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Rev Bras Ginecol Obstet. 2003;25(3):177-183
DOI 10.1590/S0100-72032003000300006
PURPOSE: to evaluate three embryo scoring systems specific for 3-day embryos and to correlate them with positive in vitro fertilization outcome. METHOD: retrospective study of the In Vitro Fertilization Program of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. A total of 137 patients submitted to the transfer of 439 embryos were evaluated. The main outcomes measured were pregnancy and implantation rates. RESULTS: a significant difference in the three scoring systems was observed between pregnant (n=53) and non-pregnant (n=84) patients (p<0.0001). In the first embryo scoring system, in which cell number alone was used, higher pregnancy (70%) and implantation rates (42%) were observed when embryos with a mean blastomere number higher than 8 were transferred. Scoring system 2, based on a total four-point score (cleavage stage, blastomere number, fragmentation and symmetry), showed increased pregnancy (52.8%) and implantation rates (31%) for scores above 2. Scoring system 3, based on cell number and morphological criteria, also showed higher pregnancy and implantation rates with increasing average scores of the transferred embryos. CONCLUSION: the three scoring systems assessed in 3-day embryos were positively correlated with pregnancy and implantation rates.
Summary
Rev Bras Ginecol Obstet. 2003;25(3):177-183
DOI 10.1590/S0100-72032003000300006
PURPOSE: to evaluate three embryo scoring systems specific for 3-day embryos and to correlate them with positive in vitro fertilization outcome. METHOD: retrospective study of the In Vitro Fertilization Program of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. A total of 137 patients submitted to the transfer of 439 embryos were evaluated. The main outcomes measured were pregnancy and implantation rates. RESULTS: a significant difference in the three scoring systems was observed between pregnant (n=53) and non-pregnant (n=84) patients (p<0.0001). In the first embryo scoring system, in which cell number alone was used, higher pregnancy (70%) and implantation rates (42%) were observed when embryos with a mean blastomere number higher than 8 were transferred. Scoring system 2, based on a total four-point score (cleavage stage, blastomere number, fragmentation and symmetry), showed increased pregnancy (52.8%) and implantation rates (31%) for scores above 2. Scoring system 3, based on cell number and morphological criteria, also showed higher pregnancy and implantation rates with increasing average scores of the transferred embryos. CONCLUSION: the three scoring systems assessed in 3-day embryos were positively correlated with pregnancy and implantation rates.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):323-327
DOI 10.1590/S0100-72032002000500006
Purpose: to assess ovarian reserve by FSH determination on the 3rd day of the menstrual cycle compared to the clomiphene test and to correlate the results with the ovarian response to controlled hyperstimulation with gonadotrophins for in vitro fertilization. Methods: a total of 49 patients older than 30 years who had been presenting a clinical picture of infertility for at least 1 year were selected. All patients were evaluated for ovarian reserve by the clomiphene citrate test and 26 of them were later submitted to controlled ovarian hyperstimulation with gonadotrophins. Of these 26 patients, 18 showed a good response to ovarian hyperstimulation and 8 showed a poor response. Mean (+ SD) FSH values were calculated for the determinations on the 3rd and on the 10th day and for their sum in the group of patients who responded favorably to ovarian stimulation, and were later correlated with the ovarian response after gonadotrophin stimulation. Results: employing a FSH value > 16.1 IU/mL on the 10th day (mean plus 2 SD) for the prediction of a poor ovarian response in the clomiphene test, the sensitivity, specificity, and positive and negative predictive values of this parameter were 50, 100, 100 and 81.8%, respectively. Considering the clomiphene test to be positive when the sum of the FSH values determined on the 3rd and 10th day plus 2 SD was > 22.6 IU/mL, we obtained 62.5% sensitivity 100% specificity, 100% positive predictive value, and 85.7% negative predictive value. A single FSH determination of 10 IU/mL on the 3rd day of the cycle for the prediction of a poor ovarian response showed 87% sensitivity, 100% specificity, 100% positive predictive value and 94.7% negative predictive value. Conclusion: in the present study, a single FSH determination on the 3rd day of the cycle showed to be more sensitive than the clomiphene test for the evaluation of ovarian reserve.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):323-327
