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PURPOSES: Polycystic ovary syndrome (PCOS) is a major cause of female infertility, being present in up to 20% of women of childbearing age. Insulin resistance (IR) plays an important role in the pathophysiology of PCOS; therefore, its treatment may benefit women with the syndrome. The main drug used for IR management is metformin (MT). We aim to review the literature on the use of metformin in women with PCOS. METHODS: Using the terms "metformin" and "polycystic ovary syndrome," we conducted a search the PubMed, EMBASE, and Google Scholar databases. The research was restricted to articles published in English. Initially, only published meta-analyses were included, in the absence of meta-analyzes, RCT and well-designed prospective studies were used. RESULTS: Metformin increases success rates and decreases complication rates when used as an adjunctive medication for ovulation induction during low complexity assisted reproduction treatments and during ovarian stimulation for in vitro fertilization in women with PCOS. Evidence about the effect of metformin on fetal and obstetric complication rates is conflicting. Metformin is associated with high incidence of gastrointestinal symptoms; however, serious adverse effects are rare and there is no evidence of teratogenicity. CONCLUSION: For women with PCOS, metformin is a good adjunctive medication for ovulation induction/stimulation for high and low complexity assisted reproduction therapies. The adverse effects are mostly mild, and there is no risk of teratogenicity, but the risk of long-term complications for the offspring is not yet defined. High heterogeneity of the studies limits extrapolation of findings, and further research is needed to determine which women will benefit most from the medication.

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Abstract Objective It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles. Methods We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0- 29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels. Results Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels>5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98). Conclusion Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.

Resumo Objetivo O excesso de peso corporal tem sido associado como fator de risco para infertilidade. Este estudo teve como objetivo avaliar a associação de sobrepeso e anovulação entre mulheres inférteis com ciclos menstruais regulares. Métodos Realizamos um estudo retrospectivo de caso-controle com mulheres com anovulação consistente em tratamento por reprodução assistida. As pacientes foram estratificadas entre aquelas com peso normal (índice de massa corporal [IMC]: 18,5- 24,9 Kg/m2) e as com sobrepeso (IMC: 25,0-29,9 Kg/m2). As pacientes com síndrome do ovário policístico ou obesidade foram excluídas. Os grupos foram pareados por idade, duração da infertilidade, níveis de prolactina, hormônio folículo-estimulante (FSH), hormônio tiroestimulante (TSH), hormônio luteinizante (LH) e estradiol. Resultados O excesso de peso associou-se significativamente à anovulaçãoquando usados os critérios de anovulação da Organização Mundial de Saúde (OMS): níveis de progesterona>5,65 ng/ml e evidência ultrassonográfica de colapso folicular (razão de chances [RC]: 2,69; IC95%: 1,04-6,98). Conclusão O IMC acima da faixa normal compromete a ovulação em mulheres inférteis não obesas com ciclos menstruais regulares.

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Una de las manifestaciones del síndrome de ovario poliquístico (SOP) es la infertilidad, y hoy es la primera causa de infertilidad por anovulación, representando aproximadamente el 80% de los casos. Las alteraciones del SOP en su mayoría son tratables y el diagnóstico temprano de las pacientes mejora su pronóstico reproductivo. Pese a su alta incidencia e importancia, los mecanismos fisiopatológicos del SOP aún son relativamente desconocidos. Recientemente se han publicado recomendaciones internacionales basadas en evidencia para su tratamiento.

Infertility is one of the main manifestations of the polycystic ovary syndrome (PCOS), and to day PCOS is the main cause of anovulatory infertility accounting for 80% of the cases. The majority of PCOS causes of infertility are treatable, and early diagnosis improves the patient's fertility outcome. In spite of its incidence and importance, the physiopathological mechanisms of PCOS are still relatively unknown. Recently an international evidence base recommendation for treatment have been published.

