T.S. Domingues

Tests for ovarian reserve: reliability and utility

Purpose of review This review discusses ovarian reserve tests for ovulation induction and their application in determining fertility capacity, and their current applications to assess risk of natural ovarian failure and to estimate ovarian function after cancer treatment. Recent findings The current arsenal of ovarian reserve tests comprises hormonal markers [basal follicle stimulating hormone, estradiol, inhibin-B, antimullerian hormone (AMH)] and ultrasonographic markers [ovarian volume, antral follicle counts (AFCs)]. These markers have limitations in terms of which test(s) should be used to reliably predict ovarian reserve with regard to accuracy, invasiveness, cost, convenience, and utility. Several studies have correlated sonographic AFCs with serum AMH levels for predicting the ovarian response to ovulation induction protocols during assisted reproduction treatments. Summary Serum AMH levels and AFC are reliable tests for predicting the ovarian response to ovulation induction. However, none of the currently employed tests of ovarian reserve can reliably predict pregnancy after assisted conception. Further, ovarian reserve tests cannot predict the onset of reproductive and hormonal menopause; thus, they should be used with caution for reproductive life-programming counseling. Moreover, there is no evidence to support the use of ovarian reserve tests to estimate the risk of ovarian sufficiency after cancer treatments.

Uterine rupture before the onset of labor following extensive resection of deeply infiltrating endometriosis with myometrial invasion.

The risk of uterine rupture (UR) before the onset of labor has been investigated in women who have undergone cesarean deliveries with previous classical incision and in those with thin lower-uterinesegment defects [1,2]. Previous myomectomies are also a known risk factor for UR [1]. Additionally, evidence published in the past three decades suggests that extensive resection of endometriosis developing within the uterine wall could increase the chances of UR [3–6]. Deeply infiltrating endometriosis (DIE) is characterized by the presence of endometrial glands and stroma outside the uterus. Deep infiltration into the myometrium is a form of DIE that begins at the uterine serosa and advances toward the endometrium. The richly vascularized uterine smooth muscle offers a favorable pathway for DIE to develop [7]. Surgical radical resection is the best option to control DIE. Unfortunately, complete resection of DIE within the uterus can cause substantial thinning of the uterine wall, leaving these areas susceptible to UR during pregnancy. Additionally, the modified blood supply in the scar tissue is associated with local ischemia.

Use of insulin sensitizers in the treatment of infertility in patients with polycystic ovary syndrome (POS)

.Desse modo, a inducao ovariana na mulher infertil e muito variavel e instavel, com um limiar muito tenue entre o hiperestimulo ovariano e a baixa resposta, pois e comum o excessivo recrutamento folicular tipico da SOP, mas a elevacao androgenica tambem contribui para sua precoce atresia. Logo, os agentes sensibilizadores de insulina vem sendo avaliados desde meados dos anos 1990, tendo a metformina (MTF) como o seu representante mais estudado, ao impedir a excessiva acao insulinica nas celulas da teca, chegando, inclusive, a restabelecer os ciclos ovula-torios