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OBJECTIVE: To verify the medical effects of metformin in polycystic ovary syndrome patients. METHOD: 10 women with polycystic ovary syndrome were including in this prospective clinical study. After a baseline workup, body mass index (BMI) and waist hip index (WHI) were measured; the diagnosis of polycystic ovary syndrome was achieved with the following basal clinical studies: vaginal ultrasound, prolactin, thyroid profile, glucose, insulin, testosterone, androstenedione, 17-hidroxiprogesterone, dehydroepiandrosterone sulfate and cortisol. The diagnosis of insulin resistance was achieved by model homeostasis assessment and the relationship glucose/insulin. Patients were given 500 mg of metformin twice a day for 3 months and reevaluated. RESULTS: 8 of 10 patients who completed treatment, showed significant improvement in insulin resistance (only by homeostasis model); there were decrease in hirsutism (mean of 35.07%), without improve menstrual cyclicity, although we achieved at least one menstruation in 42.85% in cases with amenorrhea after 2 or 3 months of treatment. There were no changes in weight, BMI neither in ovarian volume and number of follicles. CONCLUSION: A 3 month course of metformin therapy in women with polycystic ovary syndrome did not improve menstrual cyclicity, albeit significant decrease in insulin, insulin resistance and hirsutism was obtained.

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Recurrent pregnancy loss is secondary to multiple illnesses. An important cause sometimes undiagnosed is the antiphospholipid syndrome, an autoimmune disease with various clinical alterations (miscarriage, hypertensive disorders, preterm delivery, vascular thrombosis, intrauterine retard growth, death intrauterine, abruption placentae). There are major and minor clinical criteria and precise indications that guide the physician to its recognition. Antibodies related with the syndrome are anticardiolipin and lupic anticoagulant, but other phospholipids seems to be implicated on this pathology and its participation on trombotic events is even unknown. Opportune diagnosis is of vital importance for fetomaternal morbidity and mortality. The repercussions are important during gestational stage, but effects c an persist o r even appear during the puerperium, predisposing t o trombotic events. The antiphospholipid s yndrome th at accompanies gestation, requires of efficient valuation and a special treatment, with a narrow prenatal surveillance. The best therapy for reproductive future which has less undesirable effects, is with heparin and acetylsalicylic acid administration; prednisone (steroids) is used in cases of active illness. The current knowledge about this disease makes possible that a pregnancy at term can be achieved with the least as possible number of complications.

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Polycystic ovarian disease (PCOD) is the most important endocrine abnormality that affects women in reproductive age. It is characterized by chronic anovulation and hyperandrogenemia probably secondary to insulin resistance. Hence insulin sensitizers agents had been used in PCOD. Metformin is a biguanide used in the treatment of PCOD via decrease of hepatic gluconeogenesis and insulinemia; improvement peripheral glucose utilization, oxidative glucose metabolism, nonoxidative glucose metabolism and intracellular glucose transport. Such effects, when this drug is administered alone during 3 to 6 months, increase sex hormone binding globulin (SHBG), reduce free androgens index and hirsutism, decrease insulin resistance, and regulate menses in 60 to 70% of cases. Thiazolidinodiones are drugs that decrease insulin resistance in the liver with hepatic glucose production. Their mechanism of action is through the peroxisome proliferator-activated receptors gamma (PPAR-gamma), that help to decrease plasmatic concentrations of free fatty acids, pre and postprandial glucose, insulin, triglycerides, increased HDL cholesterol and decreased LDL, menses return to normality, with improvement of ovulation and decreased hirsutism. It seems that by modulation and attenuation of insulin resistance, hypoglucemic agents such as metfomin and thiazolidinodiones can be used effectively to treat anovulation, infertility and hyperandrogenemia.

