OBJECTIVES: This study aims to explore the relationships between preoperative psychosocial factors in relation to postoperative chronic pelvic pain (CPP) in adolescents and young women with endometriosis, which is a significant public health concern. As a pilot sample, there is large need to present preliminary data exploring the biopsychosocial correlates and possible predictors of central sensitization and CPP, which remains non-existent in the realm of adolescents and young adults with CPP secondary to endometriosis. METHODS: Eligible candidates included patients 12-22 years old who were diagnosed with CPP after laparoscopic confirmation of endometriosis. 25 successfully enrolled subjects had pre-surgical information obtained from baseline surveys and underwent a postoperative sensory protocol to assess mechanical allodynia, pressure pain sensitivity, central sensitization, and a self-report measure of pain sensitivity. Correlation calculations were conducted between pre-surgical factors (pain intensity, pain catastrophizing (PCS), and quality-of-life (from SF-36)) and post-surgical factors (pain and sensitivity thresholds as measured by QST and the PSQ) in the subject population as a whole, and in two population subgroups: those exhibiting central sensitization and those who are not. One-way ANOVA calculations and one sample t-tests were conducted to compare differences between cohorts and between abdominal and control sites for various study parameters. RESULTS: 6 of 25 (24%) subjects experienced a wind-up phenomenon during the temporal summation for pain test, serving as a surrogate for central sensitization. The differences in study parameters that this group (+CS) exhibited in comparison to the –CS group, failed to reach significance in all study parameters. Both cohorts exhibited positive correlations between pre-operative disability due to bodily pain (SF-36) and sensitivity of the abdomen, as well as negative correlations between disability due to bodily pain and pressure pain thresholds of the abdomen. The +CS cohort also exhibited a negative correlation between disability due to bodily pain and pinprick pain scores, a positive correlation between role limitations due to physical health (SF-36) and sensitivity of the abdomen, and a positive correlation between pain catastrophizing and sensitivity of the abdomen. As a whole, the subject population had significantly higher levels of catastrophizing than published means. In all cohorts, pressure pain thresholds of the abdomen were significantly lower than the control values, and PSQ-minor scores were significantly higher than published means. CONCLUSIONS: Results suggest the importance of pre-operative pain and psychosocial functioning on pain outcomes, particularly when considering subjects presenting with central sensitization, in young women with CPP secondary to endometriosis. The results indicate the need for a larger sample as well as established control values to further explore the relationships between these variables.

OBJECTIVES: This study aims to better understand the relationship between psychosocial factors and the development of chronic pelvic pain (CPP) in cases of adolescent endometriosis, specifically mood disorders, pain catastrophizing and quality of life, and to detect the development of central sensitization within this population. METHODS: Eligible candidates were patients between 14 and 22 years old with confirmed diagnosis of endometriosis and chronic pelvic pain who were enrolled in the Women’s Health Study: From Adolescence to Adulthood through the Boston Center for Endometriosis (BCE) and Boston Children’s Hospital. The administration of quantitative sensory testing (QST) to assess mechanical touch perception, pressure pain sensitivity and temporal summation was performed on 48 subjects. Pre-surgical baseline surveys, which included pain catastrophizing and quality of life measures, were obtained from the BCE. Record of diagnosed mood disorder (anxiety/depression) was obtained through medical chart review. Pearson correlations between QST measures, pain catastrophizing, presence of mood disorders or central sensitization and pre-surgical pain scores were conducted. One-way ANOVA calculations, and one sample and paired t-tests were conducted to gain further understanding of these variables as they relate to groups within the cohort. RESULTS: Regarding QST measures, 23 subjects (47.9%) produced a wind-up phenomenon from temporal summation during QST administration, which serves as a surrogate for the presence of central