Endometriosis in infertile women: an observational and comparative study of quality of life, anxiety, and depression.

BACKGROUND: A women's chances of getting pregnant decreases in cases of infertility, which may have several clinical etiologies. The prevalence of infertility is estimated as 10-15% worldwide. One of the causes of infertility is endometriosis, defined as the presence of an endometrial gland and/or stroma outside the uterus, inducing a chronic inflammatory reaction. Thus, infertility and endometriosis are diagnoses that significantly affect women's mental health. This study accessed and compared the levels of depression, anxiety, and quality of life in infertile women with and without endometriosis. METHODS: was an observational and cross-sectional study which included 201 infertile women, 81 of whom were also diagnosed with endometriosis. The STROBE Guidelines was used. The data were collected using validated scales: Hamilton D Questionnaire, Beck Depression Inventory, and Fertility Quality of Life Questionnaire; The data were collected at the Ideia Fertil Institute (Santo Andre, Brazil), between February 28 and June 8, 2019. RESULTS: the infertile women with endometriosis reported higher presence of depressive symptoms and a lower quality of life compared to women with infertility only. Similar presence of anxiety symptoms was observed regardless of being diagnosed with endometriosis. Women with infertility and endometriosis presented lower levels in quality-of-life domains when compared to women with infertility only - Mind and Body (58.33 × 79.17, p < 0.001), Relational (75 × 81.25, p = 0.009), Social (66.67 × 77.08, p = 0.001), Emotional (50.62 × 67.43, p < 0.001). CONCLUSION: the findings indicate the need for increased psychosocial support care for women suffering from infertility and endometriosis to assist them in maintaining and managing their own mental health and achieving their reproductive goals.

Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review.

OBJECTIVE: We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). DATA SOURCES: We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. SELECTION OF STUDIES: We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. DATA COLLECTION: Data extraction was performed by two reviewers with a preestablished data collection formulary. DATA SYNTHESIS: Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS: After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. CONCLUSION: More RCTs are needed to support or refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process.Number of Protocol registration in PROSPERO database: CRD42019121130.

OBJETIVO: Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF). FONTES DE DADOS: Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov, e OpenGrey. SELEçãO DOS ESTUDOS: Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos. EXTRAçãO DE DADOS: O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido. SíNTESE DE DADOS: Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTADOS: Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona em mulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas. CONCLUSãO: Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.

Tribulus terrestris for female sexual dysfunction: a systematic review / Tribulus terrestris para disfunção sexual feminina: uma revisão sistemática

Abstract Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary. Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. Conclusion MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130

Resumo Objetivo Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF). Fontes de dados Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov, e OpenGrey. Seleção dos estudos Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos. Extração de dados O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido. Síntese de dados Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Resultados Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona emmulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas. Conclusão Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.

Seminal profile of 23,504 patients over the years: 7 years of experience.

OBJECTIVE: To evaluate the behavior of seminal parameters over the years - 2010 to May 2017. METHODS: A retrospective study, carried out from January 2010 to May 2017, covering men who underwent sperm examination. Seminal parameters (volume, sperm concentration, motility, morphology, age and duration of infertility in years) of 23,504 men were evaluated. The groups were compared to each other to check whether there were changes to the seminal parameters in that period. RESULTS: There was no change over the years considering the time of infertility, in an average of 3.78 years. The mean age of the patients was 36.53 years, with a trend of increase in 0.2 years. In relation to the volume of semen samples, the mean value was 3.29mL, with a decrease trend in 0.05mL. As for sperm concentration, the average was 34.37 million/mL, with a decrease trend of 1.0 million/mL. Progressive sperm motility showed an average of 47.27% and there was a decrease trend of 0.67%. Finally, sperm morphology presented an average of 2.79% of normal spermatozoa, with a decrease trend of 0.33%. CONCLUSION: It can be noted that over the years, the sperm quality of men looking for assisted reproduction clinics has tended to decrease in macroscopic and microscopic parameters (volume, sperm concentration, motility and morphology).

