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.

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.

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.

[Sex hormones profile in women on dialysis program in treatment with erythropoietin]. / Perfil hormonal sexual de mulheres em programa crônico de diálise em tratamento com eritropoetina humana recombinante.

OBJECTIVE: The end stage renal disease has accompaniments in body systems, including hormonal changes. The present study was designed to evaluate the pattern of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and estradiol (E2) in 47 women with end stage renal disease (ESRD), on regular dialysis and receiving recombinant human erythropoietin (r-HuEPO). METHODS: One patient was on intermittent peritoneal dialysis, 4 on continuous ambulatory peritoneal dialysis and 42 on maintenance haemodialysis. They were divided into: Group I consisted of 10 women with regular menses, aged lesser than 48 years; Group II consisted of 15 women with amenorrhea, aged lesser than 48 years and; Group III, consisted of 22 women with amenorrhea, aged 48 years or more. Levels of FSH, LH, PRL and E2 were obtained by ELISA. RESULTS: All groups showed FSH, LH and E2 levels in the normal range for normal women without renal failure, and there was no statistical significance in the levels of these hormones between women with regular menses or women with amenorrhea aged lesser than 48 years. The serum concentrations of PRL were above the normal range in all groups. The patients aged 48 or more showed hormonal profile consistent with post-menopausal (i.e. high FSH, high LH and low estradiol). CONCLUSIONS: We conclude that ovarian function is intact on ESRD and we have to search for other causes for amenorrhea in women that do not have an abnormal hormonal sex profile.

Perfil hormonal sexual de mulheres em programa crônico de diálise em tratamento com eritropoetina humana recombinante / Sex hormones profile in women on dialysis program in treatment with erythropoietin

A IRC (insuficiência renal crônica) terminal é acompanhada por alterações sistêmicas, inclusive do eixo hipotálamo-hipofisário-gonadal. Após o aparecimento da EPO (eritropoetina humana recombinante), surgiram relatos de melhora da disfunção sexual em homens, havendo relativa escassez de dados sobre dosagens hormonais e função sexual das mulheres. No Brasil, há poucos dados sobre o perfil hormonal de mulheres em programa crônico de diálise. OBJETIVOS: Avaliação e comparação do perfil hormonal sexual, através das dosagens de FSH (hormônio folículo estimulante), LH (hormônio luteinizante), PRL (prolactina) e E2 (estradiol) de mulheres em programa crônico de diálise, sob terapêutica com EPO. MÉTODOS: Foram avaliadas 47 mulheres (uma em diálise peritoneal intermitente, quatro em diálise peritoneal ambulatorial contínua e 42 em hemodiálise), subdivididas em três grupos: (1) Grupo I, de mulheres com menos de 48 anos de idade e menstruando regularmente; (2) Grupo II, de mulheres com menos de 48 anos de idade e amenorreicas; (3) Grupo III, de mulheres com mais de 48 anos de idade e amenorreicas. Os grupos foram comparados entre si através do teste de Mann-Whitney para duas amostras independentes. RESULTADOS: Todos os grupos mostraram valores normais das dosagens séricas de FSH, LH e E2, e não houve diferença estatisticamente significante nos níveis desses hormônios entre as mulheres que menstruam e as amenorreicas com idade inferior a 48 anos. Os níveis de PRL encontravam-se acima da normalidade em todos os grupos, independentemente da idade e do padrão menstrual, não havendo diferenças estatísticas significantes entre os grupos. As pacientes do grupo III apresentaram perfis hormonais compatíveis com a menopausa, ou seja, níveis séricos de FSH e LH elevados e de E2 diminuídos