Dual trigger and the impact on oocyte quality and embryo development: a Brazilian cohort.

OBJECTIVE: We aimed to analyze controlled ovarian stimulation using GnRH antagonist in association with hCG (dual triggering) versus hCG alone (conventional triggering) for final oocyte maturation triggering in a population of unselected Brazilian women. METHODS: This was a retrospective observational study of IVF medical records between January 2019 and March 2020. Data from 335 women with infertility were included for study. All patients were divided into hCG trigger (control group; n=178) and dual trigger (n=157). RESULTS: The number of total oocytes and the number of inseminated oocytes were all significantly higher with the dual trigger protocol compared to hCG-only trigger. However, there is no significant difference in patient age, type of infertility, number of in vitro matured oocytes, trigger day, endometrial thickness, AMH concentration, the number of follicles, the number of mature oocytes and the number of fertilized oocytes. CONCLUSIONS: Using the dual trigger protocol improved the number of total oocytes retrieved and the number of inseminated oocytes.

Impact of Body Mass Index and advanced maternal age on in vitro fertilization outcomes.

OBJECTIVE: To evaluate the impact of body mass index associated with advanced maternal age on pregnancy outcomes. METHODS: A retrospective and observational study that included 808 in vitro fertilization cycles and evaluated: age, weight, height, number of oocytes and mature oocytes, number of embryos and transferred embryos, fertilization and clinical pregnancy rates. Four categories of body mass index: underweight, adequate weight, overweight and obesity. We classified age into 4 categories: 35-37; 38-40; 41-42 and over 42 years of age. The means and rates were calculated and compared between different ages and body mass index groups. RESULTS: For the fresh group, women who achieved clinical pregnancy had a lower mean age than those who did not become pregnant, being the higher the pregnancy rate the lower the age (p<0.0001). After logistic regression analysis for data associated with clinical pregnancy in the fresh group, the number of transferred embryos remained higher in the overweight category (p=0.0001). Overweight and obese women had a significantly higher rate of mature oocytes when compared with adequate weight (p=0.015). Analysis using the ROC curve indicated an area under the curve of 60% (p=0.002) for the fresh group. CONCLUSIONS: The adverse effect of high BMI on clinical pregnancy rates is greater in women under 35 years compared to older women; and age had a higher impact on live birth rate rather than BMI, when the analysis was performed on older women, with the impact of BMI on the probability of having a live birth depending on maternal age.

Impact of assisted reproduction treatment on sexual function of patients diagnosed with infertility.

PURPOSE: This study aims to update and systematize the existing evidence on the prevalence of sexual dysfunction and depression in infertile couple Renatos undergoing assisted reproduction treatments. METHODS: A bibliographic search regarding sexual dysfunction in infertile couples was performed on PubMed and LILACS, with no restrictions on the date of publication of the article. The Newcastle-Ottawa Scale (NOS) was used to evaluate studies quality. Data collection process was conducted using a form previously planned and tested, extracting the goal information in a descriptive way. RESULTS: From 111 records, only eight prospective studies were included in the synthesis. Although most of the selected studies assessed only women, three studies assessed the couple. All of them used questionnaires that showed that infertile couples experienced a higher number of sexual dysfunctions during the infertility treatment process, especially women. Regarding depression, going through the infertility process and its treatment leads to significant emotional damage to the patient or couple. CONCLUSION: Of the eight studies analyzed, six reached the conclusion that infertility is related to higher rates of sexual dysfunction. Seven studies also concluded that anxiety and depression are more prevalent in infertile patients. The treatment of sexual dysfunction is multidisciplinary, with the team being a general practitioner, gynecologist, psychologist and specialized nurse. If an organic disorder is detected, there may be a need to include specialists such as urology, gastroenterology and anesthesia. Psychological approaches often include some combination of sex education, identification of emotional and cultural factors, and eventually, couples therapy.

Correlation between anti-Müllerian hormone, age, and number of oocytes: A retrospective study in a Brazilian in vitro fertilization center.

