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Studies regarding serum Progesterone (P4) concentration and Clinical Pregnancy Rates (CPR) in fresh Embryo Transfer (ET) after Controlled Ovarian Stimulation Cycles (COS) remain inconclusive. To find a P4 cutoff point on fresh ET day associated with higher CPR, and to identify predictive factors of CPR and P4, the authors conducted a prospective cohort of 106 patients who underwent COS at a public IVF center. The luteal phase was supported with vaginal micronized progesterone (200 mg, 8/8h), beginning on oocyte retrieval day. The primary outcome was CPR beyond the 8th week of pregnancy. A ROC curve was constructed to identify the best cutoff point correlated with higher CPR. Multivariate analysis evaluated predictive variables of CPR and P4 concentration. P4 levels showed no significant differences between pregnant and non-pregnant patients (67.12 ± 31.1 ng/mL vs. 64.17 ± 61.76, p = 0.7465). The cutoff point correlated with higher CPR was P4 ≥ 28.9 ng/mL (AUC 0.5654). Women's age (OR = 0.878; 95 % CI 0.774-0.995) and top-quality embryo transfer (OR = 2.89; 95 % CI 1.148-7.316) were associated with CPR. Women's age ≥ 40 years (OR = 0.0956; 95 % CI 0.0156-0.5851), poor response to COS (OR = 0.0964; 95 % CI 0.0155-0.5966), and follicles ≥ 10 mm (OR = 1.465; 95 % CI 1.013-2.117) were associated with the cutoff point. As the ROC curve was unsatisfactory, P4 ≥ 28.9 ng/mL should not be used to infer gestational success. In fresh ET, P4 concentration may merely reflect a woman's age and individual response to COS rather than being a reliable CPR predictor.

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O lúpus eritematoso sistêmico é uma doença crônica, complexa e multifatorial que apresenta manifestações em vários órgãos. O seu acometimento ocorre 10 vezes mais no sexo feminino do que no masculino. É uma doença com uma clínica variada e com graus variados de gravidade, causando fadiga, manifestações cutâneas, como rash malar, fotossensibilidade, queda de cabelo e manifestações musculoesqueléticas, como artralgia, mialgia e atrite. Podem ocorrer flares (crises), que se caracterizam por aumento mensurável na atividade da doença. No climatério, no período da pré-menopausa, o lúpus eritematoso sistêmico ocorre com mais frequência, podendo ocorrer também na pós-menopausa. Algumas doenças são mais frequentes na fase do climatério, e a presença do lúpus pode influenciar na sua evolução, como a doença cardiovascular, osteoporose e tromboembolismo venoso. A terapia hormonal oral determina aumento do risco de tromboembolismo venoso no climatério, e na paciente com lúpus eritematoso sistêmico há aumento dos riscos de flares e de trombose. Em vista disso, a terapia hormonal é recomendada apenas para pacientes com lúpus eritematoso sistêmico estável ou inativo, sem história de síndrome antifosfolípides e com anticorpos antifosfolípides negativa, devendo-se dar preferência para a terapia estrogênica transdérmica, em menor dose e de uso contínuo. Na paciente com lúpus eritematoso sistêmico ativo ou com história de síndrome antifosfolípides ou com anticorpos antifosfolípides positiva, recomenda-se a terapia não hormonal, como os antidepressivos. (AU)

Systemic lupus erythematosus is a chronic, complex, multifactorial disease that manifests in several organs. Its involvement occurs 10 times more in females than in males. It is a disease with a varied clinic and varying degrees of severity, causing fatigue, skin manifestations such as malar rash, photosensitivity, hair loss and musculoskeletal manifestations such as arthralgia, myalgia and arthritis. Flare may occur, which are characterized by measurable increase in disease activity. In the climacteric, in the premenopausal period, systemic lupus erythematosus occurs more frequently, and may also occur in the postmenopausal period. Some diseases are more frequent in the Climacteric phase and the presence of lupus can influence its evolution, such as cardiovascular disease, osteoporosis and venous thromboembolism. Oral hormone therapy determines an increased risk of venous thromboembolism in the climacteric and in patients with systemic lupus erythematosus there is an increased risk of flares and thrombosis. In view of this, hormone therapy is only recommended for patients with stable or inactive systemic lupus erythematosus, without a history of antiphospholipid syndrome and with antiphospholipid antibodies, giving preference to transdermal estrogen therapy, at a lower dose and for continuous use. In patients with active systemic lupus erythematosus or with a history of antiphospholipid syndrome or positive antiphospholipid antibodies, non-hormonal therapy, such as antidepressants, is recommended. (AU)

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The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

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PURPOSE: To characterize and compare clinical, anthropometric and biochemical-metabolic variables in patients with polycystic ovary syndrome (PCOS), stratified according to body mass index (BMI). METHODS: A cross-sectional study conducted on 78 women aged 18 to 45 years with a clinical diagnosis of PCOS by the Rotterdam criteria. Patients were stratified according to BMI. The variables analyzed were: age, marital status, physical inactivity, menstrual irregularity, blood pressure (BP), anthropometric measurements, lipid profile, fasting glucose, and hormone measurements. To compare the variables between the different BMI values we used analysis of variance and the Kruskal-Wallis test. The level of significance was set at 5% for all tests. RESULTS: The patients had a mean age of 26.3 years, 79.5% of them were sedentary and 68% had hyperandrogenism. Waist circumference, waist/hip ratio, waist/height ratio and percentage of body fat were higher in the obese group. The markers of cardiovascular risk (CVR - fasting glucose, systolic and diastolic BP and LDL-cholesterol) were directly proportional to BMI, whereas HDL-cholesterol and SHBG were inversely related to BMI. CONCLUSION: The presence of markers of CVR factors increased proportionally to BMI, indicating that the metabolic profile of obese women with PCOS is more unfavorable than that of non-obese patients.

