A specific controlled ovarian stimulation (COS) protocol for fertility preservation in women with breast cancer undergoing neoadjuvant chemotherapy.

AIM OF THE STUDY: The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen. MATERIAL AND METHODS: Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35-36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger. RESULTS: The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10. CONCLUSIONS: The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.

Cryopreservation as a strategy for prevention of ovarian hyperstimulation syndrome in a public assisted reproduction service in São Paulo - Brazil.

OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

Oral dydrogesterone in frozen-thawed embryo transfer cycles.

OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Depot GnRH-agonist trigger for breast-cancer patient undergoing ovarian stimulation resulted in mature oocytes for cryopreservation: a case report.

This report describes the case of a 27-year-old woman with breast cancer who underwent ovarian stimulation for fertility preservation with recombinant FSH in conjunction with a gonadotrophin-releasing hormone (GnRH) antagonist and an aromatase inhibitor from the beginning of the treatment. A 3.75-mg triptorelin depot formulation was given intramuscularly when the follicular diameter of three follicles reached ≥ 20 mm and a total of 13 follicles reached ≥ 15 mm. Oocyte retrieval was scheduled for 36 h later and 10 mature oocytes were collected and vitrified. This case report demonstrates that a depot GnRH-agonist trigger effectively leads to mature oocyte retrieval, with the advantage of initiating ovarian suppression for the purpose of fertility preservation during adjuvant chemotherapy in breast-cancer patients.

The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation.

ABSTRACT: Patients submitted to oncological fertility preservation with letrozole and gonadotropins seem to present a higher rate of immature oocytes and lower fertilization rates in comparison to infertile patients submitted to IVF cycles with gonadotropins. The aim of this study was to evaluate the influence of letrozole on oocyte morphology in patients with breast cancer submitted to fertility preservation. METHODS: Retrospective analysis performed at a public tertiary hospital in São Paulo, Brazil. The oocytes were retrieved from patients with breast cancer undergoing fertility preservation (n=69), and from infertile women undergoing in vitro fertilization (n=92). We evaluated 750 oocytes obtained from breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins, and 699 oocytes from patients without breast cancer submitted to ovarian stimulation for in vitro fertilization with gonadotropins only due to male factor infertility. The mature oocytes retrieved were analyzed for the presence of refractile bodies, ooplasm color and regularity, central granulation degree, cortical granules, zona pellucida staining and regularity, perivitelline space, presence of vacuoles or abnormal smooth-surfaced endoplasmic reticle and oocyte retraction. RESULTS: There was a higher incidence of alterations in oocyte morphology in the letrozole group when compared to the control group: increased perivitelline space (p=0.007), irregular zona pellucida (p<0.001), refractile bodies (p<0.001), dark ooplasm (p<0.001), granular ooplasm (p<0.001), irregular ooplasm (p<0.001) and dense central granulation (p<0.001). CONCLUSION: Letrozole is a risk factor for worse oocyte morphology. However, the clinical impact of ovarian stimulation protocol with combined use of gonadotropins and letrozole for fertility preservation remains unclear in this setting. These data underline the importance of establishing the predictive potential of morphological dimorphisms of human oocytes in IVF outcomes.

Cervical ectopic pregnancy after in vitro fertilization: case report successfully treated with cervical electric aspiration.

Cervical ectopic gestation is a serious and potentially lethal condition considered exceptional in in vitro fertilization. Early diagnosis is critical to successful treatment and preservation of fertility. We report a rare case of cervical pregnancy after in vitro fertilization and embryo transfer, successfully treated exclusively with electrical aspiration. Case report: A 36-year-old patient attended the Department of Human Reproduction at Pérola Byington Hospital in 2015 due to primary infertility with no apparent cause for seven years. Subjected to ovulation induction with recombinant depot FSH and GnRh analogue, triggered with chorionic gonadotropin. It evolved with the collection of ten oocytes and transfer of two embryos, with cryopreservation of the remaining ones. The control with serial ultrasound showed a gestational sac in uterine cervix topography, indicating gestation of six weeks, confirmed after 24 hours by a second operator. The treatment was successfully performed by electric aspiration with an EasyGrip® cannula of 6 mm in diameter, without the occurrence of hemorrhage or the need for other procedures. Early diagnosis allowed successful conservative treatment with only cervical aspiration. The literature review confirms the rarity of the case, but does not indicate consensus on the best treatment of cervical ectopic pregnancy.