Perfil epidemiológico das pacientes inférteis com endometriose / Epidemiological profile of infertile patients with endometriosis

Objetivo: Descrever o perfil epidemiológico e clínico de pacientes inférteis com endometriose. Métodos: Estudo transversal que avaliou 450 prontuários de mulheres que procuraram tratamentos de reprodução assistida entre outubro de 2006 e maio de 2012. Analisaram-se sintomas como dismenorreia, intensidade da dor, alterações intestinais e doenças associadas. O software estatístico usado foi o Stata 11.0.Resultados: A mediana de idade foi 34 anos. A dismenorreia acometeu 84,2% das pacientes, de intensidade grave em 40,4%. Alterações intestinais presentes em 54,4%. Dentre as doenças ginecológicas associadas, destaca-se mioma em 23,3%. Em relação às doenças em tratamento, destaca-se a metabólica (8,4%). Discussão: Sabe-se que a dismenorreia é o sintoma mais prevalente nas mulheres com endometriose, assim como alterações intestinais, presente em 6% a 30% das mulheres com a endometriose profunda. Justifica-se a relação com outras doenc¸as também estrogênio-dependentes, como miomas e pólipos, devido ao endométrio dessas mulheres ter aromatases p450 e cyp19, que gerariam ambiente hiperestrogênico. No grupo estudado de mulheres brasileiras, o perfil de idade compreende a quarta década de vida, com infertilidade predominantemente primária, significativa prevalência de dismenorreia grave e associação com pólipos e mioma.

Aims: To describe epidemiological and clinical aspects of infertile patients with endometriosis. Methods: Cross section study of 450 medical records of infertile patients with endometriosis from October, 2006 to May, 2012. Symptoms such as dysmenorrhea, pain intensity, intestinal disorders where analyzed, as well as, associated diseases and treatments. The statistical software used was Stata 11.0. Results: The median age was 34 years. 84.2% of patients presented dysmenorrhea and 40.4% had severe pain intensity. Intestinal disorders was found in 54.4%. From the associated gynecologic diseases, 23.3% had myoma. Metabolic disease was found in 8.4% among the diseases in treatment. Discussion: It is known that dysmenorrhea is the most prevalent symptom in women with endometriosis, as well as intestinal disorders, that can be found between 6% and 30% women with severe endometriosis. Other studies have demonstrated the relationship of estrogen-dependent disease and women with endometrial endometriosis with aromatase enzyme P450 CYP19 mutations; which generate a hyperestrogenic environment, contributing to the development of polyps and myomas. The profile of these patients was traced as being inthe fourth decade of life, with predominantly primary infertility with prevalent symptoms of severe dysmenorrhea and association with polyps and myomas.

Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of acupuncture and moxibustion as an adjuvant treatment in women undergoing in vitro fertilisation (IVF) when embryo implantation has failed. METHODS: A prospective, randomised controlled clinical trial was conducted with 84 infertile patients who had had at least two unsuccessful attempts of IVF. The patients were randomised in three groups: control (n=28), sham (n=28) and acupuncture (n=28). The sample size was calculated by assuming a pregnancy rate of 10% when embryo implantation had failed. The pregnancy rates of the current IVF cycle were evaluated by measurement of blood ß human chorionic gonadotrophin (ßhCG) and subsequent transvaginal ultrasound. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before ovarian puncture and on the day after embryo transfer. In the acupuncture group, patients were treated with moxibustion at nine acupuncture points (BL18, BL22, BL23, BL52, CV3, CV4, CV5, CV7, GV4) and needling at 12 points. In the sham group needles were inserted in eight areas that did not correspond to known acupuncture points. RESULTS: The clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7% vs 7.1% vs 10.7%; p=0.0169). CONCLUSIONS: In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

Aspiração e alcoolização de endometriomas ovarianos recorrentes prévios ao tratamento de fertilização in vitro - estudo piloto / Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization - a pilot study

Objective: To describe the evolution of controlled ovarian hyperstimulation in women with recurrent ovarian endometriomas treated with sclerotherapy. Methods: Twenty-one patients with a laparoscopic diagnosis of stage III or IV endometriosis who had an endometrioma larger than 3 cm before ovarian hyperstimulation for in vitro fertilization were included in the study. After using a GnRH agonist analog for at least 20 days, the cysts were punctured using ultrasound guidance and subsequent ethanol sclerotherapy was performed. Then, the patients were stimulated with 100 or 200 U/day of recombinant follicle stimulating hormone, varying the dose according to the patient's age or history of a previous unilateral oophorectomy. Results: The ovarian cysts had an average diameter of 4.7 ± 1.4 cm and did not recur after aspiration during the ovulation induction. Oocyte extraction occurred after 11 days of hyperstimulation, with 3.95 ± 3.30 oocytes obtained per cycle, on average. Embryo transfer occurred in 71.4% (15/21) of patients, and the pregnancy rate after transfer was 20% (3/15). Conclusion: Aspiration followed by ethanol sclerotherapy prior to in vitro fertilization can be an option for patients who desire a pregnancy and have recurrent endometriomas.

