P–569 Woman with CYP19A1 TC/CC genotype have increased susceptibility to infertility development, independently of the cause

Study question

Is TC/CC genotype of codon 39 at CYP19A1 gene associated with the development of female infertility?

Summary answer

Yes, CYP19A1 codon 39 TC/CC genotype is associated with increased susceptibility to infertility development in women, regardless of associated cause.

What is known already

Aromatase protein is responsible for the aromatization of androgens into estrogens. This protein that catalyzes the final step in biosynthesis of estrogens is encoded by the gene CYP19A1. The CYP19A1 gene is located on chromosome 15q21.1. It is a member of the cytochrome P450 superfamily which are monooxygenases that catalyze many reactions involved in steroidogenesis. TC/CC genotype of codon 39 at CYP19A1 gene results in an increase of aromatase activity and thus affect the hormone levels which can lead to the development of various diseases, including infertility.

Study design, size, duration

A case-control study was designed to investigate the association of CYP19A1 gene polymorphism with female infertility. Case subjects, 201 women with infertility established as women under 39 years of age, that failed to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse. 161 fertile female controls, with no previous history of infertility, no previous history of gynecological pathologies compatible with infertility, and no history of IVF treatments, were selected.

Participants/materials, setting, methods

Blood was collected by venous puncture and genomic DNA was extracted. CYP19A1 genotyping was performed by polymerase chain reaction-based methods with confronting two-pair primers. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression.

Main results and the role of chance

Significant statistical association of the TC/CC genotype combined with endometriosis risk was found, with reference to TT genotype (OR 4.554; 95% CI 2.209–9.386; p < 0.001). We also found an increased risk of developing polycystic ovary syndrome (PCOS) associated with TC/CC genotype (OR 5.317; 95% CI 2.767–10.215; p < 0.001). We also observed an increased prevalence of premature ovarian failure associated with TC/CC genotype (OR 3.376; 95% CI 1.672–6.815; p = 0.001) and verified an increased prevalence of tubal pathology in carriers of TC/CC genotype (OR 3.231; 95% CI 1.653–6.314; p = 0.001). Finally, a strong association of TC/CC genotype with female infertility, regardless of the cause was found (OR 4.232; 95% CI 2.710–6.609; p < 0.001). In conclusion, TC/CC genotype is associated with increased susceptibility to infertility development in women.

Limitations, reasons for caution

The sample size may eventually be considered small, despite the strong significance found.

Wider implications of the findings: There are not many studies in this area and the few existing exhibit disparate results. The association of TC/CC genotype with endometriosis was observed in a few studies, but some disagree. This difference could be attributed to the notable heterogeneity across the different studies.

Trial registration number

Not applicable

FUT3 and FUT2 genotyping and glycoconjugate profile Lewisb as a protective factor to Toxoplasma gondii infection

The interaction between the ABO, FUT2 and FUT3 genes results in the synthesis of different glycoconjugates profiles expressed in gastrointestinal tract. Moreover, the protozoan Toxoplasma gondii, which causes toxoplasmosis, utilizes this organ as an infection route. We analyzed the frequencies of the different glycoconjugate profiles which were determined by phenotyping ABO and genotyping the status secretor (FUT2; substitution G428A) and Lewis (FUT3; substitution T202C and C314T) histo-blood systems, assessed by PCR-RFLP and PCR-SSP, respectively. A total of 244 pregnant women (G1: Seropositive; G2: Seronegative) for IgG T. gondii antibodies were enrolled. IgG anti-T. gondii antibodies were determined by ELISA. G1 was composed of 158 (64.8%) sample and G2 by 86 (36.2%). The glycoconjugate profile was accessed in 151 seropositive and 85 seronegative samples by the combination of ABO and Lewis phenotyping as well as FUT2 and FUT3 genotyping. In G1, 36 (22.8%) presented the glycoconjugate profile ALeb, 5 (3.3%) A, 13 (8.6) BLeb, 1 (0.6%) B, 41 (27.1%) Leb, 13(8.6%) H, 38(25.2%) Lea and 4 (2.6%) Lec. G2 was composed of 13 (15.3%) of ALeb, 15 (17.6%) BLeb, 1 (1.2%) B, 42 (49,4%) Leb and 14 (16.5) Lea. H and Lec glycoconjugate profiles were not found in G2. The frequencies of the glycoconjugates profiles Leb (p = 0.001) and H (p = 0.005) were significantly different compared between G1 and G2. The glycoconjugate profile H inferred from the ABO phenotyping and FUT3 and FUT2 genotyping is associated with infection by T. gondii in pregnant women and the Leb profile appears to protect the infection by this parasite.

Long-Term Viruria in Zika Virus-Infected Pregnant Women, Brazil, 2016

During the 2016 Zika virus outbreak in Brazil, we detected Zika virus RNA in urine samples collected from Zika virus–positive pregnant women during different stages of pregnancy. Women had positive and negative intervals of viruria; 3 newborns had adverse outcomes. Further research is needed to clarify the relationship between viruria and outcomes for newborns.