sensitization (+CS). Pressure sensation and pain scores correlated at all test sites (lower and upper abdomen, as well as finger control site) and wind-up phenomenon correlated in the lower and upper abdomen throughout the cohort. For the presence of mood disorders, anxiety and depression were equally distributed across the +CS and –CS groups. Review of pre-surgical pain scores and pain catastrophizing (PCS) within the cohort had significant correlations between pre-surgical pain and PCS subsets of rumination and magnification. PCS total and subset scores also correlated to +CS. One-way ANOVA calculations showed the cohort as a whole presented with clinically significant helplessness. CONCLUSIONS: Results encourage further investigation of the relationship between endometriosis, comorbid conditions, environmental factors and the development of CPP within the adolescent population. More detailed data regarding mental health and documentation of condition progression, as well as establishment of health control values and sample growth are encouraged for the continued progress of this project. / 2020-07-03T00:00:00Z

Background: Endometriosis is a chronic disease affecting about 176 million fertile women worldwide. Severe menstrual pain and pain during intercourse are the primary symptoms that characterizes the disease. It often takes a long time to get the diagnosis, the nurse should be responsive and identify the patient's needs. Aim: The aim of this literature study was to describe women's experiences of living with endometriosis and the included articles data collection methods. Method: Literature study with descriptive design. Data were collected through the databases PubMed and Cinahl, the result is built on eleven scholarly articles with qualitative and mixed designs. Main Results: The woman who lives with endometriosis experiences severe pain at different time at the menstrual cycle. The diagnosis could take up to several years for some women to receive, where a common occurrence for most of them were mistrust and normalization of the symptoms from the healthcare. Endometriosis has a major impact on women's everyday life where they are both mentally and socially affected by the disease. Most of the women used their own self-strategies as dietary changes to prevent the symptoms. The eleven scholarly articles in this study used different interview methods to collect the data. Conclusion: Endometriosis has a major negative impact on women's everyday life and relationships, the disease causes infertility and social constraints. Increased knowledge in society and in health care can contribute to reduced suffering in these women.

Endometriosis or the "career woman's disease" is a puzzling disease affecting women in their reproductive years. Research on endometriosis has focussed on aspects such as the personality characteristics of sufferers and its correlation with infertility (Venter, 1980). As yet, the experiential world of endometriosis sufferers and the relationships which are influenced by their disease have received little attention (Weinstein, 1987). Furthermore, endometriosis is construed as a physical disorder which is medically diagnosed and medically treated. As such, the epistemology surrounding the term "endometriosis" is an adherent to a largely non-contextual, non-systemic and intrinsically mechanistic biomedical model (Bogdan, 1984; Schwartz, 1982). By using an ecosystemic epistemology, this dissertation will attempt to describe the unique experiential world of the afflicted woman in terms of her coping strategies in dealing with endometriosis and to formulate a description of the interactional patterns between herself and significant others directly influenced by her disease. / Psychology / M.A. (Clinical Psychology)

Made available in DSpace on 2014-06-11T19:25:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-27Bitstream added on 2014-06-13T19:12:32Z : No. of bitstreams: 1 barretto_ab_me_botfm.pdf: 1068938 bytes, checksum: e95204fb445fad834353b39ef76acce2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo do presente estudo foi estimar os efeitos da injeção local da solução de ácido acetilsalicílico a 20% em implantes de endométrio autólogo intraperitoneal. Foram utilizadas 30 coelhas adultas dividas em 3 grupos de 10 coelhas, com indução da endometriose peritoneal. Após 20 dias da indução da endometriose as coelhas foram randomizadas e de acordo com os grupos receberam os determinados tratamentos: solução fisiológica 0,9% por 20 dias (grupo 1, controle), solução bicarbonatada de