- Email: [email protected]
R1 DIET AND WEIGHT
Abstracts, Round-Table Discussion on the role of lifestyle habits and environment on ART phase; the amplitude of LH pulses varies with the appearance of an increased percentage of smaller pulses correlating well with the acute level of progesterone; in the early luteal phase, the pattern of progesterone secretion is stable; in the mid and late luteal phase, progesterone secretion is episodic and correlates with LH pulsatile release. Single progesterone estimations in the mid and luteal phase do not accurately reflect corpus luteum adequacy. The natural process of luteolysis and luteal regression is induced by withdrawal of gonadotropin support. The luteolysis could be induced by the administration of GnRH antagonist with a significant decrease in LH secretion. However, hCG treatment can raised progesterone and estradiol in the induced luteal regression by GnRH antagonist. Ovarian stimulation with virtually all the currently used stimulation protocols can reduce LH serum concentrations in the early and mid-lutheal phase. These low LH serum concentrations may contribute to luteal phase defect observed after ovarian stimulation. Supraphysiological steroid serum concentrations, as compared to natural cycles, may adversely interfere with LH secretion by disturbing the feedback mechanisms. However, exogenously administered hCG might amplify LH secretion. GnRH agonist can trigger final follicular maturation and support the luteal phase without inducing significant desensitization in patients undergoing controlled ovarian stimulation with FSH/hMG and a GnRH agonist, followed by IVF or ICSI. It has been shown that increased endometrial thickness and implantation rates could be achieved in the patients receiving hCG along with the GnRH analogs Reference(s) Filicori M, Butler JP, Crowley Jr WF. Neuroendocrine regulation of the corpus luteum in the human. Evidence for pulsatile progesterone secretion. J Clin Invest 1984; 73: 1638\erndash;1647. Canto F, Sierralta W, Kohen P, Munoz A, Strauss JF, Devoto L. Features of natural and gonadotropin-releasing hormone antagonist-induced corpus luteum regression and effects of in vivo human chorionic gonadotropin. J Clin Endocrinol Metab 2007; 92: 4436\erndash;4443. Raman NA, Rao CV. Recent progress in luteinizing hormone/human chorionic gonadotrophin hormone research. Mol Hum Reprod 2009; 15: 703\erndash;711. L13 LH IN OVARIAN STIMULATION: EFFECTS ON ENDOMETRIUM AND CORPUS LUTEUM J. Franco Jr.. Human Reproduction Centre, Ribeir˜ ao Preto, S˜ ao Paulo, Brazil The corpus luteum is an ovarian structure with maternal instincts and suicidal tendencies. LH has a central role in the maintenance of corpus luteum function. The corpus luteum is a unique hormone-regulated reproductive gland with transitory duration (14±2 days), produce progesterone for the establishment and maintenance of early pregnancy. On the other hand, luteal regression is incompletely understood and the evaluation of the corpus luteum ”in vivo” is not free of criticisms. The frequency of pulsatile release of LH declines progressively during the luteal phase; the amplitude of LH pulses varies with the appearance of an increased percentage of smaller pulses correlating well with the acute level of progesterone; in the early luteal phase, the pattern of progesterone secretion is stable; in the mid and late luteal phase, progesterone secretion is episodic and correlates with LH pulsatile release. Single progesterone estimations in the mid and luteal phase do not accurately reflect corpus luteum adequacy. The natural process of luteolysis and luteal regression is induced by withdrawal of gonadotropin support. The luteolysis could be induced by the administration of GnRH antagonist with a significant decrease in LH secretion. However, hCG treatment
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can raised progesterone and estradiol in the induced luteal regression by GnRH antagonist. Ovarian stimulation with virtually all the currently used stimulation protocols can reduce LH serum concentrations in the early and mid-lutheal phase. These low LH serum concentrations may contribute to luteal phase defect observed after ovarian stimulation. Supraphysiological steroid serum concentrations, as compared to natural cycles, may adversely interfere with LH secretion by disturbing the feedback mechanisms. However, exogenously administered hCG might amplify LH secretion. GnRH agonist can trigger final follicular maturation and support the luteal phase without inducing significant desensitization in patients undergoing controlled ovarian stimulation with FSH/hMG and a GnRH agonist, followed by IVF or ICSI. It has been shown that increased endometrial thickness and implantation rates could be achieved in the patients receiving hCG along with the GnRH analogs. Reference(s) Filicori M, Butler JP, Crowley Jr WF. Neuroendocrine regulation of the corpus luteum in the human. Evidence for pulsatile progesterone secretion. J Clin Invest 1984; 73: 1638\erndash;1647. Canto F, Sierralta W, Kohen P, Munoz A, Strauss JF, Devoto L. Features of natural and gonadotropin-releasing hormone antagonist-induced corpus luteum regression and effects of in vivo human chorionic gonadotropin. J Clin Endocrinol Metab 2007; 92: 4436\erndash;4443. Raman NA, Rao CV. Recent progress in luteinizing hormone/human chorionic gonadotrophin hormone research. Mol Hum Reprod 2009; 15: 703\erndash;711.
