RESUMEN
A infertilidade afeta milhões de mulheres em todo o mundo, sendo quase metade dos casos decorrentes de fatores tuboperitoneal, destacando- se a endometriose como doença de grande prevalência. Este artigo apresenta um caso clínico bem-sucedido de tratamento homeopático para infertilidade, resultando em rápida desobstrução da tuba uterina e gravidez em um ciclo ovulatório. O tratamento incluiu simillium (Nux vomica) e constitucional (Calcarea phosphorica), além de medicamento episódico (Eupion, Borax veneta e Endometrium).
Infertility affects millions of women worldwide, with nearly half of the cases attributed to tuboperitoneal factors, with endometriosis being a prevalent condition. This article presents a successful clinical case of homeopathic treatment for infertility, resulting in rapid unblocking of the fallopian tube and pregnancy in one ovulatory cycle. The treatment included simillium (Nux vomica) and constitutional (Calcarea phosphorica) remedies, along with episodic medication (Eupion, Borax veneta and Endometrium).
Asunto(s)
Humanos , Femenino , Adulto , Terapéutica Homeopática , Infertilidad Femenina/tratamiento farmacológico , Calcarea Phosphorica/uso terapéutico , Eupionum/uso terapéutico , Materia Medica , Strychnos nux-vomica , EndometrioRESUMEN
OBJECTIVES: To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN: Systematic review. DATA SOURCES: We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS: Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION: The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER: CRD42022273145.
Asunto(s)
Infertilidad Femenina , Tuberculosis , Femenino , Embarazo , Humanos , Resultado del Embarazo , Mortinato , Infertilidad Femenina/tratamiento farmacológico , Infertilidad Femenina/etiología , Antituberculosos/uso terapéutico , GenitalesRESUMEN
OBJECTIVE: The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET. METHODS: This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups. RESULTS: Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups. CONCLUSIONS: Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.
Asunto(s)
Infertilidad Femenina , Tamoxifeno , Femenino , Embarazo , Humanos , Índice de Embarazo , Tamoxifeno/efectos adversos , Infertilidad Femenina/tratamiento farmacológico , Transferencia de Embrión/métodos , Hormona Folículo Estimulante , Estudios Retrospectivos , CriopreservaciónRESUMEN
Female infertility is a significant health issue worldwide with a rising incidence. Anti-cancer therapy is one of the most important reasons for increasing infertility. Although anti-cancer treatment increases the rate of survival, it decreases the quality of life through its side effects. The most substantial side effects are sexual dysfunction and infertility. Breast cancer is the most common cancer. The first-line treatment of breast cancer is chemotherapy by alkylating agents like cyclophosphamide, which leads to infertility. For instance, persistent chemotherapy-induced amenorrhea among breast cancer patients could affect almost half of the patients that undergo such therapy. However, some agents or therapeutic methods can ameliorate these intoxicating effects. Chemotherapy plus gonadotropin-releasing hormone agonist, in breast cancer patients, can not only improve overall survival but also reduce ovarian toxicity. Age plays an essential role in chemotherapy-induced amenorrhea. Chemotherapy at a younger age can reduce the risk of infertility. Gynecological cancers including uterine and ovarian cancer, which have high mortality rates, are the most related cancers to infertility. Surgery is the primary treatment of gynecological cancers. Studies demonstrated that fertility-sparing surgery is a better option than radical surgery. In addition, neoadjuvant chemotherapy is mostly a better option than primary cytoreductive surgery in terms of survival and fertility. Immune checkpoint inhibitors (ICIs) have recently played a major role in treating various cancer types. However, ICIs are associated with hypophysitis, which affects ovaries and can lead to infertility. There are some options for ovarian preservation such as embryo cryopreservation, oocyte cryopreservation, ovarian transposition, ovarian tissue cryopreservation, and ovarian suppression by GnRH agonists. Anti-müllerian hormone level can be utilized to monitor the ovarian reserve. Moreover, to avoid fertility loss, approaches such as using transplantation of human placenta mesenchymal stem cells, administrating anti-inflammatory agents and hormone therapy are under investigation.
