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Doctoral Thesis
DOI
10.11606/T.5.2012.tde-27112012-101043
Document
Author
Full name
Dani Ejzenberg
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2012
Supervisor
Committee
Serafini, Paulo Cesar (President)
Maciel, Gustavo Arantes Rosa
Navarro, Paula Andrea de Albuquerque Salles
Ribeiro, Sérgio Edgar Camões Conti
Simoes, Manuel de Jesus
Title in Portuguese
Avaliação histomorfométrica do endométrio na fase lútea de mulheres férteis e inférteis
Keywords in Portuguese
Biópsia/métodos
Endométrio/anatomia & histologia
Histeroscopia
Implantação do embrião
Infertilidade
Abstract in Portuguese
OBJETIVO: avaliar a histomorfometria do endométrio na fase lútea de mulheres férteis e inférteis. MÉTODOS: foram triadas 40 pacientes, 30 inférteis e 10 férteis, em seguimento na Clínica Ginecológica do HC-FMUSP, que concordaram em participar deste estudo. Foi realizada avaliação ultrassonográfica seriada a partir da menstruação, para determinação da ovulação. Na fase lútea as pacientes eram submetidas à histeroscopia. Foram excluídas 14 pacientes sendo 12 por falta durante a avaliação ultrassonográfica e 2 pela presença de pólipos. A casuística foi composta por 6 controles férteis, que foram comparadas a 20 casos inférteis (endometriose-8, causa tubo-peritoneal-5, causa masculina-5, sem causa aparente-2). Na histeroscopia foram coletadas duas biópsias dirigidas (sistema de Bettocchi) da parede posterior (terço distal), e da parede anterior (terço médio), e uma biópsia aspirativa com Pipelle. Foram avaliados parâmetros histomorfométricos endometriais. RESULTADOS: as duas formas de biópsia foram apropriadas para análise endometrial; a dirigida coletou menor área tecidual, porém sem sangue. Nenhum paciente fértil apresentou heterogeneidade endometrial (atraso de fase em algum sítio); isto ocorreu em 7 (35%) das inférteis (p=0,11). Foi diagnosticada endometrite em 2 (10%) casos. CONCLUSÃO: não foram observadas diferenças histomorfométricas entre o endométrio de mulheres férteis e inférteis na fase lútea. Parte das pacientes inférteis mostrou heterogeneidade endometrial e endometrite. A biópsia dirigida, assim como a aspirativa, foi adequada ao estudo endometrial na fase lútea
Title in English
Evaluation the endometrial histomorphometry of fertile and infertile women during their luteal period
Keywords in English
Biopsy/methods
Embryo implantation
Endometrium/anatomy & histology
Hysteroscopy
Infertility
Abstract in English
Objective: to evaluate the endometrial histomorphometry of fertile and infertile women during their luteal period. Methods: 40 female patients- 30 infertile and 10 fertile- who were being followed-up at the Gynecological Clinic at the Hospital das Clinicas (HC),-Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), agreed to participate in the study. Serial ultra sonograms, starting from their menstrual period, were performed to identify their ovulation. In the luteal phase the patients underwent hysteroscopy. From the initial sample, 14 patients were excluded from the study, 12 of whom for being absent during scheduled ultra sonograms and 2 for presenting polyps. The final sample thus consisted of 6 fertile females (control subjects) who were compared to 20 patients with infertility, categorized as follows: 8 due to endometriosis, 5 due to peritoneal tube conditions, 5 due to male infertility, and 2 with no apparent cause. During the hysteroscopy 2 directed biopsies (Bettocchis System) of the posterior wall (distal third section) and of the anterior wall (medial third) were performed, as well as Pipelle sampling. Endometrial histomorpholometric parameters were evaluated. Results: the two forms of endometrial sampling performed were appropriate for the endometrial analysis. The directed biopsy collected tissue from a smaller area, but it had no blood. None of the fertile patients presented endometrial heterogeneity, i.e., phase delay in any site. In contrast, this occurred in 7(35%) of the infertile females (p=0.11). Endometritis was diagnosed in 2 (10%) of the cases. Conclusions: no histomorphometric differences were observed in the endometrium of the fertile and infertile female patients during their luteal phase. About a third of infertile cases (35%) displayed endometrial heterogeneity and a small percentage of which (10%) had endometritis. Both the directed biopsy and Pipelle sampling were found satisfactory for studies of endometrium during the luteal phase
 
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Publishing Date
2012-12-19
 
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