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil

OBJECTIVES

We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil.

METHODS

This descriptive study was performed from February to October 2016 on 54 quantitative real-time PCR ZIKV-positive pregnant women identified by the public health authority of São José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR).

RESULTS

A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes.

CONCLUSIONS

Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection.

Value of the Ultrasound in the Study of Ovarian Reserve for Prediction of Oocyte Recovery

Purpose To identify which methods used in the assessment of the ovarian reserve are exclusive or complementary to identify the best response to follicle development. Methods Retrospective cohort study, involving patients undergoing assisted reproduction treatment at the Instituto de Medicina Reprodutiva e Fetal, from April 2009 to July 2014. Age, biochemical tests, and ultrasound were assessed. The data were analyzed to predict the follicular development and the relation between them, using, for statistical analysis, Statistical Package for Social Sciences software. Results Out of the 293 couples included, 50.2% presented infertility by ovarian factor. Considering the age as the main variable, a significant negative correlation with the volume of both ovaries was observed (right ovary, r = 0.21; left ovary, r = -0.22; both p < 0.0001), and with the antral follicle count (right ovary, r = -0.38; left ovary, r = -0.47; both p < 0.0001). Considering the antral follicle count as the main variable, a significant positive correlation with the total recruited oocytes was observed. When we correlated the antral follicle count with the recruited follicles larger than 18 mm, we observed that, with a cutoff of 12 antral follicles, there is a positive predictive value of 99%, and an area under the ROC curve of 0.76. Conclusion We concluded from our study that age and antral follicle count are effective predictors of ovarian response in cycles of assisted reproduction. The ovarian volume, as well as the anti-Müllerian hormone dosage, seem to be adequate markers of the ovarian reserve.

Intrauterine thrombosis of umbilical artery - case report

CONTEXT

Umbilical cord thrombosis is related to greater fetal and perinatal morbidity and mortality. It is usually associated with umbilical cord abnormalities that lead to mechanical compression with consequent vascular ectasia. Its correct diagnosis and clinical management remains a challenge that has not yet been resolved.

CASE REPORT

This study reports a case of umbilical artery thrombosis that occurred in the second half of a pregnancy. The umbilical cord was long, thin and overly twisted and the fetus presented severe intrauterine growth restriction. The clinical and histopathological findings from this case are described.

CONCLUSIONS

This case report emphasizes the difficulty in diagnosing and clinically managing abnormalities of intrauterine life with a high chance of perinatal complications.

Prematurity and Low Birth Weight did not Correlate with Anti-Toxoplasma gondii Maternal Serum Profiles--a Brazilian Report

Gestational Toxoplasma gondii infection is considered a major risk factor for miscarriage, prematurity and low birth weight in animals. However, studies focusing on this topic in humans are scarce. The objective of this study is to determine whether anti-Toxoplasma gondii maternal serum profiles correlate prematurity and low birth weight in humans. The study examined 213 pregnant women seen at the High-Risk Pregnancy Hospital de Base, São José do Rio Preto, São Paulo, Brazil. All serological profiles (IgM-/IgG+; IgM-/IgG-; IgM+/IgG+) were determined by ELISA commercial kits. Maternal age, gestational age and weight of the newborn at birth were collected and recorded in the Statement of Live Birth. Prematurity was defined as gestational age <37 weeks and low birth weight ≤ 2499 grams. The t-test was used to compare values (p < 0.05). The mean maternal age was 27.6±6.6 years. Overall, 56.3% (120/213) of the women studied were IgM-/IgG+, 36.2% (77/213) were IgM-/IgG- and 7.5% (16/213) were IgM+/IgG+. The average age of the women with serological profile IgM+/IgG+ (22.3±3.9 years) was different from women with the profile IgM-/IgG+ (27.9±6.7 years, p = 0.0011) and IgM-/IgG- (27.9±6.4 years, p = 0.0012). There was no statistically significant difference between the different serological profiles in relation to prematurity (p = 0.6742) and low birth weight (p = 0.7186). The results showed that prematurity and low birth weight did not correlate with anti-Toxoplasma gondii maternal serum profiles.

Association of Godoy & Godoy contention with mechanism with apparatus-assisted exercises in patients with arm lymphedema after breast cancer

Aim:

The aim of the current study was to evaluate the reduction in the volume of the upper limbs with lymphedema after exercises using the apparatus-assisted program associated with contention mechanism.