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PURPOSE: To evaluate the inflammatory profile of premenopausal women with anovulatory cycles, regular menstrual cycles, or using contraceptives, and the associations with sleep and health-related parameters. METHODS: Subjects completed questionnaires including the Pittsburgh Sleep Quality Index and the Epworth sleepiness scale, underwent whole-night polysomnography, and had blood collected for analysis of inflammatory, cardiovascular, and hormonal parameters. Women of reproductive age were categorized into three groups for comparisons: anovulatory menstrual cycles, regular menstrual cycles, and hormonal contraceptive use. RESULTS: Women with anovulatory menstrual cycles (n = 20) had higher circulating levels of the proinflammatory cytokine IL-6 compared with women who had regular menstrual cycles (n = 191) and those on hormonal contraception (n = 72). No other classical marker of low-grade inflammation was significantly different. Subjective and objective sleep data were similar among groups. However, the mean peripheral oxygen saturation (SpO2) during sleep was reduced in anovulatory women. The analysis of associated variables of the inflammatory profile demonstrated that mean SpO2 during sleep was a predictive factor of IL-6 levels. CONCLUSIONS: Our data suggest that in premenopausal women with anovulation, a proinflammatory condition mediated by IL-6 is associated with lower oxygen levels during sleep. These findings reflect the balance between gynecological status, the immune system, and sleep, pointing to the need to control for these factors in clinical practice and research contexts.

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Resumen: La anovulación ocurre en el 30 % de la Infertilidad y la amenorrea secundarla en el 4% de mujeres en edad reproductiva. Ambas alteraciones se pueden tornar crónicas conllevando riesgos de hiperestrogenismo e hipoestrogenismo crónicos. Tanto la anovulación como la amenorrea secundaria tienen las mismas causas endocrinas, excepto que la amenorrea tiene una adicional de causa uterina. No obstante existen muchas clasificaciones etiológicas, unas combinan la amenorrea secundaria con la primaria, otras se enfocan más a la anovulación y algunas agrupan las etiologías en compartimentos, sin lograr hacerlo en forma integral. El objetivo es revisar las clasificaciones etiológicas de anovulación y amenorrea secundaria, junto con la actualización de cada una de esas causas, a fin de seleccionar la clasificación que las agrupe integralmente para enfocar el manejo en forma fácil y práctica. Para ello, se revisó la literatura médica reciente en libros de texto, PubMed, Ovid, Clinical guidelines y Cochrane library, con palabras claves. Se concluye que la clasificación etiológica integral en cinco compartimentos es una guía fácil de seguir, para lograr el diagnóstico de cada una de esas causas, actualmente, cuando existen medicamentos y procedimientos quirúrgicos seguros para manejarlas como anovulación o como amenorrea secundaria.

Abstract: Anovulation occurs in 30% of infertility and secondary amenorrhea In 4% of women In reproductive age. Both alterations can become chronic, carrying risks of chronic hyperestrogenism and hypoestrogenism. Both anovulation and secondary amenorrhea have the same endocrine causes, except that amenorrhea has an additional uterine cause. However, there are many etiological classifications, some combine secondary and primary amenorrhea, others focus more on anovulation and some group the etiologies into compartments, without achieving a comprehensive approach. The objective is to review the etiological classifications of anovulation and secondary amenorrhea, together with the update of each one of these causes, in order to select the classification that can integrally groups them so that to their management can be focused on an easy and practical way. For this purpose, recent medical literature in textbooks, PubMed, Ovid, Clinical guidelines and Cochrane library was reviewed with key words. It is concluded that the comprehensive etiological classification in five compartments is an easy guide to follow to achieve the diagnosis of each of these causes, currently, when there are drugs and safe surgical procedures to manage them as anovulation or secondary amenorrhea.

Resumo: A anovulação ocorre em 30 % da Infertilidade e a amenorreia secundária em 4 % de mulheres em idade reprodutiva. Ambas as alterações podem se tornar crônicas, implicando riscos de hiperestrogenismo e hipoestrogenismo crônicos. Tanto a anovulação quanto a amenorreia secundária têm as mesmas causas endócrinas, exceto que esta última tem ainda causa uterina. Contudo, existem muitas classificações etiológicas, umas combinam a amenorreia secundária com a primária, outras se focam mais na anovulação, e algumas agrupam as etiologias em compartimentos sem poder fazer isso de forma integral. O objetivo é revisar as classificações etiológicas de anovulação e amenorreia secundária, junto com a atualização de cada uma dessas causas, a fim de selecionar a classificação que as agrupe integralmente para focar o manejo de forma fácil e prática. Para isso, foi revisada a literatura médica recente em textos consultados em PubMed, Ovid, Clinical guidelines e Cochrane library, a partir de palavras-chave. Conclui-se que a classificação etiológica integral em cinco compartimentos é um guia fácil de seguir para obter o diagnóstico de cada uma dessas causas, atualmente, quando existem medicamentos e procedimentos cirúrgicos seguros para manejá-las como anovulação ou como amenorreia secundária.