ácido acetilsalicílico 20% durante 10 dias (grupo 2, tratamento) e solução bicarbonatada de ácido acetilsalicílico 20% durante 20 dias (grupo 3, tratamento). Os focos de endometriose foram removidos e preparados em lâminas para análise histológica. Foi utilizado um programa de computador para análise das lâminas e aferição da área total de endometriose remanescente. A área do grupo 2 (tratamento 10 dias) foi significativamente menor que a área de endometriose no grupo 1 (controle) e no grupo 3 (tratamento 20 dias), a área não foi aferida por não ter restado endometriose remanescente em nenhuma das 10 lâminas. O tratamento com ácido acetilsalicílico em um período de 20 dias destrói toda a área de endometrios... / The objective of the present study was to estimate the effects of local injection of acetylsalicylic acid solution into intraperitoneal implants of autologous endometrium. The 30 adult female rabbits utilized were divided into 3 groups of 10 each, in which peritoneal endometriosis was induced. Twenty days after endometriosis induction the rabbits were randomized and according to group received the following treatments: physiological solution 0.9% for 20 days (Group 1, control), bicarbonate solution of acetylsalicylic acid 20% for 10 days (Group 2, treatment) and bicarbonate solution of acetylsalicylic acid 20% for 20 days (Group 3, treatment). The endometriosis foci were removed and prepared on slides for histological analysis. A computer program was utilized to analyze the slides and measure the total area of remaining endometriosis. Group 2 (10- day treatment) presented a significantly smaller endometriosis area than Group 1 (control) and Group 3 (20-day treatment); the area was not measured on account of lack of endometriosis residue in any of the 10 slides. The 20-day treatment with acetylsalicylic acid destroys the entire endometriosis area... (Complete abstract, click electronic access below)

Orientador: Rogério Saad-Hossne / Banca: José Luis Chiaradia Gabriel / Banca: Juan Llanos / Resumo: O objetivo do presente estudo foi estimar os efeitos da injeção local da solução de ácido acetilsalicílico a 20% em implantes de endométrio autólogo intraperitoneal. Foram utilizadas 30 coelhas adultas dividas em 3 grupos de 10 coelhas, com indução da endometriose peritoneal. Após 20 dias da indução da endometriose as coelhas foram randomizadas e de acordo com os grupos receberam os determinados tratamentos: solução fisiológica 0,9% por 20 dias (grupo 1, controle), solução bicarbonatada de ácido acetilsalicílico 20% durante 10 dias (grupo 2, tratamento) e solução bicarbonatada de ácido acetilsalicílico 20% durante 20 dias (grupo 3, tratamento). Os focos de endometriose foram removidos e preparados em lâminas para análise histológica. Foi utilizado um programa de computador para análise das lâminas e aferição da área total de endometriose remanescente. A área do grupo 2 (tratamento 10 dias) foi significativamente menor que a área de endometriose no grupo 1 (controle) e no grupo 3 (tratamento 20 dias), a área não foi aferida por não ter restado endometriose remanescente em nenhuma das 10 lâminas. O tratamento com ácido acetilsalicílico em um período de 20 dias destrói toda a área de endometrios... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of the present study was to estimate the effects of local injection of acetylsalicylic acid solution into intraperitoneal implants of autologous endometrium. The 30 adult female rabbits utilized were divided into 3 groups of 10 each, in which peritoneal endometriosis was induced. Twenty days after endometriosis induction the rabbits were randomized and according to group received the following treatments: physiological solution 0.9% for 20 days (Group 1, control), bicarbonate solution of acetylsalicylic acid 20% for 10 days (Group 2, treatment) and bicarbonate solution of acetylsalicylic acid 20% for 20 days (Group 3, treatment). The endometriosis foci were removed and prepared on slides for histological analysis. A computer program was utilized to analyze the slides and measure the total area of remaining endometriosis. Group 2 (10- day treatment) presented a significantly smaller endometriosis area than Group 1 (control) and Group 3 (20-day treatment); the area was not measured on account of lack of endometriosis residue in any of the 10 slides. The 20-day treatment with acetylsalicylic acid destroys the entire endometriosis area... (Complete abstract, click electronic access below) / Mestre

