Medicina Reproductiva: Síndrome de Ovarios Poliquísticos

El síndrome de ovarios poliquísticos (PCOS) es un desorden reproductivo muy común. Las mujeres con PCOS tienen con frecuencia ciclos menstruales irregulares, vello corporal excesivo, sobrepeso, y sufren de infertilidad o subfertilidad.

Muchas mujeres con PCOS tienen una disminución en la sensibilidad a la insulina por la cual su organismo compensa con la sobreproducción de insulina. Los altos niveles de insulina resultantes pueden contribuir a un exceso en la producción de andrógenos (hormonas masculinas, tales como la testosterona) y contribuyen a desórdenes ovulatorios. Además de problemas reproductivos, las mujeres con PCOS tienen posibilidades más altas de desarrollar problemas médicos tales como diabetes de tipo 2 (no insulino-dependiente), hipertensión arterial y enfermedades cardíacas. A la edad de 40 años, hasta 40% de las pacientes PCOS desarrollan deterioro de la tolerancia a la glucosa o diabetes clínica.

Dada la sólida evidencia de que el exceso de insulina juega un papel en el desarrollo de PCOS, es razonable asumir que la reducción de los niveles circulantes de insulina pueden ayudar a establecer la función reproductiva normal. Esto puede ser logrado mediante la pérdida de peso, mejoramiento nutricional y ejercicio físico. Estos cambios deben ser las primeras líneas de tratamiento para una mujer con PCOS y sobrepeso.

Agentes sensibilizantes a la insulina

En forma reciente, nuevas drogas aprobadas por la FDA para el tratamiento de la diabetes tipo 2 se han mostrado un bene?cio para las pacientes con PCOS. Estas drogas, conocidas como agentes sensibilizantes a la insulina, han mostrado poder mejorar la respuesta a la insulina, reduciendo de esta forma la necesidad de producirla y restaurando sus niveles a la normalidad. El agente sensibilizador a la insulina mejor estudiado disponible en Estados Unidos para mujeres con PCOS es la metformina, una biguanida. La metformina reduce la insulina circulante y los niveles de andrógenos y restaura la ovulación normal en algunas mujeres con PCOS. Aun si la metformina sola no restaura la ovulación, puede mejorar la respuesta de una mujer a las drogas en tratamientos de fertilidad. La irritación gastrointestinal, en especial la diarrea, es un efecto colateral común. Estos síntomas en general mejoran luego de pocas semanas. La acidosis láctica es un efecto adverso de la metformina poco usual, pero muy serio. La metformina no está recomendada para las pacientes con enfermedad renal, pulmonar, hepática o cardíaca.

La rosiglitazona y pioglitazona, las cuales pertenecen al grupo de agentes antidiabéticos tiazolidindionas, también están disponibles en Estados Unidos para las mujeres con PCOS. Las tiazolidindionas han demostrado reducir el hiperandrogenismo y restaurar la ovulación en algunas pacientes con PCOS. La toxicidad hepática es la mayor inquietud con estos agentes. Los exámenes de la función hepática deben realizarse cada dos meses durante el primer año y luego en forma periódica. Estas drogas no deberían ser utilizadas en pacientes con alguna evidencia de enfermedad hepática.

Hasta el momento, los nuevos agentes sensibilizantes a la insulina no han sido vinculados a defectos de nacimiento en animales o humanos, pero no se recomienda su uso durante el embarazo. La metformina también debería ser interrumpida en forma temporaria previo a cirugía o procedimientos con rayos X que requieran el uso de contraste endovenoso.

A diferencia de las drogas inductoras de la ovulación, los agentes sensibilizantes a la insulina conllevan poco o ningún riesgo de embarazo múltiple. Se necesitan más estudios clínicos para determinar la evolución, riesgos y complicaciones cuando estas medicaciones se utilizan para el tratamiento de pacientes con PCOS. Aunque los resultados de estudios clínicos han sido alentadores, el uso de estas medicaciones en mujeres con PCOS todavía se considera en investigación. En general, la metformina se usa como agente sensibilizador a la insulina de primera línea; las tiazolidindionas pueden ser consideradas en caso de falta de respuesta o intolerancia de la paciente a la metformina.