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OBJETIVO: Caracterizar e comparar variáveis clínicas, antropométricas e bioquímico-metabólicas de pacientes com síndrome dos ovários policísticos (SOP), estratificadas segundo o índice de massa corpórea (IMC). MÉTODOS: Estudo transversal com 78 mulheres entre 18 e 45 anos com diagnóstico de SOP, pelos Critérios de Rotterdam. As pacientes foram estratificadas segundo o IMC. As variáveis analisadas foram: idade, estado civil, sedentarismo, irregularidade menstrual, pressão arterial (PA), medidas antropométricas, perfil lipídico, glicemia em jejum e dosagens hormonais. Para comparar as variáveis analisadas entre os diferentes IMC, usou-se a Análise de Variância e o Teste de Kruskal-Wallis. O nível de significância para todos os testes foi de 5%. RESULTADOS: As pacientes apresentaram média de idade de 26,3 anos, sendo 79,5% classificadas como sedentárias e 68% com hiperandrogenismo. A circunferência da cintura, a Razão cintura/quadril, a Razão cintura/estatura e a porcentagem de gordura corporal foram maiores no grupo de obesas. A presença de marcadores de risco cardiovascular (RCV - glicemia de jejum, PA sistólica e diastólica e LDL-colesterol) foi diretamente proporcional ao IMC, enquanto que os níveis de HDL-colesterol e SHBG foram inversamente proporcionais ao IMC. CONCLUSÃO: A presença de marcadores de RCV aumentou proporcionalmente ao IMC, evidenciando que o perfil metabólico das mulheres obesas com SOP é mais desfavorável do que n não obesas.

PURPOSE: To characterize and compare clinical, anthropometric and biochemical-metabolic variables in patients with polycystic ovary syndrome (PCOS), stratified according to body mass index (BMI). METHODS: A cross-sectional study conducted on 78 women aged 18 to 45 years with a clinical diagnosis of PCOS by the Rotterdam criteria. Patients were stratified according to BMI. The variables analyzed were: age, marital status, physical inactivity, menstrual irregularity, blood pressure (BP), anthropometric measurements, lipid profile, fasting glucose, and hormone measurements. To compare the variables between the different BMI values we used analysis of variance and the Kruskal-Wallis test. The level of significance was set at 5% for all tests. RESULTS: The patients had a mean age of 26.3 years, 79.5% of them were sedentary and 68% had hyperandrogenism. Waist circumference, waist/hip ratio, waist/height ratio and percentage of body fat were higher in the obese group. The markers of cardiovascular risk (CVR - fasting glucose, systolic and diastolic BP and LDL-cholesterol) were directly proportional to BMI, whereas HDL-cholesterol and SHBG were inversely related to BMI. CONCLUSION: The presence of markers of CVR factors increased proportionally to BMI, indicating that the metabolic profile of obese women with PCOS is more unfavorable than that of non-obese patients.

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Anti-mullerian hormone (AMH) is a glycoprotein produced by granulosa cells of primary, pre-antral and small antral ovarian follicles and its clinical applicability has been recently demonstrated by several studies. Prediction of the response to ovarian stimulation for in vitro fertilization corresponds to the most frequent utilization of AMH in clinical practice, being routinely assessed in many services to identify subgroups of women susceptible to a poor response or to Ovarian Hyperstimulation Syndrome. There are great perspectives that AMH may be applicable to the individual determination of risk for iatrogenic gonadal injury in women with neoplasms who will be submitted to chemotherapy. It is also probable that AMH assessment will be included in protocols for the investigation of amenorrhea and oligomenorrhea, since AMH levels are increased in Polycystic Ovary Syndrome, reduced in premature ovarian failure and normal in other conditions such as hyperprolactinemia and hypogonadotropic hypogonadism. It is possible that AMH will be utilized in the future for the prediction of age at menopause and of reproductive prognosis, providing solid bases for pre-conceptive and contraceptive counseling.

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O hormônio antimülleriano (AMH) é uma glicoproteína produzida pelas células granulosas de folículos ovarianos primários, pré-antrais e pequenos folículos antrais e ultimamente sua aplicabilidade clínica tem sido demonstrada através de diversos estudos. A predição da resposta à estimulação ovariana para fertilização in vitro corresponde a sua mais frequente utilização na prática clínica, sendo rotineiramente realizada em muitos serviços para identificar subgrupos de mulheres suscetíveis a má resposta ou a Síndrome da Hiperestimulação Ovariana. Existem perspectivas de que o AMH possa ser aplicável na individualização do risco de injúria gonadal iatrogênica em mulheres portadoras de neoplasia que serão submetidas a quimioterapia. Também é provável que as dosagens de AMH sejam incluídas nos protocolos de investigação de amenorreias e oligomenorreias, uma vez que seus níveis encontram-se elevados em pacientes portadoras da Síndrome dos Ovários Policísticos, reduzidos em casos de falência ovariana prematura e normais em outras condições como a hiperprolactinemia e o hipogonadismo hipogonadotrófico. É possível que futuramente o AMH venha a ser utilizado na predição da idade de menopausa e do prognóstico reprodutivo da mulher, fornecendo bases sólidas ao aconselhamento conceptivo e contraceptivo.