Orientadores: Carlos Alberto Petta, Denise Engelbrecht Zantut-Wittmann / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T17:23:05Z (GMT). No. of bitstreams: 1 Arruda_MauriciodeSouza_D.pdf: 343806 bytes, checksum: 09bf586ba699ac3a35538ead5e7277a9 (MD5) Previous issue date: 2007 / Resumo: O objetivo deste estudo de corte transversal foi comparar a prevalência de doença tiroideana auto-imune e disfunção tiroideana entre mulheres portadoras de endometriose e um grupo de controle. Foram avaliadas 148 mulheres, com diagnóstico cirúrgico de endometriose, acompanhadas no Ambulatório de Endometriose do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, no período de dezembro de 2005 a abril de 2006, e comparadas a 158 mulheres atendidas no Ambulatório de Planejamento Familar da mesma intituição e no mesmo período. As pacientes foram entrevistadas durante uma de suas consultas nos respectivos Ambulatórios. Foram avaliadas: i) a função tiroideana através das dosagens dos hormônios Tiroestimulante e Tiroxina livre, e ii) a presença de doença tiroideana auto-imune através dos anticorpos anti-tiroglobulina e anti-tiroperoxidase. A associação entre as variáveis independentes, o grupo de estudo e as doenças tiroidianas foi avaliada através dos testes qui-quadrado e exato de Fisher, teste de Mann-Whitney e cálculo de odds ratio com seu respectivo intervalo de confiança 95%. A prevalência de hipotiroidismo foi de 12,2% (18 mulheres) no grupo com endometriose e 7,8% (12 mulheres) no grupo de controle (OR 1,49; IC 95%, 0,69 ¿ 3,2). A prevalência de hipotiroidismo auto-imune foi de 6,0% (9/148) e 5,0% (8/158), nos dois grupos, respectivamente (p <0,005). Identificamos 4,0% (6 mulheres) de hipotiroidismo instalado entre as mulheres com endometriose e 3,2% (5 casos) nas mulheres do grupo de controle. A prevalência de doença tiroidiana auto-imune foi de 8,8% (13/148 mulheres) entre as mulheres com endometriose e 15,8% (25/158) entre as mulheres no grupo de controle (OR 0,52; IC 95%, 0,25 ¿ 1,06). Em conclusão, os resultados obtidos neste estudo não sustentam a hipótese de que mullheres com endometriose apresentam maior prevalência de disfunção tiroidiana ou doença tiroidiana autoimune. Assim, entendemos não haver necessidade de rastreamento diferenciado para hipotiroidismo ou para disfunção tiroidiana nas mulheres com endometriose / Abstract: The objective of this cross sectional study was to compare the prevalence of autoimmune thyroid disease and thyroid dysfunction between women with endometriosis and a control group. One hundred forty eight women with surgically confirmed endometriosis attended at the endometriosis outpatient clinic at the Department of Obstetrics and Gynaecology, School of Medicine, Universidade Estadual de Campinas (Unicamp) were evaluated from December 2005 to April 2006 and compared to 158 women from the family planning outpatient clinic at the same institution, during the same time period. All patients were interviewed in one of their regular visit. Thyroid function and autoimmunity were evaluated by measuring serum level of thyroid stimulating hormone, free thyroxin and the antibodies antithyroperoxidase and antithyroglobulin. The association of independent variables and the study group with thyroid disorder and with thyroid dysfunction was assessed by X2 test and Fisher test. Prevalence of thyroid disorders and thyroid dysfuncion among women with endometriosis were calculated and compared with the control group using Mann-Whitney test and the odds ratio was calculated with the 95% confidence interval. The prevalence of hypothyroidism was 12.2 % (18 women) among women with endometriosis and 7.8% (12 women) in the control group (OR 1.49; CI 95%, 0.69 ¿ 3.23). The prevalence of autoimmune hypothyroidism was 6% (9/148) and 5% (8/158) in both groups, respectively. We identified 4% (6 women) with overt hypothyroidism in the group of women with endometriosis and 3.2% (5 cases) among women from the control group. The prevalence of autoimmune thyroid disease was 8.8 % (13 women) among women with endometriosis and 15.8% (25 women) in the control group (OR 0.52; CI 95%, 0.25 ¿ 1.06). Our data do not support the hypotesis that women with endometriosis present a higher prevalence of autoimmune thyroid disease or thyroid dysfuction. Therefore, we believe there is no need for a specific screening of thyroid diseases among women with endometriosis / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-24T13:22:43Z No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-24T13:23:08Z (GMT) No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-24T13:23:08Z (GMT). No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-14 / Endometriosis is defined by the emergence of foci of endometrial tissue with glandular and stromal or characteristics identical to those of the uterine cavity in other locations than the endometrium and focuses primarily on women of reproductive age. It is present in 10% of the general population and in 50% of cases of infertility, showing a strong genetic component by correlating the disease with various polymorphisms. One of them, G894T of eNOS gene of the enzyme endothelial nitric oxide synthase (eNOS) has been studied by have implications with infertility. The present study examined the allele frequency and genotype of this polymorphism in women with endometriosis storied in fertile and infertile. Blood samples were used 47 women with endometriosis from a center of reference in laparoscopy and infertility of the city of Goiânia, Goiás. The DNA was extracted and measured for genotypic analysis (PCR/RFLP) with primers and controls to enlarge the gene eNOS G894T. In the statistical analysis we used the Chi square tests and/or Fisher and Mann-Whitney. The patients had an average age 32.5 ± 2.9 years. Was demonstrated difference in average age between fertile and infertile patients p = 0.034, fertile was demonstrated 39,9± 3,0 anos, and infertile 37,3 ± 5,6 anos. Genotype polymorphism frequencies in study were: GG 59.6% 29.8% and GT TT 10.6%; to split into sub-groups of fertile and infertile met respectively: 70% and 50% GG; GT 30% and 29.2%; TT was null between fertile and infertile 20.8%. The allele frequency between the fertile and infertile, was, respectively: G 85% and 15% T; G 64.6% and 35.4% T, p = 0.04 (95% CI 3.0 OR = 1.12-8.29). In the frequency analysis of genotypic heritage models, codominant and recessive were respectively: (GG vs. TT) 59.6% (28/47) vs. 10.6% (5/47) p = 0.044 and recessive (TT vs. GT + GG) was 10.6% (5/47) vs. 89.4% (42%) p = 0.049. The study showed that the presence of the T allele of eNOS gene G894T polymorphism of endothelial nitric oxide synthase enzyme in fertile and infertile patients have an important role in the increase of endometriosis and in homozygous T allele confers risk for the infertility in endometriosis in women in the city of Goiânia-Goiás. / A endometriose é definida pelo aparecimento de focos de tecido endometrial com características glandulares e/ou estromais idênticas às da cavidade uterina em outras localizações, que não o endométrio e incide principalmente em mulheres em idade reprodutiva. Está presente em 10% da população geral e em 50% dos casos de infertilidade, apresentando um forte componente genético correlacionando a doença com diversos polimorfismos. Um deles, G894T do gene eNOS da enzima óxido nítrico sintase endotelial (eNOS) tem sido estudado por ter implicações com a infertilidade. O presente estudo analisou a frequência alélica e genotípica desse polimorfismo, em mulheres com endometriose estratificadas em férteis e inférteis. Foram utilizadas amostras de sangue de 47 mulheres com endometriose provenientes de um centro de referência em videolaparoscopia e infertilidade na cidade de Goiânia, Goiás. O DNA foi extraído e quantificado para a análise genotípica (PCR/RFLP) com primers e controles para ampliar o gene eNOS G894T. Na análise estatística foram utilizados os testes qui quadrado e/ou Fisher e Mann-Whitney. As pacientes apresentaram média de idade 32,5±2,9 anos. Foi demonstrada diferença nas médias de idade entre pacientes férteis e inférteis p = 0,034, as férteis apresentaram média de 39,9 ± 3,0 anos, enquanto as inférteis 37,3 ± 5,6 anos. As frequências genotípicas do polimorfismo em estudo foram: GG 59,6%, GT 29,8% e TT 10,6%; ao dividir em subgrupos de férteis e inférteis encontrou-se respectivamente: GG 70% e 50%; GT 30% e 29,2%; TT foi nulo entre as férteis e 20,8% nas inférteis. A frequência alélica entre as férteis e inférteis, foi, respectivamente: G 85% e T 15%; G 64,6% e T 35,4%, p = 0,04 (OR = 3,0 IC 95% 1,12 – 8,29). Na análise dos modelos de herança genotípica, codominante e recessivo as frequências observadas foram respectivamente: (GG vs. TT) 59,6% (28/47) vs 10,6% (5/47) p = 0,044 e recessivo (TT vs. GT +GG) foi de 10,6% (5/47) vs 89,4% (42%) p= 0,049. O estudo demonstrou que a presença do alelo T do polimorfismo G894T do gene eNOS da enzima do óxido nítrico sintase endotelial em pacientes férteis e inférteis tem um importante papel no agravamento da endometriose e em homozigose o alelo T confere risco para infertilidade na endometriose em mulheres na cidade de Goiânia - Goiás.

