Maria do Carmo Borges de Souza

Naturalização e medicalização do corpo feminino: o controle social por meio da reprodução

Trata-se de pesquisa bibliografica sobre a recorrencia do processo de naturalizacao como alicerce da medicalizacao do corpo feminino. Este processo institui uma forma de controle social com base na reproducao biologica, em que padroes de comportamento e diferencas de classe social, raca/etnia sao ordenados/redescritos. Assim, se mantem a hegemonia masculina, patriarcal e de classe, e se aprofundam as desigualdades sociais e de genero. Destaca-se a importância do desenvolvimento e da complexidade da tecnologia - que afastam as classes populares das tomadas de decisao sobre o proprio corpo e a saude reprodutiva - e da escola sobretudo, em aulas de ciencias e educacao fisica para manter e perpetuar a hegemonia burguesa.This study discusses, through bibliographic researc h, the recurrence of naturalization as basis for the medicalization of the female body, as a mea ns of social control through biological reproduction, whereby behavioral standards, social class, ethnic and race differences are rearranged/redefined. Through this process, male pa triarchal and class predominance is maintained and the rift of social and gender inequa lities grow wider. It is important to identify the role of technological developments and their co mplexities - which do not allow lowerincome classes to take decisions in regard to their own bodies and reproductive health - and schooling, specially through science and physical e ducation classes whereby upper-class predominance is sustained.

Evaluation of two incubation environments--ISO class 8 versus ISO class 5--on intracytoplasmic sperm injection cycle outcome.

OBJECTIVE To evaluate the impact of two different incubation environments-class 8 versus class 5-on embryo quality and pregnancy rate. DESIGN Retrospective comparative study. SETTING Private fertility and gynecology clinic. PATIENT(S) 123 consecutive intracytoplasmic sperm injection (ICSI) cycles were analyzed from January 2002 to February 2005. Cycles were divided into two groups: in group I (n = 60), the embryo culture was performed in class 8 air quality; in group II (n = 63), the embryo culture was performed in class 5 air quality. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of embryos available for transfer, number of good quality embryos transferred, implantation rate, and clinical pregnancy. RESULT(S) Age of women, duration of stimulation, total doses of gonadotropins, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, number of oocytes metaphase II retrieved, number of embryos available, number of good quality embryos transferred, fertilization and cleavage rates, implantation rate, and clinical pregnancy were not statistically different between the groups. CONCLUSION(S) Our study demonstrated that incubation environment class 8 is as good as incubation environment class 5 when compared in relation to the parameters analyzed. We believe that there is still room for improvement in the overall outcome of ICSI embryos.

Naturalization and medicalization of the female body: social control through reproduction

Trata-se de pesquisa bibliografica sobre a recorrencia do processo de naturalizacao como alicerce da medicalizacao do corpo feminino. Este processo institui uma forma de controle social com base na reproducao biologica, em que padroes de comportamento e diferencas de classe social, raca/etnia sao ordenados/redescritos. Assim, se mantem a hegemonia masculina, patriarcal e de classe, e se aprofundam as desigualdades sociais e de genero. Destaca-se a importância do desenvolvimento e da complexidade da tecnologia - que afastam as classes populares das tomadas de decisao sobre o proprio corpo e a saude reprodutiva - e da escola sobretudo, em aulas de ciencias e educacao fisica para manter e perpetuar a hegemonia burguesa.This study discusses, through bibliographic researc h, the recurrence of naturalization as basis for the medicalization of the female body, as a mea ns of social control through biological reproduction, whereby behavioral standards, social class, ethnic and race differences are rearranged/redefined. Through this process, male pa triarchal and class predominance is maintained and the rift of social and gender inequa lities grow wider. It is important to identify the role of technological developments and their co mplexities - which do not allow lowerincome classes to take decisions in regard to their own bodies and reproductive health - and schooling, specially through science and physical e ducation classes whereby upper-class predominance is sustained.

Body weight and 25-hidroxyvitamin D follicular levels: a prospective study of women submitted to in vitro fertilization

Objective Vitamin D deficiency has been largely related to infertility in animals. However, data demonstrating a direct association between hypovitaminosis D and infertility in humans are still conflicting. Increased body weight and an elevated body mass index (BMI) are known for their association with infertility. Therefore, this study attempted to verify whether increases in body weight and the BMI were associated with lower 25-hidroxyvitamin D [25(OH)D3] levels in the follicular fluid (FF) of patients treated for infertility with intracytoplasmic sperm injections (ICSI). This study aimed to assess the FF levels of 25(OH)D3 in women submitted to ICSI and correlate these levels with the different body weight and BMI values observed in the enrolled cohort. Methods The FF aspirates of 199 patients submitted to ICSI were collected after oocyte aspiration to check whether FF 25(OH)D3 levels were associated with weight regardless of the etiology of infertility. Chemiluminescent assays were used to assess FF 25(OH)D3 levels. The etiology of infertility was defined based on patient clinical history and follow-up. Results The patients enrolled in the study were divided into three groups according to their FF 25(OH)D3 levels, as follows: a) deficient (n=71; <20 ng/ml); b) insufficient (n=64; 21< 25(OH) D3>29 ng/ml); and c) sufficient (n=56 >30ng/ml) levels. Patients with lower FF 25(OH)D3 levels had a greater mean weight (64.1kg) when compared to patients with higher 25(OH)D3 levels (60.7kg), p<0.01. No differences were observed in terms of age or etiology of infertility. Conclusion The body weight of the individuals with FF 25(OH)D3 deficiency measured in single follicles was significantly higher regardless of the etiology of infertility. Further epidemiologic and molecular studies are required to verify whether the amount of follicular 25(OH)D3 affects the outcome of IVF procedures.