Los datos actuales sugieren el uso de agentes sensibilizadores a la insulina para la inducción de ovulación en pacientes con PCOS que desean lograr el embarazo. Debido a que estas drogas corrigen las anormalidades metabólicas asociadas con PCOS, es posible que su uso a largo plazo pueda demorar el surgimiento o reducir la probabilidad de desarrollar diabetes tipo 2 y enfermedad cardiovascular. La falta de datos, sin embargo, hace que el uso a largo plazo de los agentes sensibilizadores a la insulina con este propósito no pueda recomendarse por el momento.

Para mayor información sobre el síndrome de ovarios poliquísticos no dude en contactarse con Sublimis. Los doctores Gustavo Gallardo y Andrés Juaréz Villanueva le evacuarán todas sus dudas.

Should obese, smoking and alcohol consuming women receive assisted reproduction treatment?

The European Society of Human Reproduction and Embryology (ESHRE) has published a position statement on the impact of the life style factors obesity, smoking and alcohol consumption on natural and medically assisted reproduction.

In a literature study the ESHRE Task Force on Ethics and Law summarised the negative effects of obesity, smoking and drinking on the natural reproductive potential of patients, on IVF results, pregnancy complications and outcomes and finally on the health of the future child. The paper was published online on 19 January 2010 in Europe’s leading reproductive medicine journal Human Reproduction. The group made five recommendations.

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

ESHRE acknowledged that this was a complex issue due to personal, patient, professional and societal responsibilities and also in terms of what these responsibilities meant with regard to safety of mother and child and fair and equitable access to treatment. The respect for patient autonomy needed to be balanced with the moral weight of the interests of society and the future child.

Obesity

According to the group obesity negatively affected reproductive potential through interference with hormonal and metabolic mechanisms leading to lower ovulation frequency and reduced chances of conception. The risk of gestational diabetes increased from twofold in overweight women to eightfold for morbidly obese women. The infants of obese mothers were at risk of perinatal death, congenital abnormalities such as neural tube defects (80% increase) and cardiovascular anomalies (30% increase).

Smoking

The risk of infertility was thought to be twice as high in smokers compared to non-smokers. Female smokers needed more time to become pregnant, were less likely to do so spontaneously and had a higher risk of miscarriage. Having an accelerating effect on oocyte depletion, smoking was suggested to lead to an increase in 10 years with regards to IVF outcome. Lower birth weight, a higher risk of oral facial clefts and Sudden Infant Death Syndrome were associated with maternal smoking. Male smokers were at risk of producing sperm of reduced quality and concentration.

Alcohol Consumption

Reduced conception, lower pregnancy rates and higher miscarriage rates were suggested as adverse effects of alcohol consumption. The known effects of alcohol consumption were summarised under Foetal Alcohol Spectrum Disorders (FASD) such as physical anomalies and behavioural and cognitive deficits. Other risks associated with prenatal alcohol consumption were foetal death, preterm labour and compromised foetal growth.

Please feel free to contact Sublimis for information about assisted reproduction treatments and weight loss surgery in Argentina.

Medicina Reproductiva en Argentina: ¿Qué es la Endometriosis?

La endometriosis es una enfermedad crónica, dolorosa y de origen desconocido que afecta millones de mujeres y niñas alrededor del mundo. Está fuertemente asociada a los casos de infertilidad o subfertilidad, manifestando síntomas tanto de dificultad para concebir como para llevar a término un embarazo.

Cuando una mujer tiene endometriosis, el tejido que reviste el útero, llamado endometrio, crece fuera de él. Estas formaciones de endometrio se alojan principalmente en la cavidad pélvica y en uno o más de estos lugares: sobre o bajo los ovarios, detrás del útero, sobre los tejidos que mantienen el útero en su lugar, o sobre los intestinos o la vejiga. En casos muy raros, las áreas con endometriosis pueden llegar a los pulmones o a otras partes del cuerpo.

Mientras el tejido crece, puede convertirse en “bultos”, llamados nódulos o implantes. Estos nódulos normalmente son benignos (no cancerosos) y además de afectar la fertilidad suelen causar dolores leves o severos y menstruaciones abundantes.

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Fertility Preservation Decision Making in Cancer Patients

Atlanta, GA – New research presented at the American Society for Reproductive Medicine today highlighted the obstacles facing patients as they make decisions about preserving their reproductive options.

