RESUMO
Ovarian stimulation of poor ovarian responders still remains a challenging issue. The incidence of poor responders among infertile women is reported in 9-24% IVF cycles and is associated with very low clinical pregnancy rates. Different treatments have been reported in the literature in an attempt to identify the best stimulation protocol for those patients. Administration of dehydroepiandrosterone acetate (DHEA) was suggested as a promising treatment. It is well known that androgens can influence ovarian follicular growth, augment steroidogenesis, promote follicular recruitment and increase the number of primary and pre-antral follicles. The purpose of this review is to evaluate the effect of DHEA supplementation on women with diminished ovarian reserve. Because of the uncertainty of published data, we suggest that well-designed multicentre RCTs are required to provide more insight on the effectiveness of DHEA. The absence of significant side effects should not be considered as an argument to support DHEA treatment.
Assuntos
Adjuvantes Imunológicos/farmacologia , Desidroepiandrosterona/farmacologia , Fertilização in vitro , Feminino , Humanos , Infertilidade Feminina/terapia , Indução da Ovulação/métodos , GravidezRESUMO
The use of dehydroepiandrosterone (DHEA) may improve ovarian stimulation outcomes in women of advanced reproductive age and could reduce embryo aneuploidy. In this prospective study, 48 women diagnosed with poor ovarian response received DHEA supplementation for at least 12 weeks. These women were compared with a group of poor responders (n = 113) who did not receive supplementation. During the study period, patients taking day 2 FSH and oestradiol were measured monthly before and after treatment. Stimulation characteristics, stimulation outcome and clinical outcome (clinical pregnancy and live birth rates) were reported. Evaluation of anti-Müllerian hormone (AMH) was carried out before initiation of treatment and immediately before the subsequent stimulation. Supplementation with DHEA for at least 12 weeks resulted in a modest, but statistically significant, increase in AMH levels and decrease in baseline FSH (P < 0.001 and P = 0.007, respectively). Administration of DHEA had no effect on any of the stimulation parameters nor was there any difference in clinical pregnancy rates and live birth rates between the two groups. Supplementation with DHEA significantly affects women with poor prognosis undergoing ovarian stimulation for IVF. Patients should be counselled about the uncertain effectiveness, potential side-effects and cost of this treatment.
Assuntos
Desidroepiandrosterona/administração & dosagem , Fertilização in vitro/métodos , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Adjuvantes Imunológicos/administração & dosagem , Adulto , Hormônio Antimülleriano/metabolismo , Coeficiente de Natalidade , Desidroepiandrosterona/uso terapêutico , Estradiol/uso terapêutico , Feminino , Hormônio Foliculoestimulante/metabolismo , Humanos , Oócitos/citologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
It is well established that the PI3K/Akt/mTOR pathway plays a central role in cell growth and proliferation. It has also been suggested that its deregulation is associated with cancer. Genetic alterations, involving components of this pathway, are often encountered in endometrial cancers. Understanding and identifying the rate-limiting steps of this pathway would be crucial for the development of novel therapies against endometrial cancer. This paper reviews alterations in the PI3K/Akt pathway, which could possibly contribute to the development of endometrial cancer. In addition, potential therapeutic targets of this pathway with emphasis on the mTOR inhibitors are also presented.
Assuntos
Neoplasias do Endométrio/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismo , Animais , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Ensaios Clínicos como Assunto , Avaliação Pré-Clínica de Medicamentos , Resistencia a Medicamentos Antineoplásicos/genética , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/genética , Feminino , Predisposição Genética para Doença , Humanos , Terapia de Alvo Molecular , Inibidores de Fosfoinositídeo-3 Quinase , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/antagonistas & inibidoresRESUMO
BACKGROUND: Hysteroscopic resection of large sub-mucosal myomas embedded deep in the myometrium is often unsuccessful due to absorption of large amounts of nonionic fluid that may result in water intoxication or incomplete resection of the intramural portion of the tumor, which later protrudes within the cavity. CASE: A 35-year-old woman with a large, sessile, sub-mucosal leiomyoma underwent hysteroscopic resection using a bipolar resectoscope under laparoscopic monitoring with intermittent uterine massage. An isotonic electrolyte solution was used for uterine distention and visualization. Frequent massaging of the uterus during the procedure resulted in the expulsion of the fibroid into the endometrial cavity and facilitated complete resection. CONCLUSION: A bipolar resectoscope, which can be used with electrolyte solutions, such as 0.9% NaCl, combined with uterine massage, allows complete removal of large leiomyomas without adverse electrolyte imbalances.