injúria endometrial em reprodução humana assistida

Click here to load reader

Post on 24-Jan-2017

117 views

Category:

Health & Medicine

7 download

Embed Size (px)

TRANSCRIPT

Sexual Dysfunctions

JANICE S M DOLABELA CHAGASInstituto Sapientiae2013injria(latiminjuria, -ae, injustia, prejuzo, dano, insulto)substantivo feminino1..Atoouexpressoaltamenteofensiva.=INSULTO2.Violaododireitodeoutrem.3.Estrago,detrimento.

Definio de Injria Classe gramatical de injria:Substantivo femininoSeparao das slabas de injria:in-j-ria

American Society for Reproductive Medicine

American Society for Reproductive Medicine1DEFINIO DA PALAVRA INJRIA,Etimologia -Do latiminiura(injustia, dano, leso).n. injuryDamage,harm,orloss,asfromtrauma.Aparticularformofhurt,damage,orloss.5.Med.Traumatismo provocado por presso externa.[F.: Do lat.injuria, ae.Hom./Par.:injria(sf.),injuria(fl. deinjuriar).]

Impacto no ciclo subsequente de FIV/ICSI

American Society for Reproductive Medicine

American Society for Reproductive Medicine2

Impacto no ciclo subsequente de FIV/ICSI

Pooling of 7 controlled studies (with 2062 participants, showed that local endometrial injury induced in the cycle preceding ovarianstimulation is 70% more likely to result in a clinical pregnancy as opposed to no intervention

clinical pregnancy rates being twice as high with biopsy/scratch (RR 2.32, 95% CI 1.723.13) asopposed to hysteroscopy (RR 1.51, 95% CI 1.301.75)

American Society for Reproductive Medicine

American Society for Reproductive Medicine3Injria endometrial definidaDEFINIO DE INJRIA ENDOMETRIAL

hkjllFalha Reprodutiva

American Society for Reproductive Medicine4

Perdas Gestacionais

MAKRIGIANNAKIS et al., 2011Abortamento ClnicoConcepes espontneas perdidas.Falhas de Implantao e perdas pr-clnica

American Society for Reproductive Medicine5Falhas de implantao e perdas pr-clnica.

Perdas Gestacionais

Only a few interventions have been proposed to improve endometrial receptivity, despite evidence That up to two-thirds of implantation failures could be secondary to insufficient receptivity (Simon et al.,1998).

SANTOS et al., 2010Margarida Avo Santos, Ewart W Kuijk and Nick S Macklon; University Medical Centre Utrecht, Reproductive Medicine and Gynaecology, Heidelberglaan The Netherlands

American Society for Reproductive Medicine6The pregnancy loss iceberg: an overview of the outcomes of spontaneous versus IVF pregnancies. (a) A total of 70% of conceptions are lost prior to live birth. The majority of these losses occur prior to the time of the missed menstrual period, and are not revealed. (b) In stimulated cycles, the iceberg sinks mainly due to increased pre-implantation losses, which results in 75% of conceptions being lost prior to live birth. Adapted from Macklon et al. (2002). Although ovarian stimulation has an important role in ART, it may also have detrimental effects on oogenesis, embryo quality, endometrial receptivity and perinatal outcomes.

Perdas Gestacionais e FIV

(BOOMSMA, et al., 2009)

Endometrial secretions, aspirated immediately prior to embryo transfer from 210 women undergoing IVF, were analyzed using immunoassay for 17 regulators of implantation.

Treatment outcome after embryo transfer and subsequent implantation.

Outcome of embryo transfer (left bar) and pregnancy (right bar)in women who collected urine samples 919 days after oocyte retrieval (n = 179).

CAROLIEN M BOOMSMA, Proefschrift, Universiteit Utrecht, met een samenvatting in het Nederlands.

American Society for Reproductive Medicine7Endometrial secretion analysis identifies a cytokine profile predictive of pregnancy in IVF-Outcome of embryo transfer (left bar) and pregnancy (right bar) in women who collected urine samples 919 days after oocyte retrieval (n = 179).Outcome of pregnancy (right bar) and in women who collected urine samples 919 days after oocyte retrieval (n = 179).

When a rise in urinary hCG levels indicative of implantation was followed by a negative pregnancy test, a preclinical pregnancy loss was considered to have occurred.

A clinically recognized pregnancy was defined by a positive urinary pregnancy test. When this resulted in a menstruation shortly afterwards, this was described as a biochemical pregnancy loss.

Perdas Gestacionais e FIV

(BOOMSMA, et al., 2009) prospective cohort study

When a rise in urinary hCG levels indicativeof implantation was followed by a negative pregnancy test, a preclinical pregnancy loss was considered to have occurred.

A clinically recognized pregnancy was defined by a positive urinary pregnancy test. When this resulted in a menstruation shortly afterwards, this was described as a biochemical pregnancy loss.Treatment outcome after embryo transfer and subsequent implantation. Outcome of embryo transfer (left bar) and pregnancy (right bar) in women who collected urine samples 919 days after oocyte retrieval (n = 179).