OBJECTIVE: Is the AMH level correlated with age and number of mature oocytes retrieved from stimulated cycles? METHODS: This descriptive, retrospective, observational study included the data of about 1500 patients submitted to Assisted Reproductive Technology treatments in a clinic in Brazil between July 2012 and April 2019. Patients not submitted to IVF and/or without AMH level records were excluded. The study included women with fertility issues aged 20-50 years submitted to IVF. A total of 733 patients were included. The patients were divided by age into three groups (≤35 years old; 36-39 years old; ≥40 years old). RESULTS: The mean AMH concentration ranged from 2.65 to 1.35 ng/mL and was significantly different between the groups. The mean total number of retrieved oocytes ranged from 9.5 to 5.42 and was significantly different between the groups. The mean number of mature oocytes ranged from 7.14 to 4.58. There was no significant difference in the number of mature oocytes between patients aged 36-39 years and ≥40 years. Negative correlations were observed between patient age and total number of retrieved oocytes (-0.3354) and number of mature oocytes (-0.2839). AMH was negatively correlated with age (-0.3257), although positive correlations with total number of oocytes (0.6702) and number of mature oocytes (0.5770) were observed. CONCLUSIONS: This is the largest study performed with Brazilian patients to correlate AMH levels, age, number of oocytes, and number of mature oocytes from controlled ovarian stimulation cycles. Our data showed that as age increases, AMH levels, number of retrieved oocytes, and number of mature oocytes decrease significantly. However, no significant difference in number of mature oocytes was observed when patients aged 36-39 and ≥40 years were compared. In addition, a positive correlation was found between serum AMH levels and total number of retrieved and mature oocytes from stimulated cycles.

Hemothorax after oocyte retrieval in a patient with a history of COVID-19: a case report.

Spontaneous hemothorax is a rare disorder characterized by pleural fluid hematocrit greater than 50% of the peripheral blood hematocrit without natural or iatrogenic trauma to the lungs or pleural space. Since the first case of COVID-19, more than 85 million cases have been confirmed and most patients have sustained symptoms after more than six months of acute infection. This paper reports the case of a 38-year-old woman without signs of endometriosis and a history of COVID-19 infection who developed spontaneous hemothorax after oocyte retrieval. Three months before undergoing assisted reproductive technology (ART) treatment, the patient had a symptomatic COVID-19 infection with a negative PCR test and a positive IgG test four weeks after the onset of symptoms. Controlled ovarian stimulation and oocyte retrieval were conducted uneventfully. Two hours after oocyte retrieval, the patient developed nausea and mild hypogastric pain. Ten hours after the procedure, the patient went to the emergency department with abdominal pain. Chest computed tomography scans revealed moderate right pleural effusion and laminar left pleural effusion. Since the patient had respiratory symptoms, the choice was made to drain the pleural fluid. Fluid analysis confirmed the patient had right hemothorax (400 mL). After drainage, the patient's clinical and imaging signs improved gradually without complications. The patient was asymptomatic one week after the procedure.

Zika virus testing of asymptomatic patients undergoing assisted reproduction in Curitiba, Brazil.

OBJECTIVE: The objective is to report recent data on the infection and detection of Zika virus in infertile couples and to discuss the need to make disease surveillance compulsory in this population in order to decrease the burden on the healthcare system and expedite treatment onset. METHODS: We collected and analyzed the results of Zika virus infection screening tests of infertile couples in a private clinic in the low-incidence region of Curitiba - Brazil. RESULTS: Among the 1189 serologies performed, 98.5% were negative for Zika virus, 0.75% were positive, and 0.75% were inconclusive. The twenty-one reverse transcription polymerase chain reaction tests performed for confirmation of infection were negative. CONCLUSION: Zika virus infection screening for asymptomatic patients may lead to delayed fertility treatment initiation in addition to excessive expenses for the patients. Based on our results, we challenge the validity of mandatory screening, especially in low-incidence regions.

Intrauterine insemination as a primary viable option to infertile couples: evaluation of patients in a private center.

OBJECTIVE: This study aimed to identify which parameters positively affect the clinical pregnancy rates of IUI cycles and find which couples should opt for IUI. METHODS: This retrospective observational study included 261 patients submitted to 381 IUI cycles with fresh or cryopreserved partner semen (IU-H) from January 2012 to February 2017 in a private center in Curitiba-PR, Brazil. RESULTS: Idiopathic infertility was the most frequent finding (35.9%). Patients younger than 40 years accounted for 87.9% of the IUI cycles (n=335) and 16.1% of the clinical pregnancies (n=54). The pregnancy rate was three times higher in patients with an endometrium thickness ≥8 mm compared to patients with endometrium thickness <8mm. Sperm motility >55% was linked to higher pregnancy rates (p=0.002). Concerning gonadotropins, 159 (48.4%) took rFSH, 127 (38.7%) hMG, and 42 (12.8%) uFSH, with pregnancy rates of 21.3%, 10.4% and 10.5%, respectively. CONCLUSION: Patients under 40 years of age with endometrium thickness ≥8 mm, sperm motility >55%, and on rFSH had significantly higher pregnancy rates (p<0.05).

