RESUMO
OBJECTIVE: To determine DNA fragmentation and several molecules associated with apoptosis or proliferation in ovaries of patients with diminished ovarian reserve. DESIGN: Cross-sectional analysis. SETTING: Tertiary institutional hospital. PATIENT(S): Patients with benign uterine pathology who had undergone a hysterectomy and oophorectomy were categorized by the citrate clomiphene challenge test in diminished ovarian reserve or control group. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Apoptosis was determined using TUNEL (terminal deoxynucleotidyl transferase biotin-dUTP nick end-labeling) assay and p53, p27, Bax, caspase-3, caspase-8, caspase-9, Fas-L, Bcl-2, GATA-4, Ki-67, proliferating-cell nuclear antigen (PCNA), estrogen receptor, P receptor, and androgen receptor expression by immunohistochemistry. RESULT(S): Fifteen patients were studied. DNA fragmentation and expression of Bax, caspase-3, caspase-8, caspase-9, Fas-L, Bcl-2, GATA-4, Ki-67, and PCNA were observed in the whole ovary in both groups. In the control group, the expression of caspase-3 and caspase-8 in the ovarian stroma was significantly higher. CONCLUSION(S): DNA fragmentation and the expression of several molecules that participate in ovarian proliferation or apoptosis are present in cycling ovaries, but these markers were not significantly different in patients with diminished ovarian reserve. Thus, the mechanism leading to diminished ovarian reserve does not involve an easily detectable dysregulation in apoptosis or proliferation of ovarian follicles.
Assuntos
Proteínas Reguladoras de Apoptose/metabolismo , Substâncias de Crescimento/metabolismo , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologia , Ovário/metabolismo , Ovário/patologia , Adulto , Apoptose , Biomarcadores/metabolismo , Proliferação de Células , Células Cultivadas , Estudos Transversais , Feminino , Humanos , Técnicas In VitroRESUMO
BACKGROUND: Women with premature ovarian failure often receive hormonal replacement therapy as part of the management strategy. However, it is very unusual for patients to become pregnant while on hormonal therapy. CASE: A 33-year-old woman with a history of infertility and secondary amenorrhea was diagnosed with premature ovarian failure. Part of her infertility workup included laparoscopy-hysteroscopy, a dye test with methylene blue, and endometrial and bilateral ovarian biopsy. Two months after completion of this procedure, the patient underwent sonography, which showed an intrauterine pregnancy at 14 weeks' gestation. The pregnancy continued to term, and a healthy infant was born. CONCLUSION: In most instances the etiology of premature ovarian failure is unknown. In rare cases this condition undergoes spontaneous, reversible remission. One interesting observation in our patient is that despite the performance of invasive diagnostic tests, there were minimal detrimental effects on the patient's pregnancy and infant. This case illustrates that the remote possibility of a spontaneous pregnancy in women with prema- ture ovarian failure should always be considered, and invasive diagnostic procedures should be performed when an intrauterine pregnancy is ruled out with certainty.