DOI 10.1590/S0100-72032002000500006
Purpose: to assess ovarian reserve by FSH determination on the 3rd day of the menstrual cycle compared to the clomiphene test and to correlate the results with the ovarian response to controlled hyperstimulation with gonadotrophins for in vitro fertilization. Methods: a total of 49 patients older than 30 years who had been presenting a clinical picture of infertility for at least 1 year were selected. All patients were evaluated for ovarian reserve by the clomiphene citrate test and 26 of them were later submitted to controlled ovarian hyperstimulation with gonadotrophins. Of these 26 patients, 18 showed a good response to ovarian hyperstimulation and 8 showed a poor response. Mean (+ SD) FSH values were calculated for the determinations on the 3rd and on the 10th day and for their sum in the group of patients who responded favorably to ovarian stimulation, and were later correlated with the ovarian response after gonadotrophin stimulation. Results: employing a FSH value > 16.1 IU/mL on the 10th day (mean plus 2 SD) for the prediction of a poor ovarian response in the clomiphene test, the sensitivity, specificity, and positive and negative predictive values of this parameter were 50, 100, 100 and 81.8%, respectively. Considering the clomiphene test to be positive when the sum of the FSH values determined on the 3rd and 10th day plus 2 SD was > 22.6 IU/mL, we obtained 62.5% sensitivity 100% specificity, 100% positive predictive value, and 85.7% negative predictive value. A single FSH determination of 10 IU/mL on the 3rd day of the cycle for the prediction of a poor ovarian response showed 87% sensitivity, 100% specificity, 100% positive predictive value and 94.7% negative predictive value. Conclusion: in the present study, a single FSH determination on the 3rd day of the cycle showed to be more sensitive than the clomiphene test for the evaluation of ovarian reserve.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):405-410
DOI 10.1590/S0100-72032004000500010
OBJECTIVE: to assess the ovarian response of poor responsive patients, submitted to the bromocriptine method. PACIENTS AND METHODS: a prospective clinical trial for the in vitro fertilization (IVF) program was performed in 10 poor responsive patients. Endocrinologically normal ovulatory women under 38 years old, who had previously failed in IVF due to poor response to ovarian stimulation with the traditional protocol, were submitted to the bromocriptine method in 12 cycles. They were given bromocriptine, a dopaminergic agonist, in the preceding cycle in order to stop the prolactin production. When the medication was removed at the beginning of the stimulation cycle, an elevation of seric prolactin by a rebound phenomenon was found. This optimized its seric concentration, improving the quality of oocytes and embryos. Serum prolactin and estradiol concentrations, number of follicles, number and quality of oocytes and cleaved embryos, fertilization and pregnancy rates were analyzed. RESULTS: there was a reduction in the dose of gonadotropin administered and in the duration of ovarian stimulation and an improvement in follicular recruitment, oocyte retrieval, embryo morphology, fertilization, and ongoing pregnancy rates. Fertilization rate was 77.7%, pregnancy rate was 44.4% and live baby rate was 25%. CONCLUSION: this study suggests that the bromocriptine method enhanced follicular recruitment and embryonic development, resulting in increased fertilization and pregnancy rates when compared with the traditional protocol for poor responsive patients. Studies with a large number of patients are necessary to confirm these results.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):405-410
DOI 10.1590/S0100-72032004000500010
