[Mexican National Consensus on Assisted Reproduction Treatment]. / Consenso Nacional Mexicano de Reproducción Asistida.

BACKGROUND: It is estimated that 15% of couples living in industrialized countries are infertile, ie have failed to conceive, reproductive age, after 12 months ormore of regular intercourse without contraception. During the past decade has increased the demand for fertility treatments because they believe are moreeffective now. OBJECTIVE: To unify the therapeutic approach and service to patients and set a precedent for a Mexican Official Standard respect and support for the legislation of these procedures. METHOD: Consensus by technical experts group panel with the participation of 34 national centers accredited for use in assisted reproduction. He organized seven workshops with the following themes: 1) selection of patients for assisted reproduction treatment, 2) schemes controlled ovarian stimulation for assisted reproduction techniques of high complexity, 3) preparation and egg retrieval technique, 4) transferembryo; 5) luteal phase supplementation; 6) indications and techniques of cryopreservation and 7) informed consent. Each table had a coordinator who wrote and presented the findings to the full, it made a number of observations until they reached unanimity of criteria, which are reflected in this document. RESULTS: Patient selection for assisted reproduction techniques is the first step of the process. Proper selection lead to success, in the same way that a bad pick up for failure. In the case of egg donation the most important recommendation is that only one to two embryos transferred in order to reduce multiple pregnancy rates and maintaining high pregnancy rates.

[Future reproductive ability in post-treatment Asherman's syndrome patients]. / Futuro reproductivo en pacientes con síndrome de Asherman postratamiento.

BACKGROUND: Hysteroscopy is the best approach for the management of Asherman syndrome with reproductive purposes, since it allows a quick diagnosis and treatment of partial or total uterine adhesions. However, there are a few studies on the reproductive outcome in patients with Asherman's syndrome. OBJECTIVE: Evaluate the results of adherenciolisis hysteroscopy in women with Asherman's syndrome. PATIENTS AND METHODS: We performed a cohort study of thirty-nine patients diagnosed with Asherman's syndrome and who underwent surgical hysteroscopic adherenciolisis by bipolar energy through the period from 2006 to June 2011. RESULTS: Thirty-nine cases were reviewed. All patients restored their menstrual cycle in the course of the first three months after surgery. The pregnancy rate after hysteroscopic treatment was 71.7% (28/39), with a son living at home in 28.2% of the cases (11/39). There was no statistical difference to achieve term pregnancy based on a cut-off point at 35 years of age. A history of menstrual pattern before hysteroscopy was associated with perinatal success. All pregnancies were achieved spontaneously within the first year after the procedure. CONCLUSIONS: Spontaneous pregnancy is possible after hysteroscopic adherenciolisis in Asherman's Syndrome. It confirms the viability of using bipolar energy to restore the size and shape of the uterine cavity with minimal endometrial damage and with an exclusive reproductive purpose.

[Preliminary results of effectiveness of two schemes of controlled ovarian hyperstimulation protocols with recombinant foliculle stimulating hormone in intrauterine insemination cycles]. / Resultados preliminares del estudio de eficacia de dos esquemas de hiperestimulación ovarica controlada con hormona folículo estimulante recombinante en ciclos de inseminación intrauterina.

BACKGROUND: The intrauterine insemination (IUI) is the first line treatment in different infertility situations. OBJECTIVE: To compare the efficacy of two protocols of controlled ovarian hyper stimulation (COHS) with recombinant Follicle Stimulating hormone (rFSH) (75 vs. 150 UI/day) plus IUI, in terms of pregnancy rate, multiple pregnancies, ovarian hyper stimulation syndrome and ovarian stimulation features. MATERIALS AND METHODS: Prospective study, sequential assignment, included 35 patients that had 44 cycles of IUI. They were assigned in to two groups, group 1 that started controlled ovarian hiperestimulation with 75 and 2 with 150 UI/day of recombinant rFSH. RESULTS: We found statistically significant difference between groups in: dose of rFSH, amount of stimulation days, number of mature follicles and estradiol blood levels on the day of use of the GnRHant and hCG injection day. The pregnancy rate between group 1 and 2 were 9.1 vs. 27.2%, respectively. Of the 8 pregnancies, 75% were achieving in group 2. The twin pregnancy rate was 2.2% and there were no cases of OHSS. CONCLUSIONS: Although without significant difference between groups we found a clear trend to achieve a better pregnancy rate with the 150 UI/day protocol without a significant raise in multiple pregnancy rate nor OHSS. The multifollicular development was associated to group 2 seems to be related to the better pregnancy rate achieved by the same group.

