Effect of weight loss orientation on BMI in obese and overweight infertile patients

OBJECTIVE

The aim of this study was to evaluate the response to weight loss guidance in the anthropometric parameters of obesity and overweight infertile patients assisted fertilization treatment (high and low complexity).

METHODS

Retrospective cohort study. This survey was conducted in a population of overweight and obese infertile patients. In the first consultation at the assisted reproduction clinic (Human Reproduction Laboratory HC / UFG), obese and overweight patients were weighed, measured and instructed to lose weight and informed that being overweight could reduce the chances of success in the treatment.

RESULTS

We analyzed 56 overweight and obese patients admitted for infertility treatment at the Human Reproduction Center HC/UFG. The mean age of overweight and obese patients was 35.78 years, SD 3.70. After the orientation, only 8.92% of patients would achieve the normality rating for BMI, overweight 39.28% (decreased 14.29%), obesity I 37.5%, obesity II 10.71% and obesity III 3.57% (all degrees of obesity increased 1.79%). The mean weight of patients before and after guidance was statistically significant (p<0.0046). The mean values of BMI before and after guidance were also statistically significant (p<0.0038).

CONCLUSIONS

Weight loss guidance in this population had no effect on weight loss. On the contrary, the mean weight of patients after guidance was statistically higher than the mean in the first consultation (both weight and BMI). It is suggested that for obese and overweight infertile patients, in addition to guidance for reduction, an appointment with a nutritionist and/or endocrinologist should be immediately scheduled.

Bilateral but not unilateral tubal obstruction is associated with positive chlamydia serology

Objective:

To assess the association between positive Chlamydia trachomatis (C. trachomatis) serology and unilateral or bilateral tubal obstruction.

Methods:

This was a cross sectional study that evaluated the association of positive C. trachomatis serology (Immunofluorescence Indirect Serology, IIF or Enzyme Immune Essay, EIE), in two infertile groups: A. 243 patients (27 with unilateral obstruction and 216 without it). B. 247 patients (31 with bilateral obstruction and 216 without it). The exclusion criteria were tubal ligation (tubectomy) and tubal surgery. The statistical test (SPSS 17.0) was the Chi-Square with a p=5%. Tubal obstruction was diagnosed through hysterosalpingography (HSG).

Results:

The mean age of the patients without obstruction was 33.6 years, SD 4.9. The mean age of the patients with unilateral obstruction was 33.7 years SD 4.9. The mean age of the patients with bilateral obstruction was 33.6 years, SD 4.9. There was no statistically significant difference between the age groups. In group A (unilateral obstruction versus serology) the Chi-Square was 0.02 (p=n.s.) and the Attributable Risk (AR) = 0.7%. In Group B (bilateral obstruction versus serology) the Chi-Square test was 9.87 (p<0.005) and the AR = 14.8%.

Conclusion:

This study found a strong and statistically significant association between bilateral tubal obstruction and C. trachomatis positive serology. The power of the test was 86%. There was no association between unilateral obstruction and positive serology.

Ovulatory status of overweight women without Polycystic Ovary Syndrome

Objective:

Obesity is one of the extra hypothalamic-pituitary-ovarian axis factors that can influence ovulation. The isolated impact of obesity on ovulation without other comorbidities needs to be further studied. Our goal is to evaluate the association between the anovulation in the ultrasonographic monitoring of the ovulation cycle and the body mass increase of infertile patients without polycystic ovaries of a university service.

Methods:

Case-control study performed at the Human Reproduction Laboratory of the University Hospital. We evaluated 1,356 ultrasound monitoring reports of ovulation between January 2011 and December 2015. We named case those patients who ovulated on the monitored cycle. After applying the exclusion criteria, we consolidated a total of 110 cases and 118 controls. The exposure variables were normal BMI or patients classified with a BMI above normal. Data analysis was performed using SPSS 22.0. Differences in proportions were assessed by X² test Pearson, Fisher and Wilcoxon test. The value of p<0.05 was considered statistically significant.

Results:

The groups were comparable in age, age at menarche, number of pregnancies, deliveries, cesarean sections and abortions, number of antral follicles, FSH, prolactin and TSH values. Among the anovulatory patients, 57 (51.82%) were overweight, while among ovulatory patients, 44 (37.29%) were in this same BMI category. The odds ratio was 1.8655, with a significant p value (p<0.05).

Conclusion:

There was an association between anovulation and increase in the Body Mass Index, with an increased risk of anovulation in patients with BMI above normal.

Obesity and anovulatory infertility: A review

This global overweight and obesity epidemics has become one of the largest public health problem worldwide and is increasingly more common among women in reproductive age. Along with the prevalence of overweight women, there is an increase in women with anovulatory infertility. Thus, we carried out a bibliographic research in the PubMed, Lilacs and SciELO databases, using the combinations in Portuguese, Spanish and English of the following descriptors: "Body Mass Index", "obesity", "overweight", "female infertility" and "anovulation". The aim of this study was to assess the effects of obesity on the ovulatory profile of infertile women in the available literature.

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.

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.

Y chromosome microdeletions in Brazilian fertility clinic patients

Microdeletions in Yq are associated with defects in spermatogenesis, while those in the AZF region are considered critical for germ cell development. We examined microdeletions in the Y chromosomes of patients attended at the Laboratory of Human Reproduction of the Clinical Hospital of the Federal University of Goiás as part of a screening of patients who plan to undergo assisted reproduction. Analysis was made of the AZF region of the Y chromosome in men who had altered spermograms to detect possible microdeletions in Yq. Twenty-three patients with azoospermia and 40 with severe oligozoospermia were analyzed by PCR for the detection of six sequence-tagged sites: sY84 and sY86 for AZFa, sY127 and sY134 for AZFb, and sY254 and sY255 for AZFc. Microdeletions were detected in 28 patients, including 10 azoospermics and 18 severe oligozoospermics. The patients with azoospermia had 43.4% of their microdeletions in the AZFa region, 8.6% in the AZFb region and 17.4% in the AZFc region. In the severe oligozoospermics, 40% were in the AZFa region, 5% in the AZFb region and 5% in the AZFc region. We conclude that microdeletions can be the cause of idiopathic male infertility, supporting conclusions from previous studies.