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BACKGROUND: Most of the information in medical literature report diverse factors of breast cancer, which are related to the reproductive life of the woman. It is mentioned that menarche before the 12 years elevates the relative risk of this disease, in comparison with its appearance after the 13 years. OBJECTIVE: To determine if early menarche is a risk factor associated to breast cancer. MATERIAL AND METHODS: This retrospective, observational and descriptive study included 162 women with breast cancer from a 3 years period (2002-2004), in the Juarez Hospital of Mexico. In addition other well known risk factors for breast cancer were evaluated. The statistical analysis was made with the software program SPSS; the descriptive analysis was made by means of summary of statistics, histograms, box and bar charts. RESULTS: Early menarche doesn't have correlation with breast cancer nor with the appearance of the disease in early ages; it was present in the 12.3% (n = 20) of the patients; the menarche initiated between 12 and 13 years in 64.4% (n = 104.3) of the cases. The average age at the time of the diagnosis of breast cancer in the early menarche group was of 55 years and for the group in general of 47.6 years. The factor that seems to be related to breast cancer is overweight and obesity with 54.26 and 17.11% respectively, with an average body mass index of 27.7 kg/m2. CONCLUSIONS: There was not a correlation between early menarche as risk factor for breast cancer neither between the reproductive risk factors considered habitual and increased risk of breast cancer. Overweight and obesity seem to be related to the appearance of the disease, reason why it is required to investigate this with different random control groups in the country. We propose to study other factors that may be implicated in the genesis of breast cancer such as inflammatory factors, similar insulin growth factors and hyperinsulinism.

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INTRODUCTION: The high-resolution ultrasound has taken to discover small ovary cysts in postmenopausal asymptomatic women who in another situation would not been detected; these cysts frequently disappear spontaneously and rarely develop cancer; however, they are treated aggressively. OBJECTIVE: To know the prevalence, evolution and treatment of ovary simple cysts in the postmenopausal women in our department, since in our country there are not studies that had analyzed these data. MATERIAL AND METHODS: We made a retrospective and descriptive study in the Service of Biology of the Human Reproduction of the Hospital Juarez de Mexico, in a four-year period (2000-2003) that included 1,010 postmenopausal women. The statistical analysis was made using the SPSS software program with which we obtained descriptive measurements in localization, dispersion and by a graphic analysis. RESULTS: We found a simple cysts prevalence of 8.2% (n = 83); the average of age at the diagnosis time was 50.76 years with a standard deviation of 5.55; the cysts diameter was between 0.614 to 12,883 cm with a mean and standard deviation of 2.542 and 1.91 cm respectively; in 27.71% of the cases (n = 23), the cysts disappear spontaneously in the follow up of 3 to 36 month (mean of 14.1). Surgery was indicated in 16.46% (n = 13), by increase in the size of the cyst in 9 patients (11.64%) and by changes in morphology from simple to complex in 4 (4.82%). Tumor like markers were made only to 37 patients (44.57%), which were in normal ranks; no carcinoma was found in this group. CONCLUSIONS: The prevalence of ovary simple cysts was similar to the reported in literature. Risk of cancer of these cysts is extremely low when a suitable evaluation is made, a reason why the conservative treatment is suggested when these are simple cysts lesser than 5cm with Ca-125 levels within normal ranks. We recommend a follow up every 3-6 months by Doppler color ultrasound and tumor like markers for five years.

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BACKGROUND: Infertility is defined as the failure to conceive after a year of sexual life without a method of birth control. Most studies indicate that 15% of all couples will experience primary or secondary infertility in some moment of their reproductive life. OBJECTIVE: To gain knowledge of general characteristics from patients with infertility in our environment (social, clinical, diagnostic and therapeutic) that attended the Reproductive Biology Department of Hospital Juárez de Mexico. PATIENTS AND METHODS: A descriptive, observational, situational, and retrospective indagatory study was performed on 116 infertile patients, seen in the outpatient clinic, from January through December 1999. All had entered our protocol of infertility and selected treatment. RESULTS: The altered ovarian endocrine factor was the most frequent (82.7%), followed by cervical factor (80%), masculine factor (38%) and tuboperitoneal factor (29%). In most cases the cause was multifactorial. The percentage of successful pregnancies (31.88%) was similar to that reported in the literature. CONCLUSIONS: The most common factors that influence infertility resembled those exhibited by specialized clinics of affluent countries with similar pregnancy rates.