Prediction of metaphase II oocytes according to different serum Anti-Müllerian hormone (AMH) levels in antagonist ICSI cycles

Objective This paper aims to assess a qualitative aspect of ovarian response in terms of metaphase II oocytes according to different serum Anti-Müllerian hormone levels in antagonist ICSI cycles. A prediction index might contribute to the individualization of care. Methods This observational study looked into 287 antagonist ICSI cycles carried out with patients treated in a single center between January of 2012 and January of 2016. Serum AMH and subgroup analyses were performed based on five AMH ranges (≤ 0.3 ng/mL;> 0.3 and ≤ 0.7 ng/mL; > 0.7 and ≤ 1.0 ng/mL; > 1.0 and < 3.0 ng/mL; ≥ 3.0 ng/mL). The variables analyzed included patient age; serum FSH and antral follicle count at the start of the cycle; number of stimulation days and number follicles ≥ 15 mm on hCG day; number of oocytes retrieved and number of metaphase II oocytes. Results AMH is a better predictor of ovarian response to controlled ovarian stimulation than AFC or serum FSH, while age is an independent marker. AMH levels ≤0.70 (patients with poor prognosis) were observed in 140 patients (48.7%). Patients within this AMH level range accounted for 92% of the 24 failed cycles (cancelled cycles, no oocytes or immature oocytes retrieved). Conclusion AMH predicts the quality of ovarian response to stimulation, regardless of patient age. Women with AMH levels ≥1.0 and ≤3.0 ng/mL are probably normal responders with good prognosis. Clinical application relies on the examination of the data from each individual center and on the establishment of correlations between AMH levels and ovarian response in the form of metaphase II oocytes.

Zika virus and Assisted Reproductive Technology: to test or not to test, that is the question. Is it an unnecessary cost? The first two months of mandatory testing in an outbreak area in Rio de Janeiro, Brazil.

Objective Infection by the Zika virus is a Public Health Emergency of International Concern as defined by the World Health Organization. Resolution no. 72, issued by the Collegiate Board of the Brazilian Health Surveillance Agency (ANVISA) on March 30, 2016, made ZKV testing mandatory prior to procedures involving germ cells and tissues. This paper aims to discuss the aforementioned Resolution from the standpoint of evidence and cost-effectiveness of the measures taken within the first two months of mandatory testing. Methods The medical staff at the clinic looked into the steps needed to comply with the new rules and checked laboratories in the city to perform the tests with their lead times and costs, health insurance refunds, data maintenance capabilities, how to contact patients, decision-making processes in ongoing cases, deadlines for implementation, in addition to exchanging ideas with other clinics and gathering information from the guidelines being produced. A SWOT analysis was performed. Results A total of 152 tests were performed within the first two months of mandatory testing, in five different clinical situations: one previously symptomatic woman with a negative PCR test before starting the cycle; two asymptomatic women had positive IgM (1.3%) and negative PCR tests on days 25 and 60; one husband enrolled as a suspect with a negative RT-PCR on day 13 and another untested suspected case; a couple decided to have their oocytes cryopreserved because the husbands test result was not available on pickup day. The mean cost of USD 200 per couple is equivalent to 1.2 day of the stimulation protocol. The staff worked more efficiently and was able to respond promptly to the increased demand for ZKV testing; however, the tests failed to reassure patients of the safety of the procedure and increased costs. Conclusion The testing requirement for asymptomatic patients prior to ART should be reviewed.

A Direct Method for Quantification of Lead and Cadmium Content in Biological Fluids of the Human Reproductive System

The aim of this work was to quantify lead and cadmium content in follicular fluid and sperm from couples under in vitro fertilization therapy after developing a procedure for direct determination of such metals in those matrices by electrothermal atomic absorption spectrometry with a minimum sample pretreatment, using palladium/magnesium as chemical modifier. Samples were diluted and a particular temperature program for each analyte was followed. Several variables such as pyrolysis and atomization temperatures, diluent and dilution proportion, and modifier mass and linearity were studied in order to achieve optimal conditions. Methodologies took into account sensitivities and sensitivity ratios aiming for lower limits of detection (3σ) and quantification (10σ) and no matrix effects. Calibration against matrix matched solutions was mandatory for both matrices and metals. Accuracy of the results was verified by analysis of standard reference materials for lead and cadmium in blood and serum as well as in-house control materials as reference follicular fluid and sperm were not available. Results have shown a high degree of agreement between experimental and expected values according to Students t-test (95% confidence level). Concentration ranges (µg L−1) for cadmium and lead found were 0.64–0.99 and 0.61–1.72 in follicular fluid while those levels in sperm ranged from 0.16–0.40 and ≤0.40–1.63, respectively. Our findings were similar to those reported by other studies.