ANDRO-IVF: a novel protocol for poor responders to IVF controlled ovarian stimulation.

OBJECTIVE: This study aimed to assess a novel protocol designed to improve poor ovarian response through intra-ovarian androgenization. The endpoints were: number of oocytes and mature oocytes retrieved, fertilization, cancellation and pregnancy rates. METHODS: This prospective crossover study enrolled poor responders from previous ovarian stimulation cycles submitted to a novel protocol called ANDRO-IVF. The protocol included pretreatment with transdermal AndroGel(r) (Besins) 25 mg, oral letrozole 2.5 mg and subcutaneous hCG 2500 IU; cycle control was performed with estradiol valerate and micronized progesterone; ovarian stimulation was attained with gonadotropins FSH/LH 450 IU, GnRH antagonist and hCG 5000 IU. RESULTS: Fourteen poor responders were enrolled. One patient did not meet the inclusion criteria. Thirteen patients previously summited to the standard protocol were offered the ANDRO-IVF Protocol.-Standard Protocol: Mean age: 35.30 years; cancellation rate: 61.53%; mean number of MII oocytes retrieved per patient: 1.8; fertilization rate: 33.33%. Only two patients had embryo transfers, and none got pregnant.-ANDRO-IVF Protocol: Mean age: 35.83 years; cancellation rate: 7.69%; mean number of oocytes retrieved per patient: 5.58, MII oocytes: 3.91. ICSI was performed in 84.61% of the patients and a mean of 1.5 embryos were transferred per patient. Fertilization rate: 62.5%; cumulative pregnancy rate: 16.66%; mean duration of stimulation: 9.77 days. CONCLUSION: ANDRO-IVF allows intra-ovarian androgenization by increasing serum and intra-follicular androgen levels and preventing androgen aromatization. This protocol apparently improved clinical outcomes of poor responders in parameters such as number of oocytes retrieved and clinical pregnancy rates. Further randomized controlled trials are needed to confirm these findings.

Preimplantation genetic diagnosis for a patient with multiple endocrine neoplasia type 1: case report.

Preimplantation genetic diagnosis was carried out for embryonic analysis in a patient with multiple endocrine neoplasia type 1 (MEN1). This is a rare autosomal-dominant cancer syndrome and the patients with MEN1 are characterized by the occurrence of tumors in multiple endocrine tissues, associated with germline and somatic inactivating mutations in the MEN1 gene. This case report documents a successful preimplantation genetic diagnosis (PGD) involving a couple at-risk for MEN1 syndrome, with a birth of a healthy infant. The couple underwent a cycle of controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Embryos were biopsied at the blastocyst stage and cryopreserved; we used PCR-based DNA analysis for PGD testing. Only one of the five embryos analyzed for MEN1 syndrome was unaffected. This embryo was thawed and transferred following endometrial preparation. After positive ßHCG test; clinical pregnancy was confirmed by ultrasound, and a healthy infant was born. PGD for single gene disorders has been an emerging therapeutic tool for couples who are at risk of passing a genetic disease on to their offspring.

Cryopreservation as a strategy for prevention of ovarian hyperstimulation syndrome in a public assisted reproduction service in São Paulo - Brazil

SUMMARY OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

Oral dydrogesterone in frozen-thawed embryo transfer cycles

SUMMARY OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Pattern of prolactin secretion after administration of gonadotropin-releasing hormone agonist at the preovulatory phase of intrauterine insemination cycles.

CONTEXT AND OBJECTIVE: Administration of a gonadotropin-releasing hormone (GnRH) agonist at the preovulatory phase is an option for triggering ovulation in assisted reproductive technology cycles. The aim of this work was to investigate the pattern of prolactin secretion after the administration of a single dose of GnRH-agonist at the preovulatory phase. DESIGN AND SETTING: Descriptive study at a tertiary referral center. PARTICIPANTS: Fifteen normally ovulating patients undergoing ovarian stimulation for intrauterine insemination were studied. METHODS: Ovarian stimulation was carried out using human menopausal gonadotropin (intramuscular 75 IU daily). When at least one follicle reached 17 mm (observed echographically), 0.5 mg of buserelin acetate was administered. Blood samples were taken to determine prolactin concentrations, at the time of agonist injection and 4, 8, 12, 24 and 48 hours later. RESULTS: A statistically significant increase in serum levels of prolactin was observed 4, 8 and 12 hours after GnRH-agonist administration, with a peak at 8 hours. CONCLUSION: The administration of a single dose of GnRH-agonist at the preovulatory phase in patients undergoing ovarian stimulation performed with human menopausal gonadotropin causes a significant increase in serum prolactin levels.