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Antineoplásicos , Neoplasias de la Mama , Preservación de la Fertilidad , Infertilidad Femenina , Embarazo , Humanos , Femenino , Infertilidad Femenina/terapia , Infertilidad Femenina/tratamiento farmacológico , Antineoplásicos/efectos adversos , Amenorrea/inducido químicamente , Amenorrea/complicaciones , Amenorrea/tratamiento farmacológico , Calidad de Vida , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/complicacionesRESUMEN
Clomiphene citrate (CC) and letrozole are ovulatory stimulants that, despite high ovulation rates, achieve low pregnancy rates. This study aimed to investigate the in vitro effects of CC and letrozole, alone or in combination with estradiol, on apoptosis in human cumulus cells. We performed a controlled prospective study using primary cumulus cell cultures from patients undergoing in vitro fertilization (n=22). Alpha-inhibin immunocytochemistry was used to assess cell culture purity and morphology. Cell viability was evaluated by MTT assay, cell cycle status by flow cytometry, and Caspase-3, Bax and SOD-2, and S26 gene expression by qPCR. Cells were treated for 24 hours in 5 conditioned media: CC, CC + estradiol, letrozole, letrozole + estradiol and control. None of the treatments affected cell viability, but letrozole reduced the mean percentage of cells in the S phase compared to control (24.79 versus 21.70, p=0.0014). Clomiphene treatment increased mRNA expression of Bax (4 fold) and SOD-2 (2 fold), which was reversed by co-treatment with estradiol. SOD-2 expression increased in cells treated with letrozole compared to control (4 fold), which was also reversed by estradiol. These findings suggest that clomiphene citrate and letrozole do not significantly affect the viability of human cumulus cells. Still, the expression of genes involved in apoptosis was modulated by these drugs alone and in association with estradiol, suggesting that CC and letrozole may have direct effects on cumulus cells beyond their known mechanisms of action.
Asunto(s)
Fármacos para la Fertilidad Femenina , Infertilidad Femenina , Ciclo Celular , Clomifeno/farmacología , Clomifeno/uso terapéutico , Células del Cúmulo , Estradiol/farmacología , Estradiol/uso terapéutico , Femenino , Fármacos para la Fertilidad Femenina/farmacología , Fármacos para la Fertilidad Femenina/uso terapéutico , Humanos , Infertilidad Femenina/tratamiento farmacológico , Letrozol/farmacología , Nitrilos/farmacología , Nitrilos/uso terapéutico , Inducción de la Ovulación , Embarazo , Índice de Embarazo , Estudios Prospectivos , Superóxido Dismutasa , Triazoles/farmacología , Triazoles/uso terapéutico , Proteína X Asociada a bcl-2RESUMEN
OBJECTIVE: To compare the number of oocytes obtained in the follicular puncture of high- responder oocyte donors, submitted to ovarian stimulation for in vitro fertilization (IVF) in two different protocols: Friendly and Conventional. METHODS: There were one hundred-and-eight infertile egg-donor women, aged between 21 and 35 years, undergoing IVF in this retrospective cohort study. The women were divided into two groups: 1) Friendly protocol: controlled ovarian stimulation (COS) with corifollitropin alpha, clomiphene citrate and dydrogesterone without daily rFSH (n=52) and 2) In the Conventional protocol, we had COS with menotropin daily and ganirelix (n=66). We assessed age, body mass index, time and cause of infertility, antral follicle count (AFC) by three-dimensional ultrasound, number of visits to the clinic, COS duration, number of follicles ≥14mm on the trigger day, early ovulation frequency, number of mature oocytes, number of cryopreserved embryos, clinical pregnancy rate, frequency of OHSS. RESULTS: The ovulatory factor was higher in women in the Conventional protocol (p=0.03), and the tubal factor (p=0.02) was higher in the Friendly protocol group. The number of visits to the clinic was lower among women in the Friendly protocol (p=0.04). The number of mature eggs, the clinical pregnancy rate and the frequency of OHSS were similar between the groups. The number of frozen embryos was higher in the Friendly group (p=0.02). The regression model demonstrated that the ovulatory factor, the tubal factor and the number of visits to the clinic were not predictors of the number of mature oocytes. Only AFC was an independent predictor of the number of meiosis II oocytes (p<0.01). CONCLUSIONS: The Friendly protocol seems to be as safe and effective as the Conventional protocol for infertile high-responder oocyte donors, resulting in a similar number of mature oocytes and OHSS incidence.
