ABSTRACT
La pandemia de SARS-CoV-2 es una emergencia sanitaria sin precedentes, que ha implicado un reordenamiento en la priorización de procedimientos médicos electivos, frente a un potencial colapso del sistema de salud a nivel mundial y riesgo de contagio del personal y pacientes. Al igual que en el resto del mundo, en Chile la mayoría de los centros de medicina reproductiva han debido suspender sus diferentes terapias de reproducción asistida (TRA). Sin embargo, a raiz de la disminución del número de contagios y mayor evidencia científica disponible, la Sociedad Europea de Reproducción Humana y Embriología (ESHRE) ha recomendado reiniciar los ciclos de medicina reproductiva de forma gradual, a través de sistemas de triage, priorizando pacientes por medio de la generación de distintos escenarios. Considerando esta recomendación, se realizó una revisión sobre la evidencia existente respecto a SARS-CoV-2 / COVID-19 en medicina reproductiva recopilando diferentes directrices de las principales sociedades internacionales, con el objetivo de generar una recomendación ajustada a la realidad nacional.
SARS-CoV-2 pandemic is an unprecedented health emergency, which involves a reorganization of elective procedures, facing a potential global health system collapse. In Chile, as in the rest of the world. most reproductive medicine centers have suspended their different assisted reproduction therapies (ART). However, due to the decrease in the number of infections and due to a greater collection of scientific evidence, the European Society for Human Reproduction and Embryology (ESHRE) have recommended restarting cycles gradually through triage systems, prioritizing patients through the generation of different scenarios. With this in mind, we carried out a review of the existing evidence so far regarding SARS-CoV-2 and reproductive medicine, and we tried to compile the different guidelines of the main international societies, to generate a recommendation adjusted to our local scenario.
Subject(s)
Humans , Female , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Reproductive Medicine/standards , Reproductive Techniques, Assisted/standards , Betacoronavirus , Ovulation Induction , Fertilization in Vitro , Triage , Practice Guidelines as Topic , Patient Selection , Embryo Transfer , Pandemics/prevention & controlABSTRACT
Abstract Objective 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 formost 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 LatinAmerica, 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
Resumo Objetivo Comparar os registros das técnicas de reprodução assistida da América Latina e da Europa em relação à qualidade dos dados e acesso, utilização do tratamento, efetividade, segurança e qualidade dos serviços. Métodos Estudo ecológico usando os dados das publicações científicas dos registros da América Latina e da Europa com os ciclos iniciados durante o ano de 2013 (que são os dadosmais recentes disponíveis até dezembro de 2017). Os dados são apresentados como porcentagens, valores mínimos e máximos e números absolutos. Resultados Em comum, vemos que o número de clínicas e de ciclos de tratamento varia bastante entre os países dentro de cada região emambos os registros, embora o acesso às técnicas de reprodução assistida seja 15 vezes maior na Europa. Na América Latina, os serviços reportam voluntariamente os ciclos iniciados até o cancelamento, o nascimento ou aborto, enquanto que na Europa o que é reportado varia entre os países. Isso faz o registro da América Latina mais uniforme, apesar de ser menos representativo quando comparado ao Europeu, dado o caráter compulsório na maioria dos países deste último. A taxa de gravidez cumulativa, idade feminina, uso de injeção intracitoplasmática de espermatozoides (ICSI), ciclos comtransferência ≥ 3 embriões e taxa de gestação múltipla foram mais elevados na América Latina. Complicações da reprodução assistida, como síndrome de hiperestimulação ovariana, hemorragia, e infecções também foram mais comuns na América Latina, embora sejam incomuns em ambas as regiões. Conclusão Ambas as regiões têm pontos a melhorar na qualidade dos registros. A América Latina tem produzido um registro mais uniforme, e seus resultados clínicos são comparáveis e, algumas vezes, superiores aos Europeus. Por outro lado, a segurança do tratamento foi maior na Europa, com menores taxas de complicações, especialmente gestações múltiplas.
Subject(s)
Humans , Male , Female , Pregnancy , Registries , Reproductive Techniques, Assisted , Databases, Factual , Europe , Latin AmericaABSTRACT
The therapeutic decision for male infertility with varicocele is difficult and controversial, which requires the consideration of the patient's purpose of seeking medical help. The treatment of this condition involves not only surgery, but also medication and assisted reproductive technique (ART), and synergetic effects can be achieved by combination of the three options. In making a therapeutic decision, all related factors should be taken into full consideration.
