ABSTRACT A defect implantation process is the major reason for unexplained infertility. Estrogen andprogesterone are steroid hormones preparing the endometrium for implantation. They mediatetheir effect through their receptors: estrogen receptor alpha and beta and progesteronereceptor A and B, respectively. Leukemia inhibitory factor (LIF), which is also important forimplantation, mediates its effect through LIF receptor and the coreceptor, gp130, and is downregulated by suppressors of cytokine signaling 1. The aim of the study was to compare thelevels of the steroid hormone receptors and LIF related factors in the endometrium of twogroups of women with the diagnosis unexplained infertility: one that became pregnant afterassisted reproduction and one that did not become pregnant. Before treatment of thesewomen, endometrial mRNA was collected during the window of implantation in themenstrual cycle. The levels of specific mRNAs were measured with real-time PCR. Womenwho had become pregnant had a significantly higher level of steroid hormone receptors. Thus,these proteins seem to be important for a pregnancy and may be suitable as receptivitymarkers.

Made available in DSpace on 2015-05-14T16:53:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-10-10Bitstream added on 2015-05-14T16:59:16Z : No. of bitstreams: 1 000825160.pdf: 709651 bytes, checksum: 51e908d6fe4712ab7da7bea551017d14 (MD5) / Objetivo do estudo. Comparar os resultados entre duas técnicas de ablação endometrial de primeira geração. Tipo de estudo. Estudo prospectivo, longitudinal e analítico (Canadian Task Force II-2). Local do estudo. Hospital público terciário, centro universitário de ensino. Pacientes e métodos. Durante o período de outubro de 2011 a setembro de 2013, 73 pacientes com história de sangramento uterino anormal (SUA) e resposta insatisfatória ao tratamento clínico por um período mínimo de 12 meses, foram randomizadas e submetidas à ablação endometrial por ressecção com eletrodo monopolar em alça U seguida de eletrocoagulação com rollerball no grupo A (36 pacientes) e eletrocoagulação apenas com rollerball no grupo B (37 pacientes). As mulheres foram acompanhadas por período médio de 359 dias (280;751) e 370 dias (305;766), respectivamente. Intervenções. As pacientes foram submetidas à ablação endometrial conforme a técnica de cada grupo. Avaliações nos tempos 30, 90, 180 e 360 dias foram realizadas através de protocolo de pesquisa, que procurou avaliar o padrão de sangramento, sintomas associados, índice de falha e taxa de satisfação. Resultados. Os grupos foram clínico-epidemiologicamente homogêneos (P ≥ 0,05). O tempo cirúrgico e o volume utilizado do meio distensor foram menores nas pacientes do grupo B [média de 48,5 (±12,0) vs. 31,9 (±5,6) minutos; P < 0,001 e 5.700 mL vs. 3.500 mL; P < 0,01]. Observou-se uma considerável melhora no quadro clínico após ablação endometrial, em ambos os grupos, com redução do número de dias de sangramento (P < 0,01), assim como do número de absorventes utilizados no dia de maior fluxo (P < 0,01) e durante todo o período menstrual (P < 0,01). Houve também menor incidência de infecção do sítio cirúrgico no grupo B (30,5% vs. 8,1%; P < 0,05). A taxa de histerectomia observada no estudo foi de 9,6%, decorrente de ... / Purpose of the study. Compare the results of two techniques of endometrial ablation first generation. Type of study. Prospective, longitudinal and analytical study (Canadian Task Force II-2). The study site. Tertiary public hospital, university teaching center. Patients and methods. During the period October 2011 to September 2013, 73 patients with a history of abnormal uterine bleeding (AUB) and poor response to medical treatment for a minimum period of 12 months, were randomized and underwent endometrial ablation with monopolar resection electrode handle U followed by rollerball electrocoagulation with the group a (36 patients) with rollerball electrocoagulation only in group B (37 patients). The women were followed for an average period of 359 days (280;751) and 370 days (305;766), respectively. Interventions. The patients were submitted to endometrial ablation technique according to each group. Ratings at 30, 90, 180 and 360 days were accomplished through research protocol, which sought to assess the pattern of bleeding, associated symptoms, failure rate and satisfaction rate. Results. The groups were homogeneous clinical and epidemiologically (P ≥ 0.05). Surgical time and the volume of distension medium used were lower in group B patients [mean of 48.5 (±12.0) vs. 31.9 (±5.6) minutes; P < 0.001 and 5.700 mL vs. 3.500 mL; P < 0.01]. There was a significant improvement in clinical symptoms after endometrial ablation in both groups, reducing the number of bleeding days (P < 0.01), as well as the number of pads used on the day of the flow rate (P < 0.01) and throughout the menstrual cycle (P < 0.01). There was also a lower incidence of surgical site infection in group B (30.5% vs. 8.1%; P < 0.05). The hysterectomy rate observed in the study was 9.6%, due to technical difficulties and intraoperative hemorrhage, persistence of SUA, development of incapacitating dysmenorrhea and / or pelvic pain ...

