Assuntos
Abscesso/microbiologia , Brucelose/diagnóstico por imagem , Doenças das Tubas Uterinas/metabolismo , Doenças Ovarianas/microbiologia , Abscesso/diagnóstico por imagem , Adulto , Doenças das Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Doenças Ovarianas/diagnóstico por imagem , Doenças RarasRESUMO
The endometrium of women with hydrosalpinx has an increased number of neutrophils and lower expression of elafin, an elastase inhibitor and natural antimicrobial molecule. These findings suggest that women with hydrosalpinx have a reduced antimicrobial and antielastase activity.
Assuntos
Elafina/análise , Endométrio/química , Doenças das Tubas Uterinas/metabolismo , Adulto , Brasil , Estudos de Casos e Controles , Regulação para Baixo , Endométrio/imunologia , Doenças das Tubas Uterinas/imunologia , Feminino , Humanos , Neutrófilos/imunologiaRESUMO
OBJECTIVE: To evaluate the ovarian reserve and follicular cohort of infertile patients with minimal/mild endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients were divided into two groups: group I, minimal/mild endometriosis and group II, tubal obstruction. The following exclusion criteria were established: [1] patients with previous endocrine disorders; and [2] cases in which the cause for infertility was other than endometriosis (except for patients with tubal obstruction, in the control group). INTERVENTION(S): Serum FSH and anti-Müllerian hormone were measured on day 3. On the same day all patients were submitted to transvaginal ultrasound to evaluate the antral follicular count and the ovarian follicular cohort. MAIN OUTCOME MEASURE(S): Serum FSH, anti-Müllerian hormone, and the follicular cohort with the respective antral follicular count. RESULT(S): Serum FSH were not different between the groups. However, infertile patients with endometriosis have a decreased serum anti-Müllerian hormone (1.26 +/- 0.7 ng/mL) compared to the control group (2.02 +/- 0.72 ng/mL). The analysis of follicular cohort showed that the number of selectable follicles were similar, but the follicular diameter was different. CONCLUSION(S): Minimal/mild endometriosis is associated with a decrease in the follicular ovarian reserve. In addition, the follicular cohort of these patients is more heterogeneous in comparison to the control group.
Assuntos
Hormônio Antimülleriano/sangue , Endometriose/fisiopatologia , Infertilidade Feminina/fisiopatologia , Folículo Ovariano/fisiopatologia , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/metabolismo , Endometriose/patologia , Doenças das Tubas Uterinas/metabolismo , Doenças das Tubas Uterinas/patologia , Doenças das Tubas Uterinas/fisiopatologia , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologia , Folículo Ovariano/metabolismo , Folículo Ovariano/patologia , Estudos ProspectivosRESUMO
Hydrosalpinx is a common condition among women of reproductive age. It is related to low pregnancy rates in the settings of in vitro fertilization-embryo transfer programs. Such low rates are not yet well understood, and may be due to poor endometrial receptivity and abnormal expression of key molecules in the endometrium that are important for implantation. The available data on the inflammatory response, endometrial blood flow, integrins, leukemia inhibitory factor, matrix metalloproteinases, and homeobox gene A10 expression in the presence of hydrosalpinx are reviewed. In addition, the evidence for treatment options to improve pregnancy rates is also discussed.
Assuntos
Biomarcadores/metabolismo , Implantação do Embrião , Endométrio/metabolismo , Doenças das Tubas Uterinas/metabolismo , Endométrio/irrigação sanguínea , Endométrio/enzimologia , Endométrio/fisiopatologia , Doenças das Tubas Uterinas/enzimologia , Doenças das Tubas Uterinas/fisiopatologia , Doenças das Tubas Uterinas/terapia , Feminino , Fertilização in vitro , Proteínas Homeobox A10 , Proteínas de Homeodomínio/metabolismo , Humanos , Mediadores da Inflamação/metabolismo , Integrinas/metabolismo , Fator Inibidor de Leucemia/metabolismo , Metaloproteinases da Matriz/metabolismo , Gravidez , Fluxo Sanguíneo Regional , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the expression of alpha1 and beta3 integrin subunit on the endometrium of infertile patients with hydrosalpinx and infertile patients with tubal phimosis. DESIGN: Case-control study. SETTING: Tertiary medical center. PATIENT(S): Infertile patients with radiologic or laparoscopic diagnosis of hydrosalpinx (n = 11) or tubal phimosis (n = 12) as the only cause of infertility, and fertile controls (n = 17). INTERVENTION(S): Immunohistochemical analysis of alpha1 and beta3 integrin subunits was performed on endometrial biopsies obtained during the implantation window. MAIN OUTCOME MEASURE(S): Histologic score (HSCORE) on luminal and glandular endometrium of the patients with hydrosalpinx or tubal phimosis and the normal fertile controls. RESULT(S): The median (+/-SEM) HSCORE for beta3 subunit expression in endometrial glands was 0.39 +/- 0.23 and 0.42 +/- 0.18 for tubal phimosis and hydrosalpinx, respectively, and 1.74 +/- 0.26 for fertile controls. The median HSCORE for beta3 subunit expression in luminal epithelium for tubal phimosis, hydrosalpinx, and fertile controls was 0.07 +/- 0.06, 0.21 +/- 0.18, and 1.03 +/- 0.31, respectively. No statistical difference was observed on the expression of alpha1 integrin subunit expression between the three groups. CONCLUSION(S): The endometrial expression of beta3 integrin subunit is reduced in the presence of tubal phimosis or hydrosalpinx, during the window of implantation.
Assuntos
Endométrio/metabolismo , Doenças das Tubas Uterinas/metabolismo , Infertilidade Feminina/metabolismo , Integrina alfa1/metabolismo , Integrina beta3/metabolismo , Adulto , Estudos de Casos e Controles , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Imuno-Histoquímica , Infertilidade Feminina/patologiaRESUMO
AIM: The hysterosalpingography (HSG) was evaluated after the clinical treatment of tubal pregnancy and the possible risk of tubal obstruction through the following parameters: beta-human chorionic gonadotropin (beta-hCG) levels, size of the adnexal mass, aspects of the image at ultrasound, and color Doppler. METHODS: Eighty patients were submitted to HSG after tubal pregnancy treatment from April 1994 to February 2002. Fifty received expectant management and 30 were treated with single-dose methotrexate (MTX) (50 mg/m(2) intramuscularly). RESULTS: The patency of the ipsilateral tube was 84% and 78% after the MTX and expectant treatments, respectively (P > 0.05). After the logistic regression was performed, it was observed that levels of beta-hCG >5000 mUI/ml were directly related to the tubal obstruction risk, odds ratio = 11.79 (95% CI = 2.27-61.32). Other variables were not directly related to the tubal obstruction risk. CONCLUSIONS: In this study, the probability of ipsilateral tubal obstruction depends on the beta-hCG levels. The increase in beta-hCG levels is followed by an enhancement in tubal obstruction risk. Therefore, the beta-hCG may be effective for the prognostic of the reproductive future of these patients.