Investigators from Brown University used focus groups to explore the feelings of breast cancer patients about fertility preservation. They found that four main themes emerged for these patients:

1) costs, including time, money and emotional costs,

2) safety of the patient and any offspring,

3) prospects for successful treatment, and

4) having sufficient time to process information about fertility preservation.

Researchers at New York University used a more quantitative methodology to examine similar questions. They enrolled 16 patients in a registry, 11 of whom sought fertility preservation treatments. They found 10 of the 16 felt having a child was the most important thing in their lives. Eleven of them were concerned about the impact of their cancer treatment on their fertility. And 11 were unsure about the level of risks they would undertake to achieve their reproductive goals.

Physicians and nurses have important roles to play in counseling cancer patients about their reproductive options. A team from New York examined the current perceptions and practices of oncology nurses. Using an on-line survey, they found that nurses who were knowledgeable about fertility preservation were more than twice as likely to discus the impact of cancer treatments with their patients. More than 90% of the nurses reported that having guidelines would facilitate better discussion of reproductive issues with their patients.

Physicians’ attitudes about the potential for posthumous parenting were explored by a team from Tampa, Florida. They found a slim majority (50.5%) reported not having a view about posthumous parenting, and only 13% supported it. However, less than a quarter (22.8%) agreed with the statement “Patients with poor prognosis should not pursue fertility preservation.”

“As fertility preservation options for cancer patients continue to improve, the demands for quality information sharing between patients and their doctors and nurses must continue to improve, as well,” said R. Dale McClure, MD, President of the American Society for Reproductive Medicine.

For more information about Assisted Reproductive Technology do not hesitate to contact us.

Medicina Reproductiva en Argentina: Tabaquismo y Fertilidad

Los riesgos del consumo de tabaco son bien conocidos en lo que respecta a las enfermedades de corazón pulmones y vasos sanguíneos. Pero se han detectado efectos sustancialmente dañinos en la fertilidad, que no son generalmente tenidos en cuenta. El consumo de cigarrillos tiene un impacto negativo en la capacidad de la mujer de quedar embarazada tanto como en la de llevar un embarazo a término.

Impacto del tabaquismo en las mujeres

Virtualmente todos los estudios científicos apoyan la conclusión de que fumar tiene un impacto adverso en la fertilidad. La probabilidad de infertilidad es mayor, y el tiempo necesario para concebir también es mayor en mujeres fumadoras comparadas con no fumadoras.

El tabaquismo activo de cada cónyuge presenta efectos adversos, y el impacto de la exposición al tabaquismo pasivo, es sólo levemente menor que en el activo. Los estudios realizados evidencian que fumar es nocivo para los ovarios y que el grado de daño depende tanto de la cantidad consumida como del periodo de tiempo en el que la mujer haya fumado.

El consumo de tabaco acelera la pérdida de ovocitos y el deterioro de la función reproductiva y puede adelantar en varios años el momento de la menopausia.

Los componentes del tabaco han evidenciado interferir en la capacidad de las células ováricas para la formación de estrógeno así como en la formación de ovocitos con tendencia a presentar anomalías genéticas.

El tabaquismo además está fuertemente asociado a un riesgo mayor de aborto espontáneo, así como de embarazo ectópico .
Las embarazadas fumadoras tienen mayor probabilidad de concebir niños de bajo peso al nacer tanto como de provocar partos prematuros.
La incidencia de muerte súbita infantil esta también aumentada en los hogares en los cuáles el niño convive con algún fumador.

Impacto del tabaquismo en los resultados de los tratamientos de reproducción asistida en mujeres:

Los estudios revelan que las mujeres fumadoras requieren casi le doble de intentos de Fertilización in Vitro (FIV) respecto que las no fumadoras para lograr resultados positivos.
Asimismo, los estudios de FIV mostraron que las fumadoras necesitan dosis más elevadas de gonadotrofinas para estimular sus ovarios, que presentan menores ascensos de estradiol, menor cantidad de ovocitos obtenidos, mayor cantidad de ciclos cancelados, menor rango de implantación, y que en general atraviesan mayor cantidad de ciclos no exitosos que las no fumadoras.
El nivel de abortos también aumenta considerablemente.
Los efectos adversos del tabaquismo son mas visibles en las mujeres mayores. Especialmente en cuanto a que la reducción en la fertilidad natural que este hábito provoca en ellas no se ve efectivamente mejorada por la aplicación de técnicas de Reproducción Asistida.