Introdução: A avaliação da reserva ovariana em reprodução assistida (RA) busca identificar mulheres em que a exaustão folicular determine as dificuldades reprodutivas. Além da idade, a presença de causas outras de subfertilidade, como a endometriose (EDT), implica interferências negativas potenciais sobre a resposta ovariana. Objetivo: Avaliar a reserva folicular ovariana de mulheres subférteis portadoras de endometriose e determinar o melhor preditor de má resposta em RA. Métodos: Foram analisados 87 ciclos de RA em mulheres com idade inferior a 40 anos, ciclos menstruais regulares, sem patologias endócrinas e com ambos os ovários, sendo 30 ciclos em portadoras de EDT (casos) e 57 ciclos em mulheres subférteis por fator masculino exclusivo (controles). A reserva ovariana foi inferida pelas dosagens basais dos hormônios anti-mülleriano (AMH) e folículo estimulante (FSH), a contagem de folículos antrais pequenos (CFA) e a medida do volume ovariano médio (VOM). Curvas Receiver Operating Characteristic (ROC AUC) foram traçadas para avaliação da capacidade discriminatória de cada teste em identificar má resposta. Resultados: Pacientes com EDT apresentaram FSH basal significativamente maior em relação aos controles (9,13 ± 5,09 mUI/mL vs. 6,28 ± 2,45 mUI/mL; p < 0,05), sem diferenças para AMH, CFA e VOM. O número total de oócitos aspirados foi menor na EDT em relação aos controles (5,33 ± 3,43 vs. 8,28 ± 5,8; p < 0,05) e correlacionou-se significativamente com o AMH em ambos os grupos (EDT: r = 0,61; Controles: r = 0,58; p<0,0001). O FSH basal apresentou correlação significativa com o total de oócitos aspirados apenas na EDT (r = -0,48; p<0,01); também na EDT, o AMH basal foi o marcador individual com melhor potencial discriminatório para má resposta (AUC = 0,875), seguido de FSH basal (AUC = 0,682) e VOM (AUC = 0,665), enquanto no grupo controle, o AMH foi o melhor marcador (AUC = 0,8372), seguido do VOM (AUC = 0,709) e da CFA (AUC = 0,686). Conclusões: O FSH basal está significativamente maior nas pacientes subférteis com EDT e correlaciona-se com a resposta em RA apenas nas portadoras da doença. Já o AMH basal, é o marcador com o melhor potencial discriminatório de má resposta, independentemente da presença da endometriose. CFA e VOM não se apresentaram como bons preditores de má resposta. Sendo assim, a associação entre endometriose e subfertilidade deve estar vinculada a alterações do crescimento/desenvolvimento do folículo ovariano e não a prejuízos sobre a reserva folicular gonadal propriamente dita. / Introduction: Ovarian reserve evaluation in assisted reproduction (AR) aims to identify women in whom follicular exhaustion determines reproductive difficulties. More than age, the presence of other subfertility factors, such as endometriosis (EDT), implies potential negative interference on ovarian response. Objective: To evaluate follicular ovarian reserve in subfertile patients with endometriosis and determine the best predictor of poor response in AR. Methods: We evaluated 87 AR cycles of women presenting with less than 40 years of age, regular menses, no endocrine diseases and with both ovaries, divided in 30 EDT cycles (cases) and 57 cycles in women with subfertility associated to male factor (controls). Ovarian reserve was determined based on basal levels of anti-müllerian hormone (AMH) and follicle- stimulating hormone (FSH), small antral follicle count (AFC) and medium ovarian volume (MOV). Receiver Operating Characteristic curves (ROC AUC) were obtained for evaluation of discriminatory capacity of each test in identifying poor response. Results: EDT patients presented significantly higher basal FSH levels when compared to controls (9,13 ± 5,09 mUI/mL vs. 6,28 ± 2,45 mUI/mL; p < 0,05) and there were no differences in AMH, AFC and MOV between groups. The total number of oocytes retrieved was lower in endometriosis when compared to controls (5,33 ± 3,43 vs. 8,28 ± 5,8; p < 0,05) and significantly correlated with AMH in both groups (EDT: r = 0,61; Control: r = 0,58; p<0,0001). Basal FSH presented significant correlation with the number of oocytes retrieved only among EDT patients (r = - 0,48; p<0,01); in EDT patients, either, basal AMH was the individual marker with the best discriminatory potential for poor responders identification (AUC = 0,875), followed by basal FSH (AUC = 0,682) and MOV (AUC = 0,665), whereas among controls, AMH was the best marker (AUC = 0,8372), followed by MOV (AUC = 0,709) and AFC (AUC = 0,686). Conclusions: Basal FSH is significantly higher in subfertile patients with endometriosis and correlates with ovarian response in AR among these patients. Basal AMH, by the way, is the individual marker with the best discriminatory potential in determining poor response, which is not dependent on endometriosis presence. AFC and MOV did not presented as good predictors of poor response. The association between endometriosis and subfertility, therefore, may be linked to prejudice to growth/development of the ovarian follicle, but not to damage to the real ovarian follicular reserve.