Is HLA-E a possible genetic marker relevant for natural conception?

BACKGROUND: HLA-E products, class Ib human leukocyte antigens, act in the immunology of human reproduction as modulators of the maternal immune system during pregnancy. AIMS: To evaluate HLA-E role in the establishment of a viable pregnancy. MATERIALS & METHODS: HLA-E was genotyped by sequence-based typing (SBT) and analyzed for specific polymorphisms, comparing couples who underwent assisted reproduction treatment (ART) and fertile control couples. RESULTS: There was a significant difference in HLA-E allele and genotype distributions between ART couples and control couples. The allele HLA-E*01:03 was observed in 63.2% of ART men and in 35.1% of fertile men (P = 0.0032). CONCLUSION: These results suggest that HLA-E allelic variants may play a role in the modulation of immune responses in the context of the inability of natural conception and establishment of a viable pregnancy.

HLA-G profile of infertile couples who underwent assisted reproduction treatment.

HLA-G codes for a non-classical class I (Ib) protein which is mainly expressed in trophoblast cells. Many pieces of evidence pointed out its essential role conferring immunological tolerance to the fetus. Some HLA-G alleles have been linked to enhanced or reduced HLA-G protein levels expression, which have been associated with reproductive failure. In this study 33 couples undergoing ART (assisted reproduction treatment; n=66) and 120 couples who conceived naturally (controls; n=240) were enrolled in the study. Genotyping was performed by SBT and tagged an 1837bp at 5'URR as well as exons 2, 3 and4 of HLA-G. Alleles, genotypes and haplotypes were compared between infertile and control groups using Fisher Exact Test. The haplotype HLA-G∗010101b/HLA-G∗01:01:01 showed statistically significant higher frequency in control groups. The immunogenetics of infertility is complex and might be dependent on different genes involved in the establishment of a successful pregnancy. A better understanding of HLA-G alleles and haplotypes structure and how the genetic diversity at their regulatory sites could impact on their level of expression and build up the susceptibility or protection conditions may shed light on the comprehension of immunogenetics mechanisms acting at the fetus-maternal interface.

HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART.

Use of assisted reproductive technology to separate sperm from human immunodeficiency virus infected men resulting in pregnancy among serodiscordant couples.

Due to HIV care improvement, discordant couples more frequently seek help in order to conceive their own biological child. Besides the advance of antiretroviral therapy, unprotected intercourse is not a complete safe option, carrying a low but still present risk of HIV transmission. We report 10 serodiscordant couples in whom the male partner is HIV positive, submitted to sperm washing and intrauterine insemination. The procedure resulted in four pregnancies and no HIV transmission to mother or child was observed. Techniques of assisted reproduction can help HIV discordant couples to conceive biological offspring and is a safer option than unprotected intercourse.

Use of assisted reproductive technology to separate sperm from human immunodeficiency virus infected men resulting in pregnancy among serodiscordant couples

Due to HIV care improvement, discordant couples more frequently seek help in order to conceive their own biological child. Besides the advance of antiretroviral therapy, unprotected intercourse is not a complete safe option, carrying a low but still present risk of HIV transmission. We report 10 serodiscordant couples in whom the male partner is HIV positive, submitted to sperm washing and intrauterine insemination. The procedure resulted in four pregnancies and no HIV transmission to mother or child was observed. Techniques of assisted reproduction can help HIV discordant couples to conceive biological offspring and is a safer option than unprotected intercourse.

Criopreservação de tecido ovariano e oócitos como alternativa para preservação da fertilidade / Ovarian tissue and oocytes cryopreservation as an alternative for fertility preservation

Com os avanços no diagnóstico e tratamento de neoplasias, obteve-se nos últimos anos um grande aumento na expectativa de vida. Em pacientes do sexo feminino, ocorre com frequência a Falha Prematura Ovariana (FPO), pois os ovários são muito sensíveis ao tratamento citotóxico. Para isso a criopreservação de tecido ovariano e de gametas é importante no caso de pacientes com doenças neoplásicas, bem como em portadoras de doenças autoimunes em meninas pré-puberes a indicação é de criopreservar o tecido ovariano. Estudos experimentais e clínicos relataram sucesso após transplante autólogo de fragmentos do córtex ovariano. Portanto é responsabilidade ética oferecer a possibilidade de criopreservação de tecido ovariano por um protocolo institucional para todas as adolescentes e mulheres jovens que precisam se submeter a tratamentos radicais, para que futuramente desenvolvam uma condição reprodutiva.