American Society for Reproductive Medicine8Endometrial secretion analysis identifies a cytokine profile predictive of pregnancy in IVF-Endometrial secretions, aspirated immediately prior to embryo transfer from 210 women undergoing IVF, were analyzed usingimmunoassay for 17 regulators of implantation. 17 soluble regulators of implantation:interleukin (IL)-1b, IL-5, IL-6, IL-10, IL-12, IL-15, IL-17, IL-18,tumor necrosis factor (TNF)-a, interferon (IFN)-g, macrophage migration inhibitory factor, eotaxin, IFN-g-inducible 10 kDa protein (IP-10), monocyte chemo-attractant protein-1 (MCP-1), Dickkopf homolog 1, heparin-binding epidermal growth factor and vascular endothelial growth factor (VEGF).

http://www.embriofert.com.br/clinica/resultados_fertilityDoctors intentionally cause damage to the endometrium, which is the inner tissue lining the uterus, by using a biopsy or tool called a curette to scrape its surface.

American Society for Reproductive Medicine9Endometrial scratching boosts IVF odds by 20 percent, says studyThe scratches are thought to make it easier for embryos to attach to the uterus, raising the odds of pregnancy. TThey found women who had the procedure had about a 49 percent rate of pregnancy, compared to 29 percent in the other group. Thirty-three of the procedures resulted in live births,Sky Newsreported.

http://www.embriofert.com.br/clinica/resultados_fertility

American Society for Reproductive Medicine10Endometrial scratching boosts IVF odds by 20 percent, says study

Fertility Press - Ano 5 - N15 - Abril a Junho de 2013

nmnm

American Society for Reproductive Medicine11

Revises Sistemticas: Building Blocks para a melhor prtica

Cynthia Farquhar, M.D., M.P.H. Universidade de AucklandCo-ordinating Editor of theCochraneMenstrual Disorders and Subfertility GroupThe ASRM/IFFS 2013 Meeting

American Society for Reproductive MedicineCynthia Farquhar, M.D., M.P.H. Universidade de AucklandCoordenadora do Editor das Cochrane Menstrual Disorders and Subfertility GrupoO Meeting 2013 ASRM / FICC12

IMPLANTAO

Bridging endometrial receptivity and implantation: network ofhormones, cytokines, and growth factors

Mohan Singh, Parvesh Chaudhry and Eric Asselin

Research Group in Molecular Oncology and Endocrinology, Department of Chemistry-Biology, University of Quebec,

Journal of Endocrinology (2011) 210, 514

SINGH et al. (2011)

American Society for Reproductive Medicine13Summary of the various growth factors, cytokines, and hormones involved in implantation process.um processo inflamatrio fisiolgico ,ingresso de leuccitos, imunoglobulinas, citocinas pr inflamatrias e outros mediadores inflamatrios

Sequencia complexa de sinalizaoGELLERSEN e BROSENS (2003); REVEL (2012)

Bridging endometrial receptivity and implantation: network ofhormones, cytokines, and growth factors

Mohan Singh, Parvesh Chaudhry and Eric Asselin

Research Group in Molecular Oncology and Endocrinology, Department of Chemistry-Biology, University of Quebec,

Summary of the various growth factors, cytokines, and hormones involved in implantation process.

Journal of Endocrinology (2011) 210, 514

American Society for Reproductive Medicine14um processo inflamatrio fisiolgico ingresso de leuccitos, imunoglobulinas, citocinas pr inflamatrias e outros mediadores inflamatriosSequencia complexa de sinalizao: aquisio de ligantes de adeso; perda de componentes inibitrios. Envolvimento de clulas estromais, epiteliais, endoteliais e as imunolgicas no residentes.

JANELA DE IMPLANTAOIn a 28 day natural cycle, uterodomes have been found to appear on D20-21,

In controlled ovarian hyperstimulation cycles they appear on D19-20 and

in hormone controlled cycles on D21-22.

These variable 'windows of receptivity' are another factor that could significantly affect the outcome of assisted reproduction techniques.

MARKERT et al. (2007)

American Society for Reproductive Medicine15mudanas morfolgicas, bioqumicas e imunolgicas abrangendo os dias 20 e 24 de um ciclo menstrual regular (dias LH+7 a LH +11), que coincide com o pico da concentrao srica de progesterona.

Fatores embrionrios e endometriais envolvidos

Ocorre de forma sequencial, em que cada passo acontece para assegurar o prximo, levando ao estabelecimento da gravidez.) .Modificado de STAUM-RAM & SHALEV (2005)

American Society for Reproductive Medicine16Ocorre de forma sequencial, em que cada passo acontece para assegurar o prximo, levando ao estabelecimento da gravidez.) In a 28 day natural cycle, uterodomes have been found to appear on D20-21, In controlled ovarian hyperstimulation cycles they appear on D19-20 and in hormone controlled cycles on D21-22. These variable 'windows of receptivity' are another factor that could significantly affect the outcome of assis

View more