Objetivo: Relatar a evolução da hiperestimulação ovariana controlada em mulheres com endometriomas ovarianos recorrentes tratados com escleroterapia. Métodos: Foram estudadas 21 pacientes acompanhadas no ambulatório de reprodução humana com indicação de fertilização in vitro e diagnóstico laparoscópico de endometriose III ou IV que apresentavam endometrioma recidivado maior que 3 cm após a cirurgia. Foi realizado bloqueio prévio com análogo agonista de GnRH por pelo menos 20 dias, e os cistos foram submetidos à punção guiada por ultrassonografia e alcoolização subsequente. As pacientes foram estimuladas com 100 ou 200U/dia de hormônio folículo estimulante recombinante, com a dose variando de acordo com a idade ou ooforectomia unilateral prévia. Resultados: Os cistos ovarianos aspirados tinham em média 4,7 ± 1,4 cm e em nenhum caso a imagem se refez durante a indução da ovulação. A captação oocitária ocorreu, em média, após 11 dias de indução com 3,95 ± 3,30 oócitos por ciclo. Houve transferência embrionária em 71,4% (15/21) das pacientes, e a taxa de gravidez por transferência foi de 20% (3/15). Conclusão: A aspiração seguida da alcoolização previamente ao tratamento de fertilização in vitro pode ser uma opção para as pacientes com endometriomas recidivados e desejo reprodutivo.

[Surgical scar endometriosis: a series of 42 patients]. / Endometriose em cicatriz cirúrgica: uma série de 42 pacientes.

PURPOSE: to evaluate the frequency and clinical picture of patients with incisional endometriosis. METHODS: retrospective descriptive study performed from the medical records of patients that underwent nodules resection in the surgical scar at Faculdade de Medicina do ABC, from November 1990 to September 2003. The age, parity, number of cesarean sections, symptoms, tumor location, initial diagnosis, treatment, and recurrences were surveyed and analyzed. The results were reported as percentage, mean, and standard deviation. RESULTS: we found 42 patients that were diagnosed with scar endometriosis. From these 42 cases, 37 were of endometriosis on cesarean section scar; 3 cases of episiotomies and 2 cases on bladder in scar of hysterography. The mean age of the patients was 32.4 years old, standard deviation of ±6.2 years. All of them had previous obstetric surgery, and the main complaint was nodulation with perimenstrual pain in 40% of the cases. In 57% of the patients, the clinical evaluation was confirmed by pelvic or transvaginal ultrasonography. Patients were treated with total resection, and recurrence occurred in only two cases. CONCLUSION: scar surgical endometriosis is uncommon; however, the clinical diagnosis is easy when the signs and symptoms are known. The effective treatment is surgical resection.

[Analysis of VDR gene polymorphism Fok1 in infertile women with endometriosis]. / Análise do polimorfismo Fok1 do gene VDR em mulheres inférteis com endometriose.

PURPOSE: to evaluate the frequency of VDR gene polymorphism Fok1 in infertile women with endometriosis and Control and its relation to the disease. METHODS: a case-control study that included 147 infertile women with endometriosis and 154 fertile women without endometriosis as Control. Fok1 polymorphism (rs10735810, T2C), which promotes a T/C exchange in exon 2 of the VDR gene, was identified by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), that involves the combination of amplification by PCR and digestion with restriction endonuclease. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value < 0.05 was considered statistically significant. RESULTS: the TT, TC and CC genotype frequencies of VDR Fok1 polymorphism were 44.2%, 46.9% and 8.9% in infertile women with endometriosis and 41.6%, 50% and 8.4% in the Control Group. No significant difference was found (p=0.8), even when the patients were subdivided according to the stage of endometriosis (p=0.3 for minimal and mild endometriosis and p=0.2 for moderate and severe endometriosis). Alleles T and C were present, respectively, in 67.6% and 32.3% of infertile women with endometriosis (p=0.8), in 63.5% and 36.5% of women with minimal/mild endometriosis (p=0.5), in 72.5% and 27.5% of women with moderate/severe endometriosis (p=0.2), and in 66.6% and 33.4% of the Control Group. No statistically significant difference was found among any groups and the Control. CONCLUSION: the results suggest that VDR gene polymorphism Fok1 does not confer genetic susceptibility to endometriosis-associated infertility in the Brazilian population.