Subject(s)
Humans , Male , Clinical Decision-Making , Infertility, Male , Therapeutics , Reproductive Techniques, Assisted , Varicocele , TherapeuticsABSTRACT
In an age when a small quantity of sperm can lead to pregnancy through in vitro fertilization or intracytoplasmic sperm injection, selecting healthy sperm is important. Sperm DNA fragmentation (SDF) is known to be higher in infertile men. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and the alkaline comet test are SDF tests that directly measure DNA damage and have shown closer correlations with assisted reproduction results than indirect tools such as the sperm chromatin structure assay or the sperm chromatic dispersion test. It is difficult; however, to endorse a single test as the best test overall; instead, it is best to select a testing method based on each patient's clinical condition and goals. In a couple struggling with infertility, if the male partner has a high level of SDF, he should aim to decrease SDF through lifestyle modifications, antioxidant treatment, and ensuring an appropriate duration of abstinence, and physicians need to treat the underlying diseases of such patients. If sperm DNA damage continues despite the patient's and physician's efforts, other methods, such as micromanipulation-based sperm selection or testicular sperm extraction, should be used to select healthy sperm with nuclear DNA integrity.
Subject(s)
Humans , Male , Pregnancy , Chromatin , Deoxyuridine , DNA Damage , DNA Fragmentation , DNA , Fertilization in Vitro , Infertility , Life Style , Methods , Reproduction , Reproductive Techniques, Assisted , Sperm Injections, Intracytoplasmic , SpermatozoaABSTRACT
In recent years,assisted reproductive technology(ART)is developing rapidly,especially in vitro fertilization and embryo transfer(IVF-ET)technology.The rate of clinical pregnancy in our country is about 40％,and how to improve the rate of clinical pregnancy of IVF-ET has been the focus of the scholars research content.Environmental factors including culture system,temperature,humidity,pH value and volatile organic compounds,all of these can affect the success of IVF-ET.Now the common environmental factors affecting IVF-ET research progress were reviewed as follows.
ABSTRACT
Objective To investigate the effect of abnormality Y chromosome and sperm quality on the clinical result of insisted reproductive technique (ART). Methods We retrospectively analyzed the effect of ab-normality Y chromosome and sperm quality on embryo quality/result of pregnancy of patients undergoing ART. In-fertile men with normality Y chromosome (n=436) and with abnormality Y chromosome (n =146) from Jan 2010 to Dec 2010 were enrolled in this study. The infertile men were divided into four groups: the normality Y chromo-some plus teratozoospermia group , the normality Y chromosome plus normal sperm quality group , the abnormality Y chromosome plus teratozoospermia group, the abnormality Y chromosome plus normal sperm quality group. Embryo quality and the results of clinic pregnancy outcome were analyzed among the four groups. Results Fertilization rate of the four groups was 73.4%, 69.0%, 70.9% and 68%, respectively (P < 0.05). No significant differences were found in thecleavage rate, optimal embryo rate and pregnancy outcome among the four groups. Conclusions Both abnormality Y chromosome length and teratozoospermia may be affect the fertility rate of the infertile men undergoing IVF/ICSI.
ABSTRACT
To investigate the questions that Muslim patients, embryologists, paramedics, clinical counsellor and doctors may have pertaining to the compliance of Assisted Reproductive Technique (ART) to Shari’aa. Methods: As a preliminary study, an open-ended survey was administered to participants. Participants for the survey comprised of 21 patients, 2 embryologists, 2 doctors, 4 paramedics and 1 counsellor. Results: Data analysis showed that most of the participants posed questions that fall into six classifications which are: Munakahat (Family Law), social Hukm, Fiqh Ibadah, Fiqh Qadha (Islamic Hukm), General Fiqh and Usul Fiqh. Conclusion: It is clear that even though the participants were rather familiar with some of the existing Fatwas pertaining to ART and IVF in Malaysia, there are still remaining doubts which need to be clarified. This indicates that there are challenges faced in seeking and providing ART treatment to Muslim patients. This needs to be addressed perhaps in the form of Shari’aa-compliant guidelines to provide a clear explanation of each process and procedure in fertility treatment.
ABSTRACT
Objective To study the expression of tight junction factors in human placental tissues derived from assisted reproductive technology (ART) and natural pregnancy and its role in placental barrier.Methods Ten placental samples were collected from the women who had undergone ART treatment and 11 placenta were collected from control group.Transmission electron microscope (TEM) examination was utilized to detect the morphology of placental tight junctions.The mRNA of claudin (CLDN) 1,CLDN4,CLDN5,CLDN8,zonula occudens (ZO) 1 was detected by real-time PCR and the protein of CLDN4,CLDN8 and occludin (OCLN) were measured by western blot.Results TEM microscopy results showed that placenta samples derived both ART and control placenta had normal microscopic histological features of tight junctions,localized in the apical part of the syncytium and also between the cell-cell contacts of fetal blood vessel endothelial.The expression level of CLDN4 mRNA were 0.87 ±0.17 in ART group and 1.18 ± 0.30 in control group,respectively.The expression level of CLDN8 mRNA were 3.25 ± 2.32 in ART group and 1.08±0.41 in control group,respectively.The mRNA level of CLDN4 and CLDN8 were significantly differentially expressed in ART derived placenta when compared with control groups.The expression level of CLDN1,CLDN5,OCLN and ZO1 mRNA were 0.49 ± 0.44,0.80 ± 0.20,0.92 ± 0.18 in ART group and 1.09±0.82,1.21 ±0.78,0.80± 0.27 in control group,respectively,in which there were no significant differences between two groups.Western Blot analysis showed the protein levels of tight junctions CLDN4,CLDN8 and OCLN did not differ between groups.Conclusions Tight junction factors were expressed in human placental tissues.Tight junction derived from ATR platenta might have mild dysfunction.