Impacto del tabaquismo en los resultados de los tratamientos de reproducción asistida en hombres:

Los hombres fumadores presentan una cantidad menor de espermatozoides, así como una movilidad menor y un aumento de anormalidades en la forma y la función espermática.
El efecto del tabaquismo en la fertilidad del hombre es de todos modos mas difícil de discernir, ya que no se cuenta con estudios capaces de determinarlo.
A pesar de que el efecto del tabaquismo en la fertilidad masculina permanece sin conclusiones definitivas, el efecto dañino del tabaquismo pasivo en la mujer y la evidencia de efectos adversos en la calidad del esperma sugieren que hábito de fumar en el hombre debe ser visto como un factor de riesgo en la  infertilidad.

Abstención de tabaco como ejemplo de tratamiento en parejas que siguen tratamientos de infertilidad:

Una importante investigación mostró que la abstención de tabaco durante al menos dos meses antes de intentar una Fertilización in Vitro mejora significativamente las probabilidades de lograr la concepción.
A pesar de que el tabaquismo de larga data puede tener efectos irreversibles en la función ovárica, el efecto nocivo puede ser revertido parcialmente si el hábito es interrumpido antes de iniciar un tratamiento para corregir la infertilidad o subfertilidad.

Sumario:

Los mejores datos científicos disponibles indican que el tabaquismo contribuye  fuertemente a la infertilidad.
El tabaquismo debe ser desaconsejado tanto en hombres como en mujeres, especialmente en aquellas parejas con antecedentes de infertilidad o de aborto recurrente.
La abstención puede mejorar tanto la fertilidad natural como los niveles de éxito de los tratamientos de infertilidad o subfertilidad.

Para mayor información no dude en contactarse con nosotros.

A quick and accurate way of diagnosing endometriosis

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe’s leading reproductive medicine journal Human Reproduction .

Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated.

Now researchers at the University of Sydney and Mu’tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy.

Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman’s pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis.

In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis.

In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu’tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition.

The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis.

Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2.

The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group.

Dr Al-Jefout said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility.”

Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: “It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”

He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”

In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. “The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility.”

The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. “Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist,” he concluded.

In the second study, led by Professor Thomas D’Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A?, adrenergic and cholinergic nerve fibres).

Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: “We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis.”

Prof D’Hooghe said: “Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity.”

Dr Bokor and the team of Prof D’Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. “If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed,” said Prof D’Hooghe.

For more information about Assisted Fertilization Treatments don’t hesitate to contact us.

Source: eshre.com

Céline Dion Pregnant with Embryo Frozen for Eight Years

 Céline Dion, known for belting out pop songs with window-rattling power, will be fine-tuning her repertoire of lullabies with the news today that she’s pregnant with her second child.

It’s an arrival Dion mused about almost nine years ago when she was expecting her first baby, Rene-Charles.

When Rene-Charles was conceived through in vitro fertilization at a world-renowned New York clinic, Dion told interviewers at the time that a sibling was already in the works.

The pop megastar and her husband, Rene Angelil, got the good news of the latest infant on Monday after undergoing another round of fertility treatments.

“Celine is very, very happy,” Murielle Blondeau, a spokeswoman for Dion, said today when she confirmed the pregnancy.

“Celine and Rene are full of joy. It’s been a big dream for Celine to have a second child.”

Although Rene-Charles and the new baby are siblings, fertility experts say they are not twins. Identical twins are created from a single embryo that splits in the womb while fraternal twins come from different embryos that are carried at the same time.

Dr. Seang Lin Tan, a world-renowned fertility expert at the McGill University Reproductive Centre in Montreal, said there are documented cases where frozen embryos have been successfully used after two decades.

“There have been babies born who are healthy after the embryos have been frozen for 20 years,” he said.

Dion’s first pregnancy was well-documented, unlike that of fellow music megastar Shania Twain, who virtually disappeared while waiting to give birth around the same time.

