Andrea Cintra Facin

Histerossonossalpingografia e histerossalpingografia no diagnóstico de permeabilidade tubária em pacientes inférteis

OBJECTIVES: To compare the hysterosonosalpingography(HSS) to the hysterosalpingography(HSG) in the evaluation of the tubal factor in infertility patients. MATERIAL AND METHODS: A transversal study with 30 patients in infertility investigation, with age minor than 38 years was performed. The patients were submitted to HSS, HSG and laparoscopy (LPC) in the first cycle menstrual phase. The evaluation of tubal patency of HSS and HSG, with LPC like gold-standard was compared. It was calculated the negative predictive value (PV-) of the exams. The HSS used EcovistO like contrast agent, the HSG used water soluble contrast media and the LPC used tubal insuflation with methylene blue. It was considered significative a p< 0.05 RESULTS: The final sample was of 26 patients (4 leave the investigation). The mean age was of 30,6 years. The HSS showed tubal patency in at least one of the tubes in 24 patients (92,3%). The HSG showed tubal patency in one of the tubes in 25 patients (96,2%), and the LPC in 25 patients (96,2%). The PV- of the HSS was of 92% and the PV- of HSG was of 100%. The differences were not statistically significant (p=0.996, Yates test). CONCLUSIONS: The HSS is an alternative method in the evaluation of tubal patency in infertility patients.

Insulin-like growth factor-1 and insulin-like growth factor binding protein-1 and 3 in the follicular fluid of infertile patients submitted to in vitro fertilization

Purpose: In the present article we propose to evaluate IGF-1, IGFBP-1 and 3 in the follicular fluid of infertile patients submitted to in vitro fertilization.Methods: We performed a case-control study with 53 infertile patients submitted to the first in vitro fertilization attempt. We compared their follicular fluid concentration of IGF-1, IGFBP-1 and IGFBP-3 between the patients who became pregnant (n = 11) versus those nonpregnant (n = 42).Results: The clinical characteristics of patients from the two groups were similar in terms of age and body mass index. Data related to the analysis of ovulation induction was not different regarding length of induction in days, number of retrieved oocytes, fertilization rate, and number of transferred embryos. Furthermore, the number of FSH units required for ovarian induction was also similar between the studied groups.IGF-1 and IGFBP-1 were not significantly different between the groups (p > 0.05). However, those patients that became pregnant presented a lower follicular fluid concentration of IGFBP-3, 2237.10 ± 582.73 pg/ml and 2657.64 ± 584.15 ng/ml, respectively (p = 0.038).Conclusions: We demonstrated an association of a lower follicular fluid IGFBP-3 in individuals that became pregnant compared to subjects that did not after in vitro fertilization.

Peritoneal fluid modulates the sperm acrosomal exocytosis induced by N-acetylglucosaminyl neoglycoprotein

The effect of peritoneal fluid (PF) on the human sperm acrosome reaction (AR) was tested. Sperm was pre-incubated with PF and the AR was induced by calcium ionophore A23187 and a neoglycoprotein bearing N-acetylglycosamine residues (NGP). The AR induced by calcium ionophore was inhibited 40% by PF from controls (PFc) and 50% by PF from the endometriosis (PFe) group, but not by PF from infertile patients without endometriosis (PFi). No significant differences were found in the spontaneous AR. When the AR was induced by NGP, pre-incubation with PFc reduced (60%) the percentage of AR, while PFe and PFi caused no significant differences. The average rates of acrosome reactions obtained in control. NGP- and ionophore-treated sperm showed that NGP-induced exocytosis differed significantly between the PFc (11%) and PFe/PFi groups (17%), and the ionophore-induced AR was higher for PFi (33%) than PFc/PFe (25%). The incidence of the NGP-induced AR was reduced in the first hour of pre-incubation with PFc and remained nearly constant throughout 4 h of incubation. The present data indicate that PF possesses a protective factor which prevents premature AR.