HLA-G e reprodução humana / HLA-G and human reproduction

O gene HLA-G tem sido investigado em várias condições clínicas relacionadas à reprodução. Casais com abortamento espontâneo de repetição, mulheres com pré-eclâmpsia ou que se submetem a tratamentos de reprodução assistida têm participado de estudos caso-controle com o objetivo principal de obter informações que possam esclarecer a participação de HLA-G nessas ocorrências clínicas. Este trabalho traz uma revisão bibliográfica com os estudos principais e mais recentes que descrevem o gene HLA-G e suas isoformas proteicas, bem como a variação genética e polimorfismos que possam influenciar etapas importantes do processo reprodutivo humano. Considerando-se a gestação como uma característica multifatorial, com influência de fatores genéticos e ambientais, não existe um consenso sobre o papel desempenhado pelo gene HLA-G nesse processo. No entanto, variantes alélicas de HLA-G e suas correspondentes isoformas solúveis ou de membrana, têm sido associadas a níveis plasmáticos dos HLA-G e consideradas prognóstico favorável do processo implantacional.

The HLA-G has been investigated in several clinic conditions related to reproduction. Couples with spontaneous recurrent miscarriage, women with preeclampsia or who were submitted assisted reproduction treatments have participated in case-control studies whose main objective was to obtain information that could shed light on the involvement of HLA-G in such clinic conditions. This paper presents a bibliographic revision with the most recent major studies describing HLA-G gene and its protein isoforms, genetic variation and polymorphisms that may influence important stages of the human reproductive process. Considering pregnancy as a multifactorial feature, with the influence of genetic and environmental factors, there is no consensus about the role of HLA-G gene in pregnancy. However, allelic variants of HLA-G and their corresponding soluble or membrane bound isoforms, have been associated with plasma levels sHLA-G and considered a favorable prognosis of the implantation process.

Hormônio luteinizante e reprodução assistida / Assisted reproduction and luteinizing hormone

Com os avanços no conhecimento da fisiologia da foliculogênese, vários medicamentos e protocolos estão sendo desenvolvidos com o intuito de promover uma hiperestimulação ovariana controlada eficaz e segura. O uso do hormônio folículo-estimulante (FSH) recombinante nos esquemas de indução de ovulação já está bem definido e respaldado na literatura. Mais recentemente, vários estudos observaram que o hormônio luteinizante(LH) parece ter papel fundamental na maturação folicular tardia, otimizando os resultados dos esquemas de indução em determinados grupos de pacientes. Ainda não há um consenso para sua utilização rotineira e as conclusões são muitas vezes conflitantes. Este artigo visa abordar de forma objetiva o papel do LH nas técnicas de reprodução assistida, fazendo uma ampla revisão da literatura.

As folliculogenesis phisiology, several medicinal products and protocols have been developed to promote an effective and safe controlled ovarian hyperstimulation . The use of recombinant follicle-stimulating hormone (FSH) in schemes of ovulation stimulation is well defined and established in literature. More recently, several studies pointed out that luteinizing hormone seems to play a fundamental role in final stages of follicular maturation, optimizing results of induction schemes in certain groups of patients. There is no consensus about its routine use, and conclusions are often conflicting. This article aims to describe objectively the LH’s role in assisted reproduction techniques, thus offering a comprehensive review of the literature.