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Polycystic ovary is characterized by anovulation, hyperandrogenemia and insulin resistance. Hyperinsulinemia is known to be associated with an increase in cardiovascular risk and the development of diabetes mellitus. The finding that insulin resistance has important implications in the pathogenesis of polycystic ovarian disease has elicit the concept of a therapeutic approach of insulin-sensitizing drugs. Last decade multiple clinical trials about these drugs and upon genesis of polycystic ovary were designed; hence there is now sufficient evidence in the literature to support its clinical use. The management of polycystic ovary includes short-term objectives, such as treatment of infertility and control of androgen excess, as well as long-term considerations, such as prevention of endometrial cancer and management of dysmetabolic syndrome with its associated risk for developing type 2 diabetes and cardiovascular disease. The present review justifies the rationale use of insulin-sensitizing drugs in order to treat both short-term and long-term issues regarding polycystic ovarian disease.

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It is presented the case of a female with heterosexual precocious puberty associated to hyperandrogenism and virilization due to arrhenoblastoma, who became pregnant after surgery. Clinical study: a 14-year-old female initiated at age 6 years with premature pubarche and telarche. By age 11, the patient only had one menstrual period along with virilization. Physical exam disclosed: facial acne, cricoid enlargement, breast Tanner II, pubic hair Tanner III, clitoromegaly of 4.5 cm and hypotrophy of labia majora. Ferriman and Gallwey: 12. Basal quantitation of circulating testosterone: 1.25 ng/mL (normal: 0.2 to 0.8 ng/mL), androstenedione 13.9 ng/mL (normal: 0.5 to 2.4 ng/mL). A pelvic ultrasonographic study showed: uterus of 66 x 25 x 30 mm, right ovary of 50 x 50 mm, hyperechoic with echolucid and nodular areas (vol. 65.3 cc). Left ovary was of 30 x 30 mm with echolucid areas of 2.0 mm (vol. 5.1 cc). Cariotype: 46XX. Surgical right oophorectomy was performed containing an ovoid tumor of 4 x 3 x 3 cm. Histologic analysis revealed a Sertoli Leydig (Type II, Mayoer) cell tumor. The patient resumed menses and became pregnant at age 20 (22 week obitus). In the last assessment, performed 6 years after surgery, the patient resumed normal menses, Ferriman and Gallwey 5, Tanner V and regression of clitoromegaly to 3.0 cm. In this case, surgery provided remission of hyperandrogenism, normal menstrual cycles and fertility restoration.

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AIMS: Prolactinomas represent a 60% of pituitary tumors with various symptoms, hormonal and reproductive abnormalities. OBJECTIVE: Assessment of epidemiology of prolactinomas in our hospital. PATIENTS AND METHOD: We reviewed the clinical charts of 32 patients seen throughout 1991-2001. RESULTS: Twenty seven patients (84%) were females and 5 (16%) males. Average age was 30.3 +/- SD 11.3 years with a range of 6 to 58 years. Menstrual irregularities was the most frequent finding in patients with micro and macroadenoma; infertility was seen in 4 (33%) patients with pituitary microadenoma and 2 (10%) with macroadenoma. A patient with macroadenoma had delayed puberty and another with microadenoma isosexual precocious puberty. All cases showed hyperprolactinemia (microadenomas x 94.5 +/- SD 96.4 ng/mL; macroadenomas x 108.8 +/- SD 79.4 ng/mL). Hypothyroidism and hypogonadal hypogonadotropism were the most common associated diagnoses before an after treatment for both groups. Radiologic presence of microadenoma was observed in 12 (38%) patients and in 20 (26%) with macroadenoma. Bitemporal hemianopsia was the most common finding during visual field evaluation (28% microadenoma, 44% macroadenoma). Pharmacologic treatment with bromocriptine (2.5 - 7.5 mg) prevailed and showed a major impact upon symptoms improvement and significant decrease of serum prolactin levels (p < 0.05). Only five patients out of 20 who underwent surgery developed transient diabetes insipidus. Tumor relapse was observed in 10 (63%) of 16 patients with macroadenomas that required surgery. CONCLUSIONS: In our study prolactinomas prevailed among females in reproductive age with a higher incidence of macroadenomas. The most common alterations related to reproductive tract were menstrual irregularities, galactorrhea, infertility, hyperprolactinemia, hypogonadism and hypothyroidism. Abnormalities of puberty were also seen. Treatment with dopaminergic agonists (bromocriptine) was highly effective to decrease prolactin circulating levels.

