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1.
Wiad Lek ; 74(2): 184-189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813469

RESUMO

OBJECTIVE: The aim: To investigate the utility of testing for chlamydial heat shock protein 60 (CHSP60) antibodies in the diagnosis of tubal infertility. PATIENTS AND METHODS: Materials and methods: All the collected samples were assayed for IgM and IgG antibodies to chlamydia trachomatis and chlamydial heat shock protein 60 (CHSP60) by using immunofluorescence and enzyme-linked immunosorbent assay (ELISA) techniques, respectively. RESULTS: Results: There were no substantial differences between antibodies to C. trachomatis in females with tubal infertility (67%) and non-tubal infertility (48%). However, women with tubal infertility (45%) have more anti-CHSP60 antibodies than non-tubal infertility (9%). Antibody screening for C. trachomatis has only (63%) sensitivity and (54%) specificity for detecting tubal infertility. On the other hand, the CHSP60 antibody testing has (44%) sensitivity and 92% specificity for diagnosing tubal infertility. A positive microimmunofluorescence (MIF) titer was observed in 12 of 18 (67%) females with the tubal problem, 31 of 64 (48%) with non-tubal infertility (P=0.3, OR=2.2, 95% CI=0.71 to 8.01). The CHSP60 antibodies were found in 8 of 18 (45%) females with tubal problem & 6 of 64 (9%) women with non-tubal infertility, power factor alpha α P=0.004, OR=9.3, 95% CI=2.1 to 43.2, power= 1.002 for n= 0.05). Incorporating CHSP60 and C. trachomatis antibodies testing gives an excellent positive probability proportion of 10 to diagnose C. trachomatis associated tubal infertility. CONCLUSION: Conclusions: CHSP60 antibody testing is a more specific evaluation than antibody testing for C. trachomatis for predicting chlamydia-associated tubal infertility. Using these tests at the first infertility examination may help the immediate diagnosis for non-interceptive tubal infertility.


Assuntos
Infecções por Chlamydia , Infertilidade Feminina , Anticorpos Antibacterianos , Chaperonina 60 , Infecções por Chlamydia/complicações , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis , Feminino , Proteínas de Choque Térmico , Humanos , Infertilidade Feminina/diagnóstico , Estudos Prospectivos
2.
Cas Lek Cesk ; 160(1): 5-13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33823598

RESUMO

The immune system plays an important role in many processes of human reproduction. During pregnancy, mother's body has to accept the semialogenic fetus, therefore the role of immune processes has a high importance. Tolerance of the fetus by the mother's immune system is ensured by a complex of immune mechanisms, the knowledge of which brings us to the new insights into human reproduction processes and in seeking of new ways to modulate immunity in repeated embryo implantation failures, miscarriages, premature births, preeclampsia, and other fertility disorders and pregnancy complications. The review article is a summary of current possibilities of immunological laboratory diagnostics in reproductive immunology, presents indications for these tests and their interpretation, and mentions possible methods of therapeutic immune intervention.


Assuntos
Infertilidade Feminina , Complicações na Gravidez , Nascimento Prematuro , Implantação do Embrião , Feminino , Humanos , Sistema Imunitário , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Gravidez
3.
Cas Lek Cesk ; 160(1): 27-32, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33823601

RESUMO

Immune dysregulation can cause embryo implantation failure, possibly due to mechanisms of innate non-adaptive immunity, including natural killer (NK) and natural killer T (NKT) cells. Retrospective analysis of relative counts and functional properties of NK and NKT peripheral blood cells in women with cellular immunopathology before and after immunomodulatory treatment was realized to evaluate these values in a proportion of clinical post-treatment pregnancies. For retrospective analysis, data were collected from 184 infertile women treated for abnormal functional properties and/or numbers of NK and NKT cells after stimulation with sperm and trophoblast antigens. Flow cytometric analyses of peripheral blood both before and during/after immunomodulatory treatment were performed to determine whether clinical pregnancy was achieved. Of 184 cases, immunomodulatory treatment contributed to clinical pregnancy in 109 women (59 %), all but 25 of whom required assisted reproduction techniques to become pregnant. Clinical pregnancy was associated with significantly lower numbers of circulating NK cells (p = 0.03) and significantly less activation of NK cells by trophoblasts (p < 0.001). Increased numbers of peripheral blood NK cells and their pathological activation by trophoblast antigens are immunological factors of infertility in women. However, when appropriately chosen, immunomodulatory treatment can make clinical pregnancy more likely.