Criação de um banco de dados personalizado de baixo custo em um serviço público de reprodução humana / Created a customized database for human reproduction at a low cost for the public service

Todo serviço de reprodução humana necessita de um banco de dados para arquivar e manejar avaliações estatísticas. O serviço público de Reprodução Humana do Hospital Pérola Byington usava uma planilha Excel™ que se mostrou insuficiente para o adequado gerenciamento de informações, evidenciou a necessidade de um programa específico que facilitasse uma consulta rápida ao resumo dos ciclos de FIV, sem que houvesse qualquer probabilidade de erro no preenchimento e nas estatísticas posteriormente feitas. Considerando a inexistência de recursos para compra de um programa, tornava­se necessária a criação de uma plataforma a partir de um software de uso livre. Optamos por usar a plataforma fornecida pelo Centers for Disease Control and Prevention e assim originou­se o CRSMinfo, composto de formulários com subdivisões dos procedimentos, incluindo todas as informações relevantes para consulta e levantamento automatizado de dados. Seu uso mostrou­se extremamente eficiente, aprimorou os protocolos laboratoriais e possibilitou estudos e pesquisas.(AU)

Efficient software it's absolutely necessary for any human assisted reproduction (ART) lab. Perola Byington Public Hospital's ART center has used a spreadsheet in Excel with more than 200 columns for data storage of all in vitro fertilization cycles for years, making it very difficult to create complex statistics to analyze data and lead to quick statistic evaluation. Since we are working with a very tight budget, we selected an open source software created by the Centers for Disease Control and Prevention, and after months of programming we created CRSMinfo, which contains a form with subdivision of procedures, including all the information for research and automatic sorting of the data. The use of CRSMinfo software at Perola Byington Hospital has been extremely efficient, improving the protocols for the realization of studies and researches.(AU)

Crianças nascidas após vitrificação de oócitos em reprodução assistida em hospital público / Infants live born after oocytes vitrification in assisted reproduction public hospital

A criopreservação de oócitos contribuiu para o avanço das técnicas em reprodução humana nas últimas décadas. A metodologia tem sua aplicação na preservação da fertilidade, em programas de ovodoação, como estratégia para redução do número de embriões extranumerários criopreservados com manipulação de menor número de oócitos a fresco e para acúmulo de oócitos em ciclos com reduzida resposta ovariana. A partir do princípio de que todo cidadão tem direito a saúde, é dever do Estado garantir o acesso a todos os tipos de tratamento. O Centro de Referência da Saúde da Mulher ­ Hospital Pérola Byington implantou a técnica de vitrificação de oócitos em 2010, aprimora os protocolos continuamente e busca melhores taxas de sobrevida, fertilização, clivagem e gestação. Relatamos as duas primeiras gestações, com nascimento, obtidas a partir de oócitos vitrificados em nosso Centro, que comprovam a viabilidade da aplicação dessa técnica e oferecem, assim, atendimento ao público com equidade e gratuidade integral.(AU)

The oocytes cryopreservation contributed substantially to a breakthough in Assisted Human Reproduction techniques over the last three decades. The methodology has been applied in the fertility preservation, through oocyte donation programmes, as strategy to reduce the number of supernumerary embryos cryopreserved by manipulating the least amount of fresh oocytes, and in the accumulation of oocytes in cycles with poor ovarian responders. Assuming the principle that every citizen has the right to health, it is the duty of the State to ensure access to all types of treatment. The Woman's Health Reference Center ­ Pérola Byington Hospital has implemented the technique of oocytes vitrification since 2010, and has been improving our protocol continuously: aiming at improvements in the rates of survival, fertilization, cleavage and pregnancy. We reported the first two pregnancies, infants live born after oocytes vitrification, at our Center, proving the feasibility of the oocytes vitrification protocol applied, offering service to the public with equity and no cost for the patient.(AU)

[The age as a predictive factor in in vitro fertilization cycles]. / A idade como fator prognóstico nos ciclos de fertilização in vitro.