[Impact of office hysteroscopy in patients with a history of two or more failed cycles of IVF-ET and pre-ICSI in assisted an reproduction center]. / Repercusión de la histeroscopia de consultorio en pacientes con antecedente de dos o más ciclos fallidos de fertilización in vitro, transferencia embrionaria e inyección intracitoplasmática del espermatozoide en un centro de reproducción asistida.

BACKGROUND: Many couples fail to achieve pregnancy instead repeated FIV-TE-ICSI cycles. Good quality embryos for successful pregnancy rates should not be count apart over endometrial receptivity. OBJECTIVE: To assess the impact of office hysteroscopy in a group of patients with two or more previous failed cycles of FIV-TE-ICSI in an assisted reproduction center. MATERIAL AND METHOD: Retrospective case control study in patients with problems to conceive in two or more previous failed FIV-TE-ICSI cycles instead good quality embryos and an apparently normal uterine cavity. They were divided in two groups: A with no hysteroscopy perfomed, and 8 with hysteroscopy. Second group was divided in 81 (without pathologic findings) and 82 (with intrauterine abnormalities). Demographic variables were analized, hysteroscopic findings, good quality embryos transferred, biochemical and clinical pregnancies and perinatal results in all groups. RESULTS: No significant differences were found in demographic variables analyzed among patient with or without office hysteroscopy. Intrauterine abnormalities were found in 16 (64%) patients of group 82. No significant statistical differences were found respect biochemical, clinical pregnancies or live birth new born. CONCLUSIONS: Instead previous diagnosis of an apparently normal uterine cavity, pathologic abnormalities were found in a significant number of patients. We observed an improvement in pregnancy rates in patients in with HC was realized previous to FIV-TE-ICSI, particularly on those were endometrial pathology was found and corrected, even though the study sample did not allowed to reach results with statistical difference.

[Differing response to GnRH antagonists in cycles of ovarian hyperstimulation plus intrauterine insemination]. / Diferencia de respuesta a los antagonistas de GnRH en ciclos de hiperestimulación ovárica más inseminación intrauterina.

OBJECTIVE: To compare two flexible protocols of GnRHant in OH plus IUI vs a control group without GnRHant. MATERIALS AND METHODS: Randomized controlled trial 90 infertile patients were analyzed in 116 cycles of IUI. Cycles were randomized in 3 groups; group 1: started GnRHant when the leading follicle reached 14mm, group 2: when it reached 16mm and group 3: without GnRHant hormonal determinations were done during OH. Main outcomes were: premature LH raise incidence, premature luteinization (PL) and pregnancy rate per cycle. RESULTS: Premature LH rise incidence was 2.6% (3 cycles) and PL 6% (7 cycles). Group 1 didn't present cycles with LH rise or PL, groups 2 and 3 presented LH rise in 3.1% and 1.8% and PL in 12.5% and 5.4% respectively. Pregnancy rate with GnRHant was 16.4% (95% IC 8.1-28.1) vs. 7.2% (95% le 2.0-17.5%) without GnRHant (group 3) (p = 0.16): groups 1 and 2 represented a pregnancy rate of 20.6% (95% IC 7.9-39.7) and 12.5% (95% IC 3.5-28.9%) respectively (p = 0.49). Mature follicles number reached meaning difference between all groups (p = 0.04) specially between groups 1 and 2 (p = 0.02). CONCLUSIONS: A trend to elevate pregnancy rates was observed with GnRHant specially with when it was started when leading follicle reached 14 mm (p > 0.05). Starting GnRHant with 16 mm was not totally usefully to prevent PL.