Combination of polymorphisms in luteinizing hormone ß, estrogen receptor ß and progesterone receptor and susceptibility to infertility and endometriosis.

OBJECTIVES: To determine whether the combination of PR (PROGINS), ERß G+1730A and/or LHß G1502A polymorphisms in infertile women with and without endometriosis and in a control group increases the risk of infertility and/or endometriosis. STUDY DESIGN: Case-control study including 201 infertile women with endometriosis, 80 infertile women without endometriosis and 206 fertile women as control group. PROGINS was identified by PCR (polymerase chain reaction) and ERß G+1730A and LHß G1502A were identified by PCR-RFLP (restriction fragment length polymorphism). RESULTS: A statistically significant difference was found for the combination of LHß+ERß polymorphisms among infertile patients with endometriosis and control group (p=0.003, OR=2.468), among infertile patients with endometriosis I/II and control group (p=0.002, OR=3.081), among infertile patients with endometriosis III/IV and control group (p=0.035, OR=2.136) and for the combination of LHß+PROGINS polymorphisms among infertile patients with endometriosis I/II and control group (p=0.014, OR=3.081). However, the odds of developing endometriosis are not enhanced in the presence of the two polymorphisms, being similar to the odds when only LH polymorphism is present. CONCLUSIONS: Individually, the presence of LHß G1502A and ERß G+1730A polymorphisms is associated with infertility and endometriosis associated infertility. However, when two polymorphisms are present in the same individual it does not appear to increase the chance of developing endometriosis or infertility.

COMT polymorphism and the risk of endometriosis-related infertility.

Estrogens are important factors in the development of endometriosis, and can induce cell proliferation and stimulate cell division. COMT constitutes a crucial element in estrogen metabolism and has been suggested to be involved in the development of endometriosis. This study had the objective of to determine whether the presence of COMT val/met polymorphism (rs4680) increases the risk to endometriosis in infertile patients. A case-control study that included 198 infertile women with endometriosis, 71 infertile women without endometriosis, and 168 fertile women as control group of the Faculdade de Medicina do ABC. COMT (val/met) genotypes were identified by real time PCR (genotyping TaqMan assay) and the results were analyzed statistically by χ² test. The data showed no statistical difference in the distribution of COMT genotypes neither between infertile patients with endometriosis and control group (p = 0.567), regardless disease degree, nor between infertile patients without endometriosis and control group (p = 0.460). In conclusion, the COMT val/met polymorphism is not associated to endometriosis-related infertility in the Brazilian population evaluated. However, more studies in larger populations are necessary to confirm these results.

Endometriose em cicatriz cirúrgica: uma série de 42 pacientes / Surgical scar endometriosis: a series of 42 patients

OBJETIVO: avaliar a frequência e o quadro clínico de pacientes com endometriose incisional. MÉTODOS: estudo retrospectivo descritivo a partir da revisão de prontuários de pacientes submetidas à ressecção de nódulos em cicatriz cirúrgica na Faculdade de Medicina do ABC, no período de novembro de 1990 a setembro de 2003. A idade, a paridade, o número de cesáreas, os sintomas, a localização do tumor, o diagnóstico inicial, o tratamento e a recorrência foram relatados e analisados. Os resultados foram representados por porcentagem, média e desvio padrão. RESULTADOS: foram encontrados 42 pacientes com diagnóstico de endometriose em cicatriz. Dos 42 casos, 37 eram de endometriose em cicatriz de cesárea; 3 casos em episiotomia e 2 casos em ápice vesical aderido à histerorrafia. A média de idade das pacientes foi de 32,4 anos com desvio padrão de ±6,2 anos. Todas tinham como antecedente cirúrgico exclusivo o parto, e a queixa principal foi nodulação com dor perimenstrual em 40 por cento dos casos. Em 57 por cento das pacientes, a avaliação clínica foi complementada pelo exame de ultrassonografia pélvica ou transvaginal. As pacientes foram tratadas com ressecção completa do nódulo e a recidiva ocorreu em apenas dois casos. CONCLUSÃO: a endometriose em cicatriz cirúrgica é incomum; entretanto, tem diagnóstico inicial fácil se o quadro clínico for conhecido. O tratamento eficaz é cirúrgico.