Anti-mullerian hormone (AMH) is a glycoprotein produced by granulosa cells of primary, pre-antral and small antral ovarian follicles and its clinical applicability has been recently demonstrated by several studies. Prediction of the response to ovarian stimulation for in vitro fertilization corresponds to the most frequent utilization of AMH in clinical practice, being routinely assessed in many services to identify subgroups of women susceptible to a poor response or to Ovarian Hyperstimulation Syndrome. There are great perspectives that AMH may be applicable to the individual determination of risk for iatrogenic gonadal injury in women with neoplasms who will be submitted to chemotherapy. It is also probable that AMH assessment will be included in protocols for the investigation of amenorrhea and oligomenorrhea, since AMH levels are increased in Polycystic Ovary Syndrome, reduced in premature ovarian failure and normal in other conditions such as hyperprolactinemia and hypogonadotropic hypogonadism. It is possible that AMH will be utilized in the future for the prediction of age at menopause and of reproductive prognosis, providing solid bases for pre-conceptive and contraceptive counseling.

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OBJETIVOS: Comparar as concentrações séricas do hormônio anti- Mülleriano (AMH) no sétimo dia de estimulação ovariana em pacientes boas e más respondedoras. MÉTODOS: Foram incluídas 19 mulheres com idade ≥35 anos, ciclos menstruais regulares e que foram submetidas à estimulação ovariana para reprodução assistida. Foram excluídas mulheres portadoras de endometriose ou síndrome dos ovários policísticos ou aquelas submetidas previamente à cirurgia ovariana. Foram coletadas amostras de sangue periférico no dia basal e no sétimo dia de estimulação para dosagens de AMH, hormônio folículo estimulante (FSH) e estradiol. Os níveis de AMH foram avaliados pelo método de enzimoimunoensaio (ELISA) e os níveis de FSH e estradiol foram avaliados por imunoquimioluminescência. Ao final do ciclo, as pacientes foram classificadas como normo (obtenção de quatro ou mais oócitos durante a captação) ou más respondedoras (obtenção de menos de quatro oócitos ou cancelamento do ciclo por má resposta) e analisadas comparativamente em relação aos níveis hormonais, duração da estimulação ovariana, número de folículos recrutados, embriões produzidos e transferidos através do teste t. A associação entre os níveis de AMH e os parâmetros acima também foi avaliada pelo teste de correlação de Spearman. RESULTADOS: Não houve diferença significativa entre os grupos para os níveis de AMH, FSH e estradiol no dia basal e no sétimo dia de estimulação ovariana, sendo observada correlação significativa entre os níveis de AMH do sétimo dia e a quantidade total de FSH exógeno utilizada (p=0,02). CONCLUSÕES: Os níveis de AMH obtidos no sétimo dia do ciclo de estimulação ovariana não parecem predizer o padrão de resposta ovariana, não sendo recomendadas as suas dosagens para esta finalidade.

PURPOSE: To compare serum anti-Mullerian hormone (AMH) levels on the seventh day of ovarian stimulation between normal and poor responders. METHODS: Nineteen women aged ≥35, presenting with regular menses, submitted to ovarian stimulation for assisted reproduction were included. Women with endometriosis, polycystic ovarian syndrome or those who were previously submitted to ovarian surgery were excluded. On the basal and seventh day of ovarian stimulation, a peripheral blood sample was drawn for the determination of AMH, FSH and estradiol levels. AMH levels were assessed by ELISA and FSH, and estradiol by immunochemiluminescence. At the end of the stimulation cycle patients were classified as normal responders (if four or more oocytes were obtained during oocyte retrieval) or poor responders (if less than four oocytes were obtained during oocyte retrieval or if the cycle was cancelled due to failure of ovulation induction) and comparatively analyzed by the t-test for hormonal levels, length of ovarian stimulation, number of follicles retrieved, and number of produced and transferred embryos. The association between AMH and these parameters was also analyzed by the Spearman correlation test. RESULTS: There was no significant difference between groups for basal or the seventh day as to AMH, FSH and estradiol levels. There was a significant correlation between seventh day AMH levels and the total amount of exogenous FSH used (p=0.02). CONCLUSIONS: AMH levels on the seventh day of the ovarian stimulation cycle do not seem to predict the pattern of ovarian response and their determination is not recommended for this purpose.

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PURPOSE: To assess the prevalence of metabolic syndrome and of its defining criteria in women with polycystic ovary syndrome from the Brazilian Southeast, who were stratified according to body mass index and compared to ovulatory controls. METHODS: This was a cross-sectional study conducted on 332 women of reproductive age, who were divided into two groups: Control, consisting of 186 women with regular menstrual cycles and ovulatory symptoms and without a diagnosis of polycystic ovary syndrome or other type of chronic anovulation, and the Polycystic ovary syndrome,Group, consisting of 146 women with a diagnosis of polycystic ovary syndrome (Rotterdam Consensus ASRM/ESHRE). Each group was stratified according to the body mass index, as follows: body mass index ( < 25 ≥25 and <30, and ≥ 30 kg/m²). The frequencies of metabolic syndrome and of its defining criteria and the clinical and hormonal characteristics (follicle stimulating hormone, total testosterone, dehydroepiandrostenedione sulfate) were analyzed. RESULTS: The frequency of metabolic syndrome was six times higher in the obese Polycystic ovary syndrome Group than among control women with the same body mass index (Control with 10.5 versus Polycystic ovary syndrome with 67.9%, p<0.01); twice higher in the Polycystic ovary syndrome Group with body mass index ≥ 25 and <30 kg/m² (Control with 13.2 versus Polycystic ovary syndrome with 22.7%, p<0.01), and three times higher in the Polycystic ovary syndrome Group with body mass index <25 kg/m² (Control with 7.9 versus Polycystic ovary syndrome with 2.5%, p<0.01), compared to control women paired for the same body mass index. Regardless of the body mass index, women with polycystic ovary syndrome had a higher frequency of all the criteria defining metabolic syndrome. CONCLUSION: Women with polycystic ovary syndrome have higher frequency of metabolic syndrome and of its defining criteria regardless of the body mass index. Hyperinsulinemia and hyperandrogenism are important characteristics of the origin of these alterations, especially in obese women with polycystic ovary syndrome.