[Twin pregnancy with complete mole and coexisting fetus after in vitro fertilization and embryo transfer complicated with placenta previa accreta. A case report]. / Embarazo gemelar con mola completa y feto coexistente posterior a fertilización in vitro y transferencia de embriones complicado con placenta previa acreta. Reporte de un caso.

The double twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare event and perinatal treatment complex. Presents a significant case of this unusual partnership and describes their evolution. Patient of 33 years, secondary infertility factor-peritoneal tube and pregnancy achieved by in vitro fertilization and embryo transfer. An ultrasound early pregnancy reported twice, a sack was a complete mole, another bag was a fetus and placenta previa unchanged total. The case is carefully monitored and uterine inhibitors were administered at different stages of gestation. It settled the case by caesarean section at 37 weeks and obstetric hysterectomy for placenta previa percreta molar involution of the placenta and newborn health. The evolution of the mother and the child was appropriate.

[Delivery or cesarean section and women's emotional condition]. / Estado emocional de la mujer en relación con el parto o cesárea.

BACKGROUND: Interest to know and study women's point of view over delivery type and its late effect in emotional state has increased recently. OBJECTIVE: To determine if there is any relation between the type of delivery and emotional state in woman after the delivery or cesarean section. In addition, to know whether this resolution modifies in any way her emotional state during the puerperium. PATIENTS AND METHOD: 201 pregnant, primiparous women, all patients of the Instituto Nacional de Perinatologia; they were administered the GHQ-30 in order to determine their emotional state, and a survey designed to find out their point of view regarding vaginal delivery and cesarean section. Two administrations were carried out: one at 25 to 30 weeks of pregnancy and the second during puerperium. This was an exploratory, descriptive, comparative, test-retest, longitudinal study. RESULTS: Regarding the GHQ-30, at first administration we found 37.8% of cases and 62.2% of non-cases. At the second, we found 15.4% of cases and 84.6% of non-cases. We found a statistically significant relation regarding emotional state severity. In the survey, we found statistically significant relationship between physician's explanation delivery types, and woman's knowledge as to the same. CONCLUSIONS: There was no relationship between emotional state and delivery type for women's sample. Physician's explanation of the type of delivery (vaginal delivery, cesarean section, instrumental delivery), avoids alterations in woman's emotional state.

[Psychological symptoms in a group of climacteric women, before and after a psychotherapeutic process]. / Sintomas psicológicos en un grupo de mujeres en etapa del climaterio, antes y después de un proceso psicoterapéutico.

BACKGROUND: Two of each three women in their menopause present climacterical syndrome, showing frequently psychological symptoms, which is translated in diminution of the personal satisfaction, which generates the necessity of specialized attention. OBJECTIVE: To know the presence and frequency of psychological symptoms, before and after a psychotherapeutic process with a psychodynamic approach, in a group of women in their menopause. PATIENTS AND METHOD: The sample consisted of 41 women divided in two groups, with pre and post application of the survey of symptoms, group 1 received psychotherapy and group 2 did not, although it required it, for this reason it was considered the control. The psychotherapy consisted of 17 sessions and the used techniques most frequently were: confrontation, clarification and interpretation. RESULTS: Differences in the diminution as in the absence of symptoms were observed as much after the psychotherapeutic process. CONCLUSIONS: The psychoanalytic psychotherapy is functional in this type of patients for the diminution and in some cases the disappearance of psychological symptoms.

[Conflict areas in two psychotherapeutic groups of climacteric women]. / Areas de conflicto en mujeres en la etapa del climaterio en dos grupos de psicoterapia.

