PAULO HOMEM DE MELLO BIANCHI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies(2017) CORREA, Fernanda A.; BIANCHI, Paulo H. M.; FRANCA, Marcela M.; OTTO, Aline P.; RODRIGUES, Rodrigo J. M.; EJZENBERG, Dani; SERAFINI, Paulo C.; BARACAT, Edmundo Chada; FRANCISCO, Rossana P. V.; BRITO, Vinicius N.; ARNHOLD, Ivo J. P.; MENDONCA, Berenice B.; CARVALHO, Luciani R.Context: Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. Objective: We evaluated fertility treatment and pregnancy outcomes in five women with childhoodonset combined pituitary hormone deficiencies (CPHD). Patients and Methods: Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). Results: All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Conclusion: Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients.
- Study of two strategies to induce follicular wave emergence for assisted reproductive treatments (ART)-a preliminary trial(2015) BIANCHI, Paulo H. M.; VIERA, Lais M.; GOUVEIA, Gabriela R. F. C. A.; ROCHA, Andre M.; BARUSELLI, Pietro S.; BARACAT, Edmund C.; SERAFINI, Paulo C.This study aimed to induce follicular wave emergence (FWE) using pharmacological (recombinant hCG administration) or mechanical (aspiration of dominant follicle) interventions in infertile women. Sixteen infertile women (a parts per thousand currency sign35 years) with indications for in vitro fertilization due to tubal and/or male factor infertility were randomized into three groups: control (n = 6), pharmacological (n = 5) and mechanical (n = 5) groups. Women in both experimental groups underwent serial transvaginal sonograms (TVS) from menstrual cycle day 10 until identification of a dominant follicle a parts per thousand yen15 mm. Women in the pharmacological group received 250 mu g of recombinant-hCG to induce ovulation, and resumed serial TVS 2 days later. In the mechanical group, dominant and subordinate follicles a parts per thousand yen10 mm were aspirated, and daily TVS was resumed on the following day. An increased pool of follicles a parts per thousand yen5 and a parts per thousand currency sign9 mm after interventions characterized FWE. Women in the control group underwent ovulation induction (OI) with 150 IU/day of recombinant follicle-stimulating hormone started on menstrual cycle day 3 (D3). OI was started on the day of FWE in the experimental groups. Endometrial asynchrony with development of the embryo was expected in the experimental groups. Therefore, all viable embryos were cryopreserved and transferred in an endometrial-stimulated cycle. The number of follicles a parts per thousand yen5 and a parts per thousand currency sign9 mm increased after the interventions in both experimental groups (p < .001), indicating induction of FWE. OI outcomes were similar among the groups. The pharmacological and mechanical interventions are efficient in inducing FWE; outcomes of OI synchronized with FWE should be further investigated.
- Assisted Reproductive Technologies in Latin America and Europe: a Comparative Analysis of Reported Databases for 2013(2019) DUARTE-FILHO, Oscar Barbosa; BIANCHI, Paulo Homem de Mello; LOBEL, Alexandre Likier Steinberg; PEREGRINO, Pedro Felipe Magalhaes; PICCINATO, Carla de Azevedo; PODGAEC, SergioObjective To compare the Latin American and European assisted reproductive technology (ART) registries regarding data accessibility and quality, treatment utilization, effectiveness, safety, and quality of services. Methods We performed an ecological study using data from scientific publications of Latin American and European registries that report cycles initiated during 2013 (the most recent registries available until December of 2017). The summarized data are presented as frequencies, percentages, minimum-maximum values, and absolute numbers. Results Reporting clinics and cycle treatments were unevenly distributed between the participating countries for both registries, although access to ART is 15 times greater in Europe. In Latin America, individual services participate voluntarily reporting started cycles until cancellation, birth or miscarriage, while in Europe it varied among countries. It makes the data available from Latin America more uniform, although lesser representative when compared with European ones, given that reporting is compulsory for most countries. The cumulative live birth rate was better in Latin America. Female age, use of intracytoplasmic sperm injection (ICSI), cycles with transfer of >= 3 embryos, as well as multiple pregnancy rates were greater in the Latin American Register of Assisted Reproduction (RLA, in the Portuguese acronym). Assisted reproductive technology complications, such as ovarian hyperstimulation syndrome, hemorrhage, and infections were also higher in Latin America, although they are extremely uncommon in both regions. Conclusion Both regions have points to improve in the quality of their reports. Latin America has produced a more uniform reporting, their clinical results are generally comparable and sometimes higher than the European ones. In contrast, the safety of the treatment was higher in Europe, with lower rates of complications, especially multiple pregnancies.