Introdução: o carcinoma de endométrio é uma das neoplasias ginecológicas mais comuns nos países industrializados. O tratamento desta doença é primariamente cirúrgico. Segundo a normatização da Federação Internacional de Ginecologia e Obstetrícia (FIGO), a cirurgia ideal consiste na realização de histerectomia total, anexectomia bilateral, linfadenectomia retroperitonial e coleta de citologia peritoneal. No entanto, a realização sistemática da linfadenectomia tem sido contestada. Alguns centros de referência acreditam que deva ser realizada apenas em um grupo de pacientes com alto risco para disseminação linfática da doença. O desafio é encontrar marcadores pré-operatórios que possam ser preditivos da presença de doença linfonodal e, assim , virem a ser utilizados para a definição da necessidade da linfadenectomia. Objetivos: verificar se a expressão imuno-histoquímica (IMH) positiva da p53 na amostra endometrial diagnóstica e, se o valor sérico do CA 125 obtido no tempo pré-operatório, podem ser efetivos para prever a presença de doença linfonodal. Métodos: um estudo transversal restrospectivo foi realizado. Foram incluídas 111 pacientes com carcinoma de endométrio submetidas a histerectomia com anexectomia bilateral e linfadenectomia com ou sem citologia peritoneal. Noventa pacientes apresentavam CA 125 pré-operatório e 73, a avaliação da p53. Cinquenta e quatro pacientes apresentavam as duas variáveis em combinação. Foram estabelecidas as associações entre o valor de CA 125 e da expressão IMH da p53 com o envolvimento linfonodal. Uma curva ROC foi construída para identificar o valor de CA 125 com melhor Sensibilidade (S) e Especificidade (E) para doença linfonodal. / Introduction: endometrial carcinoma is one of the most common gynecological malignancies in industrialized countries. The treatment of this disease is primarily surgical. According to the International Federation of Gynecology and Obstetrics surgery ideal consists in performing total hysterectomy, bilateral adnexectomy, retroperitoneal lymphadenectomy and peritoneal cytology. However, the systematic lymphadenectomy has been disputed, and should only be performed in a group of patients at high risk of lymphatic spread of the disease. The challenge is to find preoperative markers that may be predictive of the presence of lymph node disease and thus come to be used to determine the necessity of lymphadenectomy. Objectives: to determine whether the positive immunohistochemical expression (IMH) of p53 in diagnostic endometrial sample and, if the value of serum CA 125, obtained during pre-operative, can be effective to predict the presence of lymph node disease. Methods: a cross-sectional study was conducted. The final sample consisted of 111 patients with endometrial carcinoma undergoing hysterectomy with bilateral adnexectomy and lymphadenectomy with or without peritoneal cytology. Ninety two patients had preoperative CA 125 and 73, evaluation of p53. Fifty four patients had both variables in combination. Associations have been established between the value of CA 125 and IMH expression of p53 with lymph node involvement. A ROC curve was constructed to identify the value of CA 125 with better sensitivity (S) and specificity (E) for lymph node disease.

Do ponto de vista da produtividade, a fertilidade é um dos parâmetros de maior importância em um rebanho bovino comercial e esta é influenciada por vários fatores, entre eles estão as condições do trato reprodutivo das fêmeas e a qualidade do sêmen utilizado. O influxo de células inflamatórias no local da deposição do sêmen logo após a inseminação artificial (IA) pode ser intensificada na presença de maior número de espermatozoides lesados durante a IA, caracterizando uma endometrite. Este estudo foi conduzido em três experimentos. Com o objetivo de comparar os métodos de colheita de material endometrial por escova ginecológica (EU) e lavado uterino (LU), bem como a interferência destes procedimentos na hemodinâmica uterina, foi proposto o Experimento 01, onde pode-se constatar que ambas as técnicas permitem o recolhimento de amostras em quantidade e qualidade suficiente para contagem, e que a porcentagem de células polimorfonucleares obtidas pela técnica LU foi superior a EU. Maior fluxo sanguíneo das artérias uterinas foi encontrado no momento de 4 horas após a realização de LU, sugerindo que este influencia na resposta vascular inflamatória. Para avaliar o efeito da LU após a IA em Tempo Fixo (IATF) na fertilidade dos animais, executou-se o Experimento 02 e constatou-se que não há diferença no índice de prenhez entre os animais submetidos ou não à LU, demonstrando que a técnica não interfere na taxa de fertilidade. Com o intuito de investigar a interferência da qualidade do sêmen na fertilidade, resposta inflamatória e hemodinâmica uterina, foi proposto o Experimento 03, onde foi possível observar influência da qualidade do sêmen sobre a taxa de prenhez, verificou-se maior porcentagem de vacas prenhes quando inseminadas com sêmen com maiores percentuais de espermatozoides apresentando integridade das membranas plasmática e acrossomal e função mitocondrial (PIAIC). Notou-se ainda a ocorrência de endometrite em 65,3 % dos animais, os quais apresentaram taxa de prenhez inferior aos que não apresentaram inflamação. Pode-se concluir que a qualidade do sêmen e a endometrite interferem na taxa de fertilidade