RESUMEN
More empathized approach is required and is obligatory to women with premature ovarian insufficiency (POI) interested for pregnancy. In order to improve fertility rate in POI patients our suggestions would be: (1) To decrease FSH value to 10-15 IU/L by increasing estrogen. Oocyte donation can be suggested after a minimum of six month interval from FSH between 10-15 IU/L and when no dominant follicles are found. (2) To perform oral glucose tolerance test (OGTT). Insulin sensitizing agents has to be included, when indicated, 3-6 month before pregnancy. (3) TSH has to be 1-2.5 mM/L during 3-6 months before pregnancy. (4) Tests for thrombophyllia (Leiden V, FII, MTHFR, PAI) have to be obligatory. They are less expensive than those repeated in vitro fertilizations. Therapy has to be included according to the indications. (5) In order to regulate disturbed immune response in POI patients with endometriosis oral contraceptive therapy is needed for atleast six months prior to the pregnancy. (5) Encourage the patients and advice them about healthy life style and eating habits. (6) Add other drugs, when they are indicated. Complex interplay between endocrine, immunological, haematological, and psychological factors are very often underdetected in POI patients. It is very important to find out the real time for oocyte donation after correcting all the disturbances, improving endometrium receptivity and reaching women's acceptable psychological status. Untreated disturbances induce cardiovascular diseases, diabetes mellitus, thyroid diseases, coagulopathioes etc.
Asunto(s)
Endometrio/fisiopatología , Estradiol/uso terapéutico , Infertilidad Femenina/etiología , Insuficiencia Ovárica Primaria/complicaciones , Endometriosis/complicaciones , Estradiol/deficiencia , Femenino , Humanos , Resistencia a la Insulina , Donación de Oocito , Insuficiencia Ovárica Primaria/tratamiento farmacológico , Insuficiencia Ovárica Primaria/inmunología , Insuficiencia Ovárica Primaria/fisiopatología , Trombofilia/complicacionesRESUMEN
Diferentes líderes de opinión han modificado su posición después del artículo del WHI, el cual también ha llevado a cambios en la terminología. De hecho, algunos colegas ahora se refieren a la prescripción de hormonas en la menopausia como la terapia hormonal (TH), en lugar del mundialmente utilizado Terapia de Reemplazo Hormonal (TRH). Por qué han descartado el término reeemplazo? Las razones para este cambio semántico, y de acuerdo a nuestro concepto, relevante, son oscuras pero creemos que este cambio no es correcto. Sin embargo, tenemos la impresión que TH puede ser un término "políticamente correcto" después de los resultados del estudio WHI.