Round-Table Discussion on the role of lifestyle habits and environment on ART R1 DIET AND WEIGHT C.Y. Andersen. University Hospital of Copenhagen, Copenhagen, Denmark The number of obese women with a BMI >30 continue to increase on a worldwide basis and according to the World Health Organisation (WHO) approximately 30% of women between 25 and 44 years of age are overweight and 20% are obese. Obesity is often associated with increased risk of conditions like diabetes, hypertension, and cardiovascular diseases, and obese women more often experience reproductive problems. Overweight women are known to be at a higher risk of menstrual disorders, anovulation and infertility. Although the precise mechanisms have not yet been elucidated, alteration of the pulsatile secretion of GnRH, reduction in circulating levels of sex hormone binding globulin (SHBG), hyper secretion of androgens and increased circulatory levels of LH are important clinical features associated with being overweight. A number these clinical shortcomings can be manipulated in different ways, for instance by performing assisted reproduction techniques. However, the result of ART is normally sub optimal compared to women with a normal weight. Most studies agree that obese women often require increased amounts of exogenous gonadotropins, the treatment cycle is more often cancelled, and fewer oocytes are normally collected, and if they do become pregnant, they have higher miscarriage rates. So ART procedures become expensive and provide a service to obese women which may be disappointing. Alternatively, many centres now focus on either a voluntary or mandatory diet restriction, exercise and weight reduction. If this approach is successful, it will enhance chances of conception either via ART or naturally,
S12 because many anovulatory women become cyclic again upon a weight reduction. However, many obese women have difficulties following this approach and it provides the fertility clinic with a different set of challenges. How do you motivate these women, should they be closely followed in their diet habits and which measures and at what cost should be applied. Furthermore, it may be difficult to make a weight reduction mandatory if the patient herself pays for the infertility treatment. The approach should ideally be taken based on an evaluation of each individual obese woman. She should be counselled on the effect of a weight reduction and should be encouraged, whenever possible, to attempt to obtain a weight reduction prior to treatment. R2 SMOKING AND ALCOHOL A. Guti´ errez. Instituto de la Ciencia de la Reproducci´ on Humana VIDA, Le´ on, Mexico Abstract not available at time of printing. R3 ENVIRONMENTAL EXPOSURE M. do Carmo Borges de Souza. G&O Barra Reprodu¸co Humana, Rio de Janeiro, Brazil In general, the scientific community supports the idea that pollution is causing a negative impact on health, but very little is known about its impact on the reproductive capacity. To establish the risk factors for the general population is difficult and occasionally questioned by some authors, as exposure, either at work or at home, cannot be easily characterized, and hence, cannot be proven. Evidence associating exposure to the increase in the time to pregnancy deserves special attention, and as some geographic regions are more contaminated than others, the differences should be analyzed in each specific population. This is the basis of our Multidisciplinary Study Programme for Reproductive Health, which is being developed since 2005 in the state of Rio de Janeiro, Brazil. Who is the infertile population in Rio de Janeiro? We have been looking for their life habits, water and food supplies, occupational history, medical and reproductive history and emotional profile in order to identify possible adverse effects. The population in the metropolitan area of Rio de Janeiro is exposed to the most prevalent organ-chlorine compounds described in the literature, as well as lead and cadmium, even though the detection levels are low. It is capital to establish methodologies for detection of lead and cadmium in both the follicular fluid and seminal fluid, reliable, suitable for use in clinical laboratories. To achieve more consistency and comparability with other studies, future investigations will be designed to involve a large number of samples. Reference(s) Costa T, Stotsz EN, Luiz, R, Souza MCB. (2009) Am´ erica Latina e a busca por reprodu¸ ca ˜o assistida: perfil da paciente em um servi¸ co p´ ublico de referˆ encia no Rio de Janeiro, Brasil. J Bras Rep Assist, 13; 21 25. Moreira FR, Mancebo AC, Souza MCB. (2009). Quantification of lead and cadmium content in biological fluids of the human reproductive system. Clin Biochemistry. Submitted. Woodruff TJ, Carlson A, Schwartz JM, Giudice LC. (2008) Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility-executive summary. Fertil Steril. 89:281 295. Silberstein T, Saphier O, Paz-Tal O, Trimarchi JR, Gonzalez L, Keefe DL. (2006) Lead concentrations in ovarian follicles compromises pregnancy. J Trace Elem Med Biol 20: 205 207. Greenlee AR, Arbuckle TE, Chyou P: Risk Factors for Female Infertility in an Agricultural Region. Epidemiology, 2003, 14(4): 429 36.
