Papers by Ana Carolina Japur de Sá Rosa e Silva
Molecular Reproduction and Development, 2014
This study examined caprine follicular development in different concentrations of alginate matrix... more This study examined caprine follicular development in different concentrations of alginate matrix to determine the optimal conditions for culture. Caprine preantral follicles were cultured in a two-dimensional system (control) or a three-dimensional encapsulated system in 0.25%, 0.5%, or 1% alginate (ALG 0.25, ALG 0.5, and ALG 1, respectively). A higher percentage of morphologically normal follicles developed in ALG 0.5 and ALG 1 than in ALG 0.25 or the control (P < 0.05). The rate of antrum formation, however, was higher in ALG 0.25 than in ALG 0.5 and ALG 1 conditions (P < 0.05), but similar to the control. Follicles cultured in ALG 0.25 had higher growth rates and meiotic resumption than those cultured in ALG 0.5, ALG 1, or the control (P < 0.05). Moreover, follicles cultured in ALG 0.25 had higher levels of estradiol and progesterone than those cultured in ALG 0.5, ALG 1, or the control, as well as higher levels of CYP19A1 and HSD3B mRNA. In conclusion, a three-dimensional system that uses ALG 0.25 fosters the in vitro development of caprine preantral follicles and increases the rate of meiotic resumption.
Fertility and Sterility, 2013
Fertility and Sterility, 2013
Vasoactive intestinal peptide (VIP) is a neuropeptide with elevated expression in regions that co... more Vasoactive intestinal peptide (VIP) is a neuropeptide with elevated expression in regions that control urogenital functions. Estrogen appears to modulate VIP expression in various organs, but this effect has not been demonstrated in the vaginal wall. The aim of this study was to evaluate the influence of estrogen status on VIP expression in vessels of the vaginal wall. Surgical specimens were removed from the vaginal walls of 18 premenopausal women and 12 postmenopausal women who were given surgery for genital prolapse grade I or II. Vaginal specimens were stained with estrogen receptor-alpha (ER-α) and VIP antibodies. Levels of follicle stimulating hormone (FSH), estradiol, prolactin, fasting glucose and serum thyroxine stimulating hormone were also measured. Estrogen status was assessed on the basis of FSH and ER-α scores. The vaginal walls of premenopausal women had significantly higher ER-α scores than those of menopausal women (premenopausal group, 3.6 ± 2.2; menopausal group, 1.4 ± 1.8; p = 0.01). Premenopausal women also had significantly higher levels of VIP in the vaginal wall than menopausal women (p = 0.02). Increasing age was associated with lower level of VIP staining (odds ratio 0.88; 95% confidence interval 0.78-0.99). Levels of ER-α and VIP expression in the posterior vaginal wall were higher in premenopausal than in menopausal women, but VIP expression was not associated with estrogen status. Age was an independent predictor of VIP staining in vaginal wall biopsies.
(N) vs. abnormal (A) responders; (peak levels 91.2 N vs. 41.7 A, P<0.001; total levels 255.53 N v... more (N) vs. abnormal (A) responders; (peak levels 91.2 N vs. 41.7 A, P<0.001; total levels 255.53 N vs. 124.3 A, P<0.001). However, the total cortisol level was not different between the 2 groups (68.58 N vs. 60.78 A., P¼0.48). Mean depression score did not differ between normal and abnormal responders (35.7 N vs. 36.5 A, P¼0.93). Anxiety scores also were similar (41.5 N vs. 40.5 A, P¼0.92). Although peak and total ACTH levels were lower than normal, total cortisol levels were similar between women with impaired and 'normal' responses. CONCLUSIONS: Almost half of the women we tested with CPP had evidence of an impaired HPA axis function. Contrary to expectations, observed alterations in HPA axis were unrelated to depression or anxiety scores. This abnormal response indicates that central functioning of the adrenal axis is impaired in women with chronic pelvic pain and may relate to differences in pain perception.
