Estudo da vascularização folicular e do corpo lúteo de éguas cíclicas tratadas com extrato de pituitária equina utilizando ultrassom Doppler colorido / Study of follicular and corpus luteum vascularization in mares treated with Equine Pituitary Extract using ultrasound color Doppler

Informações sobre a vascularização da parede folicular e do corpo lúteo equino, associadas à superovulação, são escassas. Com o objetivo de avaliar o efeito superovulatório do extrato de pituitária equina (EPE) no fluxo sanguíneo folicular e luteal, foram utilizadas seis éguas Puro Sangue Árabe, em dois ciclos estrais (controle e tratamento). As éguas foram monitoradas diariamente por ultrassonografia modo B, até que os folículos atingissem diâmetro de 23mm (desvio). No ciclo tratamento, as éguas receberam 8mg de EPE, uma vez ao dia, por via IM, até que dois ou mais folículos atingissem o diâmetro entre 32 e 35mm. A ovulação foi induzida com acetato de deslorelina, quando os folículos atingiram, no mínimo, 35mm. No momento do desvio folicular, da indução da ovulação e do último exame pré-ovulatório, foi utilizada a ultrassonografia modo B para medir o diâmetro dos folículos e, no oitavo dia pós-ovulação, para a área do corpo lúteo (CL). Utilizou-se também ultrassonografia com Doppler colorido para avaliar a perfusão sanguínea da parede folicular e do parênquima luteal. No ciclo controle, foi realizado o mesmo procedimento, exceto pelo uso do EPE. Os dados foram submetidos à análise de variância, com nível de significância de 5%. Não foi observado efeito do EPE sobre o número de ovulações, o diâmetro dos folículos, a vascularização da parede folicular e a concentração sérica de estrógeno. Os animais, tratados ou não, apresentaram CLs funcionais, não havendo diferença na área do parênquima ou da vascularização luteal, nem na concentração sérica de progesterona, no oitavo dia após a ovulação. Foi observado que o EPE proporcionou um maior número de folículos subordinados no momento da indução da ovulação do folículo dominante (P ≤ 0,05). Embora esses folículos não tenham chegado a ovular, concluiu-se que o EPE atuou no crescimento de folículos, que podem ser utilizados em outras biotécnicas, como a transferência de oócitos, com maior aproveitamento da reserva folicular de ovários equinos.(AU)

Knowledge about follicle and corpus luteum vascularization associated with superovulation in mares is scarce. Aiming to evaluate the effect of equine pituitary extract (EPE) on superovulation, the experiment was conducted using six mares Purebred Arabian in two estrous cycles (control and treatment). The mares were synchronized, and monitored daily by ultrasound B mode until the follicles reached diameter ≤ 23 mm (deviation). In the treatment cycle, from the deviation, mares received 8 mg of EPE, once a day, intramuscularly, until two or more follicles reached a diameter between 32 and 35 mm. Ovulation was induced with deslorelin acetate when follicles reached at least 35 mm. At the time of follicular deviation, induction of ovulation and final preovulatory exam, it was used B-mode ultrasound to measure the diameter of follicles and on the eighth day after ovulation to measure the area of the corpus luteum (CL); color Doppler was also used to assess blood perfusion of the follicle wall and luteal parenchyma. In the control cycle was performed the same procedure except for the use of EPE. Data were subjected to analysis of variance, with 5% significance level. There was no effect of EPE on ovulation number, diameter of follicles, vascularity of the follicular wall and serum estrogen concentration. The animals treated or not, showed functional CLs, with no difference in parenchymal area or luteal vascularization, or in serum progesterone concentration on the eighth day after ovulation. It was observed that the EPE provided a greater number of subordinate follicles at the time of induction of ovulation of the dominant follicle. Although these follicles have failed to ovulate, it was concluded that EPE influenced the follicles growth, and it can be used in other biotechnologies, with greater utilization of equine ovarian follicular reserve.(AU)

Determinación de la reserva ovárica mediante el recuento de folículos antrales en mujeres en edad reproductiva / Association between antral follicle count and age in fertile women

Background: Age plays a crucial role in women fertility and is related with a decreased oocyte quality and quantity. The evidence for this asseveration comes from data obtained in infertile women. However there is a paucity of studies in patients with proven fertility evaluating ovarian reserve and its decline with time. Aim: To measure antral follicle count (AFC) in probed fertile patients and to create a distribution chart based on variables that may affect its natural decline. Material and Methods: Observational prospective study. A transvaginal ultrasound was made between menstrual cycle days 3 and 5, evaluating AFC in 100 patients, followed during a year. Results: Median antral follicle count media was 14.5 (interval 3 to 26). There was a lineal decline of AFC with age. Women with hypertension and type 2 diabetes mellitus had significantly less follicles. However, a multiple regression analysis showed that only women's age was a significant predictor of AFC (R2 = 0.84). Conclusions: There was a lineal relationship between AFC and age in women with probed fertility.

