Effect of dyslipidemia on clinical outcome of infertility patients receiving donor eggs / 中华妇产科杂志

Objective:To explore the effect of dyslipidemia on the clinical outcome of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in infertility patients receiving donor eggs.Methods:A total of 118 patients were selected to receive egg donors and ICSI-ET at the First Affiliated Hospital of Nanjing Medical University between April 2007 and December 2020. According to the levels of triacylglycerol, serum cholesterol, high density lipoprotein (HDL), and low density lipoprotein, they were divided into dyslipidemia group (35 cases) and normal blood lipids group (83 cases). The influence of body mass index (BMI) and age was adjusted by 1∶1 propensity score matching, and the general condition and clinical outcome of the two groups were analyzed retrospectively. Finally, the relationship between lipid composition and clinical outcome was analyzed according to patients′ age and BMI.Results:(1) Comparing the pre-matching dyslipidemia group with the normal blood lipids group, the BMI of the dyslipidemia group was significantly higher than that of the normal blood lipids group [(23.5±2.4) vs (22.4±2.7) kg/m 2], and the embryo implantation rate was significantly lower than that of the normal blood lipids group [13.6% (8/59) vs 27.3% (36/132)], the differences were statistically significant (both P<0.05). (2) There were no significant differences in years of infertility, number of pregnancies, number of abortions, number of transplanted embryos, protocol of endometrial preparation, endometrial thickness on transplantation day and high quality embryo rate between the two groups, through propensity score matching (all P>0.05). The biochemical pregnancy rate [28.6% (10/35)], embryo implantation rate [13.6% (8/59)] and live birth rate [20.0% (7/35)] in dyslipidemia group were significantly lower than those in the normal blood lipids group ( P<0.05). The clinical pregnancy rate was lower than that of the normal blood lipids group ( P>0.05). (3) The results of stratified analysis showed that the level of HDL in the clinically non-pregnant group was significantly lower than that in the pregnant group in patients ≤ 35 years old [(1.5±0.3) vs (1.8±0.5) mmol/L; P<0.05]. In the overweight recipient patients, the level of HDL of the clinically non-pregnant group was lower than that of the pregnant group ( P>0.05). Conclusions:Dyslipidemia significantly reduces the biochemical pregnancy rate, embryo implantation rate and live birth rate in patients with receiving donor eggs. Especially in patients aged ≤35 years old, the reduction of HDL is closely related to adverse pregnancy outcomes.

Effect of the number of previous spontaneous abortions on the first in vitro fertilization cycle / 中华妇产科杂志

Objective@#To investigate the effect of the number of previous spontaneous abortions on the first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycle.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 1 279 patients who received IVF/ICSI treatment for the first time from July 2014 to July 2018 in Tianjin Central Hospital of Gynecology Obstetrics;they were divided into 0 time group (group A, n=924), 1 time group (group B, n=267) and 2 times group (group C, n=88) for comparison, according to the previous frequency of spontaneous abortions.@*Results@#There were no statistically significant differences in age, basal testosterone, estradiol, progesterone, prolactin and embryo quality in group A, B and C (all P>0.05). The biochemical pregnancy rate of group C (9.1%) was higher than those of the other two groups (4.1% and 4.1%; all P>0.05). The clinical pregnancy rate of group A (42.5%) [>group B (40.4%) and >group C (35.2%)] was not statistically significant(P>0.05).Early abortion rate in group A (8.9%) was<group B (15.7%), also <group C (38.7%), there were significant differences (all P<0.05).The live birth rate of group C (21.6%) was significantly lower than that of group A (35.5%; P<0.05), but the difference between group C and group B (30.7%) was not statistically significant (P>0.05).@*Conclusions@#Women with a history of one- or two-time spontaneous abortion have no obvious effect on embryo quality, and have a negative impact of clinical pregnancy rate, early abortion rate, live birth rate in the first IVF/ICSI cycle; especially for patients with a history of two times spontaneous abortion, early abortion rate has a significant increase, live birth rate decreases significantly, suggesting that patients with a history of two times of spontaneous abortion should find the causes of miscarriage according to the process of recurrent spontaneous miscarriage and receive treatment if necessary before subsequent pregnancy.

Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study / 中华医学杂志(英文版)

Background@#With the development of assisted reproductive technology (ART) and its increasing success rate in the mainland of China, more attention has been paid to the safety of ART. In this study, we explored the associations between conception by ART and pregnancy/perinatal complications, and neonatal outcomes compared with similar outcomes following spontaneous conception.@*Methods@#This retrospective cohort study of pregnancies over a 3-year period (2013-2015) was performed at Beijing Obstetrics and Gynecology Hospital, Beijing, China. Subjects were divided into two groups: conception by ART (n = 2256) or spontaneous conception (n = 6768). According to different fertilization modes, the ART group was divided into in vitro fertilization (IVF, n = 1873) and intracytoplasmic sperm injection (ICSI, n = 383) subgroups. The ART group was also divided into two different embryo transfer methods; fresh embryo transfer (ET, n = 1583) and frozen embryo transfer (FET, n = 673) subgroups. Pregnancy complications, perinatal complications, and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.@*Results@#After adjustment for maternal age, gravidity, parity, maternal education, smoking, alcohol consumption, and body mass index (BMI), pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus (GDM; OR 1.88, 95% CI 1.56-2.27), gestational hypertension (OR 2.18, 95% CI 1.83-2.60), and intrahepatic cholestasis of pregnancy (ICP) (OR 2.79, 95% CI 2.15-3.64), compared with spontaneous conception. These associations were similar for the singleton group. In the twin group, only the incidence of ICP was significantly higher than in controls. We found that pregnancies conceived by ART were associated with perinatal complications, including placental abruption (OR 2.14, 95% CI 1.33-3.45), premature rupture of membranes (PROM; OR 1.24, 95% CI 1.06-1.45), postpartum hemorrhage (OR 2.89, 95% CI 2.33-3.59) and polyhydramnios (OR 2.01, 95% CI 1.29-3.16). The singleton group had a similar result with placental abruption, but not with fetal membranes ruptures before labor and polyhydramnios. There were no significant differences in the incidence of these perinatal complications in the twin group. Some neonatal outcomes, including preterm labor (OR 4.29, 95% CI 3.84-4.80) and low birth weight (OR 1.72, 95% CI 1.42-2.08), were more likely to occur with singleton births after ART. However, there were no significant differences for these outcomes from twin pregnancies. Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups. The FET and ET subgroups showed a similar increase in complications, except for the incidence of placental abruption. After taking into account the effects of parity, birth plurality and maternal age, the ART group still exhibited increased maternal and neonatal complications, although some differences narrowed or disappeared.@*Conclusions@#This retrospective cohort study demonstrated that patients who underwent ART were at increased risk of several adverse pregnancy outcomes compared with women who conceived spontaneously. These complications may be attributed in part to the relatively high multiple pregnancy rate after ART. Elective single embryo transfer should be promoted in China to reduce the obstetrical risks of ART pregnancy. Singletons of ART pregnancy exhibited increased maternal and neonatal complications as well, suggesting that underlying infertility or other maternal or parental factors may contribute to the adverse outcomes.

Male Inflammatory Parameters Are not Useful to Predict the Outcomes of Intracytoplasmic Sperm Injection: Results from a Cross-Sectional Study

PURPOSE: The relationship between male systemic inflammation and fertility seems intriguing, but no data about its impact on the assisted reproductive technology outcomes has been reported. Here, we aimed to evaluate the prognostic role of male systemic inflammatory parameters in intracytoplasmic sperm injection (ICSI) outcomes prediction, in couples undergoing an ovum donation program. MATERIALS AND METHODS: From January 2016 to December 2017, one hundred-ten couples were considered for this cross-sectional study. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-eosinophil ratio (MER), platelet-to-lymphocyte ratio (PLR), seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate (PR) were evaluated. Male patients were divided into Group A with FR ≤70%, Group B with FR >70%. RESULTS: Overall, FR was 74.5%, CR 90.9%, PR 41.8%. Group A included 43 patients, Group B 67 men. Group A showed a median NLR of 1.55, PLR of 106.09, MER of 2.33. Group B reported a median NLR of 1.64, PLR 109.0, MER 2.76. We found no statistically differences between two groups with respect to NLR, PLR, MER (p=0.90, p=0.70, p=0.96, respectively). The age-adjusted linear regression analysis demonstrated only a relationship between NLR and sperm motility count (r=−0.02; p<0.05). Using the univariate logistic regression analysis, we found no significant associations. CONCLUSIONS: We did not find any relationship between ICSI outcomes and male inflammation parameters.