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OBJETIVO: Avaliar a prevalência de síndrome metabólica e dos seus critérios definidores em mulheres com síndrome dos ovários policísticos do Sudeste brasileiro, estratificadas de acordo com o índice de massa corpóreo e comparadas com controles ovulatórias. MÉTODOS: Estudo transversal, realizado com 332 mulheres em idade reprodutiva, que foram divididas em dois grupo: Controle, constituído por 186 mulheres com ciclos menstruais regulares, sintomas ovulatórios e sem diagnóstico de síndrome dos ovários policísticos ou outra anovulação crônica; e Síndrome dos ovários policísticos, composto por 146 mulheres com o diagnóstico de síndrome dos ovários policísticos - Consenso de Rotterdam ASRM/ESHRE. Cada um destes grupos foi estratificado de acordo com o índice de massa corpóreo (<25 ≥ 25 e < 30 e ≥ 30 kg/m²). Foram analisadas as frequências da síndrome metabólica e de seus critérios definidores, características clínicas e hormonais (hormônio folículo estimulante, testosterona total, sulfato de dehidroepiandrostenediona). RESULTADOS: A frequência da síndrome metabólica foi seis vezes maior no Grupo Síndrome dos ovários policísticos obesa em relação às mulheres controles de mesmo índice de massa corpóreo (Controle com 10,5 versus Síndrome dos ovários policísticos com 67,9 por cento, p<0,01). Essa frequência foi duas vezes mais elevada entre as mulheres do Grupo Síndrome dos ovários policísticos com índice de massa corpóreo ≥ 25 e <30 kg/m² (Controle com 13,2 versus Síndrome dos ovários policísticos com 22,7 por cento, p<0,01) e três vezes maior em portadoras de síndrome dos ovários policísticos com índice de massa corpóreo < 25 kg/m² (Controle com 7,9 versus Síndrome dos ovários policísticos com 2,5 por cento, p<0,01), em relação às mulheres controles pareadas para o mesmo índice de massa corpóreo. Independente do índice de massa corpóreo, as mulheres com síndrome dos ovários policísticos apresentaram maior frequência dos critérios definidores da síndrome metabólica. CONCLUSÃO: Mulheres com síndrome dos ovários policísticos apresentam maior frequência de síndrome metabólica e de seus critérios definidores, independentemente do índice de massa corpóreo. A hiperinsulinemia e o hiperandrogenismo são características importantes na origem destas alterações em mulheres na terceira década de vida com síndrome dos ovários policísticos.

PURPOSE: To assess the prevalence of metabolic syndrome and of its defining criteria in women with polycystic ovary syndrome from the Brazilian Southeast, who were stratified according to body mass index and compared to ovulatory controls. METHODS: This was a cross-sectional study conducted on 332 women of reproductive age, who were divided into two groups: Control, consisting of 186 women with regular menstrual cycles and ovulatory symptoms and without a diagnosis of polycystic ovary syndrome or other type of chronic anovulation, and the Polycystic ovary syndrome,Group, consisting of 146 women with a diagnosis of polycystic ovary syndrome (Rotterdam Consensus ASRM/ESHRE). Each group was stratified according to the body mass index, as follows: body mass index ( < 25 ≥25 and <30, and ≥ 30 kg/m²). The frequencies of metabolic syndrome and of its defining criteria and the clinical and hormonal characteristics (follicle stimulating hormone, total testosterone, dehydroepiandrostenedione sulfate) were analyzed. RESULTS: The frequency of metabolic syndrome was six times higher in the obese Polycystic ovary syndrome Group than among control women with the same body mass index (Control with 10.5 versus Polycystic ovary syndrome with 67.9 percent, p<0.01); twice higher in the Polycystic ovary syndrome Group with body mass index ≥ 25 and <30 kg/m² (Control with 13.2 versus Polycystic ovary syndrome with 22.7 percent, p<0.01), and three times higher in the Polycystic ovary syndrome Group with body mass index <25 kg/m² (Control with 7.9 versus Polycystic ovary syndrome with 2.5 percent, p<0.01), compared to control women paired for the same body mass index. Regardless of the body mass index, women with polycystic ovary syndrome had a higher frequency of all the criteria defining metabolic syndrome. CONCLUSION: Women with polycystic ovary syndrome have higher frequency of metabolic syndrome and of its defining criteria regardless of the body mass index. Hyperinsulinemia and hyperandrogenism are important characteristics of the origin of these alterations, especially in obese women with polycystic ovary syndrome.

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PURPOSE: To compare serum anti-Mullerian hormone (AMH) levels on the seventh day of ovarian stimulation between normal and poor responders. METHODS: Nineteen women aged ≥35, presenting with regular menses, submitted to ovarian stimulation for assisted reproduction were included. Women with endometriosis, polycystic ovarian syndrome or those who were previously submitted to ovarian surgery were excluded. On the basal and seventh day of ovarian stimulation, a peripheral blood sample was drawn for the determination of AMH, FSH and estradiol levels. AMH levels were assessed by ELISA and FSH, and estradiol by immunochemiluminescence. At the end of the stimulation cycle patients were classified as normal responders (if four or more oocytes were obtained during oocyte retrieval) or poor responders (if less than four oocytes were obtained during oocyte retrieval or if the cycle was cancelled due to failure of ovulation induction) and comparatively analyzed by the t-test for hormonal levels, length of ovarian stimulation, number of follicles retrieved, and number of produced and transferred embryos. The association between AMH and these parameters was also analyzed by the Spearman correlation test. RESULTS: There was no significant difference between groups for basal or the seventh day as to AMH, FSH and estradiol levels. There was a significant correlation between seventh day AMH levels and the total amount of exogenous FSH used (p=0.02). CONCLUSIONS: AMH levels on the seventh day of the ovarian stimulation cycle do not seem to predict the pattern of ovarian response and their determination is not recommended for this purpose.