Orientador: Egle Cristina Couto de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T11:06:18Z (GMT). No. of bitstreams: 1 Guimaraes_JoaoAgripino_M.pdf: 1627287 bytes, checksum: b5aedfb0c0a3b2d807c0d3324ae57317 (MD5) Previous issue date: 2012 / Resumo: Contexto e objetivo: Alterações imunológicas podem estar associadas à infertilidade e endometriose. O objetivo deste estudo foi avaliar se, na infertilidade inexplicada e na infertilidade associada à endometriose, ocorre polarização da resposta imunológica Th1ou Th2. Tipo de estudo e local: Foi realizado um estudo de corte transversal no Centro de Atenção Integral a Saúde da Mulher (CAISM), Universidade de Campinas (Unicamp), Campinas, São Paulo, Brasil, de janeiro a junho de 2010. Métodos: 142 mulheres foram alocadas em três grupos (52 com infertilidade inexplicada, 38 inférteis com endometriose e 52 férteis) para dosagem de citocinas Th1 (interleucina 2, fator de necrose tumoral-ALFA' e do interferon-y ) e citocinas Th2 (interleucinas 4 e 10). Os dados foram descritos através de média, desvio-padrão e mediana, e através de frequências absolutas e relativas. Os grupos foram comparados em relação às variáveis através dos testes de qui-quadrado ou exato de Fisher. As citocinas foram comparadas entre os grupos através do teste de Kruskal-Wallis; em caso de diferença significativa, foram feitas comparações dois a dois através do teste de Mann-Whitney e aceitou-se nível de significância 5%. Resultados: As mulheres com infertilidade inexplicada apresentaram menores níveis de interferon-y (p = 0,0012) e maiores níveis de interleucina-4 (p < 0,0001) do que as mulheres férteis, e maiores níveis de interferon-y (p = 0,0001) e de interleucina-4 (p = 0,0005) do que as mulheres inférteis com endometriose. Aquelas com infertilidade primária apresentaram menores níveis de interferon-y e maiores de interleucina-4 que as mulheres férteis. Conclusão: Não foi detectado qualquer tipo de polarização da resposta imunológica Th1 ou Th2 nas mulheres com infertilidade inexplicada ou com endometriose, quando comparadas com mulheres férteis / Abstract: Context and objective: Immunological alterations may be associated with infertility and endometriosis. The aim of this study was to evaluate the polarization of Th1 and Th2 immune response in women with unexplained infertility and infertility associated with endometriosis. Design and setting: A cross-sectional study was performed at the Center for Integral Attention to Women's Health (CAISM) from University of Campinas (UNICAMP), SP, Brazil, from January to June 2010. Methods: 142 women were allocated into three groups (52 with unexplained infertility, 38 infertile women with endometriosis and 52 fertile women) for measurement of Th1 (interleukin 2, tumor necrosis factor-? and interferon-?) and Th2 cytokines (interleukins 4 and 10). Data were reported as mean, standard deviation, median, and by absolute and relative frequencies. The groups were compared with respect to variables using the chi-square or Fisher exact test. Cytokines were compared between groups using the Kruskall-Wallis test and, if significant differences were noted, comparisons were made in pairs by Mann-Whitney test, with 5% significance level. Results: Women with unexplained infertility showed lower levels of interferon-? (p = 0.0012) and increased levels of interleukin-4 (p <0.0001) than fertile women, and higher levels of interferon-? (p = 0.0001) and interleukin-4 (p = 0.0005) than infertile women with endometriosis. Those with primary infertility had lower levels of interferon-? and interleukin-4 over than fertile women. Conclusion: We could not detect any polarization of Th1 or Th2 immune response in women with unexplained infertility or infertility with endometriosis, when compared with fertile women / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde