Eduardo Pandolfi Passos

Congruence of quality of life among infertile men and women: findings from a couple-based study

BACKGROUND It has been consistently demonstrated that infertility is associated with quality of life (QOL) impairments. Research to date has mostly focused on individuals reactions to infertility (mainly women), without an examination of how the partner is reacting to the same condition. The few studies that assessed QOL among couples did not use couple-based analyses, consequently not considering the intra-couple effects. The objectives of this study were to explore the congruence of QOL perception within infertile couples and to estimate the effect of depression levels on the congruence. METHODS In total, 162 couples were interviewed in an assisted reproduction clinic cross-sectionally. Subjects completed a socio-demographic form, World Health Organization Quality of Life-BREF and the Beck Depression Inventory independently. The statistical strategy was guided to ensure that subjects would be explored within pairs at all times and not as independent groups. Paired t-tests were run, and Cohens effect was estimated. Depression levels were controlled by linear multiple regressions and repeated-measures ANCOVAs. RESULTS Out of the five QOL domain scores, only two showed a significant discrepancy between partners (psychological and social relationship domains). Male depression was a significant predictor for all five QOL difference scores, whereas female depression was associated with three (overall, psychological and physical). Moreover, it was demonstrated that, except for the psychological domain and for the female depression on the physical domain, the load of depression as a predictor of the QOL difference scores was markedly low, accounting for not more than 7.5% of the variance of congruence between mens and womens QOL. CONCLUSION Our findings suggest that QOL scores do not differ markedly between spouses. Since QOL seemed similarly affected in both men and women, consideration might be given to offering interventions to them as a dyad. These results are not in line with the previous non-paired studies, and further investigations are required to address this dissimilarity.

Value of the International Federation for Cervical Pathology and Colposcopy (IFCPC) Terminology in Predicting Cervical Disease

Objective. To evaluate the colposcopic accuracy according to the International Federation for Cervical Pathology and Colposcopy (IFCPC) 2002 terminology. Materials and Methods. A series of 3,040 women derived from a general population were screened by means of Pap smear, unaided visual inspection, and high-risk human papillomavirus testing. All colposcopic examination results with abnormal findings and with biopsy confirmation (n = 468) were recorded, reviewed by 2 blinded colposcopists according to the IFCPC nomenclature, and included in this analysis. Results. The IFCPC terminology was easily reproduced by the 2 observers with excellent interobserver agreement (&kgr; =.843). Colposcopy had a sensitivity of 86% and a specificity of 30.3% in distinguishing healthy cervix from that with cervical intraepithelial neoplasia (CIN)/carcinoma. In distinguishing healthy cervix/low-grade lesions (CIN 1) from that with high-grade lesions (CIN 2/3)/carcinoma, colposcopy had a sensitivity of 61.1% and a specificity of 94.4%. Colposcopic findings graded as major changes had the highest positive predictive value for detecting high-grade lesion/carcinoma. The colposcopic abnormalities within the transformation zone and large lesions were more closely related to high-grade lesion/carcinoma, whereas a sharp outer border, multiple colposcopic abnormalities, and iodine negativity were not statistically related to severe lesions. Conclusions. Colposcopy using the new IFCPC classification is a potentially effective screening method; when used for diagnosis, a histological sampling is necessary. The categorization of major changes and minor changes is appropriate. It is important to describe the lesion localization in relation to the transformation zone and the lesion size because these characteristics are related to high-grade lesions.

Physiopathological Aspects of Corpus Luteum Defect in Infertile Patients with Mild/Minimal Endometriosis

AbstractPurpose: We describe a physiopathological model to the luteal insufficiency of infertile patients with mild/minimal endometriosis with normal hormone measurements in the early follicular phase. Methods: We designed a case-control study with 24 patients, 14 fertile with in-phase endometrium (control group) and 10 infertile with mild/minimal endometriosis and luteal insufficiency (study group). The histologic dating of endometrium was performed during cycle days 23–25 and serum TSH, FSH, LH, prolactin, and estradiol levels were measured during the early follicular phase (cycle day 3). Progesterone serum levels were measured in three different occasions during the luteal phase. Results: Patients with out-of-phase endometrium have lower estradiol levels (P = 0.031) and decreased progesterone secretion (P = 0.012) during the late luteal phase. Serum prolactin, TSH, FSH, and LH levels were similar between the groups (P > 0.05). Conclusions: The physiopathology of luteal phase defect in infertile patients with mild/minimal endometriosis is associated with a small and large luteal cells dysfunction, characterized by abnormal follicular phase (lower estradiol serum levels) and lower progesterone LH-dependent secretion.

Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: a randomized controlled trial

BACKGROUND Obesity is related to hormonal disorders that affect the reproductive system. Low-glycemic index (LGI) diets seem to exert a positive effect on weight loss and on metabolic changes that result from obesity. OBJECTIVE We investigated the effects of a hypocaloric diet with an LGI and low glycemic load on anthropometric and metabolic variables, ghrelin and leptin concentrations, and the pregnancy rate in overweight and obese infertile women who were undergoing in vitro fertilization (IVF). DESIGN The study was a randomized block-design controlled trial in which we analyzed 26 overweight or obese infertile women. Patients were assigned to a hypocaloric LGI-diet group or a control group and followed the protocol for 12 wk. Body weight, body mass index (BMI), percentage of body fat, glucose, insulin, homeostasis model assessment of insulin resistance, serum lipids, reproductive hormones, leptin, acylated ghrelin, number of oocytes retrieved in the IVF cycle, and pregnancy rate were determined. RESULTS There were greater reductions in body mass, BMI, percentage of body fat, waist:hip ratio, and leptin in the LGI-diet group than in the control group (P < 0.05). Despite a change of 18% in mean values, there was no significant increase in acylated ghrelin concentrations in the LGI group compared with the control group (P = 0.215). The LGI-diet group had 85.4% more oocytes retrieved than did the control group (7.75 ± 1.44 and 4.18 ± 0.87, respectively; P = 0.039) in the IVF cycle. Three patients (21.4%) in the LGI group experienced a spontaneous pregnancy during the follow-up, which generated 3 live births. CONCLUSIONS The hypocaloric LGI diet promoted a decrease in BMI, percentage of body fat, and leptin concentrations, which improved oocyte development and pregnancy rate. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet before being submitted for treatment with assisted reproduction technologies. A hypocaloric diet combined with LGI foods seems to be beneficial for these patients, but additional studies are required before this treatment is recommended. This trial was registered at clinicaltrials.gov as NCT02416960.

Betacellulin Overexpression in Mesenchymal Stem Cells Induces Insulin Secretion In Vitro and Ameliorates Streptozotocin-Induced Hyperglycemia in Rats

Betacellulin (BTC), a ligand of the epidermal growth factor receptor, has been shown to promote growth and differentiation of pancreatic β-cells and to improve glucose metabolism in experimental diabetic rodent models. Mesenchymal stem cells (MSCs) have been already proved to be multipotent. Recent work has attributed to rat and human MSCs the potential to differentiate into insulin-secreting cells. Our goal was to transfect rat MSCs with a plasmid containing BTC cDNA to guide MSC differentiation into insulin-producing cells. Prior to induction of cell MSC transfection, MSCs were characterized by flow cytometry and the ability to in vitro differentiate into mesoderm cell types was evaluated. After rat MSC characterization, these cells were electroporated with a plasmid containing BTC cDNA. Transfected cells were cultivated in Dulbeccos modified Eagle medium high glucose (H-DMEM) with 10 mM nicotinamide. Then, the capability of MSC-BTC to produce insulin in vitro and in vivo was evaluated. It was possible to demonstrate by radioimmunoassay analysis that 10(4) MSC-BTC cells produced up to 0.4 ng/mL of insulin, whereas MSCs transfected with the empty vector (negative control) produced no detectable insulin levels. Moreover, MSC-BTC were positive for insulin in immunohistochemistry assay. In parallel, the expression of pancreatic marker genes was demonstrated by molecular analysis of MSC-BTC. Further, when MSC-BTC were transplanted to streptozotocin diabetic rats, BTC-transfected cells ameliorated hyperglycemia from over 500 to about 200 mg/dL at 35 days post-cell transplantation. In this way, our results clearly demonstrate that BTC overabundance enhances glucose-induced insulin secretion in MSCs in vitro as well as in vivo.

Psychological distress as predictor of quality of life in men experiencing infertility: a cross-sectional survey.

BackgroundInfertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOLs dimensions in men experiencing infertility.Methods162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added.Results and DiscussionModel 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity.ConclusionSubthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.

Validação de versão para o português de questionário sobre qualidade de vida para mulher com endometriose (Endometriosis Health Profile Questionnaire - EHP-30)

PURPOSE: the objective of the present study was the development of the Brazilian Portuguese version of Endometriosis Health Profile Questionnaire (EHP-30), the cross-cultural adaptation to Brazil and the evaluation of EHP-30 Portuguese psychometric measures in a Brazilian sample. METHODS: the original instrument in English was translated into Portuguese following international guidelines, going through all stages of translation, back-translation and comparison of the versions for cross-cultural adaptation, face and content validity. A sample of 54 patients with endometriosis was used for internal consistency analyses using the Cronbach alpha. Test-retest reliability was evaluated through the intraclass correlation coefficient (ICC). In order to evaluate the convergent construct validity, the correlation between EHP-30 Portuguese and WHOQOL-Bref and Beck Depression Inventory (BDI) was tested. RESULTS: internal consistency presented alpha values of 0.8 to 0.9 suggesting homogeneity between questions. The test-retest reliability presented ICC of 0.8 to 0.9 showing instrument stability. In the construct validation, strong correlations were demonstrated of the EHP-30 Portuguese self-image scale with physical (-0.6) and psychological domains (-0.6) of WHOQOL-Bref, and EHP-30 Portuguese social support scale with BDI (0.5), confirming good correlation with other quality of life evaluation instruments. CONCLUSIONS: the EHP-30 Portuguese was found to be an easy, quickly applied instrument, and well-accepted by the patients. It presented good psychometric properties with appropriate reliability measures (internal consistency and test-retest reliability) and construct validity. These results show that EHP-30 Portuguese is an adequate instrument for quality of life evaluation in Brazilian women with endometriosis, both in clinical and research setting.

Sexual function and chemotherapy in postmenopausal women with breast cancer

BackgroundThis cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy.MethodsThe FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 ± 11.82 years in the breast cancer group and 52.58 ± 7.19 years in the control group.ResultsScores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (−41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants – a borderline significant difference (p = 0.063).ConclusionThe present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.

Sexual Function in Women from Infertile Couples and in Women Seeking Surgical Sterilization

The purpose of this study was to compare sexual function between women of infertile couples (AR) and women seeking tubal ligation (TL). Women who attended Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clinicas de Porto Alegre (HCPA) or the Serviço de Orientação e Planejamento Familiar (SERPLAN) completed the Female Sexual Function Index, a questionnaire about sexual activity in the last 4 weeks. Scored data were collected on six different domains: desire, arousal, lubrication, orgasm, satisfaction, and discomfort/pain. The greatest positive correlation in the TL group was between orgasm and sexual satisfaction (0.798), and in group AR between desire and arousal (0.627). Infertile women and fertile women who want to undergo surgical sterilization have similar sexual satisfaction scores.

Cell therapy for chemically induced ovarian failure in mice.

Cell therapy has been linked to an unexplained return of ovarian function and fertility in some cancer survivors. Studies modeling this in mice have shown that cells transplantation generates donor-derived oocytes in chemotherapy-treated recipients. This study was conducted to further clarify the impact of cell transplantation from different sources on female reproductive function after chemotherapy using a preclinical mouse model. Methods. Female mice were administered 7.5 mg/kg cisplatin followed by cell transplantation (one week later) using GFP+ female cell donors. For cell tracking, adipose derived stem cell GFP+ (ADSC), female germline stem cell GFP+/MVH+ (FGSC), or ovary cell suspension GFP+ mice were transplanted into cisplatin-treated wild-type recipients. After 7 or 14 days animals were killed and histological analysis, IHQ for GFP cells, and ELISA for estradiol were performed. Results. Histological examinations showed that ADSC, ovary cell suspension, and FGSC transplant increase the number of follicles with apparent normal structure in the cells recipient group euthanized on day 7. Cell tracking showed GFP+ samples 7 days after transplant. Conclusion. These data suggest that intraovarian injection of ADSCs and FGSC into mice with chemotherapy-induced ovarian failure diminished the damage caused by cisplatin.