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Resumen El síndrome de ovario poliquístico, es la alteración endocrina metabólica más frecuente en mujeres en edad fértil, teniendo implicaciones a nivel reproductivo, metabólico, cardiovascular y psicosocial. Actualmente, su sobrediagnóstico corresponde a una problemática común derivada de la heterogeneidad en la aplicación de los criterios actualmente avalados para su hallazgo, lo que ha contribuido en el incremento de tratamientos innecesarios, así como los efectos negativos en la calidad de vida y el bienestar de las pacientes falsamente calificadas con este trastorno. Se realizó una búsqueda en PubMed-MENDELEY y Ovid entre los meses de Febrero a Abril del 2020, obteniendo 43 artículos relacionados con el tema, publicados en los últimos 10 años. El conocimiento por parte del personal médico capacitado sobre los consensos actuales para la correcta evaluación del síndrome y el estudio individualizado de cada caso, corresponden las medidas más apropiadas para la reducción del sobrediagnóstico. MÉD.UIS.2020;33(3):21-28

Abstract Polycystic ovary syndrome is the most frequent metabolic endocrine disorder in women of childbearing age, having implications at both the reproductive, metabolic, cardiovascular and psychosocial levels. Currently, its overdiagnosis corresponds to a common problem derived from the heterogeneity in the application of the criteria currently endorsed for its discovery, which has contributed to the increase in unnecessary treatments, as well as the negative effects on the quality of life and well-being of falsely rated patients with this disorder. A search was made in PubMed-MENDELEY and Ovid between the months of February to April of 2020, obtaining 43 articles related to the topic, published in the last 10 years. The knowledge on the part of the trained medical personnel about the current consensuses for the correct evaluation of the syndrome and the individualized study of each case, correspond to the most appropriate measures for the reduction of this event. MÉD.UIS.2020;33(3):21-28

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Polycystic ovary syndrome (PCOS) affects 6% to 20% of reproductive age women and is the most frequent cause of anovulatory infertility. Its physiopathology may result in part from hypothalamic alterations in the pulsatile secretion of gonadotropin-releasing hormone (GnRH). The neuropeptide kisspeptin participates in the mechanism through stimulation of the hormone's production. The purpose of this study was to review the articles which compared kisspeptin levels in women with PCOS with those of controls. A systematic review of observational studies was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The selected studies encompassed a population of patients with PCOS and controls, whose serum kisspeptin levels were evaluated. The studies were retrieved from the Medline, Cochrane, and Embase databases, and four of them were chosen for the review. In most studies, the serum kisspeptin levels were higher in women with PCOS than in controls notwithstanding the BMI. One of the articles showed that circulating plasma levels of kisspeptin were significantly higher in women with PCOS whose BMI was lower than 25 than in obese and overweight women. Our data suggest a higher concentration of serum kisspeptin in women with PCOS irrespective of their BMI. Further experimental and clinical studies are needed to ascertain the role of kisspeptin in PCOS.

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Polycystic ovary syndrome (PCOS) affects 6-10% of women and could be considered one of the most common endocrine alterations in women of reproductive age. The syndrome is characterized by several hormonal and metabolic alterations, including insulin resistance and hyperandrogenism, which play a severe detrimental role in the patient's fertility. We aimed to offer an overview about drug metabolism in the PCOS population. Nevertheless, we did not find any study that directly compared drug metabolism between PCOS and healthy women. We therefore decided to summarize briefly how hormonal and insulin sensitizer drugs act differently in healthy and PCOS women, who show altered steroidogenesis by theca cells and metabolic imbalance, focusing especially on assisted reproductive techniques. To date, data about drug metabolism in the PCOS population appears to be extremely limited. This important gap could have significant implications for therapeutic approaches and future perspectives: the dosage of drugs commonly used for the treatment of PCOS women should be tailored according to each patient's characteristics; we should implement new clinical trials in order to identify the best pharmacologic strategy for PCOS patients undergoing in vitro fertilization (IVF); it would be advisable to create an international expert panel to investigate the drug metabolism in the PCOS population.