R. Fischer Delgado IF, Barretto HHC, Kussumi TA, Alleluia IB, Baggio CA, Paumgartten FJR: Serum levels of organochlorine pesticides and polychlorinated biphenyls among inhabitants of Greater Metropolitan, Rio de Janeiro, Brazil. Cad Saude Publica, 2002, 18(2): 519 24. R4 PSYCHOLOGICAL DISTRESS C. Palatchi. Instituto para el es tudio de la Concepci´ on Humana, Monterrey, Mexico Throughout history and in all cultures, mankind has recognized involuntary childlessness as a crisis that has the potential to affect the stability of individuals, relationships and communities. Every society has culturally looked for solutions to infertility using social, spiritual or medical measures. Infertility is a medical, social and emotional condition in which a shift in emphasis has occurred from coping through social measures to a dependence on medical interventions. Caregivers have recognized that stress is a universal life experience; it may be positive or negative in that each individual perceives or experiences an event differently. Stress challenges individual resources and requires adaptation. Distress is typically referred as negative stress. The impact of patient distress has a complex interplay or interconnectedness between the mind and the body. Psychosocial and biomedical factors contribute to the physiological response to stress and the emotional response to infertility. Infertility being an unpredictable experience, uncontrollable and ambiguous is stressful. Braverman in his chapter about the relationship between stress and in vitro fertilization outcome, says that many studies and clinical experience have indicated that the vast majority of infertile men and women do not experience significant levels of psychological trauma but the use of advanced medical technology and or third party reproduction may increase psychological distress during specific periods of treatment. Men and women feel infertility in many ways and may change over time as they experience failure in the cycles. Some of the major areas of stress that have traditionally been recognized are self esteem and body image, sexuality and intimacy, relationship with partner, family relationships, social life, finances, work, etc. In the same way many feelings are related to infertility, there are gender differences as how stress may be experienced and the coping approaches and strategies. Coping with infertility requires a completion of major adaptive tasks. An increasing focus of research has been about the relationship between stress and its effect on pregnancy outcome per treatment cycle. In the same way many feelings are related to infertility, there are gender differences as how stress may be experienced and the coping approaches and strategies. Coping with infertility requires a completion of major adaptive tasks. An increasing focus of research has been about the relationship between stress and its effect on pregnancy outcome per treatment cycle. The results have been mixed. Research has yet to continue addressing the relationship between stress and infertility. Braverman states that more recently, studies have turned their attention away from the complex relationship between stress or depression and pregnancy outcome, focusing instead on the causes behind the discontinuation of treatment and treatment perseverance, where dropout is associated with psychological factors. Reference(s) [1] Verhaak C, Burns LH. Behavioral Medicine Approaches to Infertility Counseling in Covington SN. Burns LH. (Eds.) Infertility Counseling A Comprehensive Handbook for Clinicians Second Edition. New York Cambridge University Press, 2006.
