Infertility Archives - Page 2 of 6 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(4):205-210
DOI 10.1590/S0100-72032007000400007
PURPOSE: to evaluate the experience of an assisted reproduction center that uses depot administration of half-dose of GnRH agonist for pituitary suppression in assisted reproductive cycles. METHODS: prospective study that evaluated in vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI) cycles utilizing half-dose of leuprolide acetate between August 2005 and March 2006. Recombinant FSH was administered for controlled ovarian induction based on the protocol. hCG was administered when at least one follicle reached 19 mm in diameter. IVF or ICSI was performed according to infertility factor. Up to four embryos were transferred on the second or third day after oocyte retrieval. Progesterone supplementation was initiated on the same day of oocyte retrieval, and after 14 days beta-hCG was measured. The following parameters were evaluated: number of aspirated cycles, cancelled cycles, transferred cycles, total dose of FSH employed, number of mature oocytes retrieved, fertilization rate, number of transferred embryos, embryo implantation rate, and pregnancy rate. RESULTS: A hundred and nine IVF/ICSI cycles were initiated. The mean age of the patients was 34.9 years. We observed 1.8% of cancellation rate. The mean total dose of gonadotrophins employed was 1,905 IU per cycle. We obtained 86.5% of mature oocytes and the fertilization rate was 76.3%. The mean number of embryos transferred was 2.7. Pregnancy rates per aspiration and per transfer were 25.2 and 25.7%, respectively. Of those who reached pregnancy, 26.3% were twins and 5.3% were triplets. CONCLUSIONS: the half-dose of GnRH depot employed for pituitary suppression was a useful alternative for ovarian stimulation in IVF cycles because it is comfortable and practical for the patient, besides its low cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(4):205-210
DOI 10.1590/S0100-72032007000400007
PURPOSE: to evaluate the experience of an assisted reproduction center that uses depot administration of half-dose of GnRH agonist for pituitary suppression in assisted reproductive cycles. METHODS: prospective study that evaluated in vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI) cycles utilizing half-dose of leuprolide acetate between August 2005 and March 2006. Recombinant FSH was administered for controlled ovarian induction based on the protocol. hCG was administered when at least one follicle reached 19 mm in diameter. IVF or ICSI was performed according to infertility factor. Up to four embryos were transferred on the second or third day after oocyte retrieval. Progesterone supplementation was initiated on the same day of oocyte retrieval, and after 14 days beta-hCG was measured. The following parameters were evaluated: number of aspirated cycles, cancelled cycles, transferred cycles, total dose of FSH employed, number of mature oocytes retrieved, fertilization rate, number of transferred embryos, embryo implantation rate, and pregnancy rate. RESULTS: A hundred and nine IVF/ICSI cycles were initiated. The mean age of the patients was 34.9 years. We observed 1.8% of cancellation rate. The mean total dose of gonadotrophins employed was 1,905 IU per cycle. We obtained 86.5% of mature oocytes and the fertilization rate was 76.3%. The mean number of embryos transferred was 2.7. Pregnancy rates per aspiration and per transfer were 25.2 and 25.7%, respectively. Of those who reached pregnancy, 26.3% were twins and 5.3% were triplets. CONCLUSIONS: the half-dose of GnRH depot employed for pituitary suppression was a useful alternative for ovarian stimulation in IVF cycles because it is comfortable and practical for the patient, besides its low cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):83-89
DOI 10.1590/S0100-72031998000200005
Results on investigation and immune treatment for recurrent abortion are presented. Up to 60% of patients who are free of any clinical identifiable cause for abortion are believed to have alloimmune abnormalities. One of the suggested therapies for this condition is paternal lymphocyte immunization. We present the result of 116 pregnancies followed at the Departamento de Tocoginecologia UNICAMP. Patients were thoroughly evaluated for causes of recurrent abortion mentioned in the literature (genetics, hormones, uterine abnormalities and infections), for autoimmune (antiphospholipid syndrome, abnormal autoantibodies) and for alloimmune causes (crossmatch by microlymphocytotoxicity and mixed lymphocyte culture). Patients who presented negative crossmatch and lower than 50% inhibition in mixed lymphocyte culture were treated with two concentrated intradermal paternal lymphocyte immunizations. Women were stimulated to attempt pregnancy with a positive crossmatch and higher than 50% inhibition in mixed lymphocyte culture. Women whose immune status did not change with this treatment were immunized again with paternal lymphocytes associated or not to a third party donor. We report that 81% of the women treated with this protocol had good pregnancy outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):83-89
DOI 10.1590/S0100-72031998000200005