BACKGROUND: An important consideration is to specify the areas of conflict that will be worked on during the psychotherapeutic process in order to develop a specific psychological model for a group intervention with menopausal women. OBJECTIVE: To determine the most relevant areas of psychological conflict for women in the menopausal stage by means of a focalization technique. PATIENTS AND METHOD: A descriptive, cross-sectional, longitudinal study with non-experimental design was done in 29 patients from the Perinatology National Institute of Mexico (INPer). Two groups were formed (A and B), each one with 17 participants; however, in the first session only 12 women from group A assisted. Seventeen therapy sessions were analyzed. Group formation and the number of sessions were based on research and patients needs. Women were given psychotherapeutic care once a week at the psychology department of INPer, for 90 minutes by session. Psychotherapeutic management during sessions was in charge of psychologist responsible of climacteric program of psychology department; while Gesell chamber observer was a psychologist with groups' specialization. For the statistical analysis frequency measures were used. RESULTS: Eleven areas were identified, which showed a great similarity in both groups. Main ones were: relation of the patient to relatives or extensive family, relation to the partner and relation to the children. CONCLUSIONS: This work favors a dynamic therapeutic process with the patients, in addition to being a technique, which provides structure and guidance during menopause.

[Effect of intramural and subserous myomas on in vitro fertilization cycles and their perinatal results]. / Efecto de los miomas intramurales y subserosos en los ciclos de fertilización in vitro y sus resultados perinatales.

OBJECTIVE: To evaluate the effect of intramural and subserous myomas in in vitro fertilization cycles, as well as its perinatal results. TYPE OF STUDY: Cases and controls. MATERIAL AND METHODS: All the IVF cycles between October 1999 and December 2004 were included. The variables of size and type of myomas, as well as variables of IVF cycles, implantation and pregnancy rates, and perinatal results were analyzed. We calculated the chi-square test to analyze the relationship between myomas and pregnancy. The t-Student test was used to establish the difference in the average between both groups regarding the studied variables. In the logistic regression analysis we controlled confusing variables. RESULTS: We analyzed 431 cycles made in 364 patients divided into two groups: study cases (with myomas-65 cycles) and control cases (without myomas-366 cycles). Age was two years older in the study group (35.7 vs 33.5, p < 0.001). There was no difference in: duration, type of infertility, days of stimulation, gonadotrophin dose, total and mature follicles, and fertilization and implantation rates. We only observed a difference in the recovered oocytes (8.0 vs 9.7, p = 0.027). The pregnancy, abortion and live-born children rates were of 20.0 vs 23.2, 46.1 vs 29.4, and 46.1 vs 58.8%, respectively (study and control groups; p > 0.05). Logistic regression showed that myomas do not affect the possibility of getting pregnant. CONCLUSION: Intramural and subserous myomas < 5 cm do not seem to have an effect in the IVF cycles nor in its perinatal results. In women with myomas < 5 cm that no dot distortion the uterine cavity it is questionable the usefulness of a myomectomy prior to IVF cycles.

Mitochondrial membrane potential integrity and plasma membrane translocation of phosphatidylserine as early apoptotic markers: a comparison of two different sperm subpopulations.

OBJECTIVE: To examine whether a relationship exists between loss of mitochondrial transmembrane potential and plasma membrane translocation of phosphatidylserine (PS) in subpopulations of human spermatozoa of men consulting for infertility. SETTING: A tertiary institutional research center. DESIGN: Prospective observational study. PATIENT(S): Twelve infertile men and five fertile controls were compared. INTERVENTION(S): Sperm subpopulations were compared after density gradient separation. MAIN OUTCOME MEASURE(S): Mitochondrial membrane potential was measured with a cationic dye, translocation of PS was evaluated with Annexin-V binding, and motion parameters were assessed manually. RESULT(S): In both the study and control groups and compared with the high-motility fraction, the low-motility fraction had significantly lower sperm motility and normal morphology, and significantly higher percentage of cells with disrupted mitochondrial membrane potential and plasma membrane PS translocation. There was a positive and significant correlation in both subfertile and control groups between the percentages of Annexin-V+ live cells and cells with mitochondrial membrane potential disruption (r = 0.82 and r = 0.85, respectively). CONCLUSION(S): The correlation of plasma membrane PS translocation and loss of mitochondrial membrane potential is suggestive of an early apoptosis phenotype, as is typically observed in somatic cells identified in sperm subpopulations with percentage of low-motile cells. We speculate that such changes might be used as diagnostic markers of sperm dysfunction(s) and that increased levels found in subfertile men might be indicators of reduced fertility potential.

[Prognostic factors of pregnancy in intrauterine insemination]. / Factores pronóstico de embarazo en inseminación intrauterina.

