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Abstract(s)
Introdução Sendo a infertilidade um problema da atualidade, com um grande impacto pessoal e social, e a avaliação da capacidade reprodutiva feminina um desafio frequente para o médico nos tratamentos de Procriação Medicamente Assistida, este tema apresenta-se com extrema relevância para uma abordagem mais avincada. O recurso a testes bioquímicos e de imagem, embora de baixa sensibilidade e especificidade, tem sido usado para indiretamente predizer a reserva ovárica e, deste modo, orientar o tratamento nesta área, contribuindo para o sucesso das técnicas de Fertilização In Vitro e de Injeção IntraCitoplasmática de Espermatozoides. Objetivo O presente trabalho visa correlacionar os marcadores de reserva ovárica (Hormona Folículo Estimulante, Hormona Luteinizante, Hormona Anti-Mülleriana, Estradiol, Contagem de Folículos Antrais e idade da mulher) com os ovócitos obtidos por punção, a fim de determinar o(s) parâmetro(s) que melhor se relaciona(m) com a reserva ovárica nos ciclos de Procriação Medicamente Assistida. Métodos Estudo retrospetivo e observacional, com uma amostra constituída por 156 mulheres dos 18 aos 40 anos, com uma média de idades aproximadamente de 34 anos (33.88±3.892), submetidas a Fertilização In Vitro ou Injeção IntraCitoplasmática de Espermatozoides na Unidade de Medicina Reprodutiva do Centro Hospitalar Cova da Beira, entre 2011 e 2014. Para a análise dos dados foram aplicados alguns conceitos de estatística descritiva e algumas técnicas de inferência estatística, considerando-se um nível de significância de 5%. Utilizou-se o coeficiente de correlação linear de Pearson, sempre que os seus pressupostos se verificaram, ou em alternativa o coeficiente ? de Spearman. Obteve-se um modelo de regressão linear múltiplo preditivo dos ovócitos obtidos. Resultados Correlacionando-se a idade com os diferentes marcadores de reserva ovárica verificou--se que existe uma correlação significativa, sendo negativa com a Hormona Anti-Mülleriana, a Contagem de Folículos Antrais e os ovócitos obtidos (p<0.05). De salientar que a correlação é moderada entre a idade e a Contagem de Folículos Antrais. Conclui-se ainda que os ovócitos obtidos apresentam uma correlação significativa, sendo forte positiva com a Hormona Anti-Mülleriana e moderada positiva com a Contagem de Folículos Antrais (p<0.05). A correlação com a Hormona Folículo Estimulante é significativa e negativa (p<0.05). Obteve-se um modelo de regressão linear que mostra que os parâmetros Hormona Anti--Mülleriana e Contagem de Folículos Antrais se consideram significativos na predição dos ovócitos obtidos. Conclusões A idade da mulher influencia significativamente o seu resultado reprodutivo, contudo, por si só, não o prediz, sendo a Hormona Folículo Estimulante, a Contagem de Folículos Antrais e a Hormona Anti-Mülleriana parâmetros promissores para avaliar a reserva ovárica. Contudo, comparativamente à Hormona Folículo Estimulante, a Contagem de Folículos Antrais e a Hormona Anti-Mülleriana apresentam uma correlação superior com os ovócitos obtidos, conferindo-lhes vantagem como marcadores da reserva ovárica. Estes resultados corroboram os obtidos em estudos anteriores.