Results on investigation and immune treatment for recurrent abortion are presented. Up to 60% of patients who are free of any clinical identifiable cause for abortion are believed to have alloimmune abnormalities. One of the suggested therapies for this condition is paternal lymphocyte immunization. We present the result of 116 pregnancies followed at the Departamento de Tocoginecologia UNICAMP. Patients were thoroughly evaluated for causes of recurrent abortion mentioned in the literature (genetics, hormones, uterine abnormalities and infections), for autoimmune (antiphospholipid syndrome, abnormal autoantibodies) and for alloimmune causes (crossmatch by microlymphocytotoxicity and mixed lymphocyte culture). Patients who presented negative crossmatch and lower than 50% inhibition in mixed lymphocyte culture were treated with two concentrated intradermal paternal lymphocyte immunizations. Women were stimulated to attempt pregnancy with a positive crossmatch and higher than 50% inhibition in mixed lymphocyte culture. Women whose immune status did not change with this treatment were immunized again with paternal lymphocytes associated or not to a third party donor. We report that 81% of the women treated with this protocol had good pregnancy outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):551-556
DOI 10.1590/S0100-72032006000900008
Premature ovarian failure may be idiopathic or associated with several autoimmune and genetic disorders as X chromosome deletions. We report two cases of preamture ovarian failure associated with a deletion in the long arm of X chromosome. Both patients were nulligravidas presenting secondary amenorrhea and complaints of infertility, without family history of premature ovarian failure and reporting normal puberal development. Their karyotypes showed deletions of the distal long arm of all X chromosomes and were 46,X, del(Xq22) and 46,X, del(Xq13q28), respectively. After the diagnosis the patients decided to be submitted to an in vitro fertilization with egg donation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):551-556
DOI 10.1590/S0100-72032006000900008
Premature ovarian failure may be idiopathic or associated with several autoimmune and genetic disorders as X chromosome deletions. We report two cases of preamture ovarian failure associated with a deletion in the long arm of X chromosome. Both patients were nulligravidas presenting secondary amenorrhea and complaints of infertility, without family history of premature ovarian failure and reporting normal puberal development. Their karyotypes showed deletions of the distal long arm of all X chromosomes and were 46,X, del(Xq22) and 46,X, del(Xq13q28), respectively. After the diagnosis the patients decided to be submitted to an in vitro fertilization with egg donation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):473-478
DOI 10.1590/S0100-72032006000800006
PURPOSE: to verify the effects of intrauterine levonorgestrel device (IUD) in women with adenomyosis, with implantation failure in previous in vitro fertilization (IVF) cycles. METHODS: eighty infertile women with ages up to 38 years, who had adenomyosis diagnosed by ultrasonography and MRI were selected. All the women presented antecedents of one or more tormer IVF attempts without success due to implantation failure. The women were subdivided into IUD Group, composed of 40 women with an IUD that released 20 µg of levonorgestrel/day during six months, preceding a new IVF cycle, and IVF Group, also composed of 40 women, who were directly submitted to a new IVF cycle without previous adenomyosis treatment. In the IUD Group the uterine volume, thickness and hypersignal foci of the junctional zone were assessed before and after treatment, as well as the pregnancy rates in the new IVF cycle, compared to the data obtained with the IVF Group. Statistical analyses were performed adopting the significance level of 5% (p<0,05), using the Mann-Whitney and Sudent's t tests. RESULTS: after treatment, there was a reduction of 77.7% in the cases of focal adenomyosis, in addition to a significant reduction of the uterine volume and of the mean thickness of the junctional zone from 128.8 to 93.6 ml and from 12.3 to 11.3 mm, respectively. In the IUD Group, pregnancy rate reached 30%, which was higher than, but not significantly different from that of the IVF group, which was 17.5%. CONCLUSION: the use of an IUD with levonorgestrel may be administered prior to IVF cycles in patients with adenomyosis who suffered previous implantation failure.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):473-478
DOI 10.1590/S0100-72032006000800006
PURPOSE: to verify the effects of intrauterine levonorgestrel device (IUD) in women with adenomyosis, with implantation failure in previous in vitro fertilization (IVF) cycles. METHODS: eighty infertile women with ages up to 38 years, who had adenomyosis diagnosed by ultrasonography and MRI were selected. All the women presented antecedents of one or more tormer IVF attempts without success due to implantation failure. The women were subdivided into IUD Group, composed of 40 women with an IUD that released 20 µg of levonorgestrel/day during six months, preceding a new IVF cycle, and IVF Group, also composed of 40 women, who were directly submitted to a new IVF cycle without previous adenomyosis treatment. In the IUD Group the uterine volume, thickness and hypersignal foci of the junctional zone were assessed before and after treatment, as well as the pregnancy rates in the new IVF cycle, compared to the data obtained with the IVF Group. Statistical analyses were performed adopting the significance level of 5% (p<0,05), using the Mann-Whitney and Sudent's t tests. RESULTS: after treatment, there was a reduction of 77.7% in the cases of focal adenomyosis, in addition to a significant reduction of the uterine volume and of the mean thickness of the junctional zone from 128.8 to 93.6 ml and from 12.3 to 11.3 mm, respectively. In the IUD Group, pregnancy rate reached 30%, which was higher than, but not significantly different from that of the IVF group, which was 17.5%. CONCLUSION: the use of an IUD with levonorgestrel may be administered prior to IVF cycles in patients with adenomyosis who suffered previous implantation failure.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):365-372