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OBJECTIVE: To analyze whether telomere length, X-chromosome inactivation (XCI), and androgen receptor (AR) GAG polymorphism are related to idiopathic premature ovarian insufficiency (POI). DESIGN: Case-control study. SETTING: University hospital. PATIENT(S): A total of 121 women, including 46 nonsyndromic POI and 75 controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Age, weight, height, body mass index (BMI), systolic and diastolic arterial pressure, E2, androstenedione, T, and C-reactive protein were assessed. Telomere length was estimated by quantitative real-time polymerase chain reaction, XCI was measured using the Human Androgen Receptor and X-linked retinitis pigmentosa 2 (RP2) methylation assays. AR and FMR1 polymorphism was assessed by quantitative fluorescent polymerase chain reaction and sequencing. RESULT(S): Premature ovarian insufficiency women had a higher mean age, weighed less, and exhibited lower C-reactive protein, E2, and androstenedione levels. The AR polymorphism did not differ between the groups. Four patients had premutation (55-200 CGG repeats), and none displayed a full mutation in the FMR1 gene. However, patients with POI showed shorter telomere length and higher frequency of skewed XCI. Extreme skewing (≥90%) was observed in 15% of women with POI, and shorter telomeres correlated with XCI skewing in both groups. CONCLUSION(S): Skewed XCI and shortened telomere length were associated with idiopathic POI, despite no alterations in the AR and FMR1 genes. Additionally, there is a tendency for women with short telomeres to exhibit skewed XCI.

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Abstract Aim To assess ovarian reserve (OVR) by means of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) measurement in eumenorrheic women with breast cancer, exposed to gonadotoxic chemotherapy. Method Fifty-two women (35.3 ± 3.8 years old) with breast cancer and undergoing cyclophosphamide-containing chemotherapy were enrolled. The assessment was performed before chemotherapy (T1) and after 2 (T2) and 6 months (T3). Results Six months after chemotherapy, the prevalence of regular cycles was 60%. Anti-Müllerian hormone decreased down to undetectable levels at T2 and T3 (T1: 2.53 [1.00–5.31]; T2 < 0.08; T3: < 0.08 [< 0.08–1.07] ng/mL), (p< 0.0001). Antral follicle count was 11 [8.0–13.5] follicles at T1 and lower at T2 (5.50 [3.75–8.0] and T3 (5.0 [2.5–7.0]) (p< 0.0001). In patients who remained with regular cycles during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged. Conclusion Anti-Müllerian hormone and AFC are useful as markers of OVR decline in women exposed to chemotherapy. Follicle-stimulating hormone is only adequate in women who become amenorrheic.

Resumo Objetivo Avaliar a reserva ovariana (OVR) através da contagem de folículos antrais (AFC), dosagem sérica de hormônio folículo estimulante (FSH) e hormônio anti-Mülleriano (AMH) em mulheres com câncer de mama submetidas a quimioterapia gonadotóxica. Método Foram incluídas na pesquisa 52 mulheres (35,3 ± 3,8 anos) com câncer de mama, em tratamento com quimioterapia com ciclofosfamida. As dosagens e medidas foram realizadas antes do início da quimioterapia (T1) e após 2 (T2) e 6 meses (T3). Resultados Seis meses após quimioterapia, a prevalência de ciclos regulares foi de 60%. O AMH sérico diminuiu a níveis indetectáveis em T2 e T3 (T1: 2,53 [1,00–5,31] ]; T2 < 0,08; T3: < 0,08 [< 0,08–1,07] ng/mL) (p< 0,0001). A contagem de folículos antrais foi de 11 [8,0–13,5] folículos em T1, e ainda menor em T2 (5,50 [3,75–8,0] e T3 (5,0 [2,5–7,0]), (p< 0,0001). Em pacientes que mantiveram ciclos regulares durante a quimioterapia ou retomaram a menstruação normalmente, os níveis de FSH e estradiol permaneceram inalterados. Conclusão O AMH e a AFC são marcadores úteis do declínio da OVR em mulheres expostas à quimioterapia. O FSH só é adequado em mulheres que se tornam amenorreicas.