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UNLABELLED: The association between menstrual cylce abnormalities and insulin resistance in parallel to further clinical and biochemical findings was evaluated. MATERIAL AND METHODS: An observational, retrospective and transversal study was performed through a review of clinical charts of female patients (18-35 years old) who had undergone pelvic ultrasound seen at our service of Reproductive Biology in the Hospital Juárez de México form January 1996 to May 2002 with the following: abnormal menses (n = 22), eumenorrhea as controls (n = 28); without uterine or ovarian tumors, endocrine dysfunction or contraceptives. We assessed body mass index (BMI), waist hip ratio (WHR), ferriman, acanthosis nigricans, lipid profile and hormonal quantification. We used the HOMA procedure (18) for diagnosis of insulin resistance (glucose nmol/L (18 x insulin mIU/mL (22.5 = > 5.2. RESULTS: The abnormal menstrual patterns found were opsomenorrhea (n = 34), opsoamenorrhea (n = 17), amenorrhea (n = 23), proiomenorrhea (n = 3) and eumenorrheic controls (n = 28). There were no differences in age and BMI. The frequency of insulin resistance found was: controls (35.7%), opsomenorrhea (41.17%), opsoamenorrhea (41.17%), amenorrhea (78.26%) and proiomenorrhea (0%); the group with amenorrhea was statistically significant (P < 0.002). Those patients with obesity found in our groups exhibited a highest percentage of insulin resistance (Pearson: 0.37). WHR bigger 0.85 prevailed among patients with insulin resistance (P = 0.039). The finding of polycystic ovary was prevalent among opsoamenorrhea and opsomenorrhea patients with insulin resistance. Hyperandrogenemia and polycystic ovaries showed a higher percentage in amenorrheic and opsomenorrheic females with insulin resistance (P = < 0.05). COMMENTS: The amenorrhea symptom had a significant correlation with insulin resistance and it was also associated to obesity, acanthosis and polycystic ovaries.

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UNLABELLED: We determined the incidence, epidemiology and type of erectile dysfunction, as well as risk factors related to erectile function in a Mexican population. MATERIAL AND METHODS: 452 surveys were applied in direct form, integrated by 38 questions with open answers, dichotomics and multiple to men that accompanied patients that requested medical attention in our clinic and to workers of the Hospital Juárez de México, 18 years or older, with active sexual life, that knew how to read and write. An analytic, prospective and transverse study was performed; obtaining the incidence, frequency of presentation (organic or psychological) of erectile dysfunction and the odds ratio of risk factors observed in the study. RESULTS: The incidence of erectile dysfunction in the population studied was 26.1% (n = 118); 67.8% probably of psychological origin and 32.2% organic. People younger than 40 years had a presentation of 16.45% and for those > or = 40 years was 50%. Factors of risk: > or = 40 years (OR-5.08), Obesity (OR-1.48), started sexual life > or = 18 years (OR-1.17), intercourse < or = 3/week (OR-1.86), monthly income < or = 250 american dollars (OR-4.81), married (OR-1.39) and in free union (OR-1.44), peasants (OR-3.43), bricklayers (OR-2.96), merchants (OR-2.34), using antihypertensive medication (OR-6.18), with diabetes mellitus (OR-4.09). DISCUSSION: The incidence of erectile dysfunction and its psychological origin was higher than that referred in the literature revised; the higher risk factors associated to erectile dysfunction were: age, diabetes mellitus, obesity, and the use of antihypertensive drugs.

