire both before and after the insertion of the Levonorgestrel-Medicated Intrauterine System (LNG-IUS) for six months of follow up. Methods: It held clinical, observational, descriptive and prospective research of the type of cases study where women were accompanied with endometriosis associated with pelvic pain, through the application of questionnaires, from the moment of insertion of the LNG-IUS.Results: We interviewed 10 carriers, whose profile in this study, is a woman between 20-30 years, married, a university education. The menstrual pattern predominant before insertion of the SIU-LNg was regular cycles, duration of 6 or more days and regular menstrual flow. All suffered from premenstrual symptoms and menstrual, and the main dysmenorrhea, irritability, depression and headache. The menstrual pattern after the LNG-IUS was decreased flow in most patients ("spotting"). The most frequent side effect in the first month after insertion was the dysmenorrhea with significant improvement from the second month. There was only one discontinuation of the action by irregular bleeding continual and pain. Conclusions: For aspects of quality of life, there was significant improvement on depressive symptoms, irritability, incapacity for social events, work, study, loss of appetite, sleep and sexual life. The users of LNG-IUS and suffering from endometriosis of the study, showed a great improvement in quality of life and attributed about using the method.

Accuracy of laparoscopy for assessing patients with endometriosis / Eficácia da videolaparoscopia na avaliação de mulheres com endometriose pélvica

CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological findings. The aim of this study was to evaluate the sensitivity and specificity of the macroscopic findings in relation to the histopathological findings. More specifically, we aimed to test the efficacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING: Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS: A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/or infertility. We analyzed the laparoscopic and histopathological findings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS: In 468 (47.95 percent) of the cases, the clinical and laparoscopic findings were consistent with endometriosis, and this was confirmed histopathologically in 337 (34.5 percent). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain, eight were diagnosed with endometriosis from histopathological examination of the pelvic specimens obtained. Therefore, endometriosis was confirmed in 345 patients (35.3 percent). In comparison with the histopathology, laparoscopy alone presented 97.68 percent sensitivity, 79.23 percent specificity, 72 percent positive predictive value and 98.42 percent negative predictive value. CONCLUSION: Laparoscopy should be used in conjunction with histopathology for diagnosing endometriosis.

CONTEXTO E OBJETIVO: O diagnóstico da endometriose é determinado pela visualização dos implantes à laparoscopia e pela comprovação histológica. O objetivo deste trabalho foi avaliar a sensibilidade e a especificidade dos achados macroscópicos cirúrgicos e histopatológicos. Avaliou-se a eficácia da laparoscopia isoladamente no diagnóstico da endometriose e a lateralidade da doença. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Serviço de Ginecologia do Hospital Santa Cruz em Curitiba, Paraná e na Pontifícia Universidade Católica do Paraná. MÉTODOS: Foram avaliadas 976 pacientes submetidas à videolaparoscopia por dor pélvica ou infertilidade e a biópsia. Foram analisados os achados laparoscópicos e histológicos de 468 pacientes com endometriose pélvica e de 508 pacientes sem endometriose. RESULTADOS: Foram selecionadas 468 (47,95 por cento) pacientes para inclusão no presente estudo por apresentarem quadro clínico e videolaparoscópico de suspeita de endometriose. As 508 (52,04 por cento) pacientes restantes tiveram indicação da cirurgia por outras causas relacionadas à dor pélvica e oito tiveram o diagnóstico de endometriose pelo anatomopatológico. A endometriose foi confirmada em 345 pacientes (35,3 por cento). Ao compararmos a análise histológica com os achados a videolaparoscopia, observou-se sensibilidade de 97,68 por cento, especificidade de 79,23 por cento, valor preditivo positivo de 72 por cento, valor preditivo negativo de 98,42 por cento. CONCLUSÃO: Laparoscopia deve ser usada em conjunto com histopatologia para o diagnóstico de endometriose.

A Abordagem do casal infértil / The infertile couple assessment

As escolhas que definem a pesquisa e o tratamento da infertilidade fazem parte de um desenvolvimento sistemático de procedimentos. Em breve revisão, procurou-se identificar as melhores opções disponíveis entre dados da Medicina Baseada em Evidências. A partir da definição da infertilidade, foram identificadas as situações causais que permitem o início da pesquisa, assim como justificam sua antecipação temporal. Buscaram-se considerações sobre a etiologia e o diagnóstico; a importância dos principais exames utilizados; a infertilidade sem causa aparente; o casal infértil e a reprodução assistida; e o direito dos casais de receber informações claras e objetivas sobre os procedimentos, participando das decisões de terapêuticas. De forma geral, embora se tenha ganhado exames e procedimentos, a indicação de alguns, outrora considerados clássicos e indispensáveis, hoje não encontra mais sustentação, enquanto outros, novos, ainda permanecem sem níveis de evidência definidos.

The infertile couple routine assessments include a wide range of exams. In this review we look for the best options following the criteria of Evidenced Based Medicine. We review the definition of infertility and the data from anamnesis and physical exam that can lead to the investigation. Situations in which exams are anticipated are discussed. The most common ethiology and diagnosis are reviewed, as well as the most significant tests. In addition, unexplained infertility, the infertile couple and the assisted reproductive techniques, the right of the couples to be informed and to participate of the therapeutical decisions about their fertility were discussed. Classical exams like the post coital test and the endometrium biopsy are almost useless, while many available new tests based on technology, remain without defined strength on evidence levels.