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To test the hypothesis that in domestic cats, postnatal androgens induce sterility, the aims of this study were to describe the reproductive effects and the clinical safety of a postnatal administration of a long term release androgen in this species. Thirteen newborn littermate female kittens were randomly assigned to one of the following treatment groups within the first 24h of birth: testosterone enanthate 12.5mg sc (TE; n=8) or Placebo (PL; n=5). The animals were subsequently assessed for fecal sexual hormones until puberty was attained and subsequently when matings occurred. After 21 days, ovulation and gestation were diagnosed. All queens were subsequently ovario-hysterectomized. Fecal testosterone concentrations differed between the treatment groups throughout the study period (P<0.05) being greater during the first 2 postnatal weeks in those of the TE group (P<0.01). Fecal estradiol was not affected by treatment (P>0.1). While all the females were receptive during the pubertal estrus (P>0.1), two TE (2/8) compared with all (5/5) females of the PL group had ovulations (P<0.05). Only one (1/2) compared with three (3/5) of the queens of the TE and PL groups, respectively became pregnant. All kittens of the TE group had transient clitoral enlargement. Anovulatory TE-treated cats had no corpus luteum, and a significant diminution of the endometrial glands as well as of the height of the uterine epithelium. It is concluded that, in domestic cats, a single postnatal supra-physiological dose of testosterone caused a large proportion of queens to be anovulatory and there were also histological endometrial abnormalities that also occurred with this treatment that were accompanied by mild and transient side effects.

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Introducción: El síndrome de ovario poliquístico (SOP) es una disfunción endocrino metabólica de alta prevalencia, definida por alteraciones menstruales, hirsutismo, y ováricos morfológicamente poliquístico. Objetivos: Describir las características clínicas de las pacientes con SOP atendidas en el consultorio adosado de especialidades (CAE) del Hospital clínico Herminda Martin (HCHM) de Chillán. Materiales y método: Estudio transversal de 116 pacientes con diagnóstico de SOP (CIE-10 E28.2), en edad fértil, con diagnóstico realizado en CAE del HCHM durante 2010 y 2014. Se obtuvieron datos demográficos y clínicos, luego fueron tabulados en Excel para su análisis. Resultados: El grupo etario más frecuente fueron las pacientes entre 15 y 19 años. En la mayoría de los casos, la consulta se debió a alteraciones menstruales e hirsutismo. Un 33,6% de las pacientes correspondieron a SOP clásico. Un 72,4% presentó insulinoresistencia (IR) y un 40% sobrepeso. Discusión: Su fuerte relación con síndrome metabólico, nos lleva a plantear la posibilidad de aplicar medidas de prevención primaria, en los grupos poblacionales que han sido caracterizados enfrentando esta patología como una enfermedad endocrino-metabólica y tratarla de forma integral por un grupo multidisciplinario. Se sugiere realizar una pesquisa sistemática en pacientes de riesgo, incluyendo el SOP en programas de pesquisa específicos para enfermedades no transmisibles (examen médico preventivo del adolecente y del adulto).

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic dysfunction highly prevalence, defined by menstrual alterations, hirsutism, and polycystic ovarian morphologically. Objetive: To describe the clinical characteristics of patients with PCOS treated at the "Consultorio adosado de especialidades" (CAE) of the Hospital Clínico Herminda Martin (HCHM) of Chillán. Materials and methods: A cross-sectional study of 116 patients with a diagnosis of PCOS (ICD-10 E28.2), of childbearing age, with a diagnosis made at the HCHM CAE during 2010 and 2014. Demographic and clinical data were obtained and then tabulated in Excel for your analysis. Results: The most frequent age groups were patients aged 15 to 19 years. In most cases, the consultation was due to menstrual alterations and hirsutism. A total of 33.6% of the patients were classical PCOS. 72.4% had insulin resistance (IR) and 40% were overweight. Discussion: Its strong relationship with metabolic syndrome leads us to consider the possibility of applying primary prevention measures in the population groups that have been characterized as endocrine-metabolic disease and treated in an integral way by a multidisciplinary group. It is suggested to conduct a systematic study in patients at risk, including PCOS in specific programs for noncommunicable diseases (preventive medical examination of adolescents and adults).

