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Rev Bras Ginecol Obstet. 2009;31(3):111-116
DOI 10.1590/S0100-72032009000300002
PURPOSE: to evaluate whether the presence of insulin resistance (IR) alters cardiovascular risk factors in women with polycystic ovary syndrome (POS). METHODS: transversal study where 60 POS women with ages from 18 to 35 years old, with no hormone intake, were evaluated. IR was assessed through the quantitative insulin sensitivity check index (QUICKI) and defined as QUICKI <0.33. The following variables have been compared between the groups with or without IR: anthropometric (weight, height, waist circumference, arterial blood pressure, cardiac frequency), laboratorial (homocysteine, interleucines-6, factor of tumoral-α necrosis, testosterone, fraction of free androgen, total cholesterol and fractions, triglycerides, C reactive protein, insulin, glucose), and ultrasonographical (distensibility and carotid intima-media thickness, dilation mediated by the brachial artery flux). RESULTS: Eighteen women (30%) presented IR and showed significant differences in the following anthropometric markers, as compared to the women without IR (POS with and without IR respectively): body mass index (35.56±5.69 kg/m² versus 23.90±4.88 kg/m², p<0.01), waist (108.17±11.53 versus 79.54±11.12 cm, p<0.01), systolic blood pressure (128.00±10.80 mmHg versus 114.07±8.97 mmHg, p<0.01), diastolic blood pressure (83.67±9.63 mmHg versus 77.07±7.59 mmHg, p=0.01). It has also been observed significant differences in the following laboratorial markers: triglycerides (120.00±56.53 mg/dL versus 77.79±53.46 mg/dL, p=0.01), HDL (43.06±6.30 mg/dL versus 40.45±10.82 mg/dL, p=0.01), reactive C protein (7.98±10.54 mg/L versus 2.61±3.21 mg/L, p<0.01), insulin (28.01±18.18 µU/mL versus 5.38±2.48 µU/mL, p<0.01), glucose (93.56±10.00 mg/dL versus 87.52±8.75 mg/dL, p=0.02). Additionally, two out of the three ultrasonographical markers of cardiovascular risk were also different between the groups: carotid distensibility (0.24±0.05 mmHg-1 versus 0.30±0.08 mmHg-1, p<0.01) and carotid intima-media thickness (0.52±0.08 mm versus 0.43±0.09, p<0.01). Besides, the metabolic syndrome ratio was higher in women with IR (nine cases=50% versus three cases=7.1%, p<0.01). CONCLUSIONS: POS and IR women present significant differences in several ultrasonographical, seric and anthropometric markers, which point out to higher cardiovascular risk, as compared to women without POS and IR. In face of that, the systematic IR evaluation in POS women may help to identify patients with cardiovascular risk.
Summary
Rev Bras Ginecol Obstet. 2009;31(3):111-116
DOI 10.1590/S0100-72032009000300002
PURPOSE: to evaluate whether the presence of insulin resistance (IR) alters cardiovascular risk factors in women with polycystic ovary syndrome (POS). METHODS: transversal study where 60 POS women with ages from 18 to 35 years old, with no hormone intake, were evaluated. IR was assessed through the quantitative insulin sensitivity check index (QUICKI) and defined as QUICKI <0.33. The following variables have been compared between the groups with or without IR: anthropometric (weight, height, waist circumference, arterial blood pressure, cardiac frequency), laboratorial (homocysteine, interleucines-6, factor of tumoral-α necrosis, testosterone, fraction of free androgen, total cholesterol and fractions, triglycerides, C reactive protein, insulin, glucose), and ultrasonographical (distensibility and carotid intima-media thickness, dilation mediated by the brachial artery flux). RESULTS: Eighteen women (30%) presented IR and showed significant differences in the following anthropometric markers, as compared to the women without IR (POS with and without IR respectively): body mass index (35.56±5.69 kg/m² versus 23.90±4.88 kg/m², p<0.01), waist (108.17±11.53 versus 79.54±11.12 cm, p<0.01), systolic blood pressure (128.00±10.80 mmHg versus 114.07±8.97 mmHg, p<0.01), diastolic blood pressure (83.67±9.63 mmHg versus 77.07±7.59 mmHg, p=0.01). It has also been observed significant differences in the following laboratorial markers: triglycerides (120.00±56.53 mg/dL versus 77.79±53.46 mg/dL, p=0.01), HDL (43.06±6.30 mg/dL versus 40.45±10.82 mg/dL, p=0.01), reactive C protein (7.98±10.54 mg/L versus 2.61±3.21 mg/L, p<0.01), insulin (28.01±18.18 µU/mL versus 5.38±2.48 µU/mL, p<0.01), glucose (93.56±10.00 mg/dL versus 87.52±8.75 mg/dL, p=0.02). Additionally, two out of the three ultrasonographical markers of cardiovascular risk were also different between the groups: carotid distensibility (0.24±0.05 mmHg-1 versus 0.30±0.08 mmHg-1, p<0.01) and carotid intima-media thickness (0.52±0.08 mm versus 0.43±0.09, p<0.01). Besides, the metabolic syndrome ratio was higher in women with IR (nine cases=50% versus three cases=7.1%, p<0.01). CONCLUSIONS: POS and IR women present significant differences in several ultrasonographical, seric and anthropometric markers, which point out to higher cardiovascular risk, as compared to women without POS and IR. In face of that, the systematic IR evaluation in POS women may help to identify patients with cardiovascular risk.