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Didrogesterona , Infertilidad Femenina , Clomifeno/farmacología , Clomifeno/uso terapéutico , Femenino , Fertilización In Vitro/métodos , Humanos , Infertilidad Femenina/tratamiento farmacológico , Oocitos , Inducción de la Ovulación/métodos , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: The present study aims to assess the success of controlled ovarian stimulation in intrauterine insemination cycles stimulated by recombinant-FSH and Clomiphene citrate for either mono- or bi-follicular development. METHODS: We assessed 870 infertile patients treated with controlled ovarian stimulation in intrauterine insemination cycles at a university-based infertility clinic between January 2012 and December 2017. We compared the cycles stimulated by clomiphene citrate and recombinant-FSH in two set-ups; mono- and bi-follicular development. The main outcome measure was the clinical pregnancy rate per cycle. RESULTS: The demographic and cycle parameters were similar between the groups, except for endometrial thickness on the day of hCG administration, which was higher in the recombinant-FSH group than the clomiphene citrate group. The overall clinical pregnancy rates in clomiphene citrate and recombinant-FSH groups were 9.8% and 10.3%, respectively (p=0.940). Regarding the entire cohort, clinical pregnancy was significantly higher in cases of bi-follicular development when compared to mono-follicular development (16.8% vs. 10.2%, respectively; p=0.009). CONCLUSIONS: Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development. Clomiphene citrate and recombinant-FSH cycles resulted in comparable rates of bi-follicular development, which significantly increases clinical pregnancy rate. Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development.
Asunto(s)
Fármacos para la Fertilidad Femenina , Infertilidad Femenina , Clomifeno/uso terapéutico , Femenino , Fármacos para la Fertilidad Femenina/uso terapéutico , Hormona Folículo Estimulante , Humanos , Infertilidad Femenina/tratamiento farmacológico , Infertilidad Femenina/epidemiología , Inseminación , Inducción de la Ovulación , EmbarazoRESUMEN
Objetivo: Abordar atualizações referentes à terapia medicamentosa para indução da ovulação nas mulheres diagnosticadas com síndrome dos ovários policísticos (SOP). Métodos: Revisão de literatura por meio de levantamento bibliográfico do período de 1975 a 2021, nas bases eletrônicas PubMed, SciELO e MedLine, complementado pela Diretriz Internacional Baseada em Evidências para a Avaliação e Manejo da SOP de 2018 e pelo manual da Febrasgo para SOP. Sete descritores que atendessem à finalidade da pesquisa foram utilizados. Resultados: A literatura aponta atualmente algumas drogas como opção na terapêutica para a indução de ovulação, como metformina, letrozol e citrato de clomifeno, evidenciando que o uso de letrozol isolado e em associação com a metformina apresentaram melhores taxas de ovulação, 71,5% e 75,4%, respectivamente. Conclusão: O uso do letrozol isolado ou combinado com a metformina apresentou os melhores resultados nas taxas de gravidez e ovulação, todavia o tratamento para indução ovulatória deve ser individualizado.(AU)
Objective: To address updates of medicinal therapy for ovulation induction in women diagnosed with polycystic ovary syndrome (PCOS). Methods: Reviewing Literature through a bibliographic survey from 1975 to 2021, on the electronic databases PubMed, SciELO and MedLine, complemented by the International Evidence-Based Guideline for the Evaluation and Management of PCOS 2018 and the Febrasgo guide for PCOS. Seven descriptors that matched to the purpose of the research were applied. Results: Some drugs are currently indicated in the literature as an option for ovulation induction therapy, such as: metformin, letrozole and clomiphene citrate, showing that the use of letrozole alone and in association with metformin had better ovulation rates, 71.5% and 75.4%, respectively. Conclusion: The use of letrozole alone or combined with metformin showed the best results in pregnancy and ovulation rates, however, treatment for ovulatory induction must be individualized.(AU)
Asunto(s)
Humanos , Femenino , Inducción de la Ovulación/métodos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Infertilidad Femenina/tratamiento farmacológico , Bases de Datos Bibliográficas , Clomifeno/uso terapéutico , Letrozol/uso terapéutico , Metformina/uso terapéuticoAsunto(s)
Humanos , Femenino , Endometriosis/cirugía , Endometriosis/fisiopatología , Endometriosis/tratamiento farmacológico , Endometriosis/terapia , Endometriosis/diagnóstico por imagen , Progestinas/uso terapéutico , Terapias Complementarias , Protocolos Clínicos , Combinación de Medicamentos , Estrógenos/uso terapéutico , Fármacos para la Fertilidad Femenina/uso terapéutico , Infertilidad Femenina/cirugía , Infertilidad Femenina/tratamiento farmacológicoRESUMEN