bovina. / When productivity is taking into account, fertility is one of the most important parameters in a commercial herd. It is influenced by several factors, especially by the conditions of the female reproductive tract and the quality of the semen used. The influx of inflammatory cells at the site of semen deposition after artificial insemination (AI) can be intensified by the deposition of a greater number of dead spermatozoa during AI, which characterized endometritis. This study was conducted in three different experiments. In order to compare the methods of collection of endometrial sampling by swab using a gynecological brush (GB) or uterine flushing (UF), as well as the interference of these procedures in uterine hemodynamics, we designed experiment 01. Our results reveal that both techniques allow collecting samples with good quality and sufficient quantity to be counted; moreover, the average percentage of polymorphonuclear cells obtained by UF was greater compared to those obtained by GB. It may be noted that the increased blood flow was observed in samples collected four hours after the UF procedure, suggesting that it may have an influence on the vascular inflammatory response. To evaluate the effect of uterine flushing after AIFT on animal fertility we designed the experiment 02. Our results revealed that there is no statistical difference in pregnancy rates between flushed and non flushed animals, showing that the UF does not interfere with fertility rate. Experiment 03 was designed in order to assess the inflammatory response induced by different qualities of semen and their interference on uterine hemodynamic and fertility. There was an influence of semen quality on pregnancy rates: higher percentage of pregnancy was found in the group of cows inseminated with semen with plasma and acrossome membrane integrity and mitochondrial function (PIAIC). Endometritis was noticed in 65.3% of the cows and these animals presented lower pregnancy rate compared to those that did not show an inflammatory response. We concluded that semen quality and endometritis interferes with fertility rate in bovine species.

Introdução: o carcinoma de endométrio é uma das neoplasias ginecológicas mais comuns nos países industrializados. O tratamento desta doença é primariamente cirúrgico. Segundo a normatização da Federação Internacional de Ginecologia e Obstetrícia (FIGO), a cirurgia ideal consiste na realização de histerectomia total, anexectomia bilateral, linfadenectomia retroperitonial e coleta de citologia peritoneal. No entanto, a realização sistemática da linfadenectomia tem sido contestada. Alguns centros de referência acreditam que deva ser realizada apenas em um grupo de pacientes com alto risco para disseminação linfática da doença. O desafio é encontrar marcadores pré-operatórios que possam ser preditivos da presença de doença linfonodal e, assim , virem a ser utilizados para a definição da necessidade da linfadenectomia. Objetivos: verificar se a expressão imuno-histoquímica (IMH) positiva da p53 na amostra endometrial diagnóstica e, se o valor sérico do CA 125 obtido no tempo pré-operatório, podem ser efetivos para prever a presença de doença linfonodal. Métodos: um estudo transversal restrospectivo foi realizado. Foram incluídas 111 pacientes com carcinoma de endométrio submetidas a histerectomia com anexectomia bilateral e linfadenectomia com ou sem citologia peritoneal. Noventa pacientes apresentavam CA 125 pré-operatório e 73, a avaliação da p53. Cinquenta e quatro pacientes apresentavam as duas variáveis em combinação. Foram estabelecidas as associações entre o valor de CA 125 e da expressão IMH da p53 com o envolvimento linfonodal. Uma curva ROC foi construída para identificar o valor de CA 125 com melhor Sensibilidade (S) e Especificidade (E) para doença linfonodal. / Introduction: endometrial carcinoma is one of the most common gynecological malignancies in industrialized countries. The treatment of this disease is primarily surgical. According to the International Federation of Gynecology and Obstetrics surgery ideal consists in performing total hysterectomy, bilateral adnexectomy, retroperitoneal lymphadenectomy and peritoneal cytology. However, the systematic lymphadenectomy has been disputed, and should only be performed in a group of patients at high risk of lymphatic spread of the disease. The challenge is to find preoperative markers that may be predictive of the presence of lymph node disease and thus come to be used to determine the necessity of lymphadenectomy. Objectives: to determine whether the positive immunohistochemical expression (IMH) of p53 in diagnostic endometrial sample and, if the value of serum CA 125, obtained during pre-operative, can be effective to predict the presence of lymph node disease. Methods: a cross-sectional study was conducted. The final sample consisted of 111 patients with endometrial carcinoma undergoing hysterectomy with bilateral adnexectomy and lymphadenectomy with or without peritoneal cytology. Ninety two patients had preoperative CA 125 and 73, evaluation of p53. Fifty four patients had both variables in combination. Associations have been established between the value of CA 125 and IMH expression of p53 with lymph node involvement. A ROC curve was constructed to identify the value of CA 125 with better sensitivity (S) and specificity (E) for lymph node disease.