PURPOSE: to evaluate the patient's age as an outcome predictor in an in vitro fertilization (IVF) program. METHODS: transversal study, which has included 302 women with ages varying from 24 to 46 years old, submitted to IVF, from May 2005 to July 2007. The patients were divided in three groups, according to their age: Gor=40 (n=52). The number of collected oocytes, the fertilization rates, the number of transferred embryos, the embryonary quality and the pregnancy rate were evaluated. Statistical analysis was realized through Kruskal-Wallis variance analysis and chi(2) test. RESULTS: in the Gor=40 group, 1.6. The number of oocytes obtained in G>or=40 group was significantly lower than in the other two groups (p<0.001).The fertilization rate was similar in the three groups, 61.4, 65.8 e 64.6% (p=0.2288), respectively. The percentage of good quality embryos was not statistically different among the three groups either, with rates of 57.4, 63.2 and 56.0% (p=0.2254), respectively. The average number of transferred embryos in each group was 3.1 (Gor=40), respectively, with statistically significant decrease in the G>or=40 group (p<0.001). Concerning pregnancy rates, the G>or=40 group has presented a rate of 9.6%, a result which is significantly lower (p=0.0330) than the one presented by the G

Importância do hormônio anti-Mülleriano na infertilidade / The importance of anti-Müllerian hormone in infertility

O hormônio anti-Mülleriano (HAM) é um marcador da reserva ovariana usado em técnicas de reprodução assistida com o objetivo de predizer a resposta inadequada à estimulação ovariana controlada. Também pode ser útil na predição de hiper-respostas em pacientes com síndrome dos ovários policísticos e colaborar para individualizar protocolos de estimulaçãomais adequados ao perfil de cada paciente e para o sucesso final do tratamento, muitas vezes dispendioso. Além do HAM existem outros marcadores da reserva ovariana, comocontagem de folículos antrais (CFA) e hormônio folículo estimulante (FSH), juntamente com o Estradiol (E2) e a Inibina B.

The Anti-Müllerian Hormone (AMH) is a marker of ovarian reserve used in assisted reproductive technologies, aiming at predict the response to controlled ovarian stimulation. Itmay also be useful for the prediction of hyperresponse to ovarian stimulation, as frequently observed in patients with Polycystic Ovary Syndrome. Being so, it is useful to individualize ovarian stimulation protocols, making the treatment more cost-effective. Besides AMH, there are other markers of ovarian reserve, as antral follicle count (AFC), Follicle Stimulating Hormone (FSH) along with Estradiol (E2) and inhibin B.

A idade como fator prognóstico in vitro / The age as a predictive factor in in vitro fertilization cycles

OBJETIVO: avaliar a idade da paciente como fator indicador de resultados em um programa de fertilização in vitro. MÉTODOS: estudo transversal que incluiu 302 mulheres, com idade variando entre 24 e 46 anos, submetidas ao tratamento com fertilização in vitro (FIV), no período de Maio de 2005 a Julho de 2007. As pacientes foram divididas em três grupos, de acordo com a faixa etária: G≤35 (n=161), G36-39 (n=89) e G≥40 (n=52). Foram avaliados: número de oócitos aspirados, taxas de fertilização, número de embriões transferidos, qualidade embrionária e taxas de gravidez. A análise estatística foi realizada pela análise de variância de Kruskal-Wallis e pelo teste do χ2. RESULTADOS: no Grupo G≤35, obteve-se a média de 8,8 oócitos por paciente; no Grupo G36-39, a média foi de 7,4 oócitos por paciente; e no Grupo G≥40, 1,6 oócitos por paciente. O número de oócitos obtidos no Grupo G≥40 foi significantemente menor que nos Grupos G≤35 e G36-39 (p<0,001). As taxas de fertilização nos três grupos foram semelhantes: 61,4%, 65,8% e 64,6%, respectivamente (p=0,2288). O percentual de embriões de boa qualidade também não foi estatisticamente diferente entre os grupos estudados, encontrando-se, respectivamente, taxas de 57,4%, 63,2% e 56,0% (p=0,2254). O número médio de embriões transferidos em cada grupo foi de 3,1 (G≤35), 2,8 (G36-39) e 1,5 (G≥40), havendo redução estatisticamente significante no Grupo G≥40 (p<0,001). Com relação às taxas de gravidez, o Grupo G≥40 apresentou taxa de 9,6%, resultado significantemente inferior (p=0,0339) aos Grupos G≤35 e G36-39 (26,1 e 27,0%, respectivamente), que não apresentaram diferenças significantes entre si. CONCLUSÕES: embora a qualidade embrionária, do ponto de vista morfológico, não seja diferente entre mulheres de diferentes faixas etárias, o número de oócitos coletados, o número de embriões transferidos e as taxas de gravidez confirmam que a idade da mulher é um importante fator preditivo das taxas de sucesso das técnicas...