PURPOSE: to evaluate the frequency and clinical picture of patients with incisional endometriosis. METHODS: retrospective descriptive study performed from the medical records of patients that underwent nodules resection in the surgical scar at Faculdade de Medicina do ABC, from November 1990 to September 2003. The age, parity, number of cesarean sections, symptoms, tumor location, initial diagnosis, treatment, and recurrences were surveyed and analyzed. The results were reported as percentage, mean, and standard deviation. RESULTS: we found 42 patients that were diagnosed with scar endometriosis. From these 42 cases, 37 were of endometriosis on cesarean section scar; 3 cases of episiotomies and 2 cases on bladder in scar of hysterography. The mean age of the patients was 32.4 years old, standard deviation of ±6.2 years. All of them had previous obstetric surgery, and the main complaint was nodulation with perimenstrual pain in 40 percent of the cases. In 57 percent of the patients, the clinical evaluation was confirmed by pelvic or transvaginal ultrasonography. Patients were treated with total resection, and recurrence occurred in only two cases. CONCLUSION: scar surgical endometriosis is uncommon; however, the clinical diagnosis is easy when the signs and symptoms are known. The effective treatment is surgical resection.

Analysis of vitamin D receptor gene polymorphisms in women with and without endometriosis.

An aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Genetic alterations in the vitamin D receptor gene (VDR) may lead to important defects in gene activation that principally affect immune function. We have hypothesized a possible relationship between endometriosis and/or infertility and the VDR polymorphisms (ApaI, TaqI, FokI, and BmsI). The study was a case-control study including 132 women with endometriosis-related infertility, 62 women with idiopathic infertility, and 133 controls. VDR polymorphisms were studied by restriction fragment length polymorphism. We found relatively similar VDR polymorphism genotype frequencies in cases and controls. When patients with minimal/mild and moderate/severe endometriosis were studied separately, no difference was found. When we compared infertile groups with and without endometriosis there was no statistically significant difference. The data suggest that VDR polymorphisms did not play an important role in the pathogenesis of endometriosis and/or infertility in the Brazilian women studied.

Análise do polimorfismo Fok1 do gene VDR em mulheres inférteis com endometriose / Analysis of VDR gene polymorphism Fok1 in infertile women with endometriosis

OBJETIVO: avaliar a frequência do polimorfismo Fok1 do gene do receptor da vitamina D (VDR) em mulheres inférteis com endometriose e Grupo Controle, e sua associação com a doença. MÉTODOS: estudo caso-controle que incluiu 147 mulheres inférteis com endometriose e 154 mulheres férteis sem endometriose como Controle. O polimorfismo Fok1 (rs10735810, T2C), que promove uma troca de T/C no éxon 2 do gene VDR, foi identificado por PCR-RFLP (análise de polimorfismos de fragmentos de restrição), que envolve a combinação de amplificação por PCR (reação em cadeia da polimerase) e digestão com endonuclease de restrição. O teste do χ2 foi utilizado para comparar as frequências dos genótipos e alelos entre os grupos. Todos os valores de p foram bicaudais, e o nível de significância considerado foi 0,05 (α<0,05). RESULTADOS: os genótipos TT, TC e CC do polimorfismo FokI do gene VDR apresentaram frequência de 44,2 por cento, 46,9 por cento e 8,9 por cento nas mulheres inférteis com endometriose e 41,6 por cento, 50 por cento e 8,4 por cento no Grupo Controle, e não apresentaram diferença significante quando comparados (p=0,8), mesmo quando as pacientes com endometriose foram subdivididas de acordo com o estadiamento da endometriose (p=0,3 para endometriose mínima e leve e p=0,2 para endometriose moderada e grave). Em relação aos alelos, T e C estavam presentes, respectivamente, em 67,6 por cento e 32,3 por cento das mulheres inférteis com endometriose (p=0,8), em 63,5 por cento e 36,5 por cento das mulheres com endometriose mínima/leve (p=0,5), em 72,5 por cento e 27,5 por cento das mulheres com endometriose moderada/grave (p=0,2), e em 66,6 por cento e 33,4 por cento das mulheres do Grupo Controle. Não foi observada diferença estatística significante na comparação entre nenhum dos grupos e o Grupo Controle...