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This global overweight and obesity epidemics has become one of the largest public health problem worldwide and is increasingly more common among women in reproductive age. Along with the prevalence of overweight women, there is an increase in women with anovulatory infertility. Thus, we carried out a bibliographic research in the PubMed, Lilacs and SciELO databases, using the combinations in Portuguese, Spanish and English of the following descriptors: "Body Mass Index", "obesity", "overweight", "female infertility" and "anovulation". The aim of this study was to assess the effects of obesity on the ovulatory profile of infertile women in the available literature.

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Reproductive synchrony and the consequent clustering of births are hypothesized to be regulated by seasonal changes in rainfall and food availability. Such climate-related seasonality is, however, questionable in tropical populations occupying temporally invariant habitats year round. Using the long-term data of the Cayo Santiago rhesus macaques from 1973 to 2013, this study distinguishes synchrony (a greater than chance clustering of births) from seasonality (a cluster of births during a period of the year when abiotic conditions are favorable) and shows that females are highly synchronized (>72% of births in a 3-month period) but the effects of environmental zeitgebers on reproduction are overridden by biological factors. Specifically, biotic and abiotic factors including (i) loss of immature offspring; (ii) population density; (iii) age at delivery; (iv) rainfall; and (v) changes in colony management were modeled in relation to the annual onset of births and the median birth date. Females experiencing loss of immature offspring had an interbirth interval of <365 days in average and the proportion of these females increased up to 48% due to changes in colony management overtime, although reproductive synchrony increased with increasing population density. A secular trend in both the onset of births and the median date of birth is documented and the model predicts that the median birth date will advance across all calendar-based seasons by 2050. The secular trend in reproduction appears to be triggered by changes in the age at delivery of females, the absence of physiological constraints from maternal investment due to offspring loss, shorter interbirth interval, and a higher degree of coordination due to increasing population density. This study challenges the reproductive phenology previously described for rhesus macaques highlighting the importance of long-term studies in addressing the ultimate causes of reproductive synchrony.

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SUMMARY Introduction: anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation. Objective: to identify the current indications of laparoscopic ovarian drilling and the best surgical technique. Method: a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling. Results: we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling. Conclusion: laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

RESUMO Introdução: a anovulação é uma das principais causas de infertilidade feminina, e a síndrome dos ovários policísticos (SOP) é a principal causa de anovulação. As mulheres com SOP, quando submetidas a indução medicamentosa da ovulação, costumam ter resposta satisfatória, recrutando folículos. No entanto, algumas podem não recrutar folículos ou, muitas vezes, têm uma produção excessiva deles, o que pode resultar em síndrome de hiperestímulo ovariano e/ou gravidez múltipla. O tratamento cirúrgico por laparoscopia comdrilling ovariano pode evitar ou reduzir a necessidade de indução da ovulação com medicamentos. Objetivos: identificar as indicações atuais do drilling ovariano laparoscópico e qual a melhor técnica operatória. Método: revisão da literatura médica, por meio de busca sistemática nas bases de dados MEDLINE, LILACS e Cochrane, utilizando as palavras-chave: laparoscopia, síndrome dos ovários micropolicísticos edrilling. Resultados: foram encontrados 105 artigos na literatura, sendo 27 de grande relevância descrevendo achados sobre o drilling ovariano. Conclusão: o drilling laparoscópico está indicado para pacientes com SOP com resistência ovulatória ao uso do citrato de clomifeno, índice de massa corpórea (IMC) inferior a 30 kg/m2 e hormônio luteinizante (LH) pré-cirúrgico superior 10 UI/L. A técnica operatória de preferência deve ser a realização de 5 a 10 perfurações na superfície de cada ovário bilateralmente por meio do uso de energia monopolar.

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La sospecha de Síndrome de Ovario Poliquístico es un motivo de consulta frecuente durante la adolescencia, esto probablemente está dado por la sobreposición de las características fisiológicas de este período con los criterios diagnósticos tradicionalmente usados para definir este síndrome, tales como ciclos menstruales irregulares, hiperandrogenismo y morfología ecográfica de ovario poliquístico. Es por esto que parece importante discutir si los criterios diagnósticos de Síndrome de Ovario Poliquístico aplicados en mujeres adultas pueden extrapolarse a los primeros años postmenarquia. En este artículo se discute el diagnóstico de Síndrome de Ovario Poliquístico en la adolescencia, sus controversias y su manejo.