Climacteric, 2008
Endometriosis is a benign, estrogen-dependent, chronic gynecological disorder associated with pel... more Endometriosis is a benign, estrogen-dependent, chronic gynecological disorder associated with pelvic pain and infertility. The disease most commonly affects women during the reproductive age, although postmenopausal patients do rarely present it. These rare occurrences are generally associated with hormonal use. We present three cases of endometriosis in postmenopausal patients who have no history of hormone therapy and no previous history of endometriosis or infertility. In case 1, a 62-year-old woman presented with acyclic pelvic pain and a left ovarian homogeneous cystic mass. After laparoscopic salpingoophorectomy and histological analysis, an ovarian endometriotic cyst was confirmed. In case 2, a 78-year-old woman presented with a painful abdominal wall mass that was confirmed by ultrasound and tomography. Her past medical history included an abdominal hysterectomy 20 years prior to the discovery of this mass. The lesion was surgically excised and histological analysis showed a...
Study Objective: To determine the presence of impaired gonadal function in adolescent patients su... more Study Objective: To determine the presence of impaired gonadal function in adolescent patients submitted to chemotherapy during childhood or during the pubertal period. Design: A case series study of 28 patients aged 12 to 19 years with menarche at least 2 years before the study. Setting: Tertiary care public hospital. Participants: Group I: 14 adolescents previously submitted to chemotherapy during the prepubertal or peripubertal period and with remission of oncologic disease for at least 2 years; Group II: 14 normal adolescents with no previous oncologic disease and with regular menstrual cycles. Interventions and Main Outcome Measures: Pubertal development, menstrual cycles and serum levels of folliclestimulating hormone (FSH) and luteinizing hormone (LH) were determined during the early follicular phase. Results: There were no differences between the two groups in terms of age at appearance of secondary sexual characteristics or age at menarche. Menstrual irregularity was detected in 7 of the 14 patients in Group I, all 8 of whom presented oligomenorrhea. There were no differences in LH levels between the two groups (P 5 0.55), although mean FSH levels were higher in Group I than in Group II (6.71 AE 2.99 mIU/ml vs. 3.83 AE 2.01 mIU/ml, P 5 0.01). Conclusion: Although girls submitted to chemotherapy during the prepubertal or peripubertal period presented normal sexual development, the incidence of oligomenorrhea was higher than expected for their age, and FSH levels, although within normal limits, were higher than those seen in normally cycling girls.
The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual... more The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. To assess the effect of hormone therapy (HT) on sexual function in perimenopausal and postmenopausal women. We searched for articles in the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov, Current Controlled Trials, WHO International Clinical Trials Registry Platform, ISI Web of Knowledge and OpenGrey. The last search was performed in December 2012. We included randomised controlled trials comparing HT to either placebo or no intervention (control). We considered as HT estrogens alone; estrogens in combination with progestogens; synthetic steroids (for example tibolone); or selective estrogen receptor modulators (SERMs) (for example raloxifene, bazedoxifene). Studies of other drugs possibly used in the relief of menopausal symptoms were excluded. We included studies that evaluated sexual function using any validated assessment tool. The primary outcome was a composite score for sexual function and the scores for individual domains (arousal and sexual interest, orgasm, and pain) were secondary outcomes. Studies were selected by two authors independently. Data were independently extracted by two authors and checked by a third. Risk of bias assessment was performed independently by two authors. We contacted study investigators as required. Data were analysed using standardized mean difference (SMD) and relative risk (RR). We stratified the analysis by participant characteristics with regard to menopausal symptoms. The overall quality of the evidence for the primary outcome was evaluated using the GRADE criteria. The search retrieved 2351 records from which 27 studies (16,393 women) were included. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;symptomatic or early post-menopausal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; subgroup included nine studies: perimenopausal women (one study), up to 36 months postmenopause (one study), up to five years postmenopause (one study), experiencing vasomotor or other menopausal symptoms (five studies), or experiencing hot flushes and sexual dysfunction (one study). The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;unselected postmenopausal women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; subgroup included 18 studies, which included women regardless of menopausal symptoms and permitted the inclusion of women with more than five years since the final menstrual period. No studies were restricted to women with sexual dysfunction. Only five studies evaluated sexual function as a primary outcome. Eighteen studies were deemed at high risk of bias, and the other nine studies were at unclear risk of bias. Twenty studies received commercial funding.Findings for sexual function (measured by composite score):For estrogens alone versus control, in symptomatic or early postmenopausal women the SMD and 95% CI were compatible with a small to moderate benefit in sexual function for the HT group (SMD 0.38, 95% CI 0.23 to 0.54, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00001, 3 studies, 699 women, I² = 55%, high-quality evidence). In unselected postmenopausal women, the 95% CI was compatible with no effect to a small benefit (SMD 0.16, 95% CI -0.02 to 0.34, P = 0.08, 2 studies, 478 women, I² = 44%, low-quality evidence). The subgroups were not pooled because of considerable heterogeneity.For estrogens combined with progestogens versus control, in symptomatic or early postmenopausal women the 95% CI was compatible with a small to moderate benefit for sexual function in the HT group (SMD 0.42, 95% CI 0.19 to 0.64, P = 0.0003, 1 study, 335 women, moderate-quality evidence). In unselected postmenopausal women, the 95% CI was compatible with no effect to a small benefit (SMD 0.09, 95% CI -0.02 to 0.20, P = 0.10, 3 studies, 1314 women, I² = 0%,…
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics
Thyroid diseases are relatively common in women in the reproductive period. It is currently under... more Thyroid diseases are relatively common in women in the reproductive period. It is currently understood that clinically-evident thyroid disorders may impair ovulation and, consequently, fertility. However, to date it has not been proven that high serum levels of thyroid-stimulating hormone and/or positivity for antithyroid antibodies are associated to a reduction in fertility, mainly in the absence of altered thyroxine levels. The present comprehensive review aims to present current data on the association between subclinical hypothyroidism and/or thyroid autoimmunity and reproductive outcomes.