PURPOSE: to evaluate the frequency of VDR gene polymorphism Fok1 in infertile women with endometriosis and Control and its relation to the disease. METHODS: a case-control study that included 147 infertile women with endometriosis and 154 fertile women without endometriosis as Control. Fok1 polymorphism (rs10735810, T2C), which promotes a T/C exchange in exon 2 of the VDR gene, was identified by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), that involves the combination of amplification by PCR and digestion with restriction endonuclease. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value < 0.05 was considered statistically significant. RESULTS: the TT, TC and CC genotype frequencies of VDR Fok1 polymorphism were 44.2 percent, 46.9 percent and 8.9 percent in infertile women with endometriosis and 41.6 percent, 50 percent and 8.4 percent in the Control Group. No significant difference was found (p=0.8), even when the patients were subdivided according to the stage of endometriosis (p=0.3 for minimal and mild endometriosis and p=0.2 for moderate and severe endometriosis). Alleles T and C were present, respectively, in 67.6 percent and 32.3 percent of infertile women with endometriosis (p=0.8), in 63.5 percent and 36.5 percent of women with minimal/mild endometriosis (p=0.5), in 72.5 percent and 27.5 percent of women with moderate/severe endometriosis (p=0.2), and in 66.6 percent and 33.4 percent of the Control Group. No statistically significant difference was found among any groups and the Control...

Body mass index and fertility: is there a correlation with human reproduction outcomes?

Considering the existing conflicts about how an elevated body mass index (BMI) affects fertility, this study had the objective of evaluating the impact of overweight and obesity on the results of IVF/ICSI (in-vitro fertilisation/intracytoplasmatic sperm injection) performed at the Human Reproduction Centre of Faculdade de Medicina do ABC. Retrospective data from 208 IVF cycles of 191 women, performed at our laboratory from February through June, 2008, were used to calculate their BMI. On the basis of the results, the patients were divided into two groups: Group 1: BMI <25 kg/m(2) and Group 2: BMI ≥ 25 kg/m(2). Of the 208 cycles, 137 were from patients with BMI <25 kg/m(2) and 71 cycles from patients with BMI ≥ 25 kg/m(2). Patients' ages and the number of cycles with gonadotrophin-releasing hormone agonist and antagonist were similar in both groups. The doses of follicle-stimulating hormone used for ovarian induction per cycle, the number of retrieved oocytes, fertilisation rate, embryo quality and number of transferred and frozen embryos, the hyperstimulation, pregnancy rates, miscarriage rate and live birth rates showed no statistically significant differences. BMI does not appear to be a good parameter for the definition of IVF success. The association with other methodologies may produce more consistent data about body composition and its impact on fertility.

Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization - a pilot study.

OBJECTIVE: To describe the evolution of controlled ovarian hyperstimulation in women with recurrent ovarian endometriomas treated with sclerotherapy. METHODS: Twenty-one patients with a laparoscopic diagnosis of stage III or IV endometriosis who had an endometrioma larger than 3 cm before ovarian hyperstimulation for in vitro fertilization were included in the study. After using a GnRH agonist analog for at least 20 days, the cysts were punctured using ultrasound guidance and subsequent ethanol sclerotherapy was performed. Then, the patients were stimulated with 100 or 200 U/day of recombinant follicle stimulating hormone, varying the dose according to the patient's age or history of a previous unilateral oophorectomy. RESULTS: The ovarian cysts had an average diameter of 4.7 ± 1.4 cm and did not recur after aspiration during the ovulation induction. Oocyte extraction occurred after 11 days of hyperstimulation, with 3.95 ± 3.30 oocytes obtained per cycle, on average. Embryo transfer occurred in 71.4% (15/21) of patients, and the pregnancy rate after transfer was 20% (3/15). CONCLUSION: Aspiration followed by ethanol sclerotherapy prior to in vitro fertilization can be an option for patients who desire a pregnancy and have recurrent endometriomas.

