Use of clomiphene citrate protocol for controlled ovarian stimulation impairs endometrial maturity.

INTRODUCTION: Despite recent advances in assisted reproduction techniques and recent knowledge regarding embryo and endometrium quality, implantation and birth rates remain low. The objective of this study was to investigate whether clomiphene citrate alters endometrial maturation in infertile patients. METHODS: In a prospective self-matched cohort study, we assessed the ovulation of women in spontaneous and stimulated cycles (with clomiphene citrate). We determined the ovulation day by ultrasound scanning. In both cycles, we took four blood samples (BS1 - at early proliferative phase, BS2 - at mid proliferative phase, BS3 - after ovulation and BS4 - at mid luteal phase) to determine the serum concentrations of FSH, LH, estradiol and progesterone. We retrieved an endometrial biopsy five days after ovulation, followed by blinded analysis and classification according to Noyes criteria, in both cycles. RESULTS: Twenty-two participants completed the study. There were significant differences in FSH BS3 (p=0.001), in LH BS3 and BS4 (p<0.001 and p=0.049, respectively), in estradiol BS2, BS3 and BS4 (p<0.001, p=0.024 and p<0.001, respectively) and in progesterone BS3 and BS4 (p=0.028 and p<0.001, respectively). Considering Noyes criteria, there was a one-day delay when comparing the stimulated cycle with the spontaneous cycle (p=0.004), and a two-day delay when comparing the stimulated cycle with the biopsy day. CONCLUSION: This study indicates that ovarian stimulation with clomiphene citrate delays the endometrial maturity, and could possibly impair the implantation process due to asynchrony.

Chlamydia trachomatis infection in infertile and pregnant women in southern Brazil

Introduction: Chlamydia trachomatis (CT) is the most prevalent sexually transmitted bacterial infection, affecting mainly young, sexually active women. Untreated infection may lead to reproductive complications due to tubal damage. Infections during pregnancy may cause preterm labor, low birth weight, perinatal death, and neonatal conjunctivitis and pneumonia. There are few data on CT infection in Brazil. The aim of this study was to determine CT prevalence in infertile and pregnant women. Methods: A cross-sectional study included 77 infertile and 60 asymptomatic pregnant women. First-void urine was tested for CT using PCR (Polymerase Chain Reaction). Blood samples were collected for CT IgG antibodies testing using indirect immunofluorescence. A questionnaire about medical, gynecological, and sexual history was completed by all participants. Results: We found statistically similar prevalence of PCR and IgG antibodies between the groups. There was a 61% prevalence of CT IgG antibodies in infertile women and 56.7% in pregnant women. PCR was positive in only one (1.3%) infertile woman and in none pregnant women. Conclusion: There is a high prevalence of CT IgG antibody in Brazilian pregnant and infertile women, but we found a low prevalence of positive PCR in the urine samples. CT antibodies were associated with sexual behavior and smoking (AU)