DOI 10.1590/S0100-72032006000600008
As therapeutic approaches for oncologic diseases are being improved and an increase in the survival rates are being achieved, long-term complications of these therapies, initially infrequent, assume these days an important place when considering life quality. Among the long term repercussions appears the premature ovarian failure. According to the recommendations of the American Society of Clinical Oncology recently published, the only procedures available nowadays considered to be effective for female fertility preservation are: embryo cryopreservation, conservative gynecological surgery and oophoropexy in cases of local radiotherapy. All the other proposed techniques, surch as: ovarian suppression and oocyte and ovarian tissue cryopreservation, although present promising results, are still considered as experimental options. The best choice for fertility preservation in each specific case depends on patient's age, type of treatment, existence of a partner, time available until chemo- or radiotherapy beginning, and the ovarian metastatic potential of the tumor. In the present manuscript, the available and experimental techniques for fertility preservation are revised and discussed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):365-372
DOI 10.1590/S0100-72032006000600008
As therapeutic approaches for oncologic diseases are being improved and an increase in the survival rates are being achieved, long-term complications of these therapies, initially infrequent, assume these days an important place when considering life quality. Among the long term repercussions appears the premature ovarian failure. According to the recommendations of the American Society of Clinical Oncology recently published, the only procedures available nowadays considered to be effective for female fertility preservation are: embryo cryopreservation, conservative gynecological surgery and oophoropexy in cases of local radiotherapy. All the other proposed techniques, surch as: ovarian suppression and oocyte and ovarian tissue cryopreservation, although present promising results, are still considered as experimental options. The best choice for fertility preservation in each specific case depends on patient's age, type of treatment, existence of a partner, time available until chemo- or radiotherapy beginning, and the ovarian metastatic potential of the tumor. In the present manuscript, the available and experimental techniques for fertility preservation are revised and discussed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):409-414
DOI 10.1590/S0100-72031999000700007
Purpose: to determine whether the transfer day or the stage that the embryo is transferred interferes in pregnancy and implantation rates. Methods: oocytes we recovered from 107 patients and submitted to in vitro fertilization. The embryos were cocultured on Vero cells and transferred on day 3 or day 5 post-fertilization, after morphological assessment. Results: the implantation rate of the transferred embryos on day 5 was significantly higher than when the embryos were transferred on day 3, but the pregnacy rates did not change. However, a significant difference was observed in the pregnancy rates for embryos transferred at the expanded blastocyst stage (70.6% of pregnancy) when compared to 20.0% and 10.5% at the earlier blastocyst and morula stages, respectively. Conclusions: the implantation and pregnancy rates were significantly increased when the embryos were transferred at the expanded blastocyst stage, but the culture media and culture conditions now available are not able to provide a satisfactory rate at this stage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):409-414
DOI 10.1590/S0100-72031999000700007
Purpose: to determine whether the transfer day or the stage that the embryo is transferred interferes in pregnancy and implantation rates. Methods: oocytes we recovered from 107 patients and submitted to in vitro fertilization. The embryos were cocultured on Vero cells and transferred on day 3 or day 5 post-fertilization, after morphological assessment. Results: the implantation rate of the transferred embryos on day 5 was significantly higher than when the embryos were transferred on day 3, but the pregnacy rates did not change. However, a significant difference was observed in the pregnancy rates for embryos transferred at the expanded blastocyst stage (70.6% of pregnancy) when compared to 20.0% and 10.5% at the earlier blastocyst and morula stages, respectively. Conclusions: the implantation and pregnancy rates were significantly increased when the embryos were transferred at the expanded blastocyst stage, but the culture media and culture conditions now available are not able to provide a satisfactory rate at this stage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):533-538
DOI 10.1590/S0100-72031999000900006