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PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5% (p < 0.05) in all analyses. RESULTS: vitamin E and glutathione levels were lower in the serum of infertile women with moderate/severe endometriosis (21.7 ± 6.0 mMol/L and 159.6 ± 77.2 nMol/g protein, respectively) compared to women with minimal and mild endometriosis (28.3 ± 14.4 mMol/L and 199.6 ± 56.1 nMol/g protein, respectively). Total hydroxyperoxide levels were significantly higher in the endometriosis group (8.9 ± 1.8 µMol/g protein) than in the Control Group (8.0 ± 2 µMol/g protein) and among patients with stage III/IV disease (9.7 ± 2.3 µMol/g protein) compared to patients with stage I/II disease (8.2 ± 1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. CONCLUSIONS: we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.

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OBJETIVO: comparar marcadores séricos de estresse oxidativo entre pacientes inférteis com e sem endometriose e avaliar a associação destes marcadores com o estadiamento da doença. MÉTODOS: estudo prospectivo envolvendo a inclusão consecutiva de 112 pacientes inférteis, não-obesas, com idade inferior a 39 anos, divididas em dois grupos: Endometriose (n=48, sendo 26 com endometriose mínima e leve - Estádio I/II e 22 com endometriose moderada e grave - Estádio III/IV) e Controle (n=64, com fator tubário e/ou masculino de infertilidade). Durante a fase folicular precoce do ciclo menstrual, foram coletadas amostras sanguíneas para análise dos níveis séricos de malondialdeído, glutationa e níveis totais de hidroperóxidos, por espectrofotometria e vitamina E, por cromatografia líquida de alto desempenho. Os resultados obtidos foram comparados da seguinte forma: os grupos endometriose versus controle; endometriose estádio I/II e controle, endometriose estádio III/IV e controle e entre os dois subgrupos de endometriose. Em todas as análises, foi considerado o nível de significância de 5 por cento (p<0,05). RESULTADOS: os níveis de vitamina E e glutationa foram mais baixos no soro de mulheres inférteis com endometriose moderada/grave (21,7±6,0 µMol/L e 159,6±77,2 nMol/g proteína, respectivamente) quando comparadas a mulheres com endometriose mínima e leve (28,3±14,4 µMol/L e 199,6±56,1 nMol/g proteína, respectivamente). Os níveis totais de hidroperóxidos foram significativamente mais elevados no grupo endometriose (8,9±1,8 µMol/g proteína) em relação ao Grupo Controle (8,0±2 µMol/g proteína) e nas portadoras de doença III/IV (9,7±2,3 µMol/g proteína) em relação à I/II (8,2±1,0 µMol/g proteína). Não se observou diferença significativa nos níveis séricos de malondialdeído entre os diversos grupos. CONCLUSÕES: foi evidenciada uma associação positiva entre infertilidade relacionada à endometriose, avanço do estadiamento da doença e aumento dos níveis séricos de hidroperóxidos, sugerindo aumento da produção de espécies reativas em portadoras de endometriose. Esses dados, associados à redução dos níveis séricos de vitamina E e glutationa, sugerem a ocorrência de estresse oxidativo sistêmico em portadoras de infertilidade associada à endometriose.

PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5 percent (p<0.05) in all analyses. RESULTS: vitamin E and glutathione levels were lower in the serum of infertile women with moderate/severe endometriosis (21.7±6.0 mMol/L and 159.6±77.2 nMol/g protein, respectively) compared to women with minimal and mild endometriosis (28.3±14.4 mMol/L and 199.6±56.1 nMol/g protein, respectively). Total hydroxyperoxide levels were significantly higher in the endometriosis group (8.9±1.8 µMol/g protein) than in the Control Group (8.0±2 µMol/g protein) and among patients with stage III/IV disease (9.7±2.3 µMol/g protein) compared to patients with stage I/II disease (8.2±1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. CONCLUSIONS: we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.

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A transferência de embriões realizada em procedimentos de reprodução assistida é um passo essencial para o sucesso do tratamento. Dentre aproximadamente 80% das mulheres que realizam um ciclo de reprodução assistida são submetidas à transferência de embriões, somente entre 5 e 40% ficam grávidas. Desta maneira, pode-se notar que o processo de implantação embrionária é uma etapa muito importante e a transferência de embriões é o último procedimento que pode ser realizado para tentar melhorar este processo. Originalmente, a transferência era realizada às cegas e baseava-se somente na habilidade do operador em sentir o posicionamento adequado do cateter. Entretanto, com a realização da transferência embrionária guiada por ultrassonografia, mostrou-se que frequentemente o senso subjetivo do posicionamento adequado falhava. Além disso, atualmente, sabe-se que o contato do cateter com o fundo uterino pode provocar sangramento e estimular contrações uterinas que podem expelir os embriões da cavidade endometrial, piorando a taxa de implantação e aumentando o número de gestações ectópicas. Foi demonstrado, ainda, que quanto mais distante a ponta do cateter for posicionada do fundo uterino, maiores serão as chances de gravidez. Por facilitar o procedimento, ser uma técnica relativamente barata e fácil e por não acrescentar riscos, a ultrassonografia foi imediatamente aceita para ser utilizada durante a transferência de embriões; entretanto, ainda não há consenso sobre sua superioridade em aumentar a taxa de implantação. Transferências atraumáticas e mais fáceis tendem a apresentar maiores taxas de sucesso, porém ainda se faz necessária a realização de estudos controlados que possam trazer resultados mais definitivos sobre a importância do uso da ultrassonografia durante a transferência de embriões.

