Reproduction Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):612-623
DOI 10.1590/S0100-72032006001000008
Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding efficacy of the therapeutic approaches are quite conflicting. Thus, the purpose of the present study was to describe the available scientific evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesions associated with adhesiolysis seems to be more effective than exclusive diagnostic laparoscopy. There is no sufficient evidence to determine whether surgical excision in cases of moderate or severe disease would improve the pregnancy rates. In vitro fertilization seems to be an adequate approach, especially in cases of coexistence of infertility factors and/or failure of other treatments. The possibility of using GnRH for 3 to 6 months before in vitro fertilization should be considered. Regarding pain relief, suppression of ovarian function for 3 to 6 months in patients with laparoscopically-confirmed disease reduces the pain associated with endometriosis. All studied medication seem to have similar efficacy, differing only in terms of adverse effects and costs. Ablation of endometriotic lesion reduces the pain associated with endometriosis, being less effective in cases of minimal disease. Exeresis of endometriomas with diameter > 4 cm seems to improve the rate of natural fecundity and the rate for ??? obtained after assisted reproduction procedures, in addition to reducing both pain and recurrence risk. Finally, it is important to emphasize that this subject is much controversial and the recommendations herein described should be revised as randomized controlled clinical trials with adequate casuistic generate more concrete and reliable evidence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):612-623
DOI 10.1590/S0100-72032006001000008
Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding efficacy of the therapeutic approaches are quite conflicting. Thus, the purpose of the present study was to describe the available scientific evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesions associated with adhesiolysis seems to be more effective than exclusive diagnostic laparoscopy. There is no sufficient evidence to determine whether surgical excision in cases of moderate or severe disease would improve the pregnancy rates. In vitro fertilization seems to be an adequate approach, especially in cases of coexistence of infertility factors and/or failure of other treatments. The possibility of using GnRH for 3 to 6 months before in vitro fertilization should be considered. Regarding pain relief, suppression of ovarian function for 3 to 6 months in patients with laparoscopically-confirmed disease reduces the pain associated with endometriosis. All studied medication seem to have similar efficacy, differing only in terms of adverse effects and costs. Ablation of endometriotic lesion reduces the pain associated with endometriosis, being less effective in cases of minimal disease. Exeresis of endometriomas with diameter > 4 cm seems to improve the rate of natural fecundity and the rate for ??? obtained after assisted reproduction procedures, in addition to reducing both pain and recurrence risk. Finally, it is important to emphasize that this subject is much controversial and the recommendations herein described should be revised as randomized controlled clinical trials with adequate casuistic generate more concrete and reliable evidence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):358-364
DOI 10.1590/S0100-72032006000600007
PURPOSE: to assess the frequency of stress and anxiety levels in infertile women, in order to obtain data for specific psychological intervention. METHODS: a cross-sectional study involving 152 infertile (mean age 30.3±5.4 years), and 150 healthy control women (25.7±7.9 years). All patients were evaluated with the Lipp's Inventory of Stress Symptoms and the State-Trait Anxiety Inventory. Considered dependent variables were: stress frequency and anxiety scores (state and trait). Statistical analysis was performed by the chi2 and Mann-Whitney tests, and logistical regression to test associations between response variables and considered risk factors. Statistical significance was defined as p<0.05. RESULTS: the stress was more frequent in the infertile group than in the control group (61.8 and 36.0%, respectively); however, no significant differences were observed between groups in relation to stress phases and predominant symptoms. With respect to anxiety, there were no significant differences between infertile and control groups as to median state scores (39.5 and 41.0, respectively) and anxiety trait scores (44.0 and 42.0, respectively). Factors significantly associated with greater risk for high anxiety scores in the infertile group were: unawareness of the causal factor, diagnostic phase investigation, and lack of children from other marriages. CONCLUSIONS: it can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting themselves to stressful events without serious physical or psychological compromise.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):358-364
DOI 10.1590/S0100-72032006000600007
PURPOSE: to assess the frequency of stress and anxiety levels in infertile women, in order to obtain data for specific psychological intervention. METHODS: a cross-sectional study involving 152 infertile (mean age 30.3±5.4 years), and 150 healthy control women (25.7±7.9 years). All patients were evaluated with the Lipp's Inventory of Stress Symptoms and the State-Trait Anxiety Inventory. Considered dependent variables were: stress frequency and anxiety scores (state and trait). Statistical analysis was performed by the chi2 and Mann-Whitney tests, and logistical regression to test associations between response variables and considered risk factors. Statistical significance was defined as p<0.05. RESULTS: the stress was more frequent in the infertile group than in the control group (61.8 and 36.0%, respectively); however, no significant differences were observed between groups in relation to stress phases and predominant symptoms. With respect to anxiety, there were no significant differences between infertile and control groups as to median state scores (39.5 and 41.0, respectively) and anxiety trait scores (44.0 and 42.0, respectively). Factors significantly associated with greater risk for high anxiety scores in the infertile group were: unawareness of the causal factor, diagnostic phase investigation, and lack of children from other marriages. CONCLUSIONS: it can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting themselves to stressful events without serious physical or psychological compromise.