Effects of acupuncture on ovarian blood supply and pregnancy outcomes in patients receiving assisted reproduction / 针灸推拿医学（英文版）

Objective:To observe the effects of acupuncture at the follicular phase on ovarian blood supply and pregnancy outcomes in patients who received in vitro fertilization/intracytoplasmic sperm injection-embry transfer (IVF/ICSI-ET) of assisted reproductive technology (ART).Methods:A total of 169 IVF/ICSI-ET female recipients from the Reproductive Center of Xiehe Hospital,Tongji Medical College,Huazhong University of Science & Technology were randomized into an observation group (57 cases),a placebo group (54 cases) and a control group (58 cases).The observation group received acupuncture during the follicular phase,meanwhile the placebo group received placebo-acupuncture,and the control group did not receive acupuncture.The hemodynamic index,biochemical pregnancy rate and clinical pregnancy rate of each group were observed,respectively.Results:As to the ovarian arterial hemodynamic index,the pulsatility index (PI),resistance index (RI),and the systolic-to-diastolic peak velocity ratio (S/D) of the observation group were (0.819±0.131),(0.552±0.055) and (2.306±0.512),respectively,obviously lower than those in the placebo group and the control group,and the differences were statistically significant (all P＜0.05),but there were no statistically significant differences between the placebo group and the control group (all P＞0.05).As to the biochemical pregnancy rate and clinical pregnancy rate,the biochemical pregnancy rate in the observation group was 64.9％ and the clinical pregnancy rate was 52.6％,which were significantly higher than those in the placebo group and the control group,and the differences were statistically significant (all P＜0.05),while there were no significant differences between the placebo group and the control group (both P＞0.05).Conclusion:Acupuncture treatment during the follicular phase can improve ovarian blood supply and pregnancy rate in those receiving IVF/ICSI-ET.

Effects of dyslipidemia on IVF/ICSI pregnancy outcome in patients with polycystic ovary syndrome / 中华妇产科杂志

Objective To investigate the impact of dyslipidemia on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcome in patients with polycystic ovary syndrome (PCOS).Methods From July 2013 to March 2016,468 PCOS patients with antagonist protocol in IVF/ICSI of First Affiliated Hospital of Nanjing Medical University,cycles were divided into dyslipidemia group (108 cases) and normol blood lipids group (360 cases) according to the serum cholesterol,triglyceride (TG),high-density lipoprotein,low density lipoprotein levels.The general condition and clinical outcomes of the two groups were analyzed retrospectively,including the implantation rate,clinical pregnancy rate,live birth rate and the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS),etc.Besides,stratified analysis and multivariate logistic regression analysis were used to correct the impact of body mass index (BMI).Results (1) Comparing the based data of dyslipidemia group and normal blood lipids group:age,years of infertility,basic FSH,basic LH,basic estradiol and other indexes had no significant differences (all P＞0.05),but BMI of dyslipidemia group was significantly higher than normal blood lipids group [(25.0±3.0) versus (23.1±3.0) kg/m2],difference had statistical significance (P＜0.01).(2) The high score embryo rate,endometrial thickness on the day of hCG injection,progesterone and LH levels on the day of hCG injection,moderate to severe OHSS rate and miscarriage rate in the two groups did not exhibit remarkable differences (all P＞0.05).However,the number of dominant follicle,retrieved oocyte number,estrogen level on the day of hCG injection,implantation rate,biochemical pregnancy rate,clinical pregnancy rate and the live birth rate in dyslipidemia group were significantly less than those of normal blood lipids group (all P＜0.05),the dose of gonadotropin (Gn) and days of stimulation were significantly higher compared with the normal blood lipids group,there were significant differences statistically (all P＜0.05).(3) Stratified analysis showed that no matter in BMI＜24 or BMI≥24 kg/m2 group,the dose of Gn and days of stimulation were significantly higher in the dyslipidemia group than those of the normal blood lipids group,the difference was statistically significant (P＜0.05).However,the number of oocytes retrieved,estrogen level on the day of hCG injection had obvious downtrend,and the difference was statistically significant (P＜0.05) in BMI≥24 kg/m2 group.Multivariate logistic regression analysis found that,even after the correction of BMI,dyslipidemia still had negative impact on implantation rate,biochemical pregnancy rate,clinical pregnancy rate and the live birth rate (P＜0.05).(4) Further analysis of the different components of blood lipids in the clinical pregnancy group and unobtained pregnancy group revealed that the level of triglyceride (TG) in the unobtained pregnancy group was significantly higher than that in the pregnancy group,and the difference was statistically significant (P＜0.05);logistic regression analysis also showed that the increase of TG levels was negatively correlated with the clinical pregnancy rate of PCOS patients (P＜0.05).Conclusions PCOS patients combined with dyslipidemia have a higher BMI,and dyslipidemia increases the dosage of Gn,reduces the implantation rate,clinical pregnancy rate and live birth rate,especially the increase of TG level,which has adverse effects on IVF/ICSI outcome in patients with PCOS.