Purpose: to develop an animal model for the study of, and training in, bovine biopsies. Methods: cow ovaries were obtained from a slaughterhouse and transported to the laboratory where the oocytes were aspirated, maturated and submitted to in vitro fertilization. On the 5th day after fertilization, the embryos were biopsied, with the zona pellucida being opened with a cutting blade fitted to the light microscope. One or two blastomeres were removed from the embryos and left in coculture for three additional days. After this time, embryo development was evaluated in comparison to a control group by morphological study and cell counts using specific staining for nuclei. Results: forty of the 57 biopsied embryos reached the blastocyst stage (70.2%) and hatching was observed in 11 (27.5%). Forty-two blastocysts were obtained in the control group (73.7%) and 11 of them hatched (26.2%). Cell counts showed no significant differences between groups. Conclusions: we conclude that the proposed protocol is technically feasible and supplies a good number of embryos because of the easy technique for obtaining bovine oocytes, thus representing a method that could be adopted for training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):533-538
DOI 10.1590/S0100-72031999000900006
Purpose: to develop an animal model for the study of, and training in, bovine biopsies. Methods: cow ovaries were obtained from a slaughterhouse and transported to the laboratory where the oocytes were aspirated, maturated and submitted to in vitro fertilization. On the 5th day after fertilization, the embryos were biopsied, with the zona pellucida being opened with a cutting blade fitted to the light microscope. One or two blastomeres were removed from the embryos and left in coculture for three additional days. After this time, embryo development was evaluated in comparison to a control group by morphological study and cell counts using specific staining for nuclei. Results: forty of the 57 biopsied embryos reached the blastocyst stage (70.2%) and hatching was observed in 11 (27.5%). Forty-two blastocysts were obtained in the control group (73.7%) and 11 of them hatched (26.2%). Cell counts showed no significant differences between groups. Conclusions: we conclude that the proposed protocol is technically feasible and supplies a good number of embryos because of the easy technique for obtaining bovine oocytes, thus representing a method that could be adopted for training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):597-602
DOI 10.1590/S0100-72031999001000006
Purpose: evaluation of the effect of elcometrine on ovarian endometriomata. Method: subdermal implants containing 50 mg elcometrine were inserted in 51 women with ovarian endometriomata, the volumes of which were recorded by vaginal sonography before and after each three-month interval of treatment. A new implant was inserted every 6 months according to the need for continuing treatment. Results: at admission, 74% of patients presented with dysmenorrhea, 57% chronic pelvic pain and 31% dyspareunia. Pain was rated as severe or incapacitating by 82% of the subjects. A total of 924 months of observation was recorded during the four years of study. Relief of pain was observed during the first month of treatment and severe or incapacitating pain was no longer reported by any subject by the end of the first trimester. Volume of endometriomata was reduced in 86% of the patients. In 45%, ovarian volume was restored to normal. In 41% the volume reduction was incomplete and in 14% there was no volume reduction. Seventy-seven percent presented amenorrhea during treatment. The most common adverse events were decreased libido (21%) and feeling of heaviness in lower limbs (14%). One year after discontinuation of treatment, 33% of the patients were symptomless, while 28% presented recurrence of the endometriomata before 3 months post-discontinuation. Thirty-nine percent of the patients preferred to continue using the method in order to maintain amenorrhea. Conclusion: elcometrine is effective in reducing ovarian endometriomata, without some of the side effects of other treatments.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):597-602
DOI 10.1590/S0100-72031999001000006
Purpose: evaluation of the effect of elcometrine on ovarian endometriomata. Method: subdermal implants containing 50 mg elcometrine were inserted in 51 women with ovarian endometriomata, the volumes of which were recorded by vaginal sonography before and after each three-month interval of treatment. A new implant was inserted every 6 months according to the need for continuing treatment. Results: at admission, 74% of patients presented with dysmenorrhea, 57% chronic pelvic pain and 31% dyspareunia. Pain was rated as severe or incapacitating by 82% of the subjects. A total of 924 months of observation was recorded during the four years of study. Relief of pain was observed during the first month of treatment and severe or incapacitating pain was no longer reported by any subject by the end of the first trimester. Volume of endometriomata was reduced in 86% of the patients. In 45%, ovarian volume was restored to normal. In 41% the volume reduction was incomplete and in 14% there was no volume reduction. Seventy-seven percent presented amenorrhea during treatment. The most common adverse events were decreased libido (21%) and feeling of heaviness in lower limbs (14%). One year after discontinuation of treatment, 33% of the patients were symptomless, while 28% presented recurrence of the endometriomata before 3 months post-discontinuation. Thirty-nine percent of the patients preferred to continue using the method in order to maintain amenorrhea. Conclusion: elcometrine is effective in reducing ovarian endometriomata, without some of the side effects of other treatments.