Lower follicular fluid vitamin D concentration is related to a higher number of large ovarian follicles

Vitamin D receptor-knockout mice fail to produce mature oocytes, indicating vitamin D is crucial for folliculogenesis in mice. However, the actions of vitamin D during folliculogenesis remain unknown. This prospective study aimed to assess whether follicular fluid (FF) vitamin D (25OHD3) concentrations are related to specific responses to ovarian stimulation. Women undergoing ovarian stimulation for IVF participated in the study. FF 25OHD3 concentrations were assessed in the first follicle aspirate on oocyte retrieval day. Oestradiol and progesterone concentrations were assessed on the trigger day. K-means grouping analysis showed that 25OHD3 FF concentrations clustered into a higher and lower group (mean ± SEM 17.4 ± 6.61 ng/ml and 35.5 ± 7.17 ng/ml, respectively, P < 0.001). The clusters were analysed according to the oestradiol and progesterone concentrations, follicle number and size and resulting oocyte number and maturity. The FF 25OHD3 concentrations were no different among the infertility diagnoses. The lower 25OHD3 group had more follicles (≥16.0 mm, P = 0.009) and higher serum oestradiol concentrations (P < 0.03) on the day of HCG administration. In this study, lower follicular 25OHD3 concentrations predicted a better response to ovarian stimulation shown by a greater production of larger follicles and higher serum oestradiol concentrations.

Vitamin D Receptor TaqI Polymorphism Is Associated With Reduced Follicle Number in Women Utilizing Assisted Reproductive Technologies

Purpose Calcitriol, or 1,25-hydroxycholecalciferol, is the active form of vitamin D. It binds and activates vitamin D receptor (VDR). Infertility and defective folliculogenesis have been observed in female vdr-knockout mice; however, whether VDR polymorphisms affect human ovarian responses to controlled ovarian stimulation (COS) remains unclear. We hypothesized that VDR polymorphisms are associated with infertility and COS responses. Thus, we evaluated the association between the TaqI, BsmI, and FokI VDR polymorphisms and ovarian responses in women undergoing COS. Methods In this study, we recruited a control group (n = 121) comprising volunteers with a history of natural conception and a second group of women undergoing COS (n = 70). TaqI, BsmI, and FokI genotyping was performed via restriction fragment length polymorphism analysis or TaqMan qPCR and Sanger sequencing. Intrafollicular 25(OH)D contents were measured in follicular fluid collected from COS patients during oocyte retrieval. Ovarian response parameters were obtained from patient medical records. Results There were no significant differences in the genotype frequencies of VDR polymorphisms (TaqI, BsmI and FokI) between the control and COS groups. However, the allele frequency of TaqI (C allele) was significantly lower in the COS group than in the control group (p = 0.02). Follicle number but not oocyte number was lower in patients with TaqI polymorphic (TC/CC) genotypes (p = 0.03). Importantly, the ratio between the number of follicles retrieved and intrafollicular estradiol concentrations was higher in patients with the TC/CC TaqI genotypes (p < 0.02). Conclusion We identified an association between the VDR TaqI polymorphism and reduced follicle number in women undergoing COS, suggesting that VDR signaling affects the ovarian response to stimulation via unknown mechanisms.

Vaginismus in Assisted Reproductive Technology Centers: an invisible population in need of care

Objective Genital and sexual pain is still neglected. Consequences may be dramatic, since infertility and sexual dysfunction may be reciprocally linked. This is the first study to focus on the identification of cases of vaginismus in the ART scenario and on the introduction of intra-cycle interventions as part of a comprehensive, integrated and patient-centered perspective. Methods This observational prospective study looked into 425 IVF/ICSI cycles and 226 frozen embryo transfers carried out from January 1, 2015 to December 31, 2016, and found seven cases of vaginismus. Within a six-month period, a questionnaire placed on SurveyMonkey was sent twice to 228 ART centers in Latin America. The purpose was to learn how often cases of vaginismus were found in ART centers and the perceptions around the presence of this condition. Results The few centers that took the time to answer the questionnaire (24/10.5%) stated that the number of cases in which they had trouble performing control ultrasound examination or needed to perform transfers with patients under sedation was not significant. Although 81% agreed that the incidence of these conditions is low, no references were made to cases of vaginismus, dyspareunia or sexual dysfunction. Our multidisciplinary team found seven cases of vaginismus, involving women with higher education degrees with a mean age of 37.8 years and married for a mean of four years. Although two reported they were able to tolerate intercourse, all reported undergoing treatments such as using vaginal dilators (3), psychotherapy (4) and psychiatric care (1). The care provided by the staff was designed to mitigate patient suffering. Conclusion Gentle care and sensitive listening should be integral components in the work of multidisciplinary teams to identify women with vaginismus and offer couples better quality treatment.