Assuntos
Infertilidade Feminina , Células T Matadoras Naturais , Análise de Dados , Implantação do Embrião , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/terapia , Gravidez , Estudos Retrospectivos
4.
Vet Clin North Am Food Anim Pract ; 37(1): 139-147, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33541695

RESUMO

Hysteroscopy in alpacas and llamas allows for the identification of abnormalities on the surface or within the endometrium that cannot be identified with other methods. Hysteroscopy also allows for site-directed endometrial cytology, culture, and biopsy to achieve a definitive diagnosis. Even when no cause for infertility can be found, previously infertile females tend to become pregnant and maintain their pregnancies to term following the hysteroscopic procedure. This therapeutic effect may be a response to pre-hysteroscopy estrogen treatment, dilation of the uterine horns during hysteroscopy, and/or posttreatment uterine lavages. Complications following hysteroscopy have not been reported in camelids.


Assuntos
Camelídeos Americanos , Infertilidade Feminina/veterinária , Animais , Biópsia/veterinária , Endometrite/diagnóstico , Endometrite/veterinária , Endométrio/diagnóstico por imagem , Feminino , Humanos , Histeroscopia/métodos , Histeroscopia/veterinária , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Gravidez , Útero
5.
Medicine (Baltimore) ; 99(36): e21979, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899038

RESUMO

Aim of the present study was to explore the evaluative effectiveness of age, ovarian volume (OV), antral follicle count (AFC), serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), AFC/Age ratio, AMH/Age ratio, FSH/luteinizing hormone (LH) ratio, and ovarian response prediction index (ORPI) to determine which could more advantageously assess ovarian reserve and response.This research enrolled 319 consecutive infertile women who had undergone in vitro fertilization-ET/intracytoplasmic sperm injection (IVF-ET/ICSI) treatments. Abovementioned variables were measured and calculated. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive accuracy of variables and to calculate cut-off values and corresponding sensitivity and specificity.Our study revealed that the significant variables for evaluating a decline in ovarian reserve include age, OV, FSH, AFC/Age ratio, AMH/Age ratio, and ORPI. Moreover, the area under the curve (AUC) of AFC/Age ratio was higher than other 5 variables (AUC = 1.000), and the cut-off value of AFC/Age ratio was 0.111 (sensitivity 100.00%, specificity 100.00%). The significant variables forecasting excessive ovarian response were age, AFC, AMH, FSH, AFC/Age ratio, AMH/Age ratio, FSH/LH ratio, and ORPI, and the significant variables forecasting poor ovarian response were AMH, LH, OV, AFC/Age ratio, AMH/Age ratio, and FSH/LH ratio. When ORPI was used to predict excessive response, the cut-off value of ORPI was 0.880 (sensitivity 84.72%, specificity 67.32%) and ORPI presented better effectiveness. When used to predict poor response, the evaluative effectiveness of 6 variables was almost similar, although the AUC of AFC/Age ratio presented the largest value.Regarding the infertile women, AFC/Age ratio performed better than did the other variables in evaluating ovarian reserve, and it offered excellent effectiveness in predicting poor ovarian response, however, ORPI presented better effectiveness in predicting excessive ovarian response.


Assuntos
Infertilidade Feminina/diagnóstico , Folículo Ovariano , Reserva Ovariana , Adulto , Fatores Etários , Feminino , Hormônios/sangue , Humanos , Infertilidade Feminina/sangue , Estudos Retrospectivos , Índice de Gravidade de Doença
6.
BMC Womens Health ; 20(1): 124, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532273