A proliferação celular mediada pela progesterona (P4) é essencial para a funcão uterina. Dessa forma, alterações nesse processo podem comprometer a reprodução. O diabetes do tipo 1 (DM1) está associado a diversos distúrbios reprodutivos. No entanto, o impacto do DM1 sobre a ação da P4 no ambiente uterino ainda não é conhecido. Para isso, utilizamos fêmeas de camundongo DM1 induzidas por aloxana, submetidas à ovarectomia (OVX) e reposição por P4. Verificamos por meio de histomorfometria e imunohistoquímica (PCNA) uma diminuição da área de estroma uterino e do índice de proliferação. As quantificações proteícas por Western blot monstraram um aumento do PR-A nas fêmeas diabéticas OVX e nas tratadas pela P4. Ressalta-se que as fêmeas DM1 tratados pela P4 não apresentaram a mesma expressão do RNAm para o fator de crescimento Hoxa-10. Houve também um aumento do RNAm da p27 nas fêmeas DM1 não tratadas, visto por qPCR. Nossos resultados demonstraram que o DM1 interfere negativamente na resposta proliferativa promovida pela P4. Contribuindo para compreensão dos mecanismos biológicos pelos quais o diabetes compromete as funções reprodutivas. / Progesterone (P4)-mediated cell proliferation is essential for uterine function. Therefore, alteration in this process could compromise reproduction. The type 1 diabetes (DM1) relates to several reproductive disturbs. However, the impact of DM1 on the P4 function is still not elucidated. Thus, we used alloxan-induced diabetic mice females subjected to ovariectomy and hormonal replacement therapy with P4. Histomorphometrical and immunohistochemistry to PCNA approaches showed a decrease of the uterine stromal area and the cell proliferation index. Protein quantification by Western blot showed increased levels of PR-A in both ovariectomized and P4-treated diabetic females. Importantly, P4 did not recovered the mRNA expression to the Hoxa-10 transcription factor in diabetic females. Additionally, qPCR analysis revealed increased level of p27 mRNA in diabetic females non-treated with P4. Together these results show that DM1 has a negative action on the P4-mediated cell proliferative response. These are new and important results to a better understand of the biological mechanisms by which diabetes affects the reproductive functions.

Ziel der vorliegenden Arbeit war es, die physiologische Zellinfiltration des bovinen Endo-metriums während des Zyklus bei fruchtbaren Rindern (immun-)histologisch zu bestimmen. Darauf aufbauend sollte die Endometritis unter besonderer Berücksichtigung ihres Grades histologisch definiert werden. Des Weiteren erfolgte eine histologische Dokumentation des endometrialen „Gesundheitszustandes“ klinisch gesunder Rinder und es sollte ermittelt wer-den, welche endometrialen Befunde hinsichtlich ihrer Qualität und Quantität mit einer Gravi-dität vereinbar sind und ob eine prognostische Aussage in Bezug auf die Fertilität möglich ist. Zudem wurden unterschiedliche Endometritisformen hinsichtlich Qualität und Quantität der beteiligten Entzündungszellen histologisch und immunhistologisch detailliert charakterisiert. Darüber hinaus erfolgte eine vergleichende Betrachtung der Ergebnisse der histologischen Untersuchung mit denen der Uteruszytologie. Zur Definition des Normalbefundes der endometrialen Infiltration mit freien Zellen wurden nach Ovulationsinduktion von zwölf klinisch-gynäkologisch gesunden Rindern im Östrus (Fol-likelphase) sowie von sieben Kühen zweimal im Laufe eines Zyklus (Zyklustag 6 ± 1, frühe Lutealphase und Zyklustag 14 ± 1, späte Lutealphase) zytologische Präparate und Endo-metriumbioptate entnommen und (immun-)histologisch untersucht. Das Vorkommen von Lymphozyten (T- und B-Lymphozyten), Plasmazellen, neutrophilen und eosinophilen Granu-lozyten, Makrophagen und Mastzellen (Tryptase- und Chymase-positive Mastzellen) wurde quantitativ bestimmt und statistisch untersucht. Mittels dieser Ergebnisse wurden Grenzwerte zwischen der physiologischen endometrialen Infiltration während des Zyklus und dem Vorlie-gen einer Endometritis festgelegt. Weniger als zehn neutrophile Granulozyten sowie weniger als zwölf mononukleäre Zellen (weniger als acht Lymphozyten und weniger als vier Plasma-zellen) pro Gesichtsfeld bei 400facher Vergrößerung im Bereich des Stratum compactum oder des luminalen Epithels mit angrenzenden Anteilen des Stratum compactum werden als Normalbefund angesehen. Um einen Überblick über das Endometrium klinisch gesunder Rinder zu erhalten, wurden Endometriumbioptate von 259 Milchkühen histologisch ausgewertet, wichtige Frucht¬barkeitskennzahlen dokumentiert und die Ergebnisse statistisch untersucht. Von 200 dieser Tiere wurden die Ergebnisse der rektalen Trächtigkeitsuntersuchung herangezogen und die Auswertung der Uteruszytologien in die Untersuchungen integriert. Histopathologisch zeigten sich größtenteils geringgradige Veränderungen. Chronische nicht-eitrige Endometritiden dominierten gegenüber eitrigen Entzündungen. Mit höherem Grad der Endometritis stieg der Besamungsaufwand, während sich der Besamungserfolg verringerte. Lymphfollikel traten vor allem zusammen mit nicht-eitrigen Endometritiden auf. Ein Einfluss der größtenteils gering¬gradigen Endometrose auf die Fruchtbarkeit konnte nicht nachgewiesen werden. Die Angiosklerose stieg mit der Anzahl an Abkalbungen und hatte, insbesondere interkarunkulär, mit höhergradigerer Ausprägung einen negativen Einfluss auf die Fertilität. Karunkuläre Angiosklerosen waren zudem stärker ausgeprägt als inter¬karunkuläre. Zur detaillierten Charakterisierung unterschiedlicher Endometritisformen wurden Endo¬metritiden bei 90 Rindern semiquantitiativ mittels H.E.-Färbung hinsichtlich ihres Grades und Charakters eingeteilt und anschließend die beteiligten Entzündungszellen anhand von Spe-zialverfahren (Immunhistologie, Spezialfärbung) ausgezählt. Vor allem Plasmazellen, neutrophile Granulozyten und T-Lymphozyten weisen im Vergleich zur Zyklusgruppe und mit zunehmendem Grad der Endometritis deutlich erhöhte Zellzahlen auf. Nicht-eitrige Endo-metritiden werden durch die Dominanz von Lymphozyten und insbesondere von Plasmazel-len sowie dem häufigen Vorkommen von Lymphfollikeln zu den chronischen Entzündungen gezählt. Die Entzündung innerhalb der Karunkel entspricht grundlegend in ihrem Charakter und ihrer Ausprägung der des umliegenden interkarunkulären Gewebes. Die endometrialen Zellinfiltrate fanden sich bei dieser Studie sowohl in den verschiedenen Zyklusphasen als auch bei den verschiedenen Endometritiden vor allem in den oberflächli-chen endometrialen Bereichen. Bei allen untersuchten Rindern fiel zudem auf, dass T- Lymphozyten im Endometrium in deutlich höherer Anzahl vorkommen als B-Lymphozyten. Ebenso ist die Anzahl an Mastzellen (gesamt) wesentlich höher als die Summe Tryptase- und Chymase-positiver Mastzellen. Darüber hinaus wurden erstmals Chymase-positive Mastzellen im bovinen Endometrium immunhistologisch dargestellt, die in signifikant gerin-gerer Anzahl als Tryptase-positive Mastzellen im Endometrium vorkommen. Histologie und Zytologie wiesen vor allem bei den klinisch gesunden Rindern (Gruppe 2) und den sub-/infertilen Rindern (Gruppe 3) deutliche Diskrepanzen auf. Vorkommen, Grad und Charakter einer Endometritis konnten durch die Uteruszytologie nicht eindeutig bestimmt werden. Zum einen wurde bei histologisch unauffälligen Endometrien mittels Zytologie die Diagnose ‚subklinische’ Endometritis gestellt. Zum anderen blieben histologisch festgestellte, insbesondere chronische nicht-eitrige Endometritiden, in der Zytologie unerkannt. Somit soll-te die Beurteilung der Uteruszytologie nur unter Berücksichtigung klinischer Ergebnisse so-wie unter Einbeziehung des Zyklusstandes erfolgen. Zudem sollten anhand der eigenen Er-gebnisse die Vorteile und die Aussagekraft dieses Verfahrens überdacht werden. Im Gegensatz zu den Ergebnissen der zytologischen Untersuchung konnten mittels Endo-metriumbiopsie auch chronische nicht-eitrige Endometritiden sowie degenerative endo-metriale Veränderungen (Endometrose, Angiosklerose) erkannt werden. Somit stellt die En-dometriumbiopsie, besonders bei „repeat breedern“ und bei Kühen mit unklarer klinischer Symptomatik, eine sinnvolle Ergänzung der klinischen Diagnostik dar, um klinisch nicht er-fassbare endometriale Erkrankungen festzustellen. Die Entnahme einer Endometriumbiopsie hat keine negativen Auswirkungen auf die prospektive Reproduktionsleistung bei Milchkühen. Eine hochfrequente Entnahme von Endometriumbioptaten über einen Zyklus hinweg ist dagegen nicht empfehlenswert. Beim Rind stellen geringgradige endometriale Veränderungen mit einer erneuten Gravidität vereinbare Befunde dar, während mittel- und hochgradige Veränderungen die Prognose für eine erneute Trächtigkeit stark herabsetzen.