Summary
Rev Bras Ginecol Obstet. 2007;29(3):141-146
DOI 10.1590/S0100-72032007000300005
PURPOSE: to evaluate the effect of obesity on beta-cell function in patients with polycystic ovary syndrome (PCOS). METHODS: this cross-section study evaluated 82 patients with PCOS selected consecutively, at the moment of the diagnosis. We compared 31 PCOS obese women (BMI >30 kg/m²) to 51 age-matched PCOS nonobese patients (BMI <30 kg/m²). Using fasting glucose and insulin levels, homeostatic model assessment values for insulin resistance (HOMA-IR and QUICKI) and percent beta-cell function (HOMA-%beta-cell) were calculated. As secondary variables, the age at PCOS diagnosis, age of menarche, hormonal levels (testosterone, prolactin, FSH and LH), total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were also analyzed. RESULTS: menarche was significantly earlier in obese PCOS patients (11.7±1.8 years) than in nonobese patients (12.67±1.86 years) (p<0.05). Obese patients presented lower LH levels (7.9±5 mIU/mL) than did nonobese patients (10.6±6 mIU/mL) (p<0.05). Both groups presented mean HDL cholesterol levels below 50 mg/dL. Obese patients presented significantly higher baseline insulin levels (32.5±25.2 mIU/mL) and fasting blood glucose levels (115.9±40.7 mg/dL) than did nonobese patients (8.8±6.6 mIU/mL and 90.2±8.9 mg/dL, respectively) (p<0.01). Of the obese PCOS patients, 93% presented insulin resistance versus 25% of nonobese PCOS patients (p<0.01). Eighty-six perecent of the obese women had hyperfunction of beta-cell versus 41% of nonobese with PCOS (p<0.0001). CONCLUSIONS: obese PCOS patients presented higher prevalence of insulin resistance and hyperfunction of beta-cell than did nonobese PCOS patients.
Summary
Rev Bras Ginecol Obstet. 2007;29(3):141-146
DOI 10.1590/S0100-72032007000300005
PURPOSE: to evaluate the effect of obesity on beta-cell function in patients with polycystic ovary syndrome (PCOS). METHODS: this cross-section study evaluated 82 patients with PCOS selected consecutively, at the moment of the diagnosis. We compared 31 PCOS obese women (BMI >30 kg/m²) to 51 age-matched PCOS nonobese patients (BMI <30 kg/m²). Using fasting glucose and insulin levels, homeostatic model assessment values for insulin resistance (HOMA-IR and QUICKI) and percent beta-cell function (HOMA-%beta-cell) were calculated. As secondary variables, the age at PCOS diagnosis, age of menarche, hormonal levels (testosterone, prolactin, FSH and LH), total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were also analyzed. RESULTS: menarche was significantly earlier in obese PCOS patients (11.7±1.8 years) than in nonobese patients (12.67±1.86 years) (p<0.05). Obese patients presented lower LH levels (7.9±5 mIU/mL) than did nonobese patients (10.6±6 mIU/mL) (p<0.05). Both groups presented mean HDL cholesterol levels below 50 mg/dL. Obese patients presented significantly higher baseline insulin levels (32.5±25.2 mIU/mL) and fasting blood glucose levels (115.9±40.7 mg/dL) than did nonobese patients (8.8±6.6 mIU/mL and 90.2±8.9 mg/dL, respectively) (p<0.01). Of the obese PCOS patients, 93% presented insulin resistance versus 25% of nonobese PCOS patients (p<0.01). Eighty-six perecent of the obese women had hyperfunction of beta-cell versus 41% of nonobese with PCOS (p<0.0001). CONCLUSIONS: obese PCOS patients presented higher prevalence of insulin resistance and hyperfunction of beta-cell than did nonobese PCOS patients.
