Throughout history, obesity has been perceived in different ways, sometimes asa symbol of health and prosperity, and sometimes as a disease. Nowadays, thereis consensus in considering it as a chronic disease characterized by excessive fataccumulation and linked to cardiovascular diseases, diabetes and pregnancycomplications. It is most commonly diagnosed by means of the Body Mass Index(BMI). BMI often does not accurately reflect the problem. For this reason, othermethods such as Bioelectrical Impedance Analysis (BIA) and Dual Energy X-rayAbsorptiometry (DXA) have been proposed. Anthropometric parameters such asskinfold thickness and mid-arm circumference are also used. Obesity is a global publichealth problem whose prevalence has been increasing in recent decades. In Peru, itis estimated that two-thirds of women of reproductive age have a BMI ≥ 25. Thereare genetic and environmental fa...

Obesity has a negative impact on reproductive health, with a higher incidence ofanovulation, menstrual disorders and infertility. The increase in adipose tissueis associated with insulin resistance and hyperinsulinemia, reduction in sexhormone binding globulin levels, and hyperandrogenemia. There is an increasein pro-inflammatory adipokines and a decrease in adiponectins. Female obesity isassociated with ovulatory dysfunction, lower ovarian response to ovulation inducers,decreased oocyte quantity and quality, and alteration in endometrial receptivity.Likewise, a decrease in the live birth rate has been reported in in vitro fertilizationtreatments, and an increase in the frequency of abortions. Male obesity increases theincidence of erectile dysfunction and alterations in sperm quality. Diet, exercise, andmedical therapy have been shown to be effective. Bariatric surgery is an alternative...

Clinical decisions in the management of infertility associated with endometriosis are difficult because many clinical decisión points have not been evaluated in randomized clinical trials. Laparoscopy is the gold standard for diagnosis of endometriosis and the decision to perform it should take into consideration factors such as patient´s age, duration of infertility, family history, pelvic pain, pelvic mass on ultrasound. Conservative surgical treatment of endometriosis must be directed to reproductive function recuperation by eliminating implants and reconstruction of the altered pelvic anatomy. Laparoscopic treatment of endometriosis as compared with laparotomy allows short time of hospitalization, faster recovery, smaller incisions. Surgical treatment of endometriosis associated infertility includes ablation of endometriotic implants and adhesions to improve fertility in minimal an...

En 1978, Robert Edwards y Patrick Steptoe lograron el primer embarazo con fertilización in vitro en una mujer con obstrucción tubárica bilateral; este hecho marcó un hito en el tratamiento de la infertilidad y desde entonces las técnicas de reproducción asistida no han dejado de perfeccionarse. En 1987, se logró obtener óvulos por punción ovárica guiada por ecografía transvaginal. En 1992, Palermo logró el primer embarazo con la técnica de inyección de espermatozoide intracitoplasmática (ICSI). A mediados de la década de los 90 se introdujo la biología molecular a la medicina reproductiva, lográndose el desarrollo de nuevos tratamientos de gran trascendencia para las parejas con problemas de infertilidad.

Clinical decisions in the management of infertility associated with endometriosis are difficult because many clinical decisión points have not been evaluated in randomized clinical trials. Laparoscopy is the gold standard for diagnosis of endometriosis and the decision to perform it should take into consideration factors such as patient´s age, duration of infertility, family history, pelvic pain, pelvic mass on ultrasound. Conservative surgical treatment of endometriosis must be directed to reproductive function recuperation by eliminating implants and reconstruction of the altered pelvic anatomy. Laparoscopic treatment of endometriosis as compared with laparotomy allows short time of hospitalization, faster recovery, smaller incisions. Surgical treatment of endometriosis associated infertility includes ablation of endometriotic implants and adhesions to improve fertility in minimal an...

En 1978, Robert Edwards y Patrick Steptoe lograron el primer embarazo con fertilización in vitro en una mujer con obstrucción tubárica bilateral; este hecho marcó un hito en el tratamiento de la infertilidad y desde entonces las técnicas de reproducción asistida no han dejado de perfeccionarse. En 1987, se logró obtener óvulos por punción ovárica guiada por ecografía transvaginal. En 1992, Palermo logró el primer embarazo con la técnica de inyección de espermatozoide intracitoplasmática (ICSI). A mediados de la década de los 90 se introdujo la biología molecular a la medicina reproductiva, lográndose el desarrollo de nuevos tratamientos de gran trascendencia para las parejas con problemas de infertilidad.