The association of follicular fluid volume with human oolemma stretchability during intracytoplasmic sperm injection / 대한생식의학회지

OBJECTIVE: Oocyte degeneration often occurs after intracytoplasmic sperm injection (ICSI), and the risk factor is low-quality oocytes. The follicular fluid (FF) provides a crucial microenvironment for oocyte development. We investigated the relationships between the FF volume aspirated from individual follicles and oocyte retrieval, oocyte maturity, oolemma stretchability, fertilization, and development. METHODS: This retrospective study included data obtained from 229 ICSI cycles. Ovarian stimulation was performed according to a gonadotropin-releasing hormone antagonist protocol. Each follicle was individually aspirated and divided into six groups according to FF volume (<1.0, 1.0 to <2.0, 2.0 to <3.0, 3.0 to <4.0, 4.0 to <5.0, and ≥5.0 mL). Oolemma stretchability during ICSI was evaluated using a mechanical stimulus for oolemma penetration, that is, the stretchability was assessed by oolemma penetration with aspiration (high stretchability) or without aspiration (low stretchability). RESULTS: Oocyte retrieval rates were significantly lower in the <1.0 mL group than in the ≥1.0 mL groups (46.0% [86/187] vs. 67.5%–74.3% [172/255 to 124/167], respectively; p<0.01). Low oolemma stretchability was significantly more common in the <1.0 mL group than in the ≥1.0 mL groups during ICSI (22.0% [13/59] vs. 5.8%–9.4% [6/104 to 13/139], respectively; p=0.018). There was a relationship between FF volume and oolemma stretchability. However, there were no significant differences in the rates of fertilization, cleavage, ≥7 cells at day 3, and blastocyst development among all groups. CONCLUSION: FF volume is potentially associated with the stretchability of metaphase II oolemma during ICSI. Regarding oolemma stretchability, ensuring a uniform follicular size during ovarian stimulation is crucial to obtain good-quality oocytes.

ICSI significantly improved the pregnancy rate of patients with a high sperm DNA fragmentation index / 대한생식의학회지

OBJECTIVE: Correlations between semen parameters and sperm DNA fragmentation index (DFI) were investigated to identify characteristics of sperm without DNA damage that could be used in selecting sperm for intracytoplasmic sperm injection (ICSI). Pregnancy outcomes were compared to determine whether in vitro fertilization (IVF) or ICSI is a better choice for patients who have sperm with a high-DFI. METHODS: Semen analysis was carried out in 388 patients who visited our IVF center for the first time to investigate correlations between sperm DFI and semen parameters. In addition, 1,102 IVF cycles in 867 patients were carried out in the present study; 921 cycles in the low-DFI group (DFI <30%) and 181 cycles in the high-DFI group (DFI ≥30%). Both the low- and high-DFI groups were subdivided into IVF and ICSI cycle groups. RESULTS: Sperm DFI showed significant inverse correlations with sperm motility (r=−0.435, p<0.001) and morphology (r=−0.153, p<0.05). Sperm DFI also showed significant correlations with rapid motility (r=−0.436, p<0.001), and the kinetic parameters of average-path velocity (r=−0.403) and linearity (r=−0.412). Although there was no significant difference in the pregnancy rates between IVF (48.6%) and ICSI (44.8%) in the low-DFI group, the pregnancy rate of ICSI cycles (44.8%, p<0.05) was significantly higher than IVF cycles (25.0%) in the high-DFI group. No significant difference was observed in the abortion rates between the low-DFI (52 of 921, 5.6%) and high-DFI groups (7 of 181, 3.8%). CONCLUSION: ICSI is a better choice than IVF for improving the pregnancy outcomes of patients who have sperm with a high DFI.