O impacto do índice de massa corpórea nos resultados de fertilização in vitro / Impact of body mass index on in vitro fertilization outcomes

OBJETIVO: avaliar o impacto do índice de massa corpórea (IMC) nos resultados de FIV/ICSI (Fertilização in vitro/injeção intracitoplasmática de espermatozoide) obtidos no Serviço de Reprodução Humana da Faculdade de Medicina do ABC. MÉTODOS: estudo retrospectivo que incluiu 488 ciclos de FIV/ICSI de 385 pacientes. As pacientes foram divididas em dois grupos de acordo com o IMC em peso normal (18,5 > IMC <25 kg/m²) e sobrepeso/obesidade (IMC >25 kg/m²). Foram avaliados a dose de hormônio folículo-estimulante recombinante (FSHr) utilizada, as taxas de cancelamento dos ciclos por resposta ovariana, e os resultados do laboratório de reprodução assistida como o número de oócitos, número de embriões de boa qualidade, número de embriões transferidos, e as taxas de gravidez, gestação química, abortamento e nascimentos. Para a comparação das variáveis quantitativas entre os grupos foi utilizado o teste t e o teste χ2 para comparação entre as variáveis qualitativas. Os valores de p<0,05 foram considerados significativos. RESULTADOS: considerando características da indução da ovulação, não houve diferença estatística significante entre os grupos quanto a dose de FSHr utilizada e a taxa de cancelamento, p=0,47 e p=0,85, respectivamente. Quanto aos resultados do laboratório, o número de oócitos recuperados por ciclo foi semelhante entre os grupos (p=0,09), bem como o número de embriões de boa qualidade obtidos e transferidos (p=0,7 e p=0,6). A taxa de gravidez por transferência embrionária foi de 27,6 por cento no grupo com peso normal e 29,6 por cento no grupo com sobrepeso/obesidade (p=0,76). As taxas de abortamento e de nascimentos foram semelhantes entre os grupos: p=0,54 e p=0,94. CONCLUSÃO: o IMC não influenciou os resultados de FIV/ICSI avaliados.

PURPOSE: to evaluate the impact of body mass index (BMI) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes performed at the Human Reproduction Center of Faculdade de Medicina do ABC. METHODS: retrospective data from 488 IVF cycles of 385 patients. Patients were classified into two groups according to BMI: normal weight (18.5-24.9 kg/m²) and overweight/obesity (>25 kg/m²). We evaluated the dose of recombinant follicle stimulating hormone (FSHr), the cancellation rates for ovarian cycle response, and the results of the assisted reproduction laboratory such as number of oocytes, number of good quality embryos, number of embryos transferred, and pregnancy rates, chemical pregnancy rates, miscarriage rate and live birth rate. The t test was used for comparison of quantitative variables between groups, and the χ2 test for comparison between qualitative variables. P values <0.05 were considered significant. RESULTS: considering ovulation induction characteristics, there was no statistically significant difference between groups regarding the FSHr dose administered or the cancellation rates, p=0.47 and p=0.85, respectively. Regarding laboratory findings, the number of oocytes retrieved per cycle was similar for both groups (p=0.09), as also was the number of good quality embryos obtained and transferred (p=0.7 and p=0.6). The pregnancy rate per embryo transfer was 27.6 percent for the group of normal weight and 29.6 percent for the overweight/obese group (p=0.76). Miscarriage rates and birth rates were similar for both groups, p=0.54 and p=0.94. CONCLUSION: BMI did not influence IVF/ICSI outcomes evaluated.

[Impact of body mass index on in vitro fertilization outcomes]. / O impacto do índice de massa corpórea nos resultados de fertilização in vitro.