The suspicion of polycystic ovary syndrome is a common complaint during adolescence, and is probably given by the overlap of physiological characteristics of this period of life with the diagnostic criteria traditionally used to define this syndrome, such as irregular menstrual cycles, hyperandrogenism and polycystic ovarian morphology. This is why it seems important to discuss whether these diagnostic criteria for polycystic ovary syndrome in adults can be extrapolated to the early years postmenarche. This article will discuss the diagnosis of polycystic ovary syndrome in adolescence, their controversies and their management.

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INTRODUCTION: Polycystic ovary syndrome (PCOS) is a prevalent disease affecting women of reproductive age. It may be associated with metabolic disorders such as insulin resistance (IR) and obesity. The anti-Mullerian hormone (AMH) levels seem to be higher in patients with PCOS. OBJECTIVE: The present study was designed to evaluate the association between AMH and insulin in women with PCOS with and without IR. METHODS: Cross-sectional study, including 86 patients, selected and divided into three groups: Group A: 26 women with PCOS and IR; Group B: 30 women with PCOS and without IR; and Group C: 30 controls without PCOS. RESULTS: We found significant difference between serum AMH levels in the group of women with PCOS and without IR when compared to the control group, thus showing that PCOS and IR play an important role in elevating the levels of this hormone. When the groups were compared with each other following adjustment for BMI, serum AMH levels were significantly higher in the group of women with PCOS and IR. CONCLUSION: AMH levels are significantly higher in patients with PCOS, particularly in those women with PCOS and IR. Nevertheless, larger samples are required to confirm these findings.

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Infertility is defined as the failure to conceive, with no contraception, after one year of regular intercourse in women < 35 years and after 6 months in women > 35 years. A review on causes, management and treatment of endocrine causes of was performed. Epidemiological data suggest that around 10% to 15% of couples are infertile. Anovulatory problems are responsible from 25% to 50% of causes of . Advanced age, obesity, and drugs, have a negative effect on fertility. Different hypothalamic, pituitary, thyroid, adrenal, and ovarian disorders may affect fertility as well. Infertility is a growing phenomenon in developed societies. We here provide information about how to identify endocrine patients with ovulatory dysfunction. Women must be advised about limiting factors to be avoided, in order to protect their fertility. Arq Bras Endocrinol Metab. 2014;58(2):144-52.

A infertilidade é definida como uma falha na concepção, sem anticoncepcionais, após um ano de relações sexuais regulares em mulheres com menos de 35 anos e após seis meses em mulheres com mais de 35 anos. Foi feita uma revisão das causas, manejo e tratamento das causas endócrinas causadoras de infertilidade feminina. Os dados epidemiológicos sugerem que cerca de 10% a 15% dos casais são inférteis. Os problemas de anovulação são responsáveis por 25% a 50% das causas de infertilidade feminina. A idade avançada, a obesidade e as drogas têm um efeito negativo na fertilidade. Diferentes transtornos hipotalâmicos, pituitários, tireoideanos, adrenais e ovarianos também podem afetar a fertilidade. A infertilidade é um fenômeno cada vez mais comum nas sociedades desenvolvidas. Fornecemos aqui informações sobre como identificar pacientes endocrinológicos com disfunções ovulatórias. As mulheres devem ser aconselhadas a evitar fatores limitadores de forma a proteger sua fertilidade. Arq Bras Endocrinol Metab. 2014;58(2):144-52.