OBJECTIVE: to assess the ovarian response of poor responsive patients, submitted to the bromocriptine method. PACIENTS AND METHODS: a prospective clinical trial for the in vitro fertilization (IVF) program was performed in 10 poor responsive patients. Endocrinologically normal ovulatory women under 38 years old, who had previously failed in IVF due to poor response to ovarian stimulation with the traditional protocol, were submitted to the bromocriptine method in 12 cycles. They were given bromocriptine, a dopaminergic agonist, in the preceding cycle in order to stop the prolactin production. When the medication was removed at the beginning of the stimulation cycle, an elevation of seric prolactin by a rebound phenomenon was found. This optimized its seric concentration, improving the quality of oocytes and embryos. Serum prolactin and estradiol concentrations, number of follicles, number and quality of oocytes and cleaved embryos, fertilization and pregnancy rates were analyzed. RESULTS: there was a reduction in the dose of gonadotropin administered and in the duration of ovarian stimulation and an improvement in follicular recruitment, oocyte retrieval, embryo morphology, fertilization, and ongoing pregnancy rates. Fertilization rate was 77.7%, pregnancy rate was 44.4% and live baby rate was 25%. CONCLUSION: this study suggests that the bromocriptine method enhanced follicular recruitment and embryonic development, resulting in increased fertilization and pregnancy rates when compared with the traditional protocol for poor responsive patients. Studies with a large number of patients are necessary to confirm these results.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):47-54
DOI 10.1590/S0100-72031999000100008
Purpose: to evaluate clinical and ultrasonic findings in patients with pelvic tumors at postmenopause and to correlate them with the final diagnosis. Patients and Methods: thirty-six postmenopausal women with pelvic tumor diagnosis were prospectively evaluated through clinical examination and endovaginal ultrasonography. Clinical follow-up with no surgical procedures was indicated for anechoic cystic tumors with or without thin unique septation and volume under 50 cm³. Needle aspiration was indicated for tumors with the same aspect, and volume of 50 to 100 cm³, whereas exploratory laparotomy was performed in the remaining patients. Diagnosis defined two groups of patients: benign (28) and malignant (8) pathologies. Results: anechoic cystic tumor with or without a thin septum indicates benignity (p = 0.0091). Tumors with solid areas indicate malignancy (p = 0.0024). Ascites correlates with malignancy (p = 0.0278). Heterogeneity, thick capsule, thick septa, and papillary projections predominated in malignancies but without no statistical significance (p > 0,05). Tumor volume indicates malignancy, with a median of 85.2 cm³ in benign tumors and 452.5 cm³ in malignancies (p = 0.0048), with a cutoff at 295 cm³ (sensitivity = 83.3% and specificity = 85.2%). Following this protocol, all malignancies were submitted to surgery and 11 benign tumor patients were treated with a conservative protocol (39.3% of all benign patients). Conclusion: conservative management is an adequate protocol for women with anechoic pelvic tumors with low volume, with or without single thin septum and without ascites. Differentiation between benign and malignant of complex and/or high volume tumors requires complementary investigation.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):47-54
DOI 10.1590/S0100-72031999000100008
Purpose: to evaluate clinical and ultrasonic findings in patients with pelvic tumors at postmenopause and to correlate them with the final diagnosis. Patients and Methods: thirty-six postmenopausal women with pelvic tumor diagnosis were prospectively evaluated through clinical examination and endovaginal ultrasonography. Clinical follow-up with no surgical procedures was indicated for anechoic cystic tumors with or without thin unique septation and volume under 50 cm³. Needle aspiration was indicated for tumors with the same aspect, and volume of 50 to 100 cm³, whereas exploratory laparotomy was performed in the remaining patients. Diagnosis defined two groups of patients: benign (28) and malignant (8) pathologies. Results: anechoic cystic tumor with or without a thin septum indicates benignity (p = 0.0091). Tumors with solid areas indicate malignancy (p = 0.0024). Ascites correlates with malignancy (p = 0.0278). Heterogeneity, thick capsule, thick septa, and papillary projections predominated in malignancies but without no statistical significance (p > 0,05). Tumor volume indicates malignancy, with a median of 85.2 cm³ in benign tumors and 452.5 cm³ in malignancies (p = 0.0048), with a cutoff at 295 cm³ (sensitivity = 83.3% and specificity = 85.2%). Following this protocol, all malignancies were submitted to surgery and 11 benign tumor patients were treated with a conservative protocol (39.3% of all benign patients). Conclusion: conservative management is an adequate protocol for women with anechoic pelvic tumors with low volume, with or without single thin septum and without ascites. Differentiation between benign and malignant of complex and/or high volume tumors requires complementary investigation.