Clinical decisions in the management of infertility associated with endometriosis are difficult because many clinical decisión points have not been evaluated in randomized clinical trials. Laparoscopy is the gold standard for diagnosis of endometriosis and the decision to perform it should take into consideration factors such as patient´s age, duration of infertility, family history, pelvic pain, pelvic mass on ultrasound. Conservative surgical treatment of endometriosis must be directed to reproductive function recuperation by eliminating implants and reconstruction of the altered pelvic anatomy. Laparoscopic treatment of endometriosis as compared with laparotomy allows short time of hospitalization, faster recovery, smaller incisions. Surgical treatment of endometriosis associated infertility includes ablation of endometriotic implants and adhesions to improve fertility in minimal an...

En 1978, Robert Edwards y Patrick Steptoe lograron el primer embarazo con fertilización in vitro en una mujer con obstrucción tubárica bilateral; este hecho marcó un hito en el tratamiento de la infertilidad y desde entonces las técnicas de reproducción asistida no han dejado de perfeccionarse. En 1987, se logró obtener óvulos por punción ovárica guiada por ecografía transvaginal. En 1992, Palermo logró el primer embarazo con la técnica de inyección de espermatozoide intracitoplasmática (ICSI). A mediados de la década de los 90 se introdujo la biología molecular a la medicina reproductiva, lográndose el desarrollo de nuevos tratamientos de gran trascendencia para las parejas con problemas de infertilidad.

We describe a case of ectopic intramyometrial pregnancy after in vitro fertilizationand embryo transfer (IVF-ET), treated conservatively by ultrasound-guidedintrasacular injection of methotrexate, followed by a successful twin pregnancy afterfrozen-thawed embryos transfer.

Oocyte and embryo donation has become a frequent procedure in infertile womenof advanced reproductive age, with a high pregnancy rate. In these pregnancies,the incidence of adverse obstetric events (hypertensive disorders, gestationaldiabetes, operative delivery, among others) and perinatal mortality increases.Multiple pregnancies significantly increase the risks, so single embryo transfer isrecommended. Patients should have a previous comprehensive medical examinationincluding cardiovascular and psychological evaluation, avoiding treatment in womenwith chronic diseases that significantly increase risks. This symposium will reviewinfertility management in women of advanced reproductive age with own anddonated oocytes, obstetric and perinatal complications as well as ethical aspects andspecial considerations to consider in this type of treatment.

The digenesia Müller ducts or agenesis of the uterus and vagina, known as Mayer-Rokitansky-Kuster-Hauser syndrome is a disorder of the female reproductive characterized by primary amenorrhea and abnormalities associated with urogenital tract. We present six cases of patients with Mayer-Rokitansky syndrome, describe the clinical presentation, management, and we review the literature.

OBJECTIVE: To evaluate the efficacy of intravaginal mysoprostol to induce abortion in patients with intrauterine fetal death. DESIGN: Prospective, transversal study. MATERIAL AND METHODS: 34 patients (28 with missed abortion and 6 with anembrioned pregnancy) to whom mysoprostol was administered at the dosis of 100 ug, every 4 hours for 4 doses. RESULTS: Success was obtained in 95%, as 28 patients (82.4%) expulsed products of conception and 4 patients (11.7%) had cervical modifications that permited emergency ditalation and curettage. In 75% result was obtained with the second dosis of the product, without associated complications. There were 2 failures. We did not find differences in gestational age, parity, and number of applications required. CONCLUSION: Mysoprostol is an efficacious drug with low cost.

The digenesia Müller ducts or agenesis of the uterus and vagina, known as Mayer-Rokitansky-Kuster-Hauser syndrome is a disorder of the female reproductive characterized by primary amenorrhea and abnormalities associated with urogenital tract. We present six cases of patients with Mayer-Rokitansky syndrome, describe the clinical presentation, management, and we review the literature.

The digenesia Müller ducts or agenesis of the uterus and vagina, known as Mayer-Rokitansky-Kuster-Hauser syndrome is a disorder of the female reproductive characterized by primary amenorrhea and abnormalities associated with urogenital tract. We present six cases of patients with Mayer-Rokitansky syndrome, describe the clinical presentation, management, and we review the literature.