Animal Reproduction
Quantitative real-time PCR (qPCR) is a valuable tool for gene expression studies and it is necess... more Quantitative real-time PCR (qPCR) is a valuable tool for gene expression studies and it is necessary to choose an ideal endogenous reference gene for data normalization. This work studied a set of reference genes in oocytes and cumulus cells of COCs (Cumulus-Oocyte Complexes) that are suitable for relative gene expression analyses after in vitro maturation (IVM) in bovine. Immature COCs were collected from ovaries of Nelore cattle (Bos indicus) and submitted to IVM. MII oocytes and cumulus cells were subjected to RNA extraction, reverse transcription and preamplification of cDNA. The expression level of eight reference genes (ACTB, GADPH, B2M, H2AFZ, GUSB, HPRT1, PPIA, and TBP) was measured by real time PCR and analyzed by geNorm software. The gene stability measure (M) was calculated and the ideal number of reference genes (RGs) was determined by the V value (pairwise variation). For oocyte samples, two RGs were the ideal number for relative quantification: HPRT1 and B2M and for bovine cumulus samples four were indicated: HPRT1, PPIA, B2M, and TBP genes. The normalization of a non-reference target gene (SOD1) by these reference genes was shown to be considerably different from normalization by less stable reference genes. Our results strengthen the importance of choosing good normalizing genes in order to analyze gene expression under specific experimental conditions and we suggest the use of these RGs in oocytes and cumulus cells of bovine cattle in in vitro matured COCs.
Clinical Nutrition
Overweight polycystic ovary syndrome (PCOS) patients present exacerbation of clinical symptoms an... more Overweight polycystic ovary syndrome (PCOS) patients present exacerbation of clinical symptoms and increased risk for chronic diseases. The effects of inadequate dietary intake have been investigated in body weight gain in PCOS women. The aim of this study was to evaluate the dietary pattern and to analyze possible associations with the metabolism and body composition in PCOS women. A case-control study was performed with thirty-nine women diagnosed with PCOS and thirty-five control women, matched by age and body mass index. A body composition assessment was performed by Dual-energy X-ray absorptiometry (DXA) and food intake was assessed using the seven-day food record. The metabolic parameters evaluated were fasting glucose, insulin, Homeostasis Model Assessment-estimated Insulin Resistance (HOMA-IR) index and oral glucose tolerance test (OGTT). No significant differences were observed in dietary intake of women with or without PCOS. In the analysis of the associations between dietary intake, metabolic parameters and body composition, PCOS women showed an inverse correlation between dietetic fiber intake and HOMA-IR index (r = -0.365; p = 0.024). Also in PCOS group, dietary fiber intake presented an inverse correlation with total body fat (r = -0.401; p = 0.011), trunk fat (r = -0.388; p = 0.015), and android fat (r = -0.431; p = 0.006). PCOS women group had higher glucose 120&#39;, compared to those without PCOS (p = 0.015). These results provide evidence that the adequate intake of dietary fiber contributes to more appropriate body composition and glucose metabolism in PCOS women and possibly toward the prevention of chronic non-communicable diseases.