Summary
Rev Bras Ginecol Obstet. 2002;24(7):485-489
DOI 10.1590/S0100-72032002000700009
The most frequently nontrophoblastic tumor of the placenta found is chorioangioma, with an incidence of about 1%. When they are small, they do not significantly affect the fetus, but the large ones can cause intrauterine growth restriction, polyhydramnios, premature delivery, congestive heart failure and fetal death. The authors report a case of chorioangioma in a 28-year-old woman, second gestation, whose diagnosis was established at the 32nd week by ultrasound and confirmed by the anatomopathological examination. Ultrasonography evaluations showed chronic fetal distress and the delivery was performed at 36 weeks. The newborn results were satisfactory with Apgar 9-10 and fetal weight 2.460 g.
Summary
Rev Bras Ginecol Obstet. 2002;24(7):485-489
DOI 10.1590/S0100-72032002000700009
The most frequently nontrophoblastic tumor of the placenta found is chorioangioma, with an incidence of about 1%. When they are small, they do not significantly affect the fetus, but the large ones can cause intrauterine growth restriction, polyhydramnios, premature delivery, congestive heart failure and fetal death. The authors report a case of chorioangioma in a 28-year-old woman, second gestation, whose diagnosis was established at the 32nd week by ultrasound and confirmed by the anatomopathological examination. Ultrasonography evaluations showed chronic fetal distress and the delivery was performed at 36 weeks. The newborn results were satisfactory with Apgar 9-10 and fetal weight 2.460 g.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):85-90
DOI 10.1590/S0100-72031999000200005
Purpose: to present a profile of endometriosis, stages and results of treatment among the patients seen in our Service. Methods: the medical records of 155 patients with endometriosis treated during the period from 1991 to 1996 according to a preestablished protocol were examined. Results: mean patient age was 31 years, most patients were white, with regular menstrual cycles. The most frequently observed symptoms were dysmenorrhea, pelvic pain and infertility and were mild in most of the cases. The diagnostic methods utilized were laparoscopy or echography. There was agreement between echography and laparoscopy in 96% of cases. Laparotomy was required in 28% of cases for diagnostic elucidation and/or treatment. Endometrioma was detected in 37% of the cases and endometriosis was confirmed in only 74% of the biopsies from the lesion by anatomopathological examination. There was a significant improvement with clinical treatment regardless of the drug used, with improved symptoms in approximately 50% of the patients. Assisted fertilization was performed in 34 patients, consisting of in vitro fertilization (IVF) for 80% of them, with a 27% pregnancy/transfer rate. Conclusions: the diagnostic method of choice should be laparoscopy, although echography presented a high rate of agreement. Anatomopathological examination of the lesions should be used as an adjuvant method in the diagnosis since it is not confirmatory in all of the cases. Clinical treatment with assisted reproductive technologies is a good therapeutic option, especially with the use of IVF.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):85-90
DOI 10.1590/S0100-72031999000200005
Purpose: to present a profile of endometriosis, stages and results of treatment among the patients seen in our Service. Methods: the medical records of 155 patients with endometriosis treated during the period from 1991 to 1996 according to a preestablished protocol were examined. Results: mean patient age was 31 years, most patients were white, with regular menstrual cycles. The most frequently observed symptoms were dysmenorrhea, pelvic pain and infertility and were mild in most of the cases. The diagnostic methods utilized were laparoscopy or echography. There was agreement between echography and laparoscopy in 96% of cases. Laparotomy was required in 28% of cases for diagnostic elucidation and/or treatment. Endometrioma was detected in 37% of the cases and endometriosis was confirmed in only 74% of the biopsies from the lesion by anatomopathological examination. There was a significant improvement with clinical treatment regardless of the drug used, with improved symptoms in approximately 50% of the patients. Assisted fertilization was performed in 34 patients, consisting of in vitro fertilization (IVF) for 80% of them, with a 27% pregnancy/transfer rate. Conclusions: the diagnostic method of choice should be laparoscopy, although echography presented a high rate of agreement. Anatomopathological examination of the lesions should be used as an adjuvant method in the diagnosis since it is not confirmatory in all of the cases. Clinical treatment with assisted reproductive technologies is a good therapeutic option, especially with the use of IVF.