The revelation that Dion was pregnant with Rene-Charles followed a jaw-dropping announcement that she would retire from performing to have a family.

She gave interviews about her pregnancy in which she chatted about how the frozen eggs might one day become a “brother or sister” to Rene-Charles, and she appeared in a series of photos showcasing her protruding belly.

Dion has said that she and her husband turned to medical science to help conceive because Angelil had been diagnosed with cancer in 1999.

After a neck tumour was removed, he was treated with radiation and chemotherapy which are known to affect fertility. Angelil’s cancer went into remission.

Dr. Zev Rosenwaks, who counselled the couple on their fertility options, told The Canadian Press in a 2000 interview that Dion had an intracytoplasmic sperm injection, in which a single sperm is injected into the egg.

Rosenwaks, who works with the Weill Cornell fertility clinic, said in the interview that Angelil had previously frozen his sperm.

The second fertilized egg was frozen five days after conception and stored at the New York clinic, Dion said in the television interview.

Tan said there is no real concern about Dion giving birth at age 41 and he noted the embryos were also frozen when she was much younger.

He said he hopes Dion’s pregnancy will draw attention to in vitro fertilization.

“Apparently when she got pregnant the first time, the popularity of in vitro in Canada went up quite a bit,” he said.

Source: thestar.com

For more information about Assisted Fertilization Treatments don’t hesitate to contact us.

La Endoscopía Ginecológica 

Es un tipo de práctica del tipo “cirugía mínimamente invasiva”, esencialmente ginecológica, breve y de caracter ambulatorio, que se realiza tanto con fines diagnósticos como terapéuticos.

En la actualidad, en los países avanzados, se la utiliza en más del 90% de los casos, exceptuando la patología mamaria y algunos tipos de nódulos donde su aplicación aún se encuentra en discusión.
Dentro de esta especialidad, existen dos tipos de intervenciones: videolaparoscopía y la histeroscopía.

La Videolaparoscopía:

Consiste en una técnica que consiste en la introducción a través del ombligo de una óptica que, conectada a una cámara, permitirá observar las imágenes de la pelvis y del resto del abdomen previamente dilatado con anhídrido carbónico.

Es básicamente diagnóstica, pero permite que el profesional eventualmente realice el tratamiento quirúrgico, introduciendo instrumental adicional a través de pequeñas incisiones secundarias.

Se la utiliza habitualmente para diagnosticar eficientemente y corregir alteraciones que son causa de infertilidad o subfertilidad en la mujer, además de otros trastornos ginecológicos:

- Endometriosis
- Dolor pelviano crónico
- Enfermedad pelviana inflamatoria
- Abdomen agudo ginecológico
- Embarazo ectópico
- Malformaciones genitales
- Cirugías de trompas
- Miomectomías
- Cirugías de ovarios (quistes, torsiones, abscesos)
- Histerectomías
- Operación para la incontinencia de orina de esfuerzo
- Prolapsos genitales
- Adhesiolisis o liberación de adherencias
- Resección de ganglios pelvianos

La histeroscopía:

Es un método que, al igual que la videolaparoscopía sirve para el diagnóstico y tratamiento de síntomas relacionadas con la infertilidad y aspectos ginecológicos de la mujer.

Consiste en la utilización de una óptica de espesor muy pequeño que se conecta a una cámara y se introduce por el cuello del útero, permitiendo observar minuciosamente su interior, para detectar y corregir :

- Sangrados uterinos anómalos (hiperplasias, cáncer de útero)
- Adherencias y resección de tabiques
- Presencia de pólipos, fibromas, etc.
- Presencia de cuerpos extraños: DIU, etc.

Además, permite practicar pequeñas cirugías tales como:

- Biopsias dirigidas
- Miomectomías
- Polipectomías
- Resección y ablación endometrial

Las características de la endoscopía ginecológica hacen que hoy sea una práctica usual, segura y efectiva en temas relacionados con la fertilidad y la salud de la mujer:

- como método de diagnóstico, por permitir la observación directa y una máxima precisión;
- como método quirúrgico, por ser de caracter ambulatorio, ya que no requiere internación y minimiza las molestias del postoperatorio.

Para mayor información no dude en consultar de forma gratuita con nuestros especialistas Doctor Gustavo Gallardo y Doctor Andres Juarez Villanueva.