Cause of infertility and response to ovulation induction drugs -a hospital based study

This study was performed to investigate the most common causes of infertility and the choice of the more suitable and more easily achievable treatment. A detail history and physical examination were done for all the patients who were referred to Mahdishahr Hospital with chief complaint of infertility from October 2004 to September 2005. Patients who failed to become pregnant after unprotected intercourse for 1 year were chosen as the criteria for to this study. At first semen analysis was performed for all couples. Among the patients who were complaining of oligomenorrhea, galactorrhea or in their laboratory test hyperprolactinemia was found, the treatment started with ovulation induction drugs. In all these groups of patients endometrial thickness and the size of follicles was measured by sonography in the 13th days of their period, among the patients with two or four follicles bigger or equal to 18 mm [If they were treated with clomiphene citrate, bromocriptine or dexamethasone] or when two or four follicles were bigger or equal to 16 mm [if they were treated with Human Menopausal Gonadotropin [HMG] and endometrial thickness or equal to 6mm and Human Chorionic Gonadotropin [HCG] Ampoule [10000 unit] was injected. All these patients were followed to control their response to the treatment and during the whole period of pregnancy. In the other patients hystrosalpingography or post-coital test used for finding the cause of infertility. In 57% of the patients [40 persons] there were symptoms of oligomenorrhea, galactorrhea or hyperprolactinemia. For these patients ovulation induction is started by clomiphene citrate, bromocriptine, dexamethasone and HMG. 27 cases [67%] of them conceived. Term pregnancy with normal child in 20 cases, abortion in 5 cases and unexpected preterm birth both in 21 weeks of pregnancy happened. Twenty eight percent [20 cases] of cause of infertility was male factor. 7% [5 cases] and 1/4% [lease] of causes were tubal and cervical factors respectively. It's concluded that the most common cause of infertility in Mahdishahr is the ovulatory factor. Other causes respectively are male-factor, tubal, cervical, and other factors. Besides, in a large percent of these patients who were treated by ovulation induction pregnancy happend which is noticeable

Evaluation of essential time to reach mature follicle following ovulation stimulation with clomiphene citrate

Ovulation disorders and unexplained infertility are most common infertility causes among women. The first line treatment in these cases is clomiphene citrate. This study has been designed to evaluate the essential time for growth follicle to reach 18 mm of diameter among patients who were stimulated to ovulate with clomiphene citrate. Study was experimental type and 78 women with polycystic ovary syndrome and 92 women with unexplained infertility referring to Royan Institute had taken to this study. These persons were under treatment with clomiphene citrate 100mg from day of 5-9 of menstrual cycle and follicular growth monitoring was performed by vaginal ultrasonograghy. The necessary time for follicular growth was determined separately in patients with polycystic ovary disease and unexplained infertility and its correlation with age, duration of infertility, BMI and hirsutism was studied in both groups. There was no significant association between the essential time for follicular growth groups and in both groups it was day of 14 of cycle and length of this time had no significant correlation with age, duration of infertility, hirsutism and BMI. There were more common cases of no response to follicle as absence of follicular growth or progesterone serum level less than 5ng/ml in patients with polycystic ovary syndrome. Since the average time of follicle growth in patients with PCO and unexplained infertility who were stimulated to ovulate with clomiphene citrate was the day 14 of the cycle in this study, it has been suggested in cases that follicular growth monitoring with ultrasonography or evaluation of LH peak in urine is not possible, the continuation of treatment can be scheduled on the basis that patients with have a mature follicle on day 14 of their cycle

Comparison of four different ovarian stimulation protocols in an in vitro fertilisation & embryo transfer programme.

Four different ovarian stimulation protocols were evaluated in an in vitro fertilisation and embryo transfer programme in 208 women (228 treatment cycles). In the rigid protocol (RP), 100 mg of clomiphene citrate (CC) was given from day 3 to day 7 of the menstrual cycle and 300 IU of human menopausal gonadotropin (hMG) was given from day 5 of the menstrual cycle. In the individualised protocol (IP) the same drugs and doses were used as in RP, but the day of initiation of CC depended on the length of the individual's menstrual cycle and hMG was administered from the last day of CC. In the programmed protocol (PP), ovarian function was suppressed with oral contraceptive pills (ethinyl estradiol 30 micrograms and norethisterone 1 mg) started on day 5 of the menstrual cycle for 45 to 70 days. Considering the last day of pill intake as day 0, CC was given for 5 days from day 5 and hMG (300 IU) from day 7. In the alternate day protocol (ADP), 100 mg of CC was administered from day 2 to day 6 and hMG (300 IU) was given on alternate days from day 2 to day 8 or day 10 of the cycle. In all the women, hCG (5000 IU) was administered when the diameter of at least 2 follicles was greater than or equal to 16 mm and estradiol levels were 300 pg/ml/dominant follicle. Patients not showing such a response were not treated further. The cardinal events of IVF-ET such as number of good responders, incidence of oocytes harvested, fertilised and embryos transferred per cycle were compared and it was concluded that the pregnancy rates were highest in women treated by the PP.

ultrasound study of folliculogenesis in spontaneous and induced ovarian cycles

144 ovarian cycles were studied by serial ultrasound scanning of the follicles. The cycles included 30 cycles with spontaneous ovulation, 41 cycles in women using clomiphene citrate and 73 cycles in women treated with human menopausal gonadotrophins [57 menstrual and 16 conceptional cycles]. The results showed that there was a significantly higher incidence of follicular development of multiple ovulations and in observing the corpus luteum in clomiphene citrate and HMG-treated cycles. The maximum follicular diameter and the maximum diameter of the corpus luteum were not significantly different between spontaneous and induced cycles. There was also no statistically significant difference in the number of growing follicles, those reaching the pre-ovulatory size, the number of double ovulations or in the incidence of observing the corpus luteum between HMG induced cycles which resulted in pregnancy [conceptional cycles] and those which resulted in menstruation [menstrual cycles]