RESUMO

BACKGROUND: The quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases. METHODS: The present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility Outpatient Clinic of the Instituto Ideia Fértil de Saúde Reprodutiva, Faculdade de Medicina do ABC, São Paulo, Brazil, were and responded to the Short Form (SF) Health Survey-36. Convenience sampling was used due to the authors' access to the study population; however, the sample number was calculated to be sufficient for 95% power in both groups. RESULTS: Homogeneity was observed between Grade I/II and Grade III/IV staging, with similar mean ages (35.27, ±3.64 years and 34.04, ±3.39 years, respectively, p = 0.133); types of infertility (p = 0.535); infertility time (p = 0.654); degrees of pain (p = 0.849); and symptoms common to endometriosis, namely, dysmenorrhea (p = 0.841), dyspareunia (0.466), chronic pelvic pain (p = 0.295), and intestinal (p = 0.573) or urinary (p = 0.809) diseases. Comparisons of median scores in the QoL domains demonstrated that the distributions of QoL and clinical symptoms were significantly related between the types of dyspareunia and the following domains: physical functioning (p = 0.017), role- emotional (p = 0.013), and general health (p = 0.001). Regarding pain outside of menstruation, there was significance in the pain domain (p = 0.017), and degree of pain was significance in physical functioning (p = 0.005) and role-physical (p = 0.011) domains. CONCLUSIONS: The present study pointed out that it is not the stage of endometriosis that interferes in the quality of life of women with endometriosis and infertility but rather the clinical manifestations, such as dyspareunia and pain. Thus, we can conclude that the patient's perception of the disease should be considered in health care and that the losses are independent of the degree of endometriosis in this population with the aggravating factor of infertility.


Assuntos
Depressão/etiologia , Dismenorreia/etiologia , Dispareunia/etiologia , Endometriose/complicações , Infertilidade Feminina/diagnóstico , Dor Pélvica/etiologia , Qualidade de Vida/psicologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Dismenorreia/epidemiologia , Dispareunia/epidemiologia , Endometriose/epidemiologia , Endometriose/psicologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/psicologia , Dor Pélvica/epidemiologia
7.
Fertil Steril ; 113(6): 1140-1149, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32482250

RESUMO

OBJECTIVE: To summarize current understanding of the effects of novel and prior coronaviruses on human reproduction, specifically male and female gametes, and in pregnancy. DESIGN: Review of English publications in PubMed and Embase to April 6, 2020. METHOD(S): Articles were screened for reports including coronavirus, reproduction, pathophysiology, and pregnancy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Reproductive outcomes, effects on gametes, pregnancy outcomes, and neonatal complications. RESULT(S): Seventy-nine reports formed the basis of the review. Coronavirus binding to cells involves the S1 domain of the spike protein to receptors present in reproductive tissues, including angiotensin-converting enzyme-2 (ACE2), CD26, Ezrin, and cyclophilins. Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) may cause severe orchitis leading to germ cell destruction in males. Reports indicate decreased sperm concentration and motility for 72-90 days following Coronavirus Disease 2019 (COVID-19) infection. Gonadotropin-dependent expression of ACE2 was found in human ovaries, but it is unclear whether SARS-Coronavirus 2 (CoV-2) adversely affects female gametogenesis. Evidence suggests that COVID-19 infection has a lower maternal case fatality rate than SARS or Middle East respiratory syndrome (MERS), but anecdotal reports suggest that infected, asymptomatic women may develop respiratory symptoms postpartum. Coronavirus Disease 2019 infections in pregnancy are associated with preterm delivery. Postpartum neonatal transmission from mother to child has been reported. CONCLUSION(S): Coronavirus Disease 2019 infection may affect adversely some pregnant women and their offspring. Additional studies are needed to assess effects of SARS-CoV-2 infection on male and female fertility.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Infertilidade Feminina/virologia , Infertilidade Masculina/virologia , Orquite/virologia , Pneumonia Viral/virologia , Reprodução , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Fertilidade , Interações Hospedeiro-Patógeno , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/fisiopatologia , Masculino , Orquite/diagnóstico , Orquite/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Medição de Risco , Fatores de Risco , Contagem de Espermatozoides , Motilidade Espermática
8.
Medicine (Baltimore) ; 99(20): e20199, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443342

RESUMO

INTRODUCTION: Resistance ovary syndrome (ROS) is a disease characterized by hypergonadotropic amenorrhea but with normal ovarian reserve. Currently, its pathogenesis is still unclear and the treatment methods are complex. Nevertheless, there are evident negative effects of this disease on females' physical and mental health such as gonadal dysplasia, infertility, anxiety, and depression. This article reports a case of successful ovulation induction and pregnancy with letrozole combined with HMG. This can provide clinical treatment guidelines for the disease. PATIENT CONCERNS: The patient underwent several hormone replacement cycles and ovulation induction cycles. But the dominant follicles were not extracted even after using large doses of gonadotropin. DIAGNOSIS: Resistant ovary syndrome; Primary infertility INTERVENTIONS:: Larger doses of letrozole combined with HMG were injected to stimulate ovulation and sensitize the ovaries during menstruation. This helped to examine the peripheral effects of letrozole in relation to gonadotropin. OUTCOMES: The patient displayed a dominant follicular growth and notable ovulation which resulted in a full-term pregnancy and successful delivery. CONCLUSIONS: The resistance ovary syndrome (ROS) can be treated and the findings from this case provides a possible treatment for ROS patients with infertility.