Introduction Since infertility is a current problem, with huge personal and social impact, and the evaluation of female reproductive capacity is a frequent challenge for doctors in medically assisted procreation treatments, this topic is extremely relevant for a better approach. In this regard, the use of biochemical and imaging tests, although with low sensitivity and specificity, has been used to indirectly predict the ovarian reserve and, thus, to guide the treatment infertility, contributing to the success of the techniques like In Vitro Fertilization and Intracytoplasmic Sperm Injection. Objective The present study aims to correlate ovarian reserve markers (Follicle-Stimulating Hormone, Luteinizing Hormone, Anti-Müllerian Hormone, Estradiol, Antral Follicle Count and woman's age) with oocytes obtained by puncture and thus to determine the parameter(s) that best relate(s) to the ovarian reserve in the cycles of Medically Assisted Procreation. Methods In order to achieve our objetives an retrospective and observational study was conducted. For this purpose, a sample of 156 women with ages between 18 and 40 years old, with a mean age of approximately 34 years (33.88 ± 3.892), was considered and submitted to In Vitro Fertilization or Intracytoplasmic Sperm Injection at the Reproductive Medicine Unit of Cova da Beira Hospital Center, between the time period of 2011 and 2014. In order to evaluate our proposal, some concepts of descriptive statistics and some techniques of statistical inference have been applied, with a significance level of 5%. We resort to Pearson's linear correlation coefficient, whenever its assumptions were verified, or to Spearman correlation coefficient, ?, otherwise. As a result, a predictive multiple linear regression model of oocytes was obtained. Results The results obtained show that there is a significant negative correlation with Anti-Müllerian Hormone, Antral Follicle Count and oocytes obtained (p <0.05) between the age and the different ovarian reserve markers. It is important to stress that the correlation between the age and the Antral Follicle Count is moderate. We can also conclude that the oocytes obtained indicate a significant correlation, with Anti-Müllerian Hormone (strong positive correlation) and with the Antral Follicle Count (moderate positive correlation) (p<0.05). The correlation with Follicle-Stimulating Hormone is significant and negative (p<0.05). As a result of our experiments, we obtained a linear regression model which shows that the Anti-Müllerian Hormone and Antral Follicle Count parameters are significant in the prediction of oocytes. Conclusions We can conclude that while the age of the woman can significantly influence her reproductive outcome, it cannot predict it by itself and should be complemented, with Follicle-Stimulating Hormone, Antral Follicle Count and Anti--Müllerian Hormone parameters, which have sown to be promising features to evaluate the ovarian reserve. A more detailed analysis on this, led us to also conclude that, the Antral Follicle Count and the Anti-Müllerian Hormone present a superior correlation with the oocytes obtained, when compared to the Follicle-Stimulating Hormone, thus conferring them an advantage as markers of the ovarian reserve. The results obtained corroborate those of previous studies.
Introduction Since infertility is a current problem, with huge personal and social impact, and the evaluation of female reproductive capacity is a frequent challenge for doctors in medically assisted procreation treatments, this topic is extremely relevant for a better approach. In this regard, the use of biochemical and imaging tests, although with low sensitivity and specificity, has been used to indirectly predict the ovarian reserve and, thus, to guide the treatment infertility, contributing to the success of the techniques like In Vitro Fertilization and Intracytoplasmic Sperm Injection. Objective The present study aims to correlate ovarian reserve markers (Follicle-Stimulating Hormone, Luteinizing Hormone, Anti-Müllerian Hormone, Estradiol, Antral Follicle Count and woman's age) with oocytes obtained by puncture and thus to determine the parameter(s) that best relate(s) to the ovarian reserve in the cycles of Medically Assisted Procreation. Methods In order to achieve our objetives an retrospective and observational study was conducted. For this purpose, a sample of 156 women with ages between 18 and 40 years old, with a mean age of approximately 34 years (33.88 ± 3.892), was considered and submitted to In Vitro Fertilization or Intracytoplasmic Sperm Injection at the Reproductive Medicine Unit of Cova da Beira Hospital Center, between the time period of 2011 and 2014. In order to evaluate our proposal, some concepts of descriptive statistics and some techniques of statistical inference have been applied, with a significance level of 5%. We resort to Pearson's linear correlation coefficient, whenever its assumptions were verified, or to Spearman correlation coefficient, ?, otherwise. As a result, a predictive multiple linear regression model of oocytes was obtained. Results The results obtained show that there is a significant negative correlation with Anti-Müllerian Hormone, Antral Follicle Count and oocytes obtained (p <0.05) between the age and the different ovarian reserve markers. It is important to stress that the correlation between the age and the Antral Follicle Count is moderate. We can also conclude that the oocytes obtained indicate a significant correlation, with Anti-Müllerian Hormone (strong positive correlation) and with the Antral Follicle Count (moderate positive correlation) (p<0.05). The correlation with Follicle-Stimulating Hormone is significant and negative (p<0.05). As a result of our experiments, we obtained a linear regression model which shows that the Anti-Müllerian Hormone and Antral Follicle Count parameters are significant in the prediction of oocytes. Conclusions We can conclude that while the age of the woman can significantly influence her reproductive outcome, it cannot predict it by itself and should be complemented, with Follicle-Stimulating Hormone, Antral Follicle Count and Anti--Müllerian Hormone parameters, which have sown to be promising features to evaluate the ovarian reserve. A more detailed analysis on this, led us to also conclude that, the Antral Follicle Count and the Anti-Müllerian Hormone present a superior correlation with the oocytes obtained, when compared to the Follicle-Stimulating Hormone, thus conferring them an advantage as markers of the ovarian reserve. The results obtained corroborate those of previous studies.
Description
Keywords
Fertilização In Vitro Infertilidade Injeção Intracitoplasmática de Espermatozoides Marcadores Reserva Ovárica