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can raised progesterone and estradiol in the induced luteal regression by GnRH antagonist. Ovarian stimulation with virtually all the currently used stimulation protocols can reduce LH serum concentrations in the early and mid-lutheal phase. These low LH serum concentrations may contribute to luteal phase defect observed after ovarian stimulation. Supraphysiological steroid serum concentrations, as compared to natural cycles, may adversely interfere with LH secretion by disturbing the feedback mechanisms. However, exogenously administered hCG might amplify LH secretion. GnRH agonist can trigger final follicular maturation and support the luteal phase without inducing significant desensitization in patients undergoing controlled ovarian stimulation with FSH/hMG and a GnRH agonist, followed by IVF or ICSI. It has been shown that increased endometrial thickness and implantation rates could be achieved in the patients receiving hCG along with the GnRH analogs. Reference(s) Filicori M, Butler JP, Crowley Jr WF. Neuroendocrine regulation of the corpus luteum in the human. Evidence for pulsatile progesterone secretion. J Clin Invest 1984; 73: 1638\erndash;1647. Canto F, Sierralta W, Kohen P, Munoz A, Strauss JF, Devoto L. Features of natural and gonadotropin-releasing hormone antagonist-induced corpus luteum regression and effects of in vivo human chorionic gonadotropin. J Clin Endocrinol Metab 2007; 92: 4436\erndash;4443. Raman NA, Rao CV. Recent progress in luteinizing hormone/human chorionic gonadotrophin hormone research. Mol Hum Reprod 2009; 15: 703\erndash;711.
Round-Table Discussion on the role of lifestyle habits and environment on ART R1 DIET AND WEIGHT C.Y. Andersen. University Hospital of Copenhagen, Copenhagen, Denmark The number of obese women with a BMI >30 continue to increase on a worldwide basis and according to the World Health Organisation (WHO) approximately 30% of women between 25 and 44 years of age are overweight and 20% are obese. Obesity is often associated with increased risk of conditions like diabetes, hypertension, and cardiovascular diseases, and obese women more often experience reproductive problems. Overweight women are known to be at a higher risk of menstrual disorders, anovulation and infertility. Although the precise mechanisms have not yet been elucidated, alteration of the pulsatile secretion of GnRH, reduction in circulating levels of sex hormone binding globulin (SHBG), hyper secretion of androgens and increased circulatory levels of LH are important clinical features associated with being overweight. A number these clinical shortcomings can be manipulated in different ways, for instance by performing assisted reproduction techniques. However, the result of ART is normally sub optimal compared to women with a normal weight. Most studies agree that obese women often require increased amounts of exogenous gonadotropins, the treatment cycle is more often cancelled, and fewer oocytes are normally collected, and if they do become pregnant, they have higher miscarriage rates. So ART procedures become expensive and provide a service to obese women which may be disappointing. Alternatively, many centres now focus on either a voluntary or mandatory diet restriction, exercise and weight reduction. If this approach is successful, it will enhance chances of conception either via ART or naturally,
S12 because many anovulatory women become cyclic again upon a weight reduction. However, many obese women have difficulties following this approach and it provides the fertility clinic with a different set of challenges. How do you motivate these women, should they be closely followed in their diet habits and which measures and at what cost should be applied. Furthermore, it may be difficult to make a weight reduction mandatory if the patient herself pays for the infertility treatment. The approach should ideally be taken based on an evaluation of each individual obese woman. She should be counselled on the effect of a weight reduction and should be encouraged, whenever possible, to attempt to obtain a weight reduction prior to treatment. R2 SMOKING AND ALCOHOL A. Guti´ errez. Instituto de la Ciencia de la Reproducci´ on Humana VIDA, Le´ on, Mexico Abstract not available at time of printing. R3 ENVIRONMENTAL EXPOSURE M. do Carmo Borges de Souza. G&O Barra Reprodu¸co Humana, Rio de Janeiro, Brazil In general, the scientific community supports the idea that pollution is causing a negative impact on health, but very little is known about its impact on the reproductive capacity. To establish the risk factors for the general population is difficult and occasionally questioned by some authors, as exposure, either at work or at home, cannot be easily characterized, and hence, cannot be proven. Evidence associating exposure to the increase in the time to pregnancy deserves special attention, and as some geographic regions are more contaminated than others, the differences should be analyzed in each specific population. This is the basis of our Multidisciplinary Study Programme for Reproductive Health, which is being developed since 2005 in the state of Rio de Janeiro, Brazil. Who is the infertile population in