BACKGROUND: The artificial insemination is the introduction of spermatozoa in the feminine genital tract without carrying out sexual contact and with the purpose of obtaining the pregnancy. The insemination intrauterine has improved its rate of success thanks to the technological advances and the best knowledge of human reproductive physiology. OBJECTIVES: To evaluate the prognostic factors for the pregnancy success and calculate the cumulative rate per cycle in IUI (intrauterine insemination). PATIENTS AND METHODS: This study was descriptive, retrospective, analytic, and longitudinal. The cycles of IUI were analyzed from January 1st 2003 to December 31st 2005. Couples 24-41 years old with primary and secondary infertility were included. The following variables were studied: age of participant, type of infertility, length of infertility, aetiology, postcapacitation sperm density and motility, number of follicles, endometrial thickness, and the cycle number in which the IUI was performed. Patients carried out a protocol of ovarian stimulation and follicular follow up. The results were analyzed with 11.0 SPSS, continuous variables were analyzed and reported as means +/- SD with univariate logistic regression to determine statistic significance. Categoric variables were reported in frequencies and percentages. ROC curves were calculated to determine optimal cutting points. RESULTS: 668 cycles were analyzed in 391 couples. The pregnancy rate per cycle and couple was of 13.0 and 21.7% respectively. Means +/- SD patient age was 33.5 +/- 3.4 years old. The three variables with p < 0.05 were: the infertility duration, sperm motility and the cycle number in which IUI was performed. No statistical significance was found in the remaining variables. CONCLUSIONS: The greatest success in IUI will be achieved with infertility of 4 years or less, with sperm motility of 77.6% and in the first two cycles of treatment.

[Perinatal results in pregnancies obtained with embryo transfer in vitro fertilization: a case-control study]. / Resultados perinatales de embarazos por fertilización in vitro con transferencia de embriones (FIVTE): un estudio de casos y controles.

BACKGROUND: In 1978 the first successfull birth by in vitro fertilization took place and this assisted reproduction technique became alternative of treatment in the couples with infertility that had not obtained pregnancy with conventional treatments. The conditions of clinical treatment and laboratory improved, which were in greater number of pregnancies. In 1985 the first study was published that showed adverse perinatal results in pregnancies obtained with fertilization in vitro. Some researchers attributed these results to the increase in the number of multiple pregnancies, pregnant patients older than 35 years, and to the antecedents of infertility. OBJECTIVE: To compare the perinatal outcomes of pregnancies obtained by in vitro IVFET vs spontaneous pregnancies. PATIENTS AND METHODS: A retrospective, case-control study. All pregnancies obtained after IVF ET from October 1st 1999 to November 30th 2004 were compared with a control group of naturally conceived pregnancies and matched by maternal age and the number of fetus. Data concerning obstetric complications and perinatal outcomes were recorded and matched with their control. RESULTS: We analyzed 26 vs 52 singleton, 10 vs 20 twins, 5 vs 5 triplet pregnancies, there were no controls for the quadruplet and quintuplet pregnancies. The mean gestational age at delivery and Capurro score in the singleton pregnancies were 37.8 vs 38.8 y 38.2 vs 39.4 weeks for the study and control groups respectively (p < 0.05), the female sex was more frequent in singleton pregnancies obtained by FIVTE (p < 0.05). There were no statistically significant difference in the premature rupture of membranes, preterm labor, preeclampsia, gestational diabetes, placenta accreta, preterm delivery and low birth weight. The mean birth weight of the pregnancies obtained by IVF were of 2,962.8, 2,100 and 1,532 g for singleton, twin, and triplet respectively. A higher incidence of preterm delivery was found in twin pregnancies but it was not statistically significant. CONCLUSIONS: The rates of adverse perinatal outcomes of the pregnancies after IVF were not higher than pregnancies conceived spontaneously. Twin pregnancies have a greater risk to cause preterm delivery not related to the IVFET procedure.

[Perinatal result of an institutional assisted reproduction program]. / Resultado perinatal de un programa de reproducción asistida institucional.