Assuntos
Inibidores da Aromatase/uso terapêutico , Letrozol/uso terapêutico , Insuficiência Ovariana Primária/tratamento farmacológico , Adulto , Inibidores da Aromatase/administração & dosagem , Quimioterapia Combinada/métodos , Feminino , Gonadotropinas/uso terapêutico , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/tratamento farmacológico , Injeções Intramusculares/métodos , Letrozol/administração & dosagem , Nascimento Vivo , Ovulação/efeitos dos fármacos , Ovulação/fisiologia , Indução da Ovulação/métodos , Gravidez , Resultado do Tratamento
9.
Fertil Steril ; 113(4): 683-684, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32228872

RESUMO

Many papers and reviews have described the changes of the cervix during pregnancy, cervical cancer, sexually transmitted infections, and cervicovaginal microbiota. In this Views and Reviews, we focus on some specific topics in relation to the uterine cervix and infertility: early cervical cancer and fertility sparing surgery, cesarean scar defect, cervical incompetence, and cervical müllerian anomalies.


Assuntos
Colo do Útero/patologia , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Colo do Útero/cirurgia , Feminino , Humanos , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/diagnóstico
10.
Fertil Steril ; 113(4): 818-827.e3, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32145928

RESUMO

OBJECTIVE: To evaluate the association between diminished ovarian reserve (DOR) in women at risk of recurrent pregnancy loss (RPL) using ovarian reserve tests. DESIGN: Systematic review and meta-analysis. SETTING: University medical schools. PATIENT(S): Women with a history of RPL. INTERVENTION(S): Systematic reviews of major electronic databases (MEDLINE, EMBASE, Web of Science, and Scopus) for studies that evaluated the incidence of DOR in women with RPL. MAIN OUTCOME MEASURE(S): Association between RPL and DOR. RESULT(S): In studies up to May 2019 we assessed quality using the Newcastle-Ottawa Scale and meta-analyzed data using a random-effect model. We included 15 studies (n = 3,082 women) reporting on six ovarian reserve tests: antimüllerian hormone [AMH], antral follicle count, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and FSH:LH ratio. More women with RPL seemed to have DOR compared with women who did not have RPL as measured by low AMH levels (odds ratio [OR] 2.77; 95% confidence interval [CI], 1.41-5.46) and AFC (OR 2.45; 95% CI, 1.16-5.19). Women with unexplained RPL also seemed to have a higher association with DOR compared with women whose RPL had a known etiology, as measured by low AMH levels (OR 3.23; 95% CI, 1.81-5.76). No statistically significant differences were found in the levels of any of the remaining ovarian reserve tests between those groups of women. CONCLUSION(S): There is an apparent association between DOR and RPL. Low AMH and AFC levels could predict higher odds for pregnancy loss, but more studies are needed to evaluate their prognostic value in the management of women with RPL. SYSTEMATIC REVIEW REGISTRATION NUMBER: Prospero CRD42018114673.


Assuntos
Aborto Habitual/sangue , Aborto Habitual/diagnóstico , Reserva Ovariana/fisiologia , Aborto Habitual/epidemiologia , Hormônio Antimülleriano/sangue , Estudos de Casos e Controles , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Indução da Ovulação/métodos , Indução da Ovulação/tendências , Gravidez
11.
Fertil Steril ; 113(3): 533-535, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32115183

RESUMO

This document contains the definitions of infertility and recurrent pregnancy loss as defined by the Practice Committee of the American Society for Reproductive Medicine. It replaces the document, "Definitions of Infertility and Recurrent Pregnancy Loss: a Committee Opinion," last published in 2013 (Fertil Steril 2013;99:63).