Rio de Janeiro? We have been looking for their life habits, water and food supplies, occupational history, medical and reproductive history and emotional profile in order to identify possible adverse effects. The population in the metropolitan area of Rio de Janeiro is exposed to the most prevalent organ-chlorine compounds described in the literature, as well as lead and cadmium, even though the detection levels are low. It is capital to establish methodologies for detection of lead and cadmium in both the follicular fluid and seminal fluid, reliable, suitable for use in clinical laboratories. To achieve more consistency and comparability with other studies, future investigations will be designed to involve a large number of samples. Reference(s) Costa T, Stotsz EN, Luiz, R, Souza MCB. (2009) Am´ erica Latina e a busca por reprodu¸ ca ˜o assistida: perfil da paciente em um servi¸ co p´ ublico de referˆ encia no Rio de Janeiro, Brasil. J Bras Rep Assist, 13; 21 25. Moreira FR, Mancebo AC, Souza MCB. (2009). Quantification of lead and cadmium content in biological fluids of the human reproductive system. Clin Biochemistry. Submitted. Woodruff TJ, Carlson A, Schwartz JM, Giudice LC. (2008) Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility-executive summary. Fertil Steril. 89:281 295. Silberstein T, Saphier O, Paz-Tal O, Trimarchi JR, Gonzalez L, Keefe DL. (2006) Lead concentrations in ovarian follicles compromises pregnancy. J Trace Elem Med Biol 20: 205 207. Greenlee AR, Arbuckle TE, Chyou P: Risk Factors for Female Infertility in an Agricultural Region. Epidemiology, 2003, 14(4): 429 36.
R. Fischer Delgado IF, Barretto HHC, Kussumi TA, Alleluia IB, Baggio CA, Paumgartten FJR: Serum levels of organochlorine pesticides and polychlorinated biphenyls among inhabitants of Greater Metropolitan, Rio de Janeiro, Brazil. Cad Saude Publica, 2002, 18(2): 519 24. R4 PSYCHOLOGICAL DISTRESS C. Palatchi. Instituto para el es tudio de la Concepci´ on Humana, Monterrey, Mexico Throughout history and in all cultures, mankind has recognized involuntary childlessness as a crisis that has the potential to affect the stability of individuals, relationships and communities. Every society has culturally looked for solutions to infertility using social, spiritual or medical measures. Infertility is a medical, social and emotional condition in which a shift in emphasis has occurred from coping through social measures to a dependence on medical interventions. Caregivers have recognized that stress is a universal life experience; it may be positive or negative in that each individual perceives or experiences an event differently. Stress challenges individual resources and requires adaptation. Distress is typically referred as negative stress. The impact of patient distress has a complex interplay or interconnectedness between the mind and the body. Psychosocial and biomedical factors contribute to the physiological response to stress and the emotional response to infertility. Infertility being an unpredictable experience, uncontrollable and ambiguous is stressful. Braverman in his chapter about the relationship between stress and in vitro fertilization outcome, says that many studies and clinical experience have indicated that the vast majority of infertile men and women do not experience significant levels of psychological trauma but the use of advanced medical technology and or third party reproduction may increase psychological distress during specific periods of treatment. Men and women feel infertility in many ways and may change over time as they experience failure in the cycles. Some of the major areas of stress that have traditionally been recognized are self esteem and body image, sexuality and intimacy, relationship with partner, family relationships, social life, finances, work, etc. In the same way many feelings are related to infertility, there are gender differences as how stress may be experienced and the coping approaches and strategies. Coping with infertility requires a completion of major adaptive tasks. An increasing focus of research has been about the relationship between stress and its effect on pregnancy outcome per treatment cycle. In the same way many feelings are related to infertility, there are gender differences as how stress may be experienced and the coping approaches and strategies. Coping with infertility requires a completion of major adaptive tasks. An increasing focus of research has been about the relationship between stress and its effect on pregnancy outcome per treatment cycle. The results have been mixed. Research has yet to continue addressing the relationship between stress and infertility. Braverman states that more recently, studies have turned their attention away from the complex relationship between stress or depression and pregnancy outcome, focusing instead on the causes behind the discontinuation of treatment and treatment perseverance, where dropout is associated with psychological factors. Reference(s) [1] Verhaak C, Burns LH. Behavioral Medicine Approaches to Infertility Counseling in Covington SN. Burns LH. (Eds.) Infertility Counseling A Comprehensive Handbook for Clinicians Second Edition. New York Cambridge University Press, 2006.