Studies indicate that estrogen enhances Chlamydia trachomatis serovar E infection in genital epithelial cells. Hormones have direct and indirect effects on endometrial epithelial cells. Estrogen and progesterone exposure induces endometrial stromal cells to release effectors that subsequently regulate growth and maturation of uterine epithelial cells. Estrogen enhances C. trachomatis infection by aiding entry and intracellular development in endometrial epithelial cell (Ishikawa, IK)/SHT-290 stromal cell co-culture. Enhanced chlamydial infection was mediated by direct estrogen-stimulated signaling events in epithelial cells and indirectly via estrogen-induced stromal cell effectors. The current study investigates the effects of hormones on chlamydial development using culture conditions representative of the menstrual cycle. Chlamydia trachomatis-infected IK or IK/SHT-290 cultures were exposed to 10(-8) M estrogen (E2), 10(-7) M progesterone (P4) or a combination of both hormones (10(-8) M E2 followed by 10(-9) M E2/10(-7) M P4). Chlamydial infectivity and progeny production were significantly decreased (30-66%) in cultures exposed to progesterone or estrogen/progesterone combination compared to estrogen alone. Thus, progesterone antagonized the positive effects of estrogen on chlamydial infection. These data indicate the susceptibility of endometrial epithelial cells to C. trachomatis infection during the menstrual cycle is altered by phase specific actions of sex hormones in the genital tract.

Introduction : La fécondation in vitro est de mieux en mieux connue et en amélioration constante, cependant les taux d’implantation et de grossesse sont encore bas (environ 35% par fécondation in vitro). Un des enjeux de l’amélioration de la fécondation in vitro est le développement embryonnaire et l’implantation. Pour cela, la co-culture des embryons sur un tapis de cellules endométriales maternelles autologues peut être utilisée pour améliorer le développement embryonnaire (taux d’embryon se développant jusqu’à J5 : blastocyste) et l’implantation. L’objectif de l’étude est d’étudier le lien entre la qualité du tapis cellulaire et le développement embryonnaire. Matériel et méthodes : Cette étude est une sous analyse de l’essai clinique randomisé en double aveugle OvoGen, comparant le taux de blastulation et de grossesse dans deux groupes randomisés : le groupe étude, dans lequel les embryons se développent sur un tapis cellulaire endométrial maternel et le groupe contrôle, dans lequel les embryons sont cultivés dans du milieu conventionnel. Nous avons analysé la qualité des tapis cellulaire du groupe étude (confluence des cellules, taux de cellules épithéliales et vitalité des cellules stromales) par rapport au développement embryonnaire et au taux de grossesse. Résultats : 50 tapis de cellules endométriales maternelles et 291 embryons sur les puits ont été analysés de 2012 à 2015 à la clinique ovo (Montréal, Québec). La qualité des embryons n’était pas changée par la qualité des tapis (p=0,65 pour la confluence, p=0,25 pour le taux de glande et p=0,92 pour la viabilité des cellules). En revanche, le taux de grossesse augmentait quand la confluence diminuait (p=0,022) et lorsque la viabilité des cellules stromales augmentait (p=0,001). De plus, la qualité des tapis était dépendante de la date de la biopsie : la biopsie faite à J7 après l’ovulation permettait une meilleure qualité de puits (confluence augmentée, p=0,045, taux de glande augmenté p=0,004 et viabilité stromales augmentée p=0,001) que la biopsie faite à J5 post ovulation. Discussion : Aucune des nombreuses études sur la co-culture ne porte sur la qualité des tapis cellulaire. Il est intéressant de noter que le taux de grossesse augmente avec la diminution de la confluence et l’augmentation de la viabilité des cellules stromales dans les puits contenant les embryons transférés. Comme il a déjà été démontré, (1)le jour de la biopsie endométriale influe sur la qualité du tapis cellulaire en coculture et pour que celui-ci soit de bonne qualité, il faut que l’endomètre soit réceptif (après J19 du cycle). Conclusion : Nous avons montré que la qualité des tapis cellulaires dépendait du jour de la biopsie d’endomètre et que cette qualité pouvait influencer le bénéfice de la co-culture. Il serait intéressant d’étudier la réceptivité de l’endomètre au moment de la biopsie avant utilisation des cellules en co-culture pour optimiser la qualité du tapis cellulaire. / Introduction: Lot's of progress has been made in the process of in vitro fertilization (IVF) in the last years. However, the pregnancy rate is