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. 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. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Summary
Rev Bras Ginecol Obstet. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Summary
Rev Bras Ginecol Obstet. 2008;30(5):241-247
DOI 10.1590/S0100-72032008000500006
PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro matured oocytes obtained from stimulated cycles of infertile women with polycystic ovary syndrome (PCOS) and with male factor and/or tubal infertility (Control Group) and compare in vitro maturation (IVM) rates between the groups analyzed. METHODS: five infertile patients with PCOS and eight controls, submitted to stimulated cycles for intracytoplasmic sperm injection, were selected prospectively and consecutively, and respectively assigned to the study group and the Control Group. Immature oocytes (21 and 29, respectively, from PCOS and Control Group) were submitted to IVM. After IVM, oocytes with first polar body extruded were fixed and submitted to immunostaining and fluorescence microscopy for morphological evaluation of the spindle and of chromosome distribution. Statistical analysis was performed by the Fisher test with significance, when p<0.05. RESULTS: IVM rates were similar between groups (47.6 e 44.8%, respectively, for PCOS and Control Group). Six of the ten oocytes (60%) from the study group and four of the 12 oocytes (33.3%) from the Control Group presented meiotic anomalies of the spindle and/or anomalous chromosome distribution, without statistical difference between groups. CONCLUSIONS: data from the present study did not demonstrate significant difference neither in IVM rates nor in the proportions of meiotic anomalies between in vitro matured oocytes obtained from stimulated cycles from PCOS patients and control ones.
Summary
Rev Bras Ginecol Obstet. 2008;30(5):241-247
DOI 10.1590/S0100-72032008000500006
PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro matured oocytes obtained from stimulated cycles of infertile women with polycystic ovary syndrome (PCOS) and with male factor and/or tubal infertility (Control Group) and compare in vitro maturation (IVM) rates between the groups analyzed. METHODS: five infertile patients with PCOS and eight controls, submitted to stimulated cycles for intracytoplasmic sperm injection, were selected prospectively and consecutively, and respectively assigned to the study group and the Control Group. Immature oocytes (21 and 29, respectively, from PCOS and Control Group) were submitted to IVM. After IVM, oocytes with first polar body extruded were fixed and submitted to immunostaining and fluorescence microscopy for morphological evaluation of the spindle and of chromosome distribution. Statistical analysis was performed by the Fisher test with significance, when p<0.05. RESULTS: IVM rates were similar between groups (47.6 e 44.8%, respectively, for PCOS and Control Group). Six of the ten oocytes (60%) from the study group and four of the 12 oocytes (33.3%) from the Control Group presented meiotic anomalies of the spindle and/or anomalous chromosome distribution, without statistical difference between groups. CONCLUSIONS: data from the present study did not demonstrate significant difference neither in IVM rates nor in the proportions of meiotic anomalies between in vitro matured oocytes obtained from stimulated cycles from PCOS patients and control ones.
Summary
Rev Bras Ginecol Obstet. 2017;39(6):255-257
Summary
Rev Bras Ginecol Obstet. 2017;39(6):255-257
Summary
Rev Bras Ginecol Obstet. 2012;34(6):274-277
DOI 10.1590/S0100-72032012000600006
PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.
Summary
Rev Bras Ginecol Obstet. 2012;34(6):274-277
DOI 10.1590/S0100-72032012000600006
PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.
Summary
Rev Bras Ginecol Obstet. 2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.
Summary
Rev Bras Ginecol Obstet. 2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.