Assuntos
Aborto Habitual/diagnóstico , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Infertilidade Feminina/diagnóstico , Medicina Reprodutiva/normas , Adulto , Prova Pericial , Feminino , Humanos , Gravidez , Medicina Reprodutiva/métodos , Técnicas de Reprodução Assistida/normas , Sociedades Médicas/normas , Estados Unidos
12.
Fertil Steril ; 113(4): 836-844, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32145929

RESUMO

OBJECTIVE: To describe the outcome of fertility preservation (FP) using vitrified oocytes in patients with endometriosis and to determine the impact of ovarian surgery. DESIGN: Retrospective observational study. SETTING: University-affiliated private in vitro fertilization (IVF) center. PATIENT(S): Four hundred and eighty-five women with endometriosis who underwent FP from January 2007 to July 2018. INTERVENTION(S): Vitrification of metaphase II (MII) oocytes for future use. MAIN OUTCOME MEASURE(S): Oocyte survival rate and cumulative live-birth rate (CLBR). RESULT(S): Mean age at vitrification was 35.7 ± 3.7 years. The women undergoing operations were younger than the nonsurgical patients (33.4 ± 3.6 years vs. 36.7 ± 3.7 years). The survival rate and CLBR were 83.2% and 46.4%, respectively. The number of vitrified oocytes per cycle (6.2 ± 5.8) was higher for the nonsurgical patients compared with the unilateral (5.0 ± 4.5) or bilateral (4.5 ± 4.4) surgery groups, but was comparable among the surgical patients. The effect of age (adjusted odds ratio [OR] 0.904; 95% CI, 0.858-0.952), number of oocytes (adjusted OR 1.050; 95% CI, 1.025-1.091), and survival (adjusted OR 1.011; 95% CI, 1.001-1.020) on the CLBR was confirmed. However, the effect of surgery was not observed (adjusted OR 1.142; 95% CI, 0.778-1.677). Nonetheless, the ovarian response (vitrified oocytes = 8.6 ± 6.9 vs. 5.1 ± 4.8) and CLBR (72.5% vs. 52.8%) were higher in young (≤35 years) nonsurgical patient versus the surgical patients; older women showed similar outcomes. CONCLUSION(S): Fertility preservation gives patients with endometriosis a valid treatment option to help them increase their reproductive chances. We suggest performing surgery after ovarian stimulation for FP in young women. In older women, an individualized treatment should be considered.


Assuntos
Endometriose/terapia , Preservação da Fertilidade/métodos , Recuperação de Oócitos/métodos , Oócitos/fisiologia , Vitrificação , Adulto , Endometriose/diagnóstico por imagem , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/terapia , Gravidez , Estudos Retrospectivos
13.
Fertil Steril ; 113(4): 788-796.e4, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147173

RESUMO

OBJECTIVE: To evaluate pregnancy outcomes following intrauterine insemination (IUI) in young women with low ovarian reserve compared to age-matched controls. DESIGN: Retrospective cohort SETTING: Single infertility center (July 2001-August 2018) PATIENT(S): Patients <35 years of age undergoing at least one IUI cycle with a documented serum anti-Müllerian hormone (AMH) level, patent fallopian tubes, and total motile sperm count of ≥10 million at the time of IUI. INTERVENTION(S): None MAIN OUTCOME MEASURE(S): The primary outcome was the presence of a positive serum hCG pregnancy test (>2 mIU/mL) obtained 2 weeks after the IUI procedure. Secondary outcomes included the incidence of live birth, biochemical loss, clinical miscarriage, and ectopic pregnancy. Additionally, cumulative reproductive outcomes including up to seven IUI cycles were calculated and compared between groups. RESULTS: A post-hoc power calculation demonstrated that the study sample size yielded >80% power to detect a 7% difference between groups in the primary outcome. There were 3019 patients included: 370 with AMH <1.0 ng/mL and 2649 with AMH ≥1.0 ng/mL. When adjusting for IUI treatment strategy, number of dominant follicles at time of IUI and body mass index, no difference in per-cycle or cumulative reproductive outcomes was identified between patients with low AMH (<1.0 ng/mL) and normal AMH (≥1.0 ng/mL). Analyses by treatment strategy also showed no difference in reproductive outcomes. CONCLUSION: Young patients (<35 years of age) with diminished ovarian reserve conceived as often and had per-cycle and cumulative pregnancy outcomes similar to those of age-matched controls after IUI, regardless of treatment strategy.


