Mário Silva Approbato

Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae: fatores associados à infertilidade em mulheres atendidas em um serviço público de reprodução humana

PURPOSE To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil. METHODS A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χ(2) test or Fishers exact test to evaluate the association between infection and variables. RESULTS The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004). CONCLUSION There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age.

Efeito do extrato aquoso de camomila (Chamomilla recutita L.) na prenhez de ratas e no desenvolvimento dos filhotes

Medicinal plants have active substances and their toxic effect on the organism is often unknown or ignored by users. Chamomile has been widely used by the population; however, it is contraindicated for pregnant women due to evidence of its emmenagogue and relaxing activity on smooth muscles. For these reasons, the aim of this study was to evaluate the effects of aqueous extract of chamomile on pregnancy and generated offspring. Nine Wistar rats were divided into three groups, D1 and D2, which received chamomile infusion at 5% and 10%, respectively, and the control group which received saline solution. Treatments were administered from the 1st to the 7th day after breeding. The studied parameters were abortion prevalence, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes of the offspring on the 1st, 3rd, 5th and 10th days of life. There was pregnancy in 70% of control group, 40% of D1 and 80% of D2. There was no difference in maternal weight gain on the 7th and 21st days; however, treated groups had smaller weight gain, compared to control, on the 14th day of pregnancy (p=0.04). The differences among newborn numbers were not significant. As to weight of newborns, treated animals had smaller weight gain on days 1, 3, 5 and 10 after birth (p=0.005; p=0.001; p<0.001; p<0.001; respectively). For neurological effects, there were differences in postural reflex on the 1st day, resulting in acceleration; on the other hand, for grasp (p=0.006) and orienting reflex (p=0.01), there was a delay in disappearing, and no changes occurred on the remaining days for the other assessed parameters. Chamomile may influence maternal weight gain during pregnancy, as well as offspring weight gain after birth, and may cause changes in neurological reflexes. There was no alteration in the remaining studied parameters.

Music therapy in stress: proposal of extension to Assisted Repro- duction

Infertility is recognized as a disease of several causes by the World Health Organization. Assisted reproduction has a historic of progress since the development of biotechnology. Women who need this treatment are under stress and emotional tension. Since the 1980´s, professionals have been worried with psychological aspects of the patient that undergoes the Assisted Reproduction treatment. Studies about music therapy show positive results in diminishing/reducing patients’ emotional stress in many specialties. However, there were not studies showing scientific results of this therapeutic approach. There were, though, works in correlated areas, such as Gynecology and Obstetrics. Therefore, a literature review was conducted in the following data bases: PubMed, Lilacs, Medline and Scielo in studies published between 2004 and January 2014. The descriptors/key words used were music therapy and stress; music therapy and infertility; music therapy and assisted reproduction; music therapy and gynecology and obstetrics. The therms were searched both in Portuguese and English. Therefore, this study aims to analyze what is discussed in literature about music therapy and stress in the context of health. The study will be a base for further research in the post-graduation program about the use of music therapy on emotional stress experienced by women during assisted reproduction. Articles about correlated themes, such as gynecology and obstetrics, were also considered, trying to relate them to assisted reproduction.

Low progesterone levels and ovulation by ultrasound assessment in infertile patients.

OBJECTIVE To assess the correlation between low levels of progesterone and ovulation by ultrasound monitoring in infertile patients with regular menstrual cycles. METHODS Case-control study. The sample consisted of 302 women aged 20-40 years, treated from 2000 to 2014 in the Human Reproduction Laboratory of the University Hospital of the Federal University of Goiás and in the Department of Gynecology and Obstetrics in Goiânia, Goiás. Data collection was performed by analysis of physical records (Medical Records and Health Information Services) and electronic ones (Sisfert©, 2004) after approval by a Human Research Ethics Committee. Patients were classified according to their ovulatory status, evaluated by progesterone levels and ultrasound monitoring and divided into two groups: Group I (anovulatory cycle patients, n=74) and Group II (ovulatory patients, n=228). In both groups associations were made between the percentage of patients with normal progesterone (≥ 10 ng/ml) and percentage of patients with low progesterone (5.65 - 9.9 ng/ml). The groups were paired for comparisons related to age, body mass index, duration of infertility, follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), luteinizing hormone (LH) and estradiol (E2). RESULTS There was a significant association between the percentage of ovulation by ultrasound monitoring and the percentages of patients who presented low levels of progesterone. CONCLUSION The study suggests that low serum levels of progesterone are associated with low percentage of ovulation in infertile women with regular menstrual cycles and women with unexplained infertility.

Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients.

Controlled ovarian stimulation has become an integral part of a high complexity infertility treatment. Treatment options with recombinant gonadotrophins add more to knowledge on folliculogenesis and ovarian steroidogenesis. Therefore, a literature search was conducted in the following data bases: Medline, Scielo and PubMed. The descriptors/ key words used were ovarian stimulation, in vitro fertilization, recombinant luteinizing hormone, supplementation LH. The aim of this study was to review the available literature and to assess the benefits of using recombinant luteinizing hormone associated with recombinant follicle stimulating hormone in different populations who have undergone assisted reproduction procedures.

Folic acid does not improve semen parametrs in subfertile men: A double-blin, randomized, placebo-controlled study

Objective: It is thought that oral supplementation with antioxidants might reduce damage caused by reactive oxygen species in the seminal fluid, and as a consequence it increases the fertilizing capacity of spermatozoa due to improvement of sperm parameters. Methods: The aim of this research is to evaluate the effect of folic acid supplementation, by semen analysis, in 49 subfertile men with the median age being 35.3 years (±7.7). The experimental group (n= 23) received 5mg of folic acid daily and the control group (n= 26) received placebo, both groups were treated for three months. In order to confirm the condition of sub-fertility, two spermogram were performed with an interval of 15 days between the first and the second test. Moreover, sexual intercourse and masturbation abstinence were required for two to five days before collecting the semen samples (according to the WHO recommendations). Pre and post-intervention examination was performed in the same laboratory by two professionals, according to the WHO criteria, 1999. The chi-square test was applied for both groups.

Uso da Ciprofloxacina durante a Prenhez de Ratas: efeitos sobre a Mãe e Fetos

Purpose: to study the effects of ciprofloxacin on abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes. Methods: we used 30 Wistar rats, divided into three groups: D50-treated (ciprofloxacin, 50 mg/kg); D100-treated (ciprofloxacin 100 mg/kg) and control group which received physiological saline per os, from the 1st to the 7th day after mating. We studied abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number and weight at 1st, 3rd, 5th and 10th day of life and newborn neurological reflexes at 1st, 3rd, 5th and 10th day of life. Results: there was no difference between groups in the number of rats that became pregnant. The same was found for maternal weight gain and newborn number. There was a difference in newborn mean weight on day 3rd, 5th and 10th (p = 0.006, 0.01 and 0.03, respectively). The D100 newborn group was the one with less weight gain up to the 10th day of life. We found a significant difference (p = 0.002) in the newborn orientation reflex on the 1st day of life, that disappeared afterwards. No abortion or gross malformation was found in this study. Conclusions: ciprofloxacin modified the newborn weight and reflex on the first days of life. In conclusion, we consider that the use of ciprofloxacin should be restricted during the pregnancy.

Effect of the Air Filtration System Replacement on Embryo Quality in the Assisted Reproduction Laboratory

Improving infrastructural conditions of the in vitro fertilization laboratory, such as the air quality, has profound positive effects on embryo culture. Poor environmental conditions reduce the rate of embryo formation and, therefore, of pregnancy. This review article presents important publications regarding the impact of air quality in human reproduction laboratories on embryo quality, pregnancy success, and live births. The studies demonstrate that the replacing the air filtration system improves significantly the environmental air quality, and, consequently, improves laboratory parameters, such as the fertilization rate, the number of blastocysts, the embryo implantation rate, and the number of live births. On the other hand, improving air quality decreases the number of abortions. Therefore, environmental parameters that improve embryo quality and increase healthy child birth rates must be the main targets for the assisted reproduction laboratory quality control.