OBJECTIVE: To evaluate the efficacy of intravaginal mysoprostol to induce abortion in patients with intrauterine fetal death. DESIGN: Prospective, transversal study. MATERIAL AND METHODS: 34 patients (28 with missed abortion and 6 with anembrioned pregnancy) to whom mysoprostol was administered at the dosis of 100 ug, every 4 hours for 4 doses. RESULTS: Success was obtained in 95%, as 28 patients (82.4%) expulsed products of conception and 4 patients (11.7%) had cervical modifications that permited emergency ditalation and curettage. In 75% result was obtained with the second dosis of the product, without associated complications. There were 2 failures. We did not find differences in gestational age, parity, and number of applications required. CONCLUSION: Mysoprostol is an efficacious drug with low cost.

A case-control study was designed to evaluate risk factors for gestational trophoblastic disease. At Arzobispo Loayza Hospital, between 1984 lo 1992. The incidence of hydatidyforme mole was 4,711000 deliveries. Mean age of the study group was 28,42 years. High school level of education was associated with lower risk (OR=0,48; CI=0,233-0,98). Socioeconomic status was not related to risk. No effect of protection or risk was related to the parity of the patients. Women with the disease bad an average age at first pregnancy (19,97 years) lower than that of controls (21,22 years). The personal history of previous gestational trophoblastic disease was associated with an odds ratio of 6.51; however, it was without significance (p=0,101).

To determine the incidence and characteristics of presentation of endometriosis patients with infertility. DESIGN: In a retrospective study of medical records of 2720 patients attending the Infertility Clinic of the Archbishop Loayza Hospital, between the months of January 1993 and July 1997 was revised RESULTS: Of the 532 patients underwent laparoscopy or laparotomy and 773 cases of endometriosis was found, representing 32.5%. They entered the study 166 cases that met the inclusion criteria. The age of the patients was 33.3 ± 4.9 years (mean ± standard deviation). 59% of the cases occurred in stage I of endometriosis. Most patients (59.6%) had primary infertility and infertility average time was 51.2 (± 38.4) months. 75.9% of the patients had some type of symptoms, primarily pain (dysmenorrhea, dyspareunia, chronic pelvic pain), but only 25.9% had alterations in the pelvic exam. 66% ...

To determine the incidence and characteristics of presentation of endometriosis patients with infertility. DESIGN: In a retrospective study of medical records of 2720 patients attending the Infertility Clinic of the Archbishop Loayza Hospital, between the months of January 1993 and July 1997 was revised RESULTS: Of the 532 patients underwent laparoscopy or laparotomy and 773 cases of endometriosis was found, representing 32.5%. They entered the study 166 cases that met the inclusion criteria. The age of the patients was 33.3 ± 4.9 years (mean ± standard deviation). 59% of the cases occurred in stage I of endometriosis. Most patients (59.6%) had primary infertility and infertility average time was 51.2 (± 38.4) months. 75.9% of the patients had some type of symptoms, primarily pain (dysmenorrhea, dyspareunia, chronic pelvic pain), but only 25.9% had alterations in the pelvic exam. 66% ...

A case-control study was designed to evaluate risk factors for gestational trophoblastic disease. At Arzobispo Loayza Hospital, between 1984 lo 1992. The incidence of hydatidyforme mole was 4,711000 deliveries. Mean age of the study group was 28,42 years. High school level of education was associated with lower risk (OR=0,48; CI=0,233-0,98). Socioeconomic status was not related to risk. No effect of protection or risk was related to the parity of the patients. Women with the disease bad an average age at first pregnancy (19,97 years) lower than that of controls (21,22 years). The personal history of previous gestational trophoblastic disease was associated with an odds ratio of 6.51; however, it was without significance (p=0,101).

Objective: To determine the current status of male infertility in a general hospital. Design: Descriptive, retrospective study. Material and Methods: We reviewed 371 charts of male patients attended at Arzobispo Loayza Hospital Infertility Service in a 4 - year period. Inclusion criteria were male infertility diagnosis with pathological results in two or more spermatograms and/or ejaculatory sexual dysfunction. Results: We found 79 cases of male infertility, incidence 21,3%. Average age at diagnosis was 35, 9 years, average time of infertility 4 years, 64,8% with primary infertility. Most frequent diagnosis were infection of accessory sexual glands (38%), abnormal seminal plasma (16,5%), azoospermia (15,2%), idiopathic astenozoospermia (12, 7%). Most frequent germ found was hemolytic Streptococcus alpha (50%). 22,8% of the couples conceived mostly with antibiotics use, intrauterine insem...