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2018
Gender incongruence is defined as a condition in which an individual self-identifies and desires ... more Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular tes...
JBRA assisted reproduction, Jan 12, 2018
This study aimed to evaluate the clinical pregnancy rate of intrauterine insemination cycles in r... more This study aimed to evaluate the clinical pregnancy rate of intrauterine insemination cycles in relation to patient age, cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility. This retrospective observational study included 237 intrauterine insemination cycles performed from 2011 to 2015 at the Assisted Reproduction Service of the Hospital das Clínicas of the Ribeirão Preto Medical School, University of São Paulo. Student's t-test was used to compare quantitative variables and the chi-square test was used to compare qualitative variables. Patient age was inversely and significantly correlated with pregnancy rates (p=0.001) (Pregnant women = 32.56±5.64 years, non-pregnant women = 36.64±5.03 years). Cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility were not associated with pregnancy rates. The overall clinical pregnancy rate was 7.59%. In the subgroup of patien...
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, Jan 30, 2017
Objective To evaluate the effects of nutritional counseling on the dietary habits and anthropomet... more Objective To evaluate the effects of nutritional counseling on the dietary habits and anthropometric parameters of overweight and obese adolescents with polycystic ovary syndrome (PCOS). Methods This was a prospective, longitudinal and auto-controlled study. Thirty adolescents aged 13-19 years-old, diagnosed with PCOS received nutritional counseling and were followed-up for 6 months. After the follow-up period, the results were evaluated through body weight, body mass index (BMI) and waist circumference (WC). Results Sixty-percent of the adolescents adhered to the nutritional counseling and, of these, 50% lost weight. Adolescents who lost weight changed their dietary habits by adopting hypocaloric diets and eating more meals per day, as per nutritional counseling. The waist circumference (WC) decreased significantly, although the body weight decreased non-significantly after adoption of a hypocaloric diet. Conclusion Although there was no significant weight loss, there was a conside...
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, Jun 1, 2017
Purpose The views of infertile couples regarding oocyte donation by third parties and adoption ar... more Purpose The views of infertile couples regarding oocyte donation by third parties and adoption are unknown, as these may be interpreted as a final closure of the available options for conception. This study aimed to determine the acceptance of oocyte donation, oocyte reception, and child adoption of infertile women who submitted to assisted reproductive technology (ART) treatment Methods Sixty-nine women who were under treatment for infertility and submitted to ART procedures were included in this cross-sectional study. They were evaluated using semi-structured questionnaires administered during ovulation induction in a treatment cycle. Marital status, religion, years of schooling, occupation, type of infertility, age, duration of infertility, number of previous ART cycles, mean oocyte number per cycle, and mean number of embryos per cycle had no influence on a woman's acceptance of oocyte donation or oocyte reception. Results More than 90% of the patients thought that the subje...
Pediatric and Adolescent Oncofertility, 2017
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Objective: The aim of this retrospective study was to compare the pregnancy rates and characteris... more Objective: The aim of this retrospective study was to compare the pregnancy rates and characteristics of ovar- ian stimulation between rFSH filled by mass or filled by bioassay for intrauterine insemination in couples with unexplained and male subfertility. Methods: We assessed 51 cycles of patients that had used rFSH bioassay and 51 cycles of patients that had used rFSH filled-by-mass. Ovarian stimulation was performed with 75 UI of rFSH every other day from cycle day 3. Dose adjust was made when necessary with 37,5- 75 UI rFSH. Intrauterine insemination was performed 30-40 hours after recombinant hCG (rhCG). The presen- ce of at least one and maximum of three folicles ≥18mm was the criteria for using r hCG. Results: Pregnancy rates per cycle and per patient were respectively 9,8% and 10,9% in the rFSH bioassay group, 5,8% e 7,7% in the rFSH filled-by-mass group, with no significance ( p=0,71 and 0,84). Also, we did not find differences between ovarian stimulation characteristics: ...
This study compared the long-term effects of the levonorgestrel-releasing intrauterine device wit... more This study compared the long-term effects of the levonorgestrel-releasing intrauterine device with those of GnRH agonist administration on serum levels of CA-125 in patients with endometriosis. The levonorgestrel-releasing intrauterine device was found to be as efficient as GnRH agonist in reducing CA-125 serum levels.
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Papers by Ana Carolina Japur de Sá Rosa e Silva