The embryo transfer performed during assisted reproductive procedures is a crucial step to a successful treatment. From the 80% of women who initiate an assisted reproduction cycle and are submitted to embryo transfer, only 5 to 40% will become pregnant. Therefore, the embryo implantation process is a very important phase and is the last procedure to be performed aiming at improving this process. Originally, the transfer was ?blind? and based only on the performer ability in setting the catheter in the adequate position. However, ultrasonography has shown that this subjective sense frequently fails. Additionally, it is currently known that the catheter contact with the uterine fundus may cause bleeding and stimulate uterine contractions that may expel the embryos from endometrial cavity, worsening implantation rates and raising the number of ectopic pregnancies. It was also demonstrated that when the catheter was placed more distant from uterine fundus higher were the pregnancy rates. Ultrasonography was immediately accepted to be used during embryo transfer, since it makes the procedure easier, it is relatively cheap and do not increase any risks; however, there is still no consensus whether the use of ultrasonography increase the implantation rate. Atraumatic and easier transfers are prone to had higher success rates, however more controlled trials are still necessary to unveil more definite results with regard to the importance of ultrasonography during embryo transfer.

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Objetivo: avaliar mudanças no padrão da densidade mamográfica (DM) de mulheres na pós-menopausa após um ano de utilização de terapia estroprogestativa de baixa dose com uso intermitente de norgestimato (NMG). Material e métodos: estudo prospectivo com 40 pacientes menopausadas; divididas em dois grupos: tratado (n igual 20) usando 1 mg de 17-beta-estradiol diariamente e 90 mcg de NMG, de forma intermitente (trés dias utilizando e três dias não); e controle (placebo). As mamografias foram realizadas antes e depois de 12 meses do início do tratamento. A DM foi aferida por dois métodos qualitativos (classificação de Wolfe e do Breast Imaging Reporting and Data System - BIRADS) por dois observadores. A variabilidade interobservador foi considerada baixa nas duas classificações, assim como houve ótima concordância entre os dois métodos. Os testes t de Student e McNemar foram utilizados para, respectivamente comparação de médias e variáveis binomiais. Resultados: ambos os grupos foram considerados homogêneos quanto à idade, índice de massa corpórea, idade da menarca e da menopausa, duração do menacme, tempo de menopausa e paridade. Após 12 meses de seguimento, uma paciente (5%) do Grupo de Estudo e duas pacientes do Grupo Controle (10%) apresentaram aumento da densidade mamáría de acordo com a classificação de Wolfe, sem diferença significativa entre os grupos. Observou-se aumento da mamária, de acordo com a classificação de BIRADS em duas pacientes (10%) do Grupo de Estudo e três pacientes do Grupo Controte (15%), sem diferença significativa entre os grupos. Conclusões: a terapia hormonal de baixa dose com uso intermitente de NMG não foi associada com aumento de densidade mamária após 12 meses de tratamento, ratificando literatura corrente

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Objetivo: investigar o efeito do pré-maturação com o inibidor de maturação nuclear, butirolactona-I (BLI), sobre o fuso meiótico e distribuição cromossômica de oócitos bovinos, o que poderia melhorar a qualidade oocitária e embriogênese. Material e métodos: oócitos imaturos, obtidos de vacas abatidas em matadouro (n igual 610) foram submetidos nos grupos: Controle (n igual 208) submetidos à maturação in vitro (MI) em TCM 199 por 24 horas; BLI -18 horas (n igual 208) submetidos à pré-maturação com 100 miuM de BLI por 24 horas e posterior indução da MI em TCM 199, por 18 horas; BLI 24 horas (n igual 195), pré-maturados com 100 miuM de BLI, por 24 horas, seguida por 24 horas de MIV em TCM 199. Em seguida, os oócitos foram fixados, corados por imunofluorescência e avaliados. Resultados: o bloqueio meiótico ocorreu em 88,8% dos oócitos pré-maturados. As taxas de maturaçao foram similares (79,3; 73,5 e 82%, respectivamente, para Controle, BLI 18 horas e BLI 24 horas). Observou-se 82,5% oócitos normais em metáfase II no Controle e 80 e 82% nos grupos BLI 18 horas e BLI 24 horas, respectivamente. A incidência de anomalias meióticas não diferiu (17,5; 20 e 18%, respectivamente, para Controle, BLI 18 horas e BLI 24 horas) - p menor que 0,05, teste do x2. Conclusões: a BLI bloqueia a meiose sem promover danos ao fuso meiótico e distribuição cromossômica oocitária após a MIV

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Introdução: O climatério, período de transição entre a fase reprodutiva e não-reprodutiva, ocasiona mudanças biopsicossociais nas mulheres que o vivenciam. A associação entre a maior prevalência de depressão nesse período é, no entanto, ainda controversa. O objetivo deste estudo foi avaliar a prevalência de depressão em mulheres climatéricas atendidas em um hospital universitário numa cidade da Região Nordeste do Brasil e identificar fatores associados. Método: Foi realizado um estudo prospectivo e analítico de 70 mulheres climatéricas. O diagnóstico de depressão foi dado segundo critérios diagnósticos da Classificação Internacional de Doenças em um período de seguimento mínimo de 3 meses. Foram investigadas as seguintes variáveis: escolaridade, situação conjugal, renda pessoal, gravidade da depressão segundo escala de Hamilton, presença e intensidade de sintomas climatéricos, menopausa (natural ou cirúrgica), dependência econômica do parceiro, antecedentes familiares de depressão, história prévia de depressão pós-parto, episódios depressivos e transtorno disfórico pré-menstrual, alterações da função sexual e visão positiva ou negativa da menopausa. Resultados: Um percentual de 34,3 por cento das pacientes apresentou depressão, sendo 70,8 por cento destas na categoria leve da escala de Hamilton. Não houve associação estatisticamente significante entre variáveis socioeconômicas, diminuição da libido e antecedentes familiares de depressão com a presença de depressão. Houve associação entre a presença de depressão e pacientes com sintomas vasomotores (p = 0,03), insônia (p < 0,001), menopausa (p = 0,05), com histórico de depressão pós-parto (p = 0,04) e transtorno disfórico pré-menstrual (p = 0,05) e visão negativa da menopausa (p = 0,001). Conclusões: Foi encontrada uma alta prevalência de depressão nas pacientes estudadas. Múltiplos fatores (impacto da menopausa, antecedentes psiquiátricos e visão pessoal sobre a menopausa) foram associados ...

Introduction: The climacteric is a transition period between reproductive and non-reproductive ages that leads to biopsychossocial changes in women who experience it. However, association between a larger prevalence of depression in this period is still controversial. The objective of this study was to assess the prevalence of depression in climacteric women receiving care at a university hospital in a Northeastern Brazilian municipality and to identify associated factors. Method: A prospective, analytic study of 70 climacteric women was performed. Diagnosis of depression was performed according to the International Classification of Diseases diagnostic criteria through a minimal 3-month follow-up period. The following variables were investigated: educational level, marital status, personal income, Hamilton Depression Rating Scale, presence and intensity of climacteric symptoms, menopause (natural or surgical), financial dependence on the partner, family history of depression, previous history of postpartum depression, depressive episodes, premenstrual dysphoric disorder, sexual function disorders, and positive or negative attitudes toward menopause. Results: A percentage of 34.3 percent of the patients had depression, and 70.8 percent were classified as mild intensity according to Hamilton scale. There was no statistically significant association between socioeconomic variables, reduced sex drive and family history of depression and presence of depression. Conversely, presence of vasomotor symptoms (p = 0.03), insomnia (p < 0.001), menopause (p = 0.05), history of postpartum depression (p = 0.04), premenstrual dysphoric disorder (p = 0.05), and negative attitude toward menopause (p = 0.001) were statistically associated with depression. Conclusions: There was a high prevalence of depression in assessed women. Multiple factors (impact of menopause, psychiatric history and personal impressions of menopause) are responsible for its occurrence.

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OBJETIVO: avaliar o fuso meiótico e a distribuição cromossômica de oócitos maturados in vitro, obtidos de ciclos estimulados de mulheres inférteis com endometriose e fatores masculino e/ou tubário de infertilidade (Grupo Controle), comparando as taxas de maturação in vitro (MIV) entre os dois grupos avaliados. MÉTODOS: quatorze pacientes com endometriose e oito com fator tubário ou masculino, submetidas à estimulação ovariana para injeção intracitoplasmática de espermatozóide, foram selecionadas, prospectiva e consecutivamente, e constituíram os Grupos de Estudo e Controle, respectivamente. Oócitos imaturos (46 e 22, respectivamente, dos Grupos Endometriose e Controle) foram submetidos à MIV. Oócitos que apresentaram a extrusão do primeiro corpúsculo polar foram fixados e corados para avaliação dos microtúbulos e cromatina por técnica de imunofluorescência. A análise estatística foi realizada utilizando o teste exato de Fisher, com significância estatística quando p<0,05. RESULTADOS: não se observou diferença significativa nas taxas de MIV entre os dois grupos avaliados (45,6 e 54,5 por cento, respectivamente, nos Grupos Endometriose e Controle). A organização cromossômica e do fuso meiótico foi observada em 18 e 11 oócitos dos Grupos Endometriose e Controle, respectivamente. No Grupo Endometriose, oito oócitos (44,4 por cento) se apresentavam como metáfase II (MII) normais, três (16,7 por cento) MII anormais, cinco (27,8 por cento) estavam em estágio de telófase I e dois (11,1 por cento) sofreram ativação partenogenética. No Grupo Controle, cinco oócitos (45,4 por cento) se apresentavam como MII normais, três (27,3 por cento) MII anormais, um (9,1 por cento) estava em estágio de telófase I e dois (18,2 por cento) sofreram ativação partenogenética. Não se observou diferença significativa na porcentagem de anomalias meióticas entre os oócitos em MII dos dois grupos avaliados. CONCLUSÕES: os dados do presente estudo não demonstraram diferença...

PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro mature oocytes from stimulated cycles of infertile women with endometriosis, and with male and/or tubal infertility factors (Control Group), comparing the rates of in vitro maturation (IVM) between the two groups evaluated. METHODS: fourteen patients with endometriosis and eight with male and/or tubal infertility factors, submitted to ovarian stimulation for intracytoplasmatic sperm injection have been prospectively and consecutively selected, and formed a Study and Control Group, respectively. Immature oocytes (46 and 22, respectively, from the Endometriosis and Control Groups) were submitted to IVM. Oocytes presenting extrusion of the first polar corpuscle were fixed and stained for microtubules and chromatin evaluation through immunofluorescence technique. Statistical analysis has been done by the Fisher's exact test, with statistical significance at p<0.05. RESULTS: there was no significant difference in the IVM rates between the two groups evaluated (45.6 and 54.5 percent for the Endometriosis and Control Groups, respectively). The chromosome and meiotic spindle organization was observed in 18 and 11 oocytes from the Endometriosis and Control Groups, respectively. In the Endometriosis Group, eight oocytes (44.4 percent) presented themselves as normal metaphase II (MII), three (16.7 percent) as abnormal MII, five (27.8 percent) were in telophase stage I and two (11.1 percent) underwent parthenogenetic activation. In the Control Group, five oocytes (45.4 percent) presented themselves as normal MII, three (27.3 percent) as abnormal MII, one (9.1 percent) was in telophase stage I and two (18.2 percent) underwent parthenogenetic activation. There was no significant difference in meiotic anomaly rate between the oocytes in MII from both groups. CONCLUSIONS: the present study data did not show significant differences in the IVM or in the meiotic anomalies...

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OBJETIVO: avaliar o fuso meiótico e a distribuição cromossômica de oócitos maturados in vitro, obtidos de ciclos estimulados de mulheres inférteis com síndrome dos ovários policísticos (SOP) e fatores masculino e/ou tubário de infertilidade (Grupo Controle) e comparar as taxas de maturação in vitro (MIV) entre os dois grupos avaliados. MÉTODOS: cinco pacientes inférteis com SOP e oito pacientes controles, submetidas à estimulação ovariana para injeção intracitoplasmática de espermatozóide, foram selecionadas prospectiva e consecutivamente, e constituíram os grupos de estudo e Controle, respectivamente. Oócitos imaturos captados após estimulação ovariana para a realização de injeção intracitoplasmática de espermatozóide (21 e 29, respectivamente, nos Grupos SOP e Controle) foram submetidos à MIV. Apenas os oócitos que apresentaram a extrusão do primeiro corpúsculo polar após a MIV foram fixados e submetidos à imunocoloração e análise por microscopia de fluorescência para avaliação morfológica do fuso e da distribuição cromossômica. A análise estatística foi realizada utilizando o teste exato de Fisher, com significância estatística quando p<0,05. RESULTADOS: as taxas de MIV foram similares entre os dois grupos (47,6 e 44,8 por cento, respectivamente, nos Grupos SOP e Controle). Seis dos dez oócitos (60 por cento) analisados do grupo de estudo e quatro dos 12 oócitos (33,3 por cento) analisados do Grupo Controle apresentaram anomalias meióticas, caracterizadas por anomalias do fuso e/ou distribuição cromossômica oocitária, sem diferença significativa entre os grupos. CONCLUSÕES: os dados do presente estudo não demonstraram diferença significativa nas taxas de MIV e nas proporções de anomalias meióticas entre os oócitos maturados in vitro, provenientes de ciclos estimulados de pacientes com SOP, quando comparados aos controles.

PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro matured oocytes obtained from stimulated cycles of infertile women with polycystic ovary syndrome (PCOS) and with male factor and/or tubal infertility (Control Group) and compare in vitro maturation (IVM) rates between the groups analyzed. METHODS: five infertile patients with PCOS and eight controls, submitted to stimulated cycles for intracytoplasmic sperm injection, were selected prospectively and consecutively, and respectively assigned to the study group and the Control Group. Immature oocytes (21 and 29, respectively, from PCOS and Control Group) were submitted to IVM. After IVM, oocytes with first polar body extruded were fixed and submitted to immunostaining and fluorescence microscopy for morphological evaluation of the spindle and of chromosome distribution. Statistical analysis was performed by the Fisher test with significance, when p<0.05. RESULTS: IVM rates were similar between groups (47.6 e 44.8 percent, respectively, for PCOS and Control Group). Six of the ten oocytes (60 percent) from the study group and four of the 12 oocytes (33.3 percent) from the Control Group presented meiotic anomalies of the spindle and/or anomalous chromosome distribution, without statistical difference between groups. CONCLUSIONS: data from the present study did not demonstrate significant difference neither in IVM rates nor in the proportions of meiotic anomalies between in vitro matured oocytes obtained from stimulated cycles from PCOS patients and control ones.

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OBJECTIVE: To assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, who were submitted to ovulation induction for assisted reproduction procedures. DESIGN: Prospective study. SETTING: Assisted conception unit, university hospital. PATIENT(S): Infertile patients 20 to 38 years of age were selected prospectively and consecutively and were divided into the endometriosis group (17 patients with pelvic endometriosis) and the control group (19 patients with previous tubal ligation or male factor and without endometriosis). INTERVENTION(S): Peripheral blood samples were collected on D1 (before the beginning of the use of gonadotropins), D2 (day of hCG administration), and D3 (day of oocyte retrieval). On D3, follicular-fluid samples free from blood contamination also were collected and stored. MAIN OUTCOME MEASURE(S): Lipid peroxidation was assessed by malondialdehyde quantification by spectrophotometry, and measurement of vitamin E was performed by HLPC. RESULT(S): On D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the control group. On D2, LP levels were significantly higher in the endometriosis group compared with in the control group, and vitamin E levels continued to be significantly higher in the control group. On D3, there was no significant difference in serum and follicular-fluid levels of LP and vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas malondialdehyde levels were significantly lower in follicular fluid than in serum only in the control group. CONCLUSION(S): Before the beginning of ovulation induction, a significant decrease in vitamin E was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After ovulation induction with exogenous gonadotropins, the group of patients with endometriosis not only presented increased lipid peroxidation but also maintained lower vitamin E levels than the control group, a fact that hypothetically could compromise oocyte quality in endometriotic patients. However, on the day of oocyte retrieval, both serum LP potential and vitamin E levels were found to be similar in the two groups.

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