Asunto(s)
Bancos de Esperma/organización & administración , Criopreservación/métodos , Estudios de Evaluación como Asunto , Femenino , Humanos , Inseminación Artificial Heteróloga , Masculino , Embarazo , Preservación de Semen , Enfermedades de Transmisión Sexual/prevención & control , Donantes de TejidosRESUMEN
Six patients with symptomatic leiomyomata uteri and in whom surgical treatment was indicated received, during 3 months, intramuscular leuprolide acetate, 3,75 mg monthly, in order to 1) achieve a reduction of myomata size and 2) recover an anemic patient before surgery. In every patient, amenorrhea was induced since the second month of treatment. A significant decrease of myomas sizes was achieved. The reduction of the volume of the largest myoma in each case, varied between 51% and 77% (x = 60% +/- ES 4,3) LH and estradiol plasma levels diminished significantly and FSH did not changed in response to treatment. Side effects were well tolerated. Hot flashes were present in all patients, headaches in 2 and loss of strength in 2. Surgery was accomplished after 3 months of treatment. Myomectomy was performed in 5 cases and total hysterectomy in 1. Uterine shrinkage and the period of amenorrhea induced by Lupron-depot facilitated hysterectomy and myomectomy techniques and the recovery of one patient with a severe anemia.
Asunto(s)
Leiomioma/patología , Leuprolida/administración & dosificación , Neoplasias Uterinas/patología , Adulto , Femenino , Humanos , Inyecciones Intramusculares , Leiomioma/tratamiento farmacológico , Leuprolida/uso terapéutico , Cuidados Preoperatorios , Neoplasias Uterinas/tratamiento farmacológicoRESUMEN
Twenty-one sterile couples, between September 1989, and August 1991, were treated for ovulation stimulation of their cycles, in order to practice in them, a in vitro fertilization and tube embryo transfer (ZIFT). Two protocols of ovulation induction were used, both with leuprolide acetate (Lupron), one in the luteal phase and the other in follicular phase and since the second or the fourth day of the cycle, respectively, gonadotropins were added (Metrodine and Pergonal). Out of all the twenty-nine initiated cycles, twenty-seven were aspirated (93.1%) and twenty-four reached an embryo transfer (82.8%). Seven clinic pregnancies were obtained (29.17% per transfer) and four deliveries (16.67% per transfer). The sterility period average was 69.64 +/- 36.6 months and the patients age average was 34.1 +/- 4.38 years. The global rate of fertilization was 63.53%. With luteal phase Lupron best results were got (pregnancy rate of 38.46% per transfer) and there were not considerable difference in the number of gonadotropins ampulla employed. When embryos were transfer to the tubes and the uteri the pregnant rate was 50% per transfer, in comparison to 18.75% when transfer was made only in the tubes.
Asunto(s)
Transferencia de Embrión , Fertilización In Vitro , Transferencia Intrafalopiana del Cigoto , Chile , Transferencia de Embrión/estadística & datos numéricos , Femenino , Hormona Folículo Estimulante/uso terapéutico , Humanos , Infertilidad Femenina/terapia , Leuprolida/uso terapéutico , Menotropinas/uso terapéutico , Inducción de la Ovulación/métodos , Embarazo/estadística & datos numéricos , Transferencia Intrafalopiana del Cigoto/estadística & datos numéricosRESUMEN
Results of assisted reproductive techniques (IV, GIFT and ZIFT) have improved progressively during the last years but they are still not satisfactory specially when they are analyzed in terms of cost efficacy. During 1990, in the world literature, the following successful results were reported: pregnancy rates of 20% and delivery rates of 15% for IVF-ET, 29% and 22% for GIFT and 21% and 16% for ZIFT. In spite of the small number of cases reported in Chile, results are similar to those of USA and Europe. Results of assisted fertilization techniques have improved with the use of Gn-RH agonists and are worse in patients older than 35 years of age than in younger ones. Pregnancies rates are higher when the number of transferred ovocytes increases although transfer of more than 3 or 4 ovocytes or embryos is contraindicated because of the risks of multiple pregnancies. When more than 3 or 4 embryos are obtained those not transferred are usually cryopreserved. IVF-ET is the first choice of treatment in cases of infertility due to severe tubal damage and/or extensive and dense pelvic adhesions. In cases of infertility with normal tubes, intrauterine inseminations in 3 to 4 controlled hyperstimulated cycles are recommended before indicating an assisted fertilization procedure. The most risky complication of assisted reproduction, besides multiple pregnancy, is severe ovarian hyperstimulation syndrome (SOHS). This syndrome is prevented by not injecting HCG or by not transferring ovocytes or embryos in cases of high estradiol levels after HMG and/or FSH administration.
Asunto(s)
Fertilización In Vitro , Técnicas Reproductivas , Adulto , Femenino , Humanos , Edad Materna , Inducción de la Ovulación , Embarazo , Embarazo Múltiple , Técnicas Reproductivas/estadística & datos numéricosRESUMEN
Ten patients with polycystic ovarian disease and normoprolactinemia received bromocriptine 5 mg daily for up to 4 months. The following parameters were evaluated before treatment and at monthly intervals menstrual patterns, hirsutism score, weight, and blood pressure and LH, FSH, prolactine, unbound and total testosterone in plasma. In 5 out of 10 subjects with oligomenorhea or amenorhea normal menstruations were observed; 3 additional subjects got more frequent but not normal menstruation and 2 patients got pregnant. No changes in LH, FSH and androgens were observed. Prolactin levels fell significantly in all subjects. No clinical nor biochemical parameter predicted the improvement in menstrual patterns. Bromocriptine may have a place in the treatment of polycystic ovarian diseases with normoprolactinemia though its mechanism of action is unclear.
Asunto(s)
Bromocriptina/uso terapéutico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adolescente , Adulto , Bromocriptina/farmacología , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Trastornos de la Menstruación/etiología , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Embarazo , Complicaciones del Embarazo , Prolactina/sangre , Estudios Prospectivos , Testosterona/sangreRESUMEN
Three infertile couples were submitted to in vitro fertilization and uterine embryo transfer (IVF+ET) and 7 to in vitro fertilization and pronuclear stage tubal transfer (IVF+PROST). In order to programmed menstruation Norethisterone, 10 mg daily, were administered during the cycle preceding the one of controlled ovarian hyperstimulation. In order to inhibit endogenous production of FSH and LH, leuprolide acetate, a Gn-RH agonist, was injected subcutaneously 1 mg daily during 6 days and 0.5 mg fowardly from the luteal phase of the cycle proceeding the one of hyperstimulation until the day of HCG administration. To achieve superovulation pure FSH (Metrodine), HMG (Pergonal) and HCG (Endocorion) were used. Oocyte retrieval was performed through transvaginal puncture under ultrasonographic control. For oocyte and embryo identification and classification, spermatozoa separation and capacitation and gamete insemination and incubation procedures habitual techniques were employed. Pronuclear embryo tubal transfer was performed through a laparoscope 17 hours after insemination and embryo transfer to the uterine cavity after 48 hours. Nine of 10 patients responded to gonadotrophin hyperstimulation and were submitted to ovarian puncture. 69 oocytes (7, per patient) were obtained, 59 (81.15% of which were mature. 74.55% of the inseminated oocytes fertilized. Two patients got pregnant: one, submitted to IVF+PROST, presently has a multiple pregnancy with triplets and the second, submitted to IVF+UT, had a missed abortion at 8 weeks of pregnancy.