Assuntos
Fertilização In Vitro/tendências , Infertilidade Feminina/terapia , Inseminação Artificial/tendências , Reserva Ovariana/fisiologia , Resultado da Gravidez/epidemiologia , Adulto , Hormônio Antimülleriano/sangue , Estudos de Coortes , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico , Inseminação Artificial/métodos , Gravidez , Estudos Retrospectivos , Adulto Jovem
14.
Fertil Steril ; 113(1): 66-70, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32033726

RESUMO

This document reviews gonadotropin treatment for ovulation induction in anovulatory women and outlines the recommended pretreatment evaluation, indications, treatment regimens, and complications of gonadotropin treatment. It replaces the document with a similar name, last published in 2008 (Fertil Steril 2008;90:S7-12).


Assuntos
Comitês Consultivos/normas , Anovulação/tratamento farmacológico , Gonadotropinas/administração & dosagem , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/métodos , Anovulação/diagnóstico , Anovulação/metabolismo , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/metabolismo
15.
Fertil Steril ; 113(2): 354-363.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32106989

RESUMO

OBJECTIVE: To evaluate the effectiveness of intracytoplasmic sperm injection (ICSI) in improving fertilization rates compared to conventional in vitro fertilization rates (IVF) among women aged ≥38 years with a non-male factor diagnosis. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women aged ≥38 years with a non-male factor diagnosis receiving IVF or ICSI. INTERVENTION(S): A systematic review of databases including PubMed and Embase was performed. Study protocol was registered at the International Prospective Register of Systematic Reviews. Studies were selected if they compared fertilization rates from ICSI with those from conventional IVF among women aged ≥38 years with a non-male factor infertility diagnosis. A random effects model was used. Meta-analysis of Observational Studies in Epidemiology guidelines were applied. MAIN OUTCOME MEASURE(S): Fertilization rate. RESULTS: Seven studies including 8796 retrieved oocytes (ICSI: 4,369; IVF: 4,427) with mean female age ≥38 years met the inclusion criteria. There was no significant difference in fertilization rates between ICSI and conventional IVF (relative risk [RR] 0.99, 95% confidence interval [CI] 0.93-1.06; P = .8). Heterogeneity was observed between studies (I2 = 58.2; P < .05). Heterogeneity was significant (I2 = 57.1; P < .05) when cycles with prior fertilization failure were excluded; however, when analysis was restricted to poor responders (RR 1.01, 95% CI 0.97-1.05; P = .6), heterogeneity was no longer significant (I2 = 0.0; P = .5). CONCLUSIONS: No difference was found in fertilization rates between conventional IVF and ICSI. Further studies are needed to assess the impact of ICSI in this population, controlling for other indications such as preimplantation genetic testing.


Assuntos
Fertilidade , Fertilização In Vitro , Fertilização , Infertilidade Feminina/terapia , Injeções de Esperma Intracitoplásmicas , Adulto , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Idade Materna , Pessoa de Meia-Idade , Gravidez , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Resultado do Tratamento
16.
Fertil Steril ; 113(3): 670-678.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32061358

RESUMO

OBJECTIVE: To study the prostanoid profile of the endometria of patients with recurrent implantation failure (RIF), unexplained infertility (UIF), and recurrent miscarriages (RM), and to compare them with the endometria of healthy fertile controls. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENT(S): Fifteen patients with RIF, 18 patients with UIF, 16 patients with RM, and 23 fertile controls were recruited. INTERVENTION(S): Endometrial samples were taken during the window of implantation. After tissue homogenization and extraction, analysis with ultra-performance liquid chromatography diode array detector electrospray ionisation tandem mass spectrometry was performed. MAIN OUTCOME MEASURES: Concentrations of prostaglandin (PG) D1, PGE1, PGF1α, 6-ketoPGF1α, PGD2, PGE2, PGF2α, 15-deoxy-Δ12,14-PGJ2, PGD3, PGE3, PGF3α, thromboxane B2, 13,14-dihydro-PGE1, 13,14-dihydro-PGF1α, 13,14-dihydro-PGF2α, 13,14-dihydro-15-keto-PGE1, 13,14-dihydro-15-keto-PGE2, and 13,14-dihydro-15-keto-PGF2α were assessed. RESULT(S): Comparison of the endometria of patients with UIF and the controls showed no statistically significant differences. When the endometria of patients with RIF were compared with the controls, thromboxane B2 (TXB2) was found significantly higher (843.1 pg/mg vs. 133.5 pg/mg). When the endometria of patients with RM were compared with controls, 13,14-dihydro-15-keto PGF2α and TXB2 were found significantly higher (3907.30 pg/mg vs. 17.80 pg/mg and 858.7 pg/mg vs. 133.5 pg/mg respectively). CONCLUSION(S): We identified increased endometrial presence of TXB2 in patients with RM and RIF, and 13,14-dihydro-15-keto PGF2α in patients with RM. Although common ground is observed for RM and RIF, prostanoids, on the other hand, might make their own contribution to endometrial receptivity as important as genes and proteins. Attempts to normalize the prostaglandin profile of the endometrium via enzymatic activity can open new therapeutic options.