BACKGROUND: Assisted reproductive technology manipulates masculine gametes, embryos and implantation. It also aids the known or unknown factor of sterility without having the base problem correction as a target. In vitro fertilization and embryo transfer are among these techniques. OBJECTIVE: To describe the overall outcome and the final perinatal offspring after in vitro fertilization cycle in an institutional third level hospital. MATERIALS AND METHODS: IVF cycles were retrospectively analyzed from October 1999 to May 2004. Several variables were described like: age, fertilization rate, implantation and pregnancy rate, fetal status, time of gestation during labor, miscarriage follicle-stimulating hormone rate and take-home baby rate. Patients underwent hypophyseal supression with GnRH analog, using a long luteal phase protocol and stimulated with recombinant FSH. Overall data is expressed as average +/- standard deviation and percentage. RESULTS: 365 cycles were analyzed in 314 patients, average age was of 34 +/- 3.7 years, tubal factor was diagnosed in 63.3%, fertilization rate was of 60.4%, implantation rate of 37.1%, per transfer pregnancy rate of 25.1%, per transfer live born rate of 21.7%, multiple pregnancy rate of 29.3%, miscarriage rate of 28% and ectopic pregnancy rate of 4.8%. In 87.8% of the cases caesarean operation was made; multiple pregnancy offspring weighted more than 1250 g in 70% of them; 70.5% was born after 32 weeks of pregnancy; 90% was born live and with good prognosis. Glucose metabolism alterations were the most frequent maternal complication. CONCLUSION: Although the results obtained were similar to those of assisted reproduction centers, it suggests improving multiple pregnancy rate and abortion rate.

[Estrogen role in the luteal phase support in in vitro fertilization with embryo transfer cycles]. / Papel de los estrógenos en el soporte de la fase lútea en ciclos de fertilización in vitro con transferencia de embriones.

OBJECTIVE: To evaluate the effectiveness of estradiol administration for luteal phase support and to describe the progesterone and estradiol behavior in vitro fertilization-embryo transfer luteal phase. MATERIAL AND METHODS: Patients undergoing in vitro fertilization-embryo transfer with controlled ovarian hyperstimulation and using gonadotropin releasing hormone agonist. They were divided at random into two groups: group 1 would receive progesterone alone, and group 2 would take estrogen and progesterone. Serum concentrations of estradiol and progesterone were measured on days 7 and 14 post-embryo transfer. RESULTS: We examined 52 patients; 24 received progesterone alone and 28 took estrogen and progesterone. Significantly higher estradiol and progesterone concentrations on day 14 were found in pregnant women. It was not on day 7. A significant increment of estrogen was found in the estrogen and progesterone group. Progesterone did not increase significantly. Pregnancy rate was the same in both groups. CONCLUSIONS: For patients undergoing in vitro fertilization-embryo transfer, the addition of estradiol to the progesterone support regimen does not have beneficial effects in terms of pregnancy rate. On day 7 neither progesterone nor estradiol are good predictors of pregnancy.

Laparoscopia y su utilidad en el tratamiento del testículo impalpable / Usefulness of fluoroscopy in the treatment of impalppable testicle

Se desarrolló una técnica laparoscópica para el diagnóstico y el tratamiento de pacientes con testículo impalpable. A través de una pequeña incisión umbilical fue posible la exploración sistemática de la cavidad abdominopélvica después de inducir neumoperitoneo por medio de un insuflador automático de bióxido de carbono. Fue posible la identificación de los vasos gonadales y el conducto deferente al entrar en el conducto inguinal. Se corroboró el diagnóstico de anorquia al no encontrar estructuras gonadales o de los anexos. Se describe la orquiectomía laparoendoscópica. Se consideró que, entre los procedimientos seguros y eficaces, esta técnica es un recurso importante para la cirugía urológica

Buceo y embarazo: informe de un caso y revisión de la literatura / Scuba diving and pregnancy: report of a case review of the literature