still low. There are two important issues in IVF: embryo development and implantation. One answer may be the endometrial autologue co-culture which could improve the embryo development and the implantation rate in many ways. The aim of this study is to assess the effect of co-culture quality on human embryo development and implantation rate. Materials and methods: The ovogen study was a randomized, double blind trial analysis. OvoGen compared the blastulation and the pregnancy rate in two randomized groups: the study group, with autologous endometrial co-culture and the control group, with conventional media. The outcome of our study was to assess the correlation between the quality of autologous endometrial co-culture (cells confluence, rate of epithelials cells and stromals cells viability) and the embryo development. Results: FIfty patients in the co-culture group were analyzed between 2012 to 2015 at the ovo clinic (Montreal, Quebec). 291 embryos were analyzed, each cocultured on a monolayer endometrial cells. The embryo quality was not significantly linked with the co-culture quality (p=0,65 for the cells confluence, 0,25 for the epithelial cells rate and 0,92 for the stromal cells viability). On the other hand, the 11 pregnancy rate increased in correlation with the decreasing of the confluence (p=0,022) and the increase of stromal cells (p=0,001). Moreover, the moment of the biopsy had an effect on the co-culture: when the biopsy was performed seven days after the ovulation, the quality of the co-culture was better (confluence increased p=0,045, epithelials cells increased p= 0,004 and stromal cells viability increased p=0,001) than when the biopsy was done five days after the ovulation. Discussion: There were no previous study on the quality of the co-culture and its effect on the embryo development. The fact that the pregnancy rate increased with the decrease of the confluence in the co-culture is interesting. Indeed, we could easily explain why a huge confluence could be prejudicial for the dialog between embryo and endometrium. Moreover, in accordance with previous experience, the day of the biopsy in the cycle is important for the quality of the endometrium. This is why the day of the biopsy may have an effect on the co-culture quality. Conclusion: Our results show that the moment of the biopsy has an effect on the quality of the co-culture and that the quality of the co-culture has an effect on the pregnancy rate. It could be interesting to study the endometrium receptivity on the biopsy before the co-culture to optimize the quality and the benefit of the co-culture.

INTRODUÇÃO: O Sangramento Uterino Disfuncional (SUD) é uma das causas mais prevalentes de sangramento uterino, estando relacionado a variações hormonais, independente de causas orgânicas. A ablação endometrial é uma das opções terapêuticas, porém está associada à necessidade de treinamento específico e apresenta alto custo. Este estudo tem como objetivo desenvolver modelo de ablação endometrial em ratas adultas. Além disso, avaliar os efeitos histológicos e histomorfométricos causados pelo ácido tricloroacético no útero desses animais, bem como a regeneração endometrial e o retorno do ciclo estral. MÉTODOS: 30 ratas fêmeas adultas foram divididas em dois grupos. Todos os animais foram submetidos à injeção intra-uterina de SF 0,9% em um corno uterino e de ácido tricloroacético (ATA) no corno contralateral. O primeiro grupo, constituído de 15 ratas, foi sacrificado após 1 dia da injeção e tiveram os úteros removidos (Grupo 1). O segundo grupo, constituído de 15 ratas, foi sacrificado após voltar a apresentar um ciclo estral normal, quando foram submetidos à coleta de esfregaços vaginais e eutanasiados em fase de diestro, o que ocorreu cerca de 20 a 30 dias após o procedimento (Grupo 2). As espessuras do epitélio superficial e do estroma endometrial, o número de glândulas endometriais por campo e a espessura miometrial foram comparadas entre os cornos uterinos de cada animal do Grupo 1. As mesmas comparações foram realizadas entre os cornos dos animais do Grupo 2. Por fim, foi avaliada a regeneração endometrial nos Grupos 1 e 2. RESULTADOS: Todos os animais apresentaram recuperação satisfatória do procedimento, não havendo sinais de toxicidade aguda associada ao uso de ATA. No grupo 1, as medianas da espessura do epitélio superficial do endométrio (ATA 0mm vs. Controle 0,05mm,p=0,0001), da espessura do estroma endometrial (ATA 0,325mm vs. Controle 0,525mm, p=0,0006), do número de glândulas (ATA 4,5 vs. Controle 6,5, p=0,0012) e da espessura miometrial (ATA 0,25mm vs. Controle 