PURPOSE: To investigate the impact of a 3-month course of intracortical injections of autologous platelet-rich plasma (PRP) upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART). METHODS: Prospective controlled, non-randomized comparative study conducted in a private fertility clinic, in Venezuela. Women with abnormal ovarian reserve markers (FSH, AMH and AFC) who declined oocyte donation were allocated to one of the following groups according to patient choice: monthly intracortical ovarian PRP injections for three cycles, or no intervention. Primary outcomes were the change in FSH, AMH and AFC pre- and post-treatment. Secondary outcomes included the number of oocytes collected and fertilized, biochemical/clinical pregnancy rates and miscarriage and live birth rates. RESULTS: Eighty-three women were included, of which 46 received PRP treatment and 37 underwent no intervention. Overall median age was 41 years (IQR 39-44). There were no demographic differences between the study groups. At the 3-month follow-up, women treated with PRP experienced a significant improvement in FSH, AMH and AFC, whereas there was no change in the control group. Furthermore, overall rates of biochemical (26.1% versus 5.4%, P = 0.02) and clinical pregnancy (23.9% versus 5.4%, P = 0.03) were higher in the PRP group, while there was no difference in the rates of first trimester miscarriage and live birth between groups. CONCLUSION: PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART, although further evidence is required to evaluate the impact of PRP on pregnancy outcomes.
Asunto(s)
Infertilidad Femenina/tratamiento farmacológico , Reserva Ovárica/efectos de los fármacos , Plasma Rico en Plaquetas , Técnicas Reproductivas Asistidas , Adulto , Tasa de Natalidad , Transfusión de Sangre Autóloga , Femenino , Fertilización In Vitro , Hormona Folículo Estimulante , Humanos , Infertilidad Femenina/sangre , Infertilidad Femenina/epidemiología , Inducción de la Ovulación , Embarazo , Resultado del Embarazo , Venezuela/epidemiologíaRESUMEN
A síndrome dos ovários policísticos (SOP) é responsável por cerca de 80% dos casos de infertilidade anovulatória. Não há na literatura evidências suficientes para a definição do tratamento ideal da infertilidade na SOP, mas repete-se que deve ser iniciado por mudanças no estilo de vida, e frequentemente envolve a indução farmacológica da ovulação e, em casos selecionados, as técnicas de reprodução assistida e o drilling ovariano laparoscópico. Este texto pretende reunir informações atuais sobre o manejo da infertilidade em mulheres com SOP e, dessa forma, permitir ao ginecologista a escolha da melhor abordagem, de forma Individualizada e baseada nas melhores evidências disponíveis.(AU)
Asunto(s)
Humanos , Femenino , Síndrome del Ovario Poliquístico/complicaciones , Infertilidad Femenina/tratamiento farmacológico , Anovulación/tratamiento farmacológico , Inducción de la Ovulación/métodos , Acetilcisteína/uso terapéutico , Vitamina D/uso terapéutico , Inseminación Artificial , Corticoesteroides/uso terapéutico , Moduladores de los Receptores de Estrógeno/uso terapéutico , Técnicas Reproductivas Asistidas , Tiazolidinedionas/uso terapéutico , Inhibidores de la Aromatasa/uso terapéutico , Técnicas de Maduración In Vitro de los Oocitos , Gonadotropinas/uso terapéutico , Infertilidad Femenina/cirugía , Inositol/uso terapéutico , Metformina/uso terapéuticoRESUMEN
Some of the common side effects of the injectable gonadotropins, used during fertility treatments, are pain at the injection site, skin erythema, muscle pain, and rarely vasovagal reflex. These side effects cause inconvenience and lower patient's tolerance for fertility treatments.The purpose of this study was to evaluate the safety and efficacy of an FDA-approved dose of nasal human menopausal gonadotropins (Menopur) in women undergoing fertility treatment. Healthy regularly cycling reproductive-aged women (n=4) with infertility were enrolled. A total of 75 IU of each Menopur bottle was dissolved and placed in a nasal pump spray device (concentration of 3.75 IU/spray). Each participant was allowed to inhale a total of 2 sprays daily after which ovarian response during the follicular phase was monitored by transvaginal ultrasound and serum hormone measurement. None of the participants reported any side effects at the nasal site of drug administration. No known common side effects of the Menopur drug were reported by any of the participants. Despite adequate absorption of the nasal Menopur, as confirmed by elevated serum FSH levels while taking the nasal medication, 3 out of 4 participants did not show any follicular growth until cycle day 13 while only one participant who agreed to continue taking the medication until cycle day 20 developed one dominant follicle and had elevated serum estradiol levels. This FDA approved case series suggest that nasal route of Menopur administration seems to be safe at a very low doses and it constitutes a potential novel approach for ovarian stimulation.