Assuntos
Aborto Habitual/metabolismo , Implantação do Embrião/fisiologia , Endométrio/metabolismo , Infertilidade Feminina/classificação , Infertilidade Feminina/metabolismo , Prostaglandinas/metabolismo , Aborto Habitual/patologia , Adulto , Biópsia , Estudos de Casos e Controles , Estudos de Coortes , Endométrio/química , Endométrio/patologia , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Metaboloma , Gravidez , Prostaglandinas/análise
17.
Fertil Steril ; 113(1): 187-196.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31718829

RESUMO

OBJECTIVE: To investigate whether chronic endometritis (CE) affects the immune status of peripheral blood and endometrium in patients with recurrent reproductive failure (RRF). DESIGN: Retrospective study. SETTING: Private fertility center. PATIENTS(S): A total of 524 RRF patients, including 324 women with recurrent miscarriage (RM) and 200 women with recurrent implantation failure (RIF). INTERVENTION(S): Peripheral blood and endometrium samples were collected in the midluteal phase before in vitro fertilization treatment or pregnancy. The number of peripheral T, natural killer (NK), and B cells, as well as cytotoxicity of NK cells and expression of TH1 cytokines were analyzed with the use of flow cytometry, and uterine immune cells were subjected to immunohistochemistry. MAIN OUTCOME MEASURE(S): Peripheral immune cells, cytokines, NK cytotoxicity, and endometrial immune cells were compared in RRF patients with versus without CE. RESULT(S): The proportion and function of the analyzed immune cell subsets in peripheral blood as well as the percentages of CD56+ NK cells, CD163+ M2 macrophages, and CD1a+ immature dendritic cells in the endometrium were not significantly altered between non-CE and CE patients, whereas the proportions of uterine CD68+ macrophages, CD83+ mature dendritic cells, CD8+ T cells, and Foxp3+ regulatory T cells were significantly elevated in CE patients. After antibiotic treatment, the percentage of CD68+ macrophages, CD83+ mature dendritic cells, CD8+ T cells, and Foxp3+ regulatory T cells in endometrium were significantly reduced in patients with cured CE. CONCLUSION(S): CE contributes to elevated endometrial infiltration levels of immune cells. The excessive presence of endometrial immune cells in CE patients may be involved in reduced endometrial receptivity and recurrent pregnancy failures.


Assuntos
Aborto Habitual/imunologia , Implantação do Embrião/fisiologia , Endometrite/imunologia , Endométrio/imunologia , Infertilidade Feminina/imunologia , Útero/imunologia , Aborto Habitual/sangue , Aborto Habitual/diagnóstico , Adulto , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Endometrite/sangue , Endometrite/diagnóstico , Endométrio/metabolismo , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Gravidez , Estudos Retrospectivos , Útero/metabolismo
18.
Fertil Steril ; 113(2): 383-391, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31759634