Morte celular programada e peroxidação lipídica no espermatozoide humano / Programed cell death and lipid peroxidation in human spermatozoa

O principal marcador bioquímico da apoptose precoce em células somáticas é a translocação da fosfatidilserina para o folheto externo da membrana plasmática e fragmentação do DNA. Essas características têm sido também descritas em espermatozoides e são observadas com maior frequência nos ejaculados de homens inférteis. O espermatozoide humano tem uma alta concentração de ácidos graxos poliinsaturados em sua membrama e pouca proteção adequada com antioxidante. Ácidos graxos poli-insaturados são necessários para eventos de fusão da membrana associados à fertilização. No entanto, a presença deles acarreta uma vulnerabilidade para os danos peroxidativos. Sob várias condições de tensão oxidativa, o início da cascata da peroxidação lipídica resulta em perda da fluidez e prejuízo da função espermática. No campo da reprodução humana, principalmente nos aspectos referentes à infertilidade masculina, conhecer os mecanismos da apoptose e da peroxidação lipídica é essencial. Na abordagem da infertilidade masculina, a avaliação da translocação da fosfatidilserina (através da aderência à anexia V como marcador da apoptose) e a aferição da peroxidação lipídica têm como objetivo tentar identificar os casos com mau prognóstico na criopreservação/descongelamento. A identificação de tais casos poderia evitar desgastes psicológicos e econômicos nesses pacientes, bem como a indicação de uma outra abordagem para o seu acompanhamento.

Plasma membrane translocation of phosphatidylserine and DNA fragmentation are considered the main biochemical markers of early apoptosis in somatic cells. These characteristics have been also described in sperm cells and are commonly observed in ejaculated infertile men. The membrane of human spermatozoa contains a high concentration of polyunsaturated fatty acids and inadequate antioxidative protection. Although polyunsaturated fatty acids are required in membrane events associated with potential fertilization, their appearance may increase the vulnerability to peroxidative damage. Under oxidative stress, lipid peroxidation results in motility and sperm function damage. In the field of human reproduction, mainly in the area of male infertility, it is essential to know the apoptosis mechanism and the effects of lipid peroxidation. In the study of male infertility, the evaluation of plasma membrane phosphatidylserine translocation (assessed by annexin V binding as a apoptosis marker) and spontaneous lipid peroxidation aim to identify the bad prognostic cases for those that are submitted to cryopreservation process stress. This would prevent psychological and economic losses in these patients and establish another evaluation method for their infertility.

Inseminação intrauterina: uma alternativarealista em reprodução assistida / Intrauterine insemination: a realistic alternative in assisted reproduction

Objetivo: o propósito deste estudo é determinar se a probabilidade de gravidez aumenta com a utilização da inseminação intrauterina associada à hiperestimulação ovariana controlada. Material e Métodos: este estudo prospectivo incluiu 51 mulheres submetidas a 64 ciclos de inseminação intraovariana. Três protocolos de estimulação ovariana foram utilizados: citrato de clomifeno mais gonadotrofina menopausal humana, gonadotrofina menopausal humana ou hormônio recombinante folículo estimulante isolados. As pacientes foram monitoradas por meio de ultrassonografia transvaginal e determinações séricas dos níveis de hormônio luteinizante e hormônio folículo estimulante. Foram, ainda, separadas por idade em dois grupos: Grupo 1 (≤35 anos) e Grupo 2 (>35 anos). Resultados: observou-se uma taxa de 18,7% de gravidez por ciclo e de 23,5% de gravidez por paciente. As taxas de gravidez foram três vezes maiores no Grupo 1 em comparação ao Grupo 2 (24,3 e 8,7%, respectivamente). Não foram observadas diferenças em relação aos parâmetros de hormônio folículo estimulante, espessura do endométrio, número de folículos >16 mm, concentração espermática, total de espermatozoides móveis e taxa de gravidez nos diferentes protocolos de estimulação ovariana. Conclusões: os achados do presente estudo dão suporte à utilização da inseminação intrauterina no tratamento para casais inférteis.

Objective: the purpose of this study was to determine whether pregnancy outcomes are improved by intrauterine insemination combined with controlled ovarian hyperstimulation. Material and methods: this prospective study included 51 women who underwent 64 cycles of intrauterine insemination. Three ovarian stimulation protocols were applied: clomiphene citrate plus human menopausal gonadotropin, human menopausal gonadotropin or recombinant follicle stimulating hormone. Patients were monitored by transvaginal ultrasonography and serum luteinising hormone and follicle stimulating hormone levels. The patients were divided by age into two groups: Group 1 (≤35 years) and Group 2 (>35 years). Results: we observed 18.7% of pregnancy per cycle and 23.5% of pregnancy per woman. Pregnancy rates were three times higher in Group 1 in comparison to Grupo 2 (24.3 and 8.7%, respectively). No differences were observed among the protocols in terms of follicle stimulating hormone parameters, endometrial size, number of ovarian follicles >16mm, sperm concentration, number of motile spermatozoa and pregnancy rates. Conclusions: The findings of this study support the use of intrauterine insemination as treatment for infertile couples.