PURPOSE: to evaluate the patient’s age as an outcome predictor in an in vitro fertilization (IVF) program. METHODS: transversal study, which has included 302 women with ages varying from 24 to 46 years old, submitted to IVF, from May 2005 to July 2007. The patients were divided in three groups, according to their age: G≤35 (n=161), G 36-39 (n=89) e G≥40 (n=52). The number of collected oocytes, the fertilization rates, the number of transferred embryos, the embryonary quality and the pregnancy rate were evaluated. Statistical analysis was realized through Kruskal-Wallis variance analysis and χ2 test. RESULTS: in the G≤35 group, an average of 8.8 oocytes by patient was obtained; in the G 36-49 group, 7.4; and in the G≥40 group, 1.6. The number of oocytes obtained in G≥40 group was significantly lower than in the other two groups (p<0.001).The fertilization rate was similar in the three groups, 61.4, 65.8 e 64.6% (p=0.2288), respectively. The percentage of good quality embryos was not statistically different among the three groups either, with rates of 57.4, 63.2 and 56.0% (p=0.2254), respectively. The average number of transferred embryos in each group was 3.1 (G≤35), 2.8 (G 36-39) and 1.5 (G≥40), respectively, with statistically significant decrease in the G≥40 group (p<0.001). Concerning pregnancy rates, the G≥40 group has presented a rate of 9.6%, a result which is significantly lower (p=0.0330) than the one presented by the G≤35 and G 36-39 groups (26.1 e 27.0%, respectively), with no significant difference between themselves. CONCLUSIONS: though the embryonary quality is not different among women from different age groups, the number of collected oocytes, the number of transferred embryos and the pregnancy rate indicate that the women’s age is an important predictive factor of success for the techniques of assisted reproduction and should be taken into consideration when this kind of treatment is proposed to women over 40.

Protocolos de estimulação ovariana controlada para criopreservação de oócitos em pacientes com câncer de mama / Controlled ovarian stimulation protocols for cryopreservation of oocytesin patients with breast cancer

Os autores apresentam os protocolos de estimulação ovariana usados no Centro de Referência da Saúde da Mulher para captação e vitrificação de oócitos em pacientes com câncer de mama que desejam preservar a fertilidade antes de se submeter a quimioterapia.

The authors present the ovarian stimulation protocols employed at the Women's Health Reference Center in order to retrieve oocytes for vitrification in breast cancer patients wishing fertility preservation prior to chemotherapy.

Pattern of prolactin secretion after administration of gonadotropin-releasing hormone agonist at the preovulatory phase of intrauterine insemination cycles

CONTEXTO E OBJETIVO: A administração de um agonista do hormônio liberador das gonadotropinas no momento pré-ovulatório é uma opção para desencadear a ovulação nos ciclos de reprodução assistida. O objetivo deste trabalho é investigar o padrão da secreção de prolactina após a administração de dose única de agonista no momento pré-ovulatório. TIPO DE ESTUDO E LOCAL: Estudo descritivo realizado em um centro de referência terciário. PARTICIPANTES: 15 pacientes normo-ovulatórias submetidas a indução da ovulação para inseminação intra-uterina. MÉTODOS: A estimulação ovariana foi realizada com gonadotropinas da mulher menopausada (75 UI por via intramuscular diariamente). Na presença de pelo menos um folículo de 17 mm (observado por ultra-sonografia), administrou-se 0,5 mg de acetato de buserelina. Foram colhidas amostras de sangue para determinação dos níveis de prolactina no momento da injeção do agonista e 4, 8, 12, 24 e 48 horas depois. RESULTADOS: Observou-se aumento significante nas concentrações séricas de prolactina 4, 8 e 12 horas após a administração do análogo, com um pico após 8 horas. CONCLUSÃO: A administração de uma dose única de análogo agonista no momento pré-ovulatório de pacientes estimuladas com gonadotropinas da mulher menopausada promove aumento significante nas concentrações séricas de prolactina.

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.

Dolorimetria: um equipamento alternativo / Dolorimetry: an alternative equipment

Descreve-se o uso de um "dolorímetro" alternativo de fácil manejo e baixo custo para utilizaçäo em pesquisa e em aulas práticas de analgesia