RESUMO

OBJECTIVE: To study the association between extra vitamin D from a mandatory margarine fortification program and chance of live birth among infertile women. DESIGN: Nationwide cohort study. SETTING: Not applicable. PATIENT(S): The study population consisted of 16,212 women diagnosed with infertility from June 1, 1980, to August 31, 1991. INTERVENTIONS(S): We took advantage of the mandatory vitamin D fortification program of margarine in Denmark that was abruptly stopped on May 31, 1985. The termination of the vitamin D fortification served as a cutoff point to separate the study population into various exposure groups. MAIN OUTCOME MEASURE(S): Odds ratios and 95% confidence intervals for the association between vitamin D exposure status and chance of a live birth within 12, 15, and 18 months after first infertility diagnosis. RESULT(S): Women who were diagnosed with infertility during the vitamin D-exposed period had an increased chance of a live birth compared with women diagnosed with infertility during the nonexposed period. For women diagnosed with infertility during the wash-out period, the chance of a live birth was also increased, but somewhat lower. Similar estimates were obtained with longer follow-up, in women with anovulatory infertility, and little seasonal variation was observed when calendar period of conception was applied. CONCLUSION(S): Our findings suggest that infertile women exposed to extra vitamin D from a margarine fortification program had an increased chance of live birth compared with women not exposed to extra vitamin D from fortification.


Assuntos
Fertilidade , Alimentos Fortificados , Infertilidade Feminina/fisiopatologia , Margarina , Vitamina D/administração & dosagem , Adulto , Dinamarca/epidemiologia , Suplementos Nutricionais , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Nascimento Vivo , Gravidez , Taxa de Gravidez , Recomendações Nutricionais , Sistema de Registros , Fatores de Tempo
19.
Gynecol Endocrinol ; 36(2): 104-108, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31607185

RESUMO

Endometriosis is a common disease in women of reproduction age. It causes pain and difficulty in getting pregnant. However the exact causes of infertility associated with endometriosis still remain controversial. The treatment of endometriosis consists of medical treatment of pain as well as medical and surgical treatment of infertility caused by endometriosis and assisted reproduction techniques. Since the treatment of endometriosis is often connected with diminishing ovarian reserve, the techniques for ovarian tissue preservation and oocyte and embryo freezing are used to maintain the ability for childbearing.


Assuntos
Endometriose/diagnóstico , Endometriose/terapia , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/terapia , Feminino , Preservação da Fertilidade , Procedimentos Cirúrgicos em Ginecologia , Humanos
20.
J Clin Endocrinol Metab ; 105(1)2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586179

RESUMO

CONTEXT: The relationship between reproductive and cardiometabolic aging is unclear. It is unknown if the relationship differs across different clinical populations. OBJECTIVE: To determine whether markers of ovarian reserve are associated with cardiometabolic risk in reproductive aged women with unexplained infertility (UI), polycystic ovary syndrome (PCOS), and regularly cycling women (OVA). DESIGN AND SETTING: Cross-sectional data from 8 US-based academic centers. PARTICIPANTS: Women aged 25-40 from 3 clinical populations: 870 with UI, 640 with PCOS, and 921 community-based OVA. MAIN OUTCOME MEASURES: Multivariable linear regression models were used to relate anti-mullerian hormone (AMH) and antral follicle count with cardiometabolic parameters including body mass index (BMI), waist circumference (WC), fasting glucose and insulin, homeostasis model assessment-insulin resistance (HOMA-IR), lipids, and C-reactive protein. RESULTS: In age and study site-adjusted models, AMH inversely related to BMI in the UI and OVA groups (P = 0.02 and P < 0.001). Among women with PCOS, AMH inversely related to BMI (P < 0.001), and also to WC (P < 0.001), fasting insulin (P < 0.01), HOMA-IR (P < 0.01), triglycerides (P = 0.04), and C-reactive protein (P < 0.001) and directly related to higher total (P = 0.02), low-density lipoprotein (P < 0.01), and high-density lipoprotein cholesterol (P < 0.01). In OVA, AMH also varied inversely with WC (P < 0.001), fasting insulin (P = 0.02), and HOMA-IR (P = 0.02). Adjustment for BMI eliminated associations in the OVA group but in PCOS, the relationship of AMH to total (P = 0.03) and low-density lipoprotein cholesterol (P = 0.003) remained. CONCLUSION: Associations observed between AMH and cardiometabolic indices are largely explained by BMI in women with and without PCOS. (J Clin Endocrinol Metab XX: 0-0, 2019).


Assuntos
Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Infertilidade Feminina/sangue , Síndrome do Ovário Policístico/sangue , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/epidemiologia , Prognóstico , Estados Unidos/epidemiologia
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