Super ICSI veio para ficar? / IMSIcomes to stay?

Este estudo consiste em avaliar a real eficácia da técnica de IMSI comparada a ICSI convencional. O estudo teve caráter bibliográfico, baseado na análise de bases de dados LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde, MEDLINE - Literatura Internacional em Ciências da Saúde, SciELO - Scientific Electronic Library Online e COCHRANE - Revisões Sistemáticas da Colaboração Cochrane. A IMSI é uma técnica que utiliza novo sistema óptico chamado "contraste de fase interferencial" que apresenta objetivas de maior poder de ampliação eletrônica das imagens, podendo observar os espermatozóides em detalhes, detectar seus defeitos e selecionar os melhores, já que são aumentados em até 12.500 vezes, enquanto que a ICSI convencional possui um aumento de no máximo 400 vezes. Portanto, com esta nova técnica espera-se que a taxs de gravidez aumente, alcançando valores próximos a 50 por cento. Porém, como ainda é uma técnica nova, será necessário a realização de mais estudos para verificar sua real eficácia.

Apoptose e peroxidação lipídica antes e após criopreservação / Apoptosis and lipid peroxidation before and after cryopreservation

Objetivo: availar a existência da associação entre os parâmetros da análise seminal básica e a porcentagem de apoptose e peroxidação lipídica antes e após criopreservação. Material e médotos: foram avaliados ejaculados de 16 homens portadores de infertilidade primária atendidos no Laboratório de Andrologia do Jones Institute for Reproductive Medicine nos Estados Unidos. A porcentagem de apoptose foi avaliada pela aderência à anexina, a peroxidação lipídica espontânea por meio de análise espectofotométrica e os parâmetros da motilidade por meio da análise computadorizada. Resultados: antes do congelamento, houve maior porcentagem de espermatozóides apoptóticos (41,4%) e menor porcentagem de espermatozoides vivos (49,7%) em homens com menor concentração espermática (p menor que 0,05). Após criopreservação, a porcentagem de espermatozoides vivos foi menor nos sujeitos com menor concentração espermática (42,6%; p igual 0,06). Não houve diferenças significativas da morfologia e motilidade antes e após criopreservação. Antes do congelamento, houve correlação entre espermatozoides vivos e sua concentração (p menor que 0,05); uma correlação negativa entre a concentração de espermatozoides e apoptose (p menor que 0,05). Conclusões: antes e após criopreservação, houve maior proporção de espermatozoides apópticos em homens com menor concentração espermática; não foi encontrada associação entre a motilidade e morfologia com a apoptose peroxidação lipídica não apresentou associação com qualquer parâmetro da análise seminal básica

Ablação endometrial no sangramento uterino anormal benigno / Endometrial ablation in abnormal uterine bleeding

A ablação endometrial surgiu na década de 80 tendo como principal indicação o SUA (Sangramento Uterino Anormal), é considerada uma técnica cirúrgica nova e segura. Tem como principal objetivo a remoção endometrial até a superfície miometrial. Para sua realização deve-se selecionar adequadamente o paciente, preparar seu endométrio e escolher dentre as técnicas possíveis a que melhor se adeque a patologia da paciente. Apesar de tantas técnicas diferentes apresentadas ainda é consderado como padrão ouro à ressecção transcervical utilizando alça de loop com acoagulação final pelo rollerball. O SUA segundo autores seriam todos os sangramentos uterinos anormais independentes da idade ou da causa, incluindo hemorragia uterina disfuncional. São causas do SUA: endometriose, anatômicas como pólipos e miomas; endócrinas como disfunção do eixo hipotálamo-hipófise-gonada-adrenal; hematogênicas; iatrogênicas; obesidade; grandes fumantes; alcoólatras e depressão. Na ausência de patologia uterina orgânica significativa, hemorragia aguda ou sangramento pós-menopausal, a terapia medicamentosa será a primeira escolha. Como tratamento cirúrgico têm-se a curetagem, a histerectomia, e atualmente a ablação endometrial. Discute-se a validade do diagnóstico histopatológico conseguido através da curetagem, também os custos e os riscos da histerectomia, e finalmente as novas técnicas de ablação endometrial (1ª e 2ª geração) com suas respectivas complicações.