Asunto(s)
Administración Intranasal , Fármacos para la Fertilidad Femenina , Fertilización In Vitro , Menotropinas , Adulto , Femenino , Fármacos para la Fertilidad Femenina/administración & dosificación , Fármacos para la Fertilidad Femenina/efectos adversos , Fármacos para la Fertilidad Femenina/farmacología , Fármacos para la Fertilidad Femenina/uso terapéutico , Humanos , Infertilidad Femenina/tratamiento farmacológico , Menotropinas/administración & dosificación , Menotropinas/efectos adversos , Menotropinas/farmacología , Menotropinas/uso terapéutico , Rociadores Nasales , Folículo Ovárico/efectos de los fármacos , Inducción de la OvulaciónRESUMEN
A síndrome dos ovários policísticos (SOP) é uma complexa desordem endócrina caracterizada por distúrbios reprodutivos e metabólicos, sendo a causa mais comum de infertilidade ovariana. A prevalência é entre 5 e 10% em mulheres na idade reprodutiva. Sua etiologia permanece obscura e a variabilidade de expressão fenotípica continua a desafiar os cuidados clínicos e pesquisas sobre a heterogeneidade desta condição. Embora mudanças no estilo de vida bem como o uso de citrato de clomifeno (CC) serem o padrão para o tratamento da infertilidade nestas pacientes, o uso da metformina tem se destacado como tratamento para esse fim ante sua eficácia. Partindo deste princípio, esta revisão tem por objetivo avaliar a eficácia da metformina em melhorar as taxas de ovulação e de gravidez clínica, seja como tratamento isolado ou combinado ao CC.(AU)
The polycystic ovary syndrome (PCOS) is a complex endocrine disease characterized by reproductive and metabolic disorders. It is the most common cause of ovarian infertility and has a prevalence of 5-10% in reproductive age women. Its etiology remains unclear, and the variability of phenotypic expression continues to yield clinical care and research on the heterogeneity of this challenging condition. Although life style changes as well as the use of clomiphene citrate (CC) is a standard treatment of infertility in these patients; metformin use has been highlighted in recent years as a treatment for this purpose due its effectiveness in treating PCOS. Based on this principle, this review aims to assess the metformin effectiveness in improving ovulation rates and clinical pregnancy, either alone or in combination as the CC treatment.(AU)
Asunto(s)
Humanos , Femenino , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Clomifeno/uso terapéutico , Ácido Cítrico , Infertilidad Femenina/tratamiento farmacológico , Metformina/uso terapéutico , Ovulación , Bases de Datos BibliográficasRESUMEN
OBJETIVO: Develar la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida. MÉTODO: Se trata de un estudio de caso con diseño fenomenológico. Se seleccionó una mujer portadora del fenómeno en estudio que accedió a compartir su experiencia mediante una entrevista en profundidad. La pregunta que guió el estudio fue ¿Cómo se muestra la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida? El análisis fue realizado de acuerdo a Streubert(1). Los pasos a seguir fueron: obtener la descripción de la participante, separar los supuestos del investigador ("bracketing"), leer la transcripción hecha "verbatim", revelar esencias, comprender las unidades de significado, desarrollar las descripciones, devolver a la participante para su validación, revisar literatura relevante, y compartir los resultados con la comunidad de enfermería. RESULTADOS: Destacan unidades de significado sobre sufrimiento por el tratamiento y las múltiples pérdidas que enfrenta la entrevistada. Se contraponen felicidad y angustia durante el embarazo, y esperanza al lograr el objetivo de vida planteado con su pareja. Surge el fortalecimiento del vínculo con su esposo, y finalmente miedo ante el verse enfrentada a la maternidad. Como conclusión se permite comprender que las mujeres enfrentadas a TRA tienen necesidades de cuidado únicas, por lo que el rol de enfermería es fundamental, sobre todo de acompañamiento. Se debe seguir estudiando este fenómeno en mujeres chilenas, e involucrar la perspectiva del padre.
OBJECTIVE: Reveal the lived experience of pregnancy and delivery of a woman diagnosed with infertility who did conceive through assisted reproduction techniques. METHOD: This is a case study with a qualitative health research design of phenomenology. The participant was a woman who is carrier of the phenomenon understudy and that agreedto share her experience through an in-depth interview. The study base question was ¿How the pregnancy and delivery process lived experience of a woman with infertility diagnosis who did conceive through assisted reproduction techniques is shown?. According to Streubert(1),the phenomenological analysis process steps are: to obtain the participant's description, to separate the assumptions of the researcher ("bracketing"), to read the transcript made "verbatim". Reveal essences, understand the units of meaning, develop the descriptions, return the participant for validation, review relevant literature, and share the results with the nursing community. RESULTS: There are significant units of meaning of suffering due to the treatment and the multiple losses that the interviewee faces. There is also the contrast between happiness and anguish in the course of pregnancy, and hope for having achieved the goal of life raised with her partner. The strengthening of the bond with her husband arises, and finally fears of being confronted with motherhood. As a conclusion, it is possible to understand that women facing ART have unique care needs, so the role of nursing is fundamental, especially accompaniment. This phenomenon should continue to be studied in Chilean women, and involve the perspective of the father.
Asunto(s)
Humanos , Femenino , Técnicas Reproductivas Asistidas , Parto/psicología , Infertilidad Femenina/psicología , Infertilidad Femenina/tratamiento farmacológico , Enfermeras y Enfermeros , Embarazo/psicología , Entrevistas como Asunto , AbortoRESUMEN
BACKGROUND: To compare the expression of receptivity markers in epithelial and stromal cells in the endometrium of ovulatory women and infertile with hypothalamic pituitary dysfunction (HPD), untreated or treated with clomiphene citrate (CC), or with recombinant follicle stimulating hormone (rFSH). METHODS: Twelve control ovulatory and 32 anovulatory women, 22 of whom received ovulation induction with CC (n = 12) or rFSH (n = 10). Endometrial biopsies were obtained during the mid-secretory phase. Hormonal secretion was measured by chemiluminescence immunoassay, endometrial dating and cellular expression and distribution of receptivity proteins were evaluated by quantitative immunohistochemistry. RESULTS: CC or rFSH treatments, modified the expression of epithelial receptivity markers, such as Glycodelin A, beta-catenin, CD166/ALCAM and IGF-1R, but not in stromal markers. Also, a change in their cell distribution was observed. CONCLUSIONS: Treatment of infertile women with HPD modified the expression and distribution of receptivity markers in the mid-secretory phase of the endometrium in epithelial but not stromal cells, which can help to explain changes in the receptivity of the endometrium during treatments and suggest an important role of these cells in the receptivity window.
Asunto(s)
Biomarcadores/metabolismo , Implantación del Embrión/efectos de los fármacos , Endometrio/patología , Células Epiteliales/patología , Fármacos para la Fertilidad Femenina/uso terapéutico , Infertilidad Femenina/patología , Inducción de la Ovulación/métodos , Adulto , Estudios de Casos y Controles , Clomifeno/uso terapéutico , Endometrio/efectos de los fármacos , Endometrio/metabolismo , Células Epiteliales/metabolismo , Femenino , Hormona Folículo Estimulante/uso terapéutico , Estudios de Seguimiento , Humanos , Hipotálamo/efectos de los fármacos , Hipotálamo/metabolismo , Hipotálamo/patología , Técnicas para Inmunoenzimas , Infertilidad Femenina/tratamiento farmacológico , Infertilidad Femenina/metabolismo , Hipófisis/efectos de los fármacos , Hipófisis/metabolismo , Hipófisis/patología , Proteínas Recombinantes/metabolismoRESUMEN
OBJECTIVE: To investigate the follicular size at spontaneous rupture on pregnancy rate in patients with polycystic ovary syndrome (PCOS) undergoing clomiphene citrate (CC) ovulation. DESIGN: Cross-sectional study. PATIENTS AND METHODS: One hundred and four women with ovulatory cycles after use of CC followed by ultrasound to determine the follicle size at the time of rupture, which was subsequently correlated with the occurrence of pregnancy or not in coit cycles. RESULTS: In the group of follicular rupture at a mean diameter ≤25 mm (n = 54), pregnancy rate was 35.1% and when follicular rupture occurred at a mean diameter >25 mm (n = 50), it was 34% (p > 0.05). When different diameters at follicular rupture were randomly correlated with the pregnancy rate, there was no significant difference. CONCLUSION: Our data suggest that the occurrence of pregnancy after ovulation induction with CC in women with PCOS is not associated with follicle size at the time of rupture.
Asunto(s)
Infertilidad Femenina/tratamiento farmacológico , Folículo Ovárico/diagnóstico por imagen , Ovulación , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adulto , Clomifeno/uso terapéutico , Estudios Transversales , Antagonistas de Estrógenos/uso terapéutico , Femenino , Humanos , Infertilidad Femenina/etiología , Tamaño de los Órganos , Folículo Ovárico/crecimiento & desarrollo , Inducción de la Ovulación , Síndrome del Ovario Poliquístico/complicaciones , Embarazo , Índice de Embarazo , UltrasonografíaRESUMEN
BACKGROUND: There is conflicting data regarding exogenous sex hormones [oral contraceptives (OC) and hormonal replacement therapy (HRT)] exposure and different outcomes on Systemic Lupus Erythematosus (SLE). The aim of this work is to determine, through a systematic review and meta-analysis the risks associated with estrogen use for women with SLE as well as the association of estrogen with developing SLE. METHODS AND FINDINGS: MEDLINE, EMBASE, SciElo, BIREME and the Cochrane library (1982 to July 2012), were databases from which were selected and reviewed (PRISMA guidelines) randomized controlled trials, cross-sectional, case-control and prospective or retrospective nonrandomized, comparative studies without language restrictions. Those were evaluated by two investigators who extracted information on study characteristics, outcomes of interest, risk of bias and summarized strength of evidence. A total of 6,879 articles were identified; 20 full-text articles were included. Thirty-two meta-analyses were developed. A significant association between HRT exposure (Random model) and an increased risk of developing SLE was found (Rate Ratio: 1.96; 95%-CI: 1.51-2.56; P-value<0.001). One of eleven meta-analyses evaluating the risk for SLE associated with OC exposure had a marginally significant result. There were no associations between HRT or OC exposure and specific outcomes of SLE. It was not always possible to Meta-analyze all the available data. There was a wide heterogeneity of SLE outcome measurements and estrogen therapy administration. CONCLUSION: An association between HRT exposure and SLE causality was observed. No association was found when analyzing the risk for SLE among OC users, however since women with high disease activity/Thromboses or antiphospholipid-antibodies were excluded from most of the studies, caution should be exercised in interpreting the present results. To identify risk factors that predispose healthy individuals to the development of SLE who are planning to start HRT or OC is suggested.
Asunto(s)
Anticonceptivos Orales/administración & dosificación , Terapia de Reemplazo de Estrógeno , Estrógenos/uso terapéutico , Infertilidad Femenina/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Infertilidad Femenina/patología , Lupus Eritematoso Sistémico/inducido químicamente , Lupus Eritematoso Sistémico/patología , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Estudios Retrospectivos , RiesgoRESUMEN
Hyperprolactinemia, frequently caused by a prolactinoma, is an important cause of infertility among young women. Dopamine agonists (DA) are the treatment of choice. Although cabergoline (CAB) is currently considered the gold standard DA, bromocriptine (BRC) remains the drug of choice for women desiring pregnancy, as it was proven to be safe in more than 6,000 pregnancies. The purpose of this review is to perform a critical evaluation of CAB safety in pregnancy, as it is used by most patients harboring prolactinomas. Although the number of CAB-induced pregnancies (about 800) is still reduced as compared with those under BRC treatment, data in the literature do not point to increase risk of preterm delivery or fetal malformations, comparing to pregnancies induced by BRC and those in the general population. Moreover, CAB use throughout pregnancy was reported in about ten cases, without evidence of any harm to fetal development. Therefore, even though BRC still remains the recommended DA drug for pregnancy induction or use during pregnancy in women with prolactinomas, increasing evidences point to the safety of CAB for this purpose.