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UNLABELLED: The policystic ovary (PO) results from a systemic hormonal dysfunction, characterized by hyperandrogenemia, insulin resistance and anovulation. OBJECTIVE: Assessment was made of clinical and biochemical features of patients with PO. MATERIAL AND METHODS: A retrospective analysis of 211 clinical of charts of patients with ultrasonographic diagnosis of PO seen at the Hospital Juárez de México from 1996 to 2000 was performed. Evaluation was made of body mass index (BMI), waist hip index (WHI), Ferriman index, acanthosis nigricans, lipid and hormonal profile. RESULTS: Of patients studied (n = 211) 64% had infertility and abnormal menses associated to PO, while the rest was normal. Both groups (PO and normal), were similar in age and distribution as well as family back grown for diabetes mellitus, hypertensive disease and obesity. The clinical manifestations observed on patients with PO were infertility 79.16%, anovulation 68.42%, hirsutism 66.9% obesity (66.9%). Biochemical findings in PO patients vs normal patients were: hyperandrogenism (86.73% vs 71.4%), insulin resistance (60.46% vs 37.5%), dislipidemic (56.41% vs 31.5%), LH/FSH ratio > 2 (19.51% vs 10.51%). Regarding sensitivity and specificity for clinical and biochemical findings ranged from 0.64 at 0.90, minimum value had infertility and maximum anovulation; specificity (interval 0.31 to the 0.71) minor corresponded to hyperprolactinemia and higher to infertility. The estimated risk factor (OR) for the population studied exhibited anovulation (OR, 7; 95% IC, 1.79-32.92); infertility (OR, 4.51; 95% IC, 2.03-10.13); insulin resistance (OR, 3; 95% IC, 0.82-8.16); hyperandrogenism (OR, 2.61; 95% IC, 1.02-6.69); and obesity (OR, 2.16; 95% IC, 1.17-4). We concluded that population with PO has a higher risk of infertility, anovulation, obesity, hyperandrogenism, dyslipidemia, insulin resistance and abnormal menses.

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We describe herein a 38 year old male who complained of persistent cephalalgias during six months which were associated to hyperprolactinemia and a pituitary macroprolactinoma shown by MRI. The patient was treated with cabergoline (0.5 mg/week) and remained asymptomatic for a year. The last MRI showed a normal pituitary.

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UNLABELLED: Male genital infections are a relevant cause in the etiology of infertility, due to abnormalities in sperm quality, affecting spermatozoal count and motility. OBJECTIVE: Identify the most common bacteria isolated from seminal cultures and their impact on seminal quality. MATERIAL AND METHODS: A retrospective, longitudinal and observational study was performed by reviewing 295 files of infertile males seen in our clinic of Reproductive Biology at the Hospital Juárez de México, in whom seminogram and seminal cultures were practiced for detection of seminal infection and quality assessment. RESULTS: 47% of cases presented infection by one or two bacteria, Staphylococcus epidermidis, Streptococcus (alpha and beta hemolitic) and Escherichia coli prevailed. The main alterations in quality were motility, pH, morphology and viscosity in association with S. epidermidis and E. coli. CONCLUSIONS: Nearly half of our group of study disclosed seminal infections and it resembled the percentages reported in the literature; most of them were asymptomatic. In disparity with other reports the most common bacterial agent found in association with changes in seminal quality was a skin saprophyte.

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Se revisa la frecuencia de amenorrea y esterilidad a la suspención de anticonceptivos hormonales, concluyéndose que ésta es baja. Destaca que la población más susceptible de presentar alteraciones en este sentido es aquella con anteceentes de disfunción hipotálamo-hipofisaria

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