0,35mm, p=0,009) foram significativamente inferior no corno que recebeu a injeção de ATA. No Grupo 2, quatro animais (27%) morreram na segunda semana após o procedimento e, em seis animais (40%), o material obtido não pode ser avaliado devido à intensa destruição tecidual. Nos cinco animais restantes (33%) a mediana da espessura do epitélio superficial do endométrio (ATA 0,0mm vs. Controle 0,05mm, p<0,004), da espessura do estroma endometrial (ATA 0,325mm vs. Controle 0,725mm, p=0,011), do número de glândulas (ATA 3 vs. Controle 6,5, p=0,011) e da espessura miometrial (ATA 0,35mm vs. Controle 0,5mm, p=0,024), foram significativamente inferior no corno submetido à injeção de ATA. Quanto à mediana da espessura do epitélio superficial do endométrio (Grupo 1 0mm vs. Grupo 2 0mm, p=1) e à mediana da espessura do estroma endometrial (Grupo 1 0,325mm vs. Grupo 2 0,325mm, p=0,857), não houve diferenças significantes entre os cornos uterinos submetidos à injeção de ATA. A mediana do número de glândulas após a injeção de ATA foi superior no Grupo 1 em comparação ao Grupo 2 (p=0,003). CONCLUSÃO: O estudo permitiu o desenvolvimento de um modelo experimental viável de ablação de endométrio em ratas adultas. As alterações histológicas e histomorfométricas encontradas nos cornos uterinos mostraram que o ácido tricloroacético é um potente agente na destruição química endometrial. Não houve regeneração endometrial após retorno ao ciclo estral. / INTRODUCTION: Dysfunctional uterine bleeding is one of the most prevalent causes of uterine bleeding and it is related to hormonal variations without organic causes. Endometrial ablation is a therapeutic option but the methods are frequently expensive and dependent of high cost technologies. The objective of the present study is to develop an animal model of endometrial ablation in adults female rats. In addition, to evaluated the histological and histomorphometric effects after trichloroacetic acid (TCA) exposure into uterine cavity. METHODS: A total of thirty female adult rats were divided in two groups of 15 rats each. All animals were submitted to injection of 0,3 ml of TCA 90% in one uterine horn and the same amount of saline solution 0,9% (control) in the other. Group 1 was sacrificed in the following day of the procedure, whereas group 2 was sacrificed in phase of diestrous after recovery of normal estral cycle identified by vaginal smears, approximately 20 to 30 days after the procedure. Superficial epithelia of the endometrium, estromal thickness, number of endometrial glands as well as of myometrium thickness were assessed and compared between the uterine horns of the same rats of group 1. The same evaluation was performed in group 2. Also, endometrial regeneration was evaluated comparing histological alterations in the uterine horn that was injected with TCA in group 1 and 2. RESULTS: All animals recovered satisfactorily from the procedure. In group 1, superficial epithelia of the endometrium (TCA 0,0mm vs 0,05 mm control, p=0,0001), estromal thickness (TCA 0,325mm vs 0,525 mm Control, p=0,009), number of endometrial glands (TCA 4,5mm vs 6,5 mm control, p=0,001) and mean myometrial thickness (TCA 0,25mm vs 0,35 mm Control, p=0,0006) presented a significant difference between the horns showing endometrial destruction on TCA uterine horn. In group 2, four rats (27%) died in the second week after the initial procedure and six rats (40%) had no viable material to be analyzed due to extent tissue destruction. The rest of the group (33%) showed a mean superficial epithelia of the endometrium (TCA 0,0mm vs 0.05 mm control, p<0,004), mean estromal thickness (TCA 0,325mm vs 0,725 mm Control, p=0,011), mean number of endometrial glands (TCA 3 vs 6,5 control, p=0,011) and mean myometrial thickness (TCA 0,35mm vs 0.5 mm Control, p=0,024) significant different between horns showing endometrial destruction on TCA uterine horn. There was no significant difference in the mean superficial epithelia of the endometrium (group 1 0mm vs. group 2 0mm, p=1) and mean estromal thickness (group 1 0,325mm vs. group 2 0,325mm, p=0,857) between TCA uterine horn from both groups. However, number of endometrial glands (4,5mm in group 1 vs 3 mm in group 2, p=0,003) was higher in group 1. CONCLUSION: The study developed a valid model for endometrial ablation in adult females rats. The histological and histomorphometric effects observed in the uterine horns showed that the trichloroacetic acid is a potent agent for endometrial ablation in rat model. In the current model no endometrial regeneration was observed after recovery of normal estral cycle.