RESUMO -A IRC (insuficiência renal crônica) terminal é acompa- INTRODUÇÃOAntes do advento da eritropoetina humana recombinante (EPO), a anemia era comum e responsabilizada por várias alterações presentes na insuficiência renal crônica terminal (IRCT), inclusive as de ordem sexual. Sua correção por transfusões repetidas implicava em risco aumentado de infecções por vírus das hepatites 1,2 , oferta excessiva de antígenos de histocompatibilidade 3 , etc. A disfunção sexual, a infertilidade e a diminuição da libido eram amplamente conhecidas em homens e mulheres, e estas apresentavam alterações menstruais, classicamente, amenorréia 4,5 , o que levou à publicação de vários estudos de dosagens hormonais no final dos anos 70 e início dos anos 80 4,6,7,8,9,10,11 . O uso clínico da EPO permitiu o tratamento adequado, eficaz e sem os riscos descritos da anemia, além de melhora da qualidade de vida 2,12,13,14 e da função sexual de homens e mulheres 12,13,15 . Desde então, existem na literatura inúmeros relatos sobre a melhora da impotência em homens, havendo comparativamente uma escassez de dados sobre o perfil hormonal sexual das mulheres em programa crônico de diálise. Em nosso meio, os dados são praticamente inexistentes.Com o advento da EPO e o consequente tratamento da anemia, apareceram relatos de normalização dos níveis de PRL e retorno da menstruação 12,13 , bem como supressão dos níveis basais de FSH e LH 15 , com os autores sugerindo que os pacientes tratados com EPO apresentavam melhora da função sexual por normalização da retroalimentação no eixo hipotálamo-hipofisário-gonadal, já que pacientes com os mesmos níveis de hemoglobina e hematócrito sem EPO apresentavam perfis hormonais alterados. Os mesmos resultados não foram obtidos por outros autores 33 e um estudo comparando pacientes policitêmicos (com baixa EPO endógena) com pacientes anêmicos (com alta EPO endógena) sugeriu que a doença de base, mais do que os níveis de EPO, é que realmente afeta os diversos eixos hormonais (em especial, o eixo hipotálamo-hipofisário), embora o tratamento da anemia, per se, possa melhorar alguns parâmetros hormonais 34 . Os estudos relatados geralmente comparam os perfis das pacientes renais crônicas em diálise com controles normais ou receptoras de transplante renal. Este estudo pretende avaliar e comparar o perfil hormonal de mulheres que menstruam com mulheres amenorreicas, todas em programa de diálise e em tratamento com a EPO, através da comparação dos níveis séricos de FSH, LH e E2 de mulheres em programa crônico de diálise que menstruam e amenorreicas, com idade inferior a 48 anos; do padrão hormonal da PRL de pacientes em programa crônico de diálise que menstruam, amenorreicas com idade menor
Background:The objective was to compare the use of micronized vaginal progesterone 800 mg daily and oral dydrogesterone 40 mg daily in the endometrial preparation for frozen-thawed embryo transfer (FET). Methods: Prospective randomized study with women undergoing FET along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally received 40 mg/day dydrogesterone (DYD group, n = 36) or 800 mg/day micronized vaginal progesterone (MVP group, n = 37) after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation. Biochemical pregnancy, clinical pregnancy and live birth rates were the secondary outcome. Results: The reproductive outcomes in FET cycles were similar, with pregnancy and Live birth rates in the didrogesterone and MVP treatment groups being respectively: Biochemistry (38.9%/37.8%; p = 0.189 [95% confidence interval (CI) = -23.4-21.2]), Clinical (33.3%/35.1%; p = 0.192 [95% CI = -20.0-23.6]); 12 Weeks Pregnancy (33.3%/32.4%; p = 0.196 [95% CI = -22.4-20.6]); Live birth ). Conclusions: 40 mg/day dydrogesterone and 800 mg/day MVP revealed similar reproductive results in FET cycles. The use of oral dydrogesterone is a reasonable option, may be more accepted by patients in terms of ease of use and lower cost. Clinical Trial Registration: U1111-1247-1845.
OBJECTIVE:The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS:This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS:The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS:The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.
OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.
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