Patients and method:

Twenty-eight female patients were selected and referred for evaluation and treatment of lymphedema after breast cancer therapy. The ages of the women ranged from 42 to 72 years with a mean age of 57 years. Inclusion criteria were treatment of cancer associated to a difference of at least 200 mL between the edematous and the contralateral limbs. Patients with active infections, skin lesions, and active disease were not included in the study. Four series of exercises using devices based on pedals, pulleys, a horizontal reflexion bar, and an elevation bar were selected. The participants were advised about the form of exercise: 15 minutes for each device, low intensity (less than 10 movements per minute), in the seated position, and the use of contention. Water displacement volumetry was performed before and after the 60-minute exercise session. The paired t-test was utilized with an alpha error of 5% considered acceptable (P value < 0.05).

Results:

The mean difference between the volumetric measures before and after exercise was significant, with all the participants having reductions in the volume of the limbs using the four selected devices over time and at an intensity determined by this study.

Conclusion:

Association of a Godoy and Godoy contention during apparatus-assisted exercise reduced the edema in patients with lymphedema of the upper limbs.

Seropositivity rates for toxoplasmosis, rubella, syphilis, cytomegalovirus, hepatitis and HIV among pregnant women receiving care at a public health service, São Paulo state, Brazil

Infectious and parasitic diseases affecting women during their reproductive age may result in vertical transmission. The aim of this study was to determine the seroprevalence for TORSCH among pregnant women receiving care at a university hospital. Records of 574 pregnant women who received medical attention from January 2006 to December 2007 were assessed. The mean age was 27.2 ± 6.5 years ranging from 13 to 44. The results of the immunodiagnostic tests were: 62.0% (345/556) for IgG and 3.4% (19/556) for IgM anti-T. gondii; 93.1% (433/465) for IgG and 0.6% (3/465) for IgM anti-rubella; 0.9% (5/561) for VDRL; 1.8% (10/554) for HBsAg; 0.7% (4/545) for anti-HCV and 2.1% (11/531) for HIV. In conclusion, the results of immunodiagnostic tests for the TORSCH panel among pregnant women attending a perinatal service of a university hospital are in agreement with those reported by previous studies and by governmental sources.

Prevalence of anticardiolipin antibodies in pregnancies with history of repeated miscarriages

AIM

This study aimed at evaluating the prevalence of high anticardiolipin antibody and lupus anticoagulant levels in women with histories of at least two miscarriages.

METHODS

The presence of high anticardiolipin antibody and lupus anticoagulant levels were evaluated in 52 patients with ages between 17 and 41 (mean 26.7 years old) who had histories of repeated miscarriages.

RESULTS

High anticardiolipin antibody levels were identified in 55.77% and lupus anticoagulant levels in 2% of the individuals.

CONCLUSION

In conclusion, women who suffer from repeated miscarriages present with a high prevalence of anticardiolipin antibodies. Further studies on this issue are crucial as these antibodies are associated with hypercoagulability and thus increased the risk of thromboembolic events.

Tubal schistosomiasis in Brazilian women: a case report

Several authors have reported schistosomiasis caused by Schistosoma haematobium in the female genital tract of patients in endemic areas. This work describes tubal schistosomiasis by Schistosoma mansoni in a Brazilian woman submitted to hysterectomy for uterine myomatosis and metrorrhagia. Macroscopy evidenced hydrosalpinx of the left tube and multiple Schistosoma mansoni eggs were identified by anatomopathological examination. This article illustrates a rare form of schistosomiasis as the cause of tubal damage.

Antiphospholipid antibodies and growth retardation in intrauterine development

The aim of this study was to evaluate the efficacy of prophylaxis using low-dose non-fractioned heparin and aspirin in the prevention of intrauterine growth restriction and low birth weights in patients suffering from antiphospholipid antibody syndrome. Intrauterine growth retardation and birth weights of 34 gestations involving 28 women with histories of multiple miscarriages and elevated antiphospholipid antibody levels were evaluated in a prospective study in the period from April 1988 to July 2004. A control group was formed of 39 women without previous history of miscarriages over a total of 40 gestations. Intrauterine growth retardation was considered when the weight of the newborn baby was below the tenth percentile for gestational age according to the fetal weight chart. Diagnosis of antiphospholipid antibodies was achieved using the ELIZA test to measure the IgG and IgM immunoglobulin levels. Evaluation of lupus anticoagulant was performed using the activated partial thromboplastin time (aPTT). Women suffering from antiphospholipid antibodies underwent prophylactic treatment during gestation with low doses of acetylsalicylic acid (100 mg daily) associated to low doses of subcutaneous heparin (5000 IU twice daily). The non-paired Student t-test, Fisher Exact and Mann-Whitney tests were used for statistical analysis with an a error of up to 5% considered acceptable. A statistically higher number of newborns suffered intrauterine growth retardation and low birth weights in the study group than in the control group. In conclusion, children of mothers suffering from antiphospholipid antibody syndrome, even those undergoing prophylactic treatment with low-dose non-fractioned heparin and aspirin, are associated to intrauterine growth retardation and low birth weights.