PURPOSE: to evaluate the impact of body mass index (BMI) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes performed at the Human Reproduction Center of Faculdade de Medicina do ABC. METHODS: retrospective data from 488 IVF cycles of 385 patients. Patients were classified into two groups according to BMI: normal weight (18.5-24.9 kg/m²) and overweight/obesity (>25 kg/m²). We evaluated the dose of recombinant follicle stimulating hormone (FSHr), the cancellation rates for ovarian cycle response, and the results of the assisted reproduction laboratory such as number of oocytes, number of good quality embryos, number of embryos transferred, and pregnancy rates, chemical pregnancy rates, miscarriage rate and live birth rate. The t test was used for comparison of quantitative variables between groups, and the χ2 test for comparison between qualitative variables. P values <0.05 were considered significant. RESULTS: considering ovulation induction characteristics, there was no statistically significant difference between groups regarding the FSHr dose administered or the cancellation rates, p=0.47 and p=0.85, respectively. Regarding laboratory findings, the number of oocytes retrieved per cycle was similar for both groups (p=0.09), as also was the number of good quality embryos obtained and transferred (p=0.7 and p=0.6). The pregnancy rate per embryo transfer was 27.6% for the group of normal weight and 29.6% for the overweight/obese group (p=0.76). Miscarriage rates and birth rates were similar for both groups, p=0.54 and p=0.94. CONCLUSION: BMI did not influence IVF/ICSI outcomes evaluated.

Estudo da deformabilidade eritrocitária através da ectacitometria / Study of erythrocyte deformability through ecktacytrometry

A deformabilidade eritrocitária foi estudada através da ectacitometria em uma série de pacientes portadores de esferocitose hereditária e de anemia falciforme e, comparados com os achados de indivíduos normais. A ectacitometria foi realizada no aparelho LORCA (Laser assisted rotational cell analyser - R & R Mechatronics, Holanda). Observamos diminuiçäo da deformmbilidade celular, medida através do índice de elongaçäo (ou de deformabilidade) em todos os pacientes portadores de esferocitose hereditária e de anemia falciforme. O grau de diminuiçäo da deformabilidade esteve relacionado à maior gravidade clínica, havendo correlaçäo com a porcentagem de células microcíticas e hiperdensas, verificado na esferocitose hereditária e também na anemia falciforme. A perda de material da membrana, com consequente alteraçäo da geometrial celular, desidrataçäo celular e aumento da viscosidade citoplasmática, concorrem para a diminuiçäo da deformabilidade observada na esferocitose hereditária. Na anemia falciforme a diminuiçäo da deformabilidade está relacionada ao aumento da densidade celular, secundária às características da hemoglobina S, à desidrataçäo celular e a danos da membrana eritrocitária

A nova lei dos transplantes: a percepcao de populares e de religiosos / A new law about organ transplantation: the perception from peoples and religious

A nova lei dos transplantes, sancionada em 1997, trouxe grandes mudanças na forma de doaçäo de órgäos, transformando todos os brasileiros maiores de 21 anos em doadores, a menos que se manifestem contra em documento de identidade ou habilitaçäo. Isto tem gerado grande polêmica sobre a liberdade de escolha, utilizaçäoadequada de tecidos e órgäos e conceito de morte encefálica. Era a impressäo geral que a populaçäo näo estaria bem informada a respeito da nova lei e que as religiöes seriam contra a doaçäo de órgäos. Este estudo teve como objetivos verificar a compreensäo da populaçäo e dos dirigentes das principais religiöes frenteà nova lei, definindo o perfil da populaçäo, verificando a influência das religiöes na anuência da lei assim como o impacto dos conceitos religiosos na aceitaçäo dos transplantes. Para isto foi aplicado um questionário para 150 membros da comunidade, escolhidos ao acaso em um shopping center do Grande ABC e outro para dirigentes das seguintes religiöes. Adventista do 7 dia, Católica Apostólica Ortodoxa, Católica Apostólica Romana, Episcopal Anglicana, Espírita kardexista, Judaica, Luterana do Brasil, Presbiteriana, Testemunhas de Jeová e Universal do Reino de Deus. Todas as religiöes se mostraram favoráveis à nova lei exceto a Adventista, que tinha restriçöes. Apenas a Luterana, a Presbiteriana, a Espírita e a Testemunha de Jeová divulgavam o assunto em cultos. Em conclusäo, a maioria da populaçäo é favorável à nova lei e doaria seus órgäos independentemente da mesma; os dirigentes religiosos näo influenciam a opiniäo dos fiéis e a nova lei näo vai alterar, a curto prazo, a situaçäo dos transplantes no Brasil porque o problema é mais amplo, incluindo a falta de infra estrutura, integraçäo e verbas do Sistema de Saúde