Se ha incrementado el número de mujeres en edad fértil que practican el buceo SCUBA. Algunas lo han hecho sin saber que se encontraban embarazadas. La preocupación de los padres es que el producto pudiese sufrir alteracion por estar en el período de embriogénesis. Se hace una revisión de la literatura y se presenta el caso de una paciente que efectuó una inmersión a 25 metros de profundidad a los 28 días de gestación por fecha de ovulación. El bebé no mostró ninguna malformación a su nacimiento, y el crecimiento y desarrollo durante los primeros 18 meses de vida ha sido totalmente normal. Definitivamente un sólo caso de una inmersión es concluyente de que el producto no presentará malformaciones y dada la discrepancia en cuanto a los hallazgos en los estudio en animales y cuestionarios retrospectivos a mujeres que bucearon estando embarazadas y que algunos muestran un ligero incremento en la incidencia de malformaciones de fetos, no se recomienda que se continúe practicando el buceo durante el embarazo

Impacto de la variable edad materna sobre la recuperación ovular, fertilización y segmentación en un programa de reproducción asistida / Impact of maternal age variable on ovular recuperation, fertilization and egmentation in an Assisted Reproduction program

Se encontró la edad materna aumentada como responsable primaria de la falla biológica ovárica que se traduce a su vez, tanto en una respuesta hormonal alterada, como en una reducción en el número de ovocitos susceptibles de captura; esta disminución en el número de ovocitos y no una alteración intríseca en su cálidad es al momento la traducción biológica del envejecimiento ovárico. Por lo tanto, la variable edad materna, con su repercusión ovárica y endometrial, se convierte en la variable de mayor impacto en los programas de reproducción asistida. La variable edad es estadísticamente independiente de otras variables tales como indicación del procedimiento, tipo de esterilidad, tipo de estimulación ovárica empleada. Debe considerarse a la edad de la paciente como un factor pronóstico muy importante al proponer métodos de Reproducción Asistida a las parejas, independientemente del mayor riesgo de problemas en la gestación.

Manejo alternativo de la anemia ferropénia en el estado gravido-puerperal / Alternativa management ferropenic anemia in the gravido-puerperal state

Se realizó un estudio observacional, longitudinal, prospectivo, descriptivo y abierto en 80 pacientes obstétricas del Hospital Regional "20 de noviembre" del ISSSTE, de noviembre de 1986 a agosto de 1987. Se formaron dos grupos; 40 pacientes embarazadas (entre 15 y 35 semanas de gestación) y 40 puérperas ( 1 a 6o. día de puerperio). Ambos grupos con diagnóstico de anemia con deficiencia de hierro confirmada; se calculó la deficiencia de hierro en base al nivel de hemoglobina, peso de la paciente y estado obstétrico. Posteriormente se administró hierro dextrán diluidos por vía intravenosa. Las pacientes de ambos grupos fueron valoradas seis semanas después de la infusión de hierro. Los niveles de hemoglobina, hematócrito y cuenta eritrocitaria presentaron una elevación significativa así como disminución de las anormalidades observadas en el frotis sanguíneo; el 10% de las pacientes de ambos grupos presentaron reacciones secundarias leves, que cedieron en forma espontánea o con tratamiento médico

Morbimortalidad en la paciente lúpica embarazada / Morbimortality in pregnant lupus patient

Se estudiaron los expedientes de 14 pacientes con diagnóstico certero de lupus eritematoso sistémico (LES) asociado al embarazo, en el periodo comprendido entre noviembre de 1986 a julio de 1988 en el Hospital Regional "20 de Noviembre", del ISSSTE. Se evaluaron las siguientes variables: edad materna, edad de inicio del LES, critérios del lupus que presentaban las pacientes en la fase aguda de la enfermedad, antecedentes ginecoobstétricos, atención prenatal, semanas de gestación, estudios de laboratorio, tratamiento anteparto transporto y postparto, datos del recién nacido y complicaciones maternas. El 50% de las pacientes tenían antecedentes de aborto, hubo un alto porcentaje de partos pretérmino (42.85%); 71.42% de las pacientes cursaron con hipertensión arterial; 64.31% tuvo anemia; el tratamiento fue a base de corticoides y fármacos antihipertensivos; se encontró una relación significativa entre los valores de complemento hemolítico disminuido y peso del producto