ABSTRACT
Physiological function of reactive oxygen species (ROS) has been known since a long, but recently toxic effects of ROS on spermatozoa have gained much importance in male infertility. Mitochondrial DNA (mtDNA) is believed to be both source and target of ROS. mtDNA unlike nuclear DNA is not compactly packed and hence more susceptible to oxidative stress (OS) than nuclear DNA. In the present study, the role of OS in mitochondrial genome changes was studied in men with idiopathic infertility. The study included 33 infertile oligo-asthenozoospermic (OA) men and 30 fertile controls. Semen analyses were performed and OS was measured by estimating the level of malondialdehye (MDA) in the seminal plasma and ROS in the sperm. Sperm mtDNA was sequenced by standard PCR-DNA sequencing protocol for ATPase and nicotinamide adenine dinucleotide dehydrogenase (ND) groups of genes. Sperm count and progressive motility were found to be significantly lower in infertile group than the fertile controls. Semen MDA and ROS levels of infertile group were significantly higher (p<0.0001), when compared to the control group. However, catalase and glutathione peroxidase (GPx) levels were significantly lower in infertile group, compared to controls, but no significant difference in superoxide dismutase (SOD) activity was observed between control and cases. This might be due to higher expression of SOD alone in order to overcome OS in the semen. mtDNA analysis showed significant and high frequency of nucleotide changes in the ATPase (6 and 8), ND (2, 3, 4 and 5) genes of infertile cases compared to the controls. Hence excess ROS and low antioxidant levels in the semen might cause mtDNA mutations and vice versa in OA men that might impair the fertilizing capacity of spermatozoa. Thus, it is important to understand the etiology of mitochondrial genome mutations in idiopathic OA cases for better diagnostic and prognostic value in infertility treatment/assisted reproductive technique
Subject(s)
Adult , Antioxidants/metabolism , Asthenozoospermia/genetics , Asthenozoospermia/metabolism , Case-Control Studies , DNA, Mitochondrial/genetics , Humans , Male , Mutation , Oligospermia/genetics , Oligospermia/metabolism , Oxidative Stress , Semen/metabolism , Spermatozoa/metabolism , Spermatozoa/pathology , Spermatozoa/ultrastructureABSTRACT
The recent advancement of Assisted Reproductive Techniques (ART) has been problematic for the diagnosis and treatment of male infertility. Instead of exploring in depth the nature of the male infertility to achieve a natural pregnancy, ART concentrates mainly on obtaining a sperm for the purpose of fertilizing the ovum. This approach favors fertilization over the correction of male infertility and therefore often overlooks appropriate treatment options. In other words, ART is not consistent with bioethical practices and can lead to unfortunate outcomes for many infertile men. In particular, varicocelectomy, vasovasostomy, and epididymovasostomy result in high pregnancy rates when compared with ART. Moreover, redo-vasovasostomy has also been found to produce high pregnancy rates when the first trial proved unsuccessful. Twenty-five percent of male infertility cases diagnosed by semen analysis are deemed idiopathic. For the remaining seventy-five percent, however, the cause of infertility can be identified. Therefore, the primary approach to infertility should be to treat the underlying cause and thereby enable natural pregnancy to occur.
Subject(s)
Humans , Male , Male , Pregnancy , Diagnosis , Fertilization , Infertility , Infertility, Male , Ovum , Pregnancy Rate , Reproductive Techniques, Assisted , Semen Analysis , Spermatozoa , VasovasostomyABSTRACT
Accurate diagnosis and evaluation of surgically uncorrectable azoospermia are essential for appropriate treatment and intervention. This article summarized the latest ideas and issues in male infertility. The state of art is reviewed, including diagnostic tools for azoospermic men, sperm retrieval techniques, as well as assisted reproductive technique currently issued. Coupled with sperm retrieval, intracytoplasmic sperm injection(ICSI) has dramatically changed the treatment of surgically uncorrectable azoospermia. Despite severely impaired spermatogenesis, men with the finding of focal spermatogenesis in the testis biopsy specimens have become candidates for treatment. These couples should not only be counseled regarding the possibility of passing infertility to the offspring but also informed that genetic abnormalities may exist. Microsurgical reconstruction remains the treatment of choice for men with reconstructable obstructive azoospermia. Sperm retrieval techniques performed with ICSI are highly effective for men in whom reconstruction is not feasible and with impaired spermatogenesis.