- Sonographic signs of deep infiltrative endometriosis among women submitted to routine transvaginal sonography: clinicaland imaging aspects(2022) RAIZA, Luciana Cristina Pasquini; BIANCHI, Paulo Homem de Mello; PICCINATO, Carla de Azevedo; PODGAEC, SergioObjective: To evaluate the prevalence of sonographic signs suggestive of deep infiltrative endometriosis and endometriomas in patients referred for transvaginal sonography as part of a routine annual gynecological evaluation. We also describe the clinical and imaging aspects associated with the incidental findings of endometriosis. Methods: This was a retrospective observational study including women (n=339; aged 18-56 years) referred for transvaginal sonography as part of a routine gynecological evaluation (without clinical suspicion of endometriosis). Patients were asked about their symptoms. In addition, they were systematically checked by an experienced radiologist for sonographic signs of deep infiltrative endometriosis (hypoechoic nodules or tissue thickening, with regular or irregular margins) in the retrocervical area, vaginal fornix, rectosigmoid junction, and bladder, as well as for ovarian endometriomas (cysts with thick walls and hypoechogenic content). Results: Signs suggestive of deep infiltrative endometriosis or endometriomas were identified in 27 of the 339 women (8.0%; 95%CI: 5.1-10.8). Endometriomas were observed in 8 patients (2.4%; 95%CI: 0.7-4.0); 23 women had signs of lesions in the retrocervical area (6.8%; 95%CI: 4.1-9.5), 3 in the rectum and sigmoid colon (0.9%; 95%CI: 0-1.9), and 1 in the vagina (0.3%; 95%CI: 0-0.9). Six patients (1.8%) had signs of endometriosis at more than one site, and thirteen were asymptomatic. There were no significant differences in symptomatology between women with and without sonographic signs of deep infiltrative endometriosis. Conclusion: Routine transvaginal sonography offers an opportunity to search for signs of deep infiltrative endometriosis in oligosymptomatic women particularly those not previously suspected to have endometriosis.
- Successful Live Birth in a Woman With 17 alpha-Hydroxylase Deficiency Through IVF Frozen-Thawed Embryo Transfer(2016) BIANCHI, Paulo Homem de Mello; GOUVEIA, Gabriela Romanenghi Fanti Carvalho Araujo; COSTA, Elaine M. Frade; DOMENICE, Sorahia; MARTIN, Regina M.; CARVALHO, Luciane Carneiro de; PELAES, Tatiana; INACIO, Marlene; CODARIN, Rodrigo Rocha; FARIA, Maria Beatriz Sator de; FRANCISCO, Rossana Pulcineli Vieira; BARACAT, Edmund Chada; SERAFINI, Paulo Cesar; MENDONCA, Berenice B.Context: Congenital adrenal hyperplasia (CAH) dueto 17 alpha-hydroxylase deficiency in 46,XX patients is characterized by primary amenorrhea, absent or incomplete sexual maturation, infertility, low serum levels of estradiol, and elevated progesterone (P). There were no previous reports of singleton live births from such women. Objective: To describe the first successful singleton live birth in a female with CAH due to 17 alpha-hydroxylase deficiency. Case Description: A 26-year-old Brazilian woman with CAH associated with 17 alpha-hydroxylase deficiency due to the compound heterozygote mutation (p.W406R/P428L) in the CYP17A1 gene expressed the desire to conceive. In vitro fertilization (IVF) was recommended due to the complexity of the disorder. The first attempt of treatment failed despite the production of viable embryos. At the second IVF attempt, all viable embryos were frozen due to inadequate endometrial development associated with prematurely elevated serum P during ovarian stimulation. Subsequently, a long-acting GnRH agonist and oral dexamethasone were used to lower ovarian and adrenal P overproduction. Once serum levels of P were < 1 ng/mL, endometrial preparation with estradiol valerate and frozen-thawed embryo transfer were performed, resulting in a singleton pregnancy. Estradiol supplementation was completely suspended by 14 weeks of gestation. She delivered at 30 weeks and 4 days due to acute fetal distress. The puerperium was uneventful; the newborn was discharged in good conditions 5 weeks after birth. Conclusion: A successful live birth was achieved in a woman with 17-hydroxylase deficiency through IVF, cryopreservation of all embryos, and frozen-thawed embryo transfer after adequate endometrial preparation.