RESUMO

Objective. To evaluate the factors associated with postpartum ovarian resumption and follicular dynamics in Holstein cows under high altitude conditions (2,600 masl). Materials and methods. Forty-five Holstein cows were studied between 14 days before and 120 days after calving. Uterine involution, follicular dynamics, serum progesterone and peripartum pathologies were evaluated; additionally, body condition (BC), calving type, milk yield, were also evaluated. According to hormonal and reproductive findings, cows were classified into two groups: early ovarian resumption (EOR) or delayed ovarian resumption (DOR). Results. The occurrence of the first follicular for EOR animals (n=31) was produced on average 9.58±3.45 days postpartum and was similar to the DOR group (n=10) [10.8±4.83 days; p>0.05)]. The first postpartum ovulation occurred at 21.55±5.90 days (EOR) and was significantly delayed (48.7±27.85 days) for DOR animals (p<0.05). Thirty-six point five percent of the cows (n=f) had normal estrus cycles (18 to 24 days), while 63.5% (n=26) showed dysciclia. The factors associated with ovarian resumption and cyclicity were the loss of BC [OR=3.3, CI 95% (1.2-13.3) (p<0.05)] and lameness [OR= 9.0, CI 95% (1.2-13.3) (p<0.05)]. Conclusions. Although the emergence of postpartum follicular waves was observed early, under the experimental conditions of this study there are factors that may affect the first ovulation favoring the occurrence of anovulatory conditions. The determinant factors were low body condition and lameness.

Objetivo. Evaluar los factores asociados con la reactivación ovárica y la dinámica folicular postparto en vacas de la raza Holstein bajo condiciones de altura (2600 msnm). Materiales y métodos. Cuarenta y cinco vacas Holstein fueron estudiadas entre 14 días preparto y 120 días posteriores al mismo. Fueron evaluadas la involución uterina, dinámica folicular, progesterona sérica y presentación de patologías en el periparto; adicionalmente la condición corporal (CC), tipo de parto y producción de leche. De acuerdo con los hallazgos reproductivos y hormonales, las vacas se agruparon en dos grupos: reactivación ovárica temprana (ROT) o retardada (ROR). Resultados. La emergencia de la primera onda folicular para animales ROT (n=31), ocurrió en promedio 9.58±3.45 días postparto y fue similar a los ROR (n=10) [10.8±4.83 días (p>0.05)]. La primera ovulación postparto se observó a los 21.55±5.90 días (ROT) y fue significativamente más demorada (48.7±27.85 días) para los animales ROR (p<0.05). El 36.5% de los animales (n=f) presentaron ciclos estrales normales (18 a 24 días), mientras que el 63.5% (n=26) mostraron disciclia. Los factores asociados con la reactivación ovárica y la ciclicidad fueron la pérdida de CC [OR= 3.3, IC 95% (1.2-13.3) (p<0.05)] y la presentación de cojeras [OR= 9.0, IC 95% (1.2-13.3) (p<0.05)]. Conclusiones. Aunque la emergencia de ondas foliculares postparto se presentó de manera rápida, bajo las condiciones experimentales del presente estudio, existen factores que afectan la primera ovulación favoreciendo la presentación de condiciones anovulatorias. La presentación de cojeras, y la pérdida de CC postparto fueron factores determinantes.

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RESUMO

A síndrome dos ovários policísticos (SOP) é uma condição endócrina que está associada a diversos fatores de risco cardiometabólico, tais como obesidade central, resistência à insulina, diabetes tipo 2, síndrome metabólica e hipertensão arterial. Esses fatores estão associados à hiperatividade adrenérgica, que é um importante fator prognóstico para o desenvolvimento de distúrbios cardiovasculares. Nos últimos anos, diante das alterações cardiometabólicas comuns na SOP, estudos têm investigado o controle autonômico cardíaco dessas pacientes, principalmente empregando-se a variabilidade da frequência cardíaca (VFC). Nesse sentido, nesta revisão, discorreremos sobre os achados recentes dos estudos que buscaram investigar a VFC em mulheres com SOP, assim como os métodos não invasivos de análise do controle autonômico a partir de índices básicos relacionados a essa metodologia de investigação.

Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with several cardiometabolic risk factors, such as central obesity, insulin resistance, type 2 diabetes, metabolic syndrome, and hypertension. These factors are associated with adrenergic overactivity, which is an important prognostic factor for the development of cardiovascular disorders. Given the common cardiometabolic disturbances occurring in PCOS women, over the last years studies have investigated the cardiac autonomic control of these patients, mainly based on heart rate variability (HRV). Thus, in this review, we will discuss the recent findings of the studies that investigated the HRV of women with PCOS, as well as noninvasive methods of analysis of autonomic control starting from basic indexes related to this methodology.

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