Fernando Monteiro de Freitas

The effect of the levonorgestrel-releasing intrauterine system and the copper intrauterine device on subendometrial microvascularization and uterine artery blood flow

OBJECTIVE To evaluate the effect of the levonorgestrel intrauterine system (LNG-IUS) and TCU 380A on the subendometrial vascularization and the uterine artery blood flow during the midluteal phase. DESIGN Prospective clinical trial. SETTING Teaching hospital. PATIENT(S) The trial included 27 patients who received the LNG-IUS compared with 25 patients who received the TCU 380A. INTERVENTION(S) The subendometrial blood flow was evaluated using power Doppler analysis, uterine artery pulsatility index (PI), and resistance index (RI) just before inserting the intrauterine device in the midluteal phase and 3 months after. MAIN OUTCOME MEASUREMENT(S) Power Doppler analysis, PI, RI, and endometrial thickness. RESULT(S) There were no significant differences in subendometrial vascularization between the groups. Pulsatility index and RI variability (before and after) increased and endometrial thickness reduced in LNG-IUS users. We used the multiple logistic regression model to examine the potential confounding bias (age and parity). The LNG-IUS was independently associated with increased PI. CONCLUSION(S) No subendometrial microvascularization difference was found between the groups. It is the first direct evidence that LNG-IUS reduced uterine artery blood flow, even after controlling for age and parity.

Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device)

BACKGROUND A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. STUDY DESIGN This study has a prospective clinical trial design. RESULTS There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. CONCLUSION The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion.

Predictive factors for motile sperm recovery using testicular biopsy in nonobstructive azoospermic patients

Objective: The objective of the presentstudy was to assess the predictive value ofhormone values, histological analysis for thefinding of motile spermatozoa on testicularbiopsy in nonobstructive azoospermia.Methods: This cross-sectional studyassessed serum follicle-stimulating hormone(FSH), luteinizing hormone, prolactin and totaltestosterone values in 50 patients undergoingtesticular biopsy prior to ICSI. P< 0.05 wasconsidered significant.Results: Recovery was successful in 28cases, and motile spermatozoa were retrieved in7. Significant differences were detectedbetween presence of motile spermatozoa andabsence of spermatozoa in terms of FSH values(P = 0.003, one-way ANOVA). The other variablesdid not present statistical differences. Areceiver operating characteristic curve showedthat FSH levels below 17.00 IU/L werepredictive of motile spermatozoa recovery.Conclusions: FSH values can serve as apredictive factor for the recovery of motilespermatozoa using biopsy in azoospermicpatients. On the other hand, histologicalanalysis and other hormone values were nothelpful in the prediction of motile sperm.

Effect of raloxifene and low-dose percutaneous 17β-estradiol on menopause symptoms and endometrium—A randomized controlled trial

OBJECTIVE To investigate the effects on climacteric symptoms and endometrium of percutaneous low-dose 17beta-estradiol associated with raloxifene in postmenopausal women. DESIGN randomized placebo-controlled study. METHOD Fifty-two postmenopausal women with moderate to severe hot flushes were randomized to receive either 60 mg raloxifene (RLX; n=20), 0.5 mg percutaneous 17beta-estradiol associated to 60 mg raloxifene (RLX+E2; n=16) or placebo (PLC; n=16). Climacteric symptoms (Kupperman index) and vaginal bleeding were evaluated. At baseline and at the end of the study endometrial thickness was measured and endometrial samples were collected for histological study. RESULTS At baseline, the mean Kupperman index was 23.7+/-1.8 in RLX group, 22.9+/-1.9 in RLX+E2 group and 22.6+/-1.9 in the placebo group (NS). After 3 months, there was a significant reduction in Kupperman index mean values in both groups, but no statistical difference was observed between groups. However, RLX+E2 and placebo were significantly superior to RLX in reducing hot flush severity (p<0.05). Endometrial thickness did not change in both groups. The association of percutaneous low-dose 17beta-estradiol to raloxifene was not associated with proliferation of endometrium neither in hysteroscopies nor in endometrial biopsies at the third month of treatment. No vaginal bleeding was reported during the study. CONCLUSIONS The association of percutaneous low dose of 17beta-estradiol with raloxifene exerted favorable effects on hot flushes severity of postmenopausal women, providing a safe profile in endometrium at least in short-term therapy.

Sperm recovery prediction in azoospermic patients using Doppler ultrasonography

Purpose: To evaluate power Doppler ultrasonography to predict sperm recovery in azoospermic patients. Methods: Color Doppler and power Doppler ultrasonography of testis were performed in 38 patients before testicular sperm extraction. Analysis of blood flow included the pulsatility and resistance index of intratesticular vessels and testicular artery, and power Doppler of testis. The results of power Doppler of testis were classified into three categories: 0, no vessels found; 1, one to three vessels; 2, more than three vessels found. Results: Power Doppler of both testis showed a significant difference between obstructive azoospermia and non-obstructive azoospermia (Fisher’s exact test – P = 0.02), and between the groups with and without sperm recovery (Fisher’s exact test – P = 0.001). Doppler indices of intratesticular vessels and testicular artery were similar between the groups. Conclusions: Testicular Power Doppler assessment showed that patients with obstructive azoospermia have better blood flow than patients with non-obstructive azoospermia, and power Doppler is able to predict sperm recovery in azoospermic patients.

Effect of conjugated estrogen versus conjugated estrogen associated with medroxyprogesterone acetate in postmenopausal women on internal carotid artery pulsatility index: A randomized pilot study

Aim:  To compare the effect of conjugated estrogen (CEE) versus conjugated estrogen and medroxyprogesterone acetate (MPA) therapy on internal carotid artery pulsatility index (PI) in postmenopausal women.

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.

Effects of hormone therapy on the endometrium in postmenopausal women: a one year randomized trial of low dose oral estradiol in association with a levonorgestrel-releasing intrauterine system or drospirenone

OBJETIVOS: comparar os efeitos endometriais e no padrao de sangramento uterino de tratamento com (1) sistema intrauterine com levonorgestrel (SIU-LNG) e estradiol (1 mg/dia, v.o.) ou (2) associacao oral de drospirenona (DRSP) (2 mg/dia) e estradiol (1 mg/dia). METODOS: trinta e quatro pacientes (idade 52,53 ± 4,44 grupo SIU-LNG e 53,15 ± 4,018 grupo DRSP)foram randomizadas. A gravidade dos sintomas menopausais foi avaliado pelo indice de Kupperman a cada tres meses. Ultrassom transvaginal, histeroscopia e avaliacao histologica foram repetidos apos 12 meses. Durante este periodo, as pacientes fizeram registros em calendarios menstruais. Todas as variaveis categoricas foram descritas como porcentagens. Variaveis foram testadas para distribuicao normal e teste t de Student para amostras independents e ANOVA para medidas repetidas foram utilizados quando apropriado. Significância estatistica foi considerada para p<0.05. RESULTADOS: leve sangramento vaginal foi relatado no primeiro mes de tratamento por 53,3% das pacientes do grupo SIU-LNG/estradiol vs. 7,7% das pacientes do grupo drospirenona/estradiol. Nao houve diferenca na espessura endometrial entre os grupos durante o periodo do estudo. Os achados histologicos ao final do estudo motraram endometrio atrofico em 53,3% das pacientes no grupo SIU-LNG/estradiol vs. 76,9% das pacientes no grupo drospirenona/estradiol. CONCLUSOES: nossos resultados sugerem boa protecao endometrial com ambos os tratamentos de terapia hormonal.