Effects of fertilization methods and sperm sources on the developmental capacity of surplus embryos / 重庆医学

Objective To analyze the effects of fertilization methods and sperm sources in intra‐cytoplasmic sperm injection (ICSI) on the developmental capacity of surplus embryos .Methods A retrospective study was carried out to compare the blasto‐cyst rate of the surplus embryos from 2 697 patients .According to the fertilization methods ,the embryos were divided into IVF group and ICSI group .According to sperm sources ,the ICSI group was divided into ejaculated group and testicular sperm group . The rates of blastocyst formation and good quality blastocysts were compared between different fertilization methods and sperm sources .Results There were 8 426 embryo developed in 2 697 patients .The blastocyst formation rate of surplus embryos was high‐er in the IVF group(n=1 048 ,53 .18% ) than that in the ICSI group(n=1 378 ,49 .27% ) ,but with no statistically significant differ‐ent(P> 0 .05) .The rates of blastocyst were not statistically significant different between the IVF group and in the rescue ICSI group(P>0 .05) .The rates of blastocyst were not statistically significant different between the ejaculated group and the testicular sperm group(P>0 .05) .Conclusion There were not statistically significant different of the rate of blastocyst between different fer‐tilization methods and sperm sources in ICSI .

Pregnancy and birth after intracytoplasmic sperm injection with normal testicular spermatozoa in a patient with azoospermia and tail stump epididymal sperm

Main findings: An intriguing yet perplexing case report of a successful pregnancy and live birth with intracytoplasmic sperm injection using normal testicular sperm, after the finding of azoospermia in the semen analysis and discovering only tail stump abnormal sperm in the epididymis. Case hypothesis: A tail stump sperm defect of genetic origin was suspected. However, after obtaining normal testicular sperm we concluded that obstructive azoospermia, either idiopathic or secondary to multiple minor genital trauma was the plausible scenario. This has rendered the search of previous reports on a similar condition, but none was found. However, it has raised scientific thoughts for future research. Promising future implications: The importance of reporting this case is to alert urologists performing sperm retrieval that healthy and morphologically normal sperm may be found in the testis of azoospermic men with 100% tail stump epididymal sperm. Retrieval of normal testicular sperm obviates the need of a more complex investigation, including sperm electron microscopy. It also offers the possibility of utilizing such gametes for sperm injections rather than abnormal tail stump sperm that may be associated with a poor reproductive outcome.

Influence of basic thyroid-stimulating hormone levels on outcomes of IVF/ICSI in Qinghai / 中华妇产科杂志

Objective To study basic thyroid stimulating hormone (bTSH) levels impact on outcomes of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in Qinghai.Methods Totally 282 cases with IVF cycles and 93 cases with ICSI cycles were studied prospectively,according to bTSH level,patients were divided into four groups.Reproduction rate,clinical pregnancy rate,miscarriage rate and live birth rate were studied among four groups.Results (1) In 375 cases with IVF/ICSI cycles,bTSH was positively correlated with abortion rate (r=0.42,P=0.04),but live birth rate and growing rate showed negative correlations with bTSH (r=-0.42,-0.28; P=0.04,0.03).bTSH and the number of eggs,the number of fertilized eggs,the number of embryos,biochemical pregnancy rate,and clinical pregnancy rate were no significant correlation (all P＞0.05).(2) Among women at group of ≤1.7,＞1.7 and ≤2.5,＞2.5 and ≤3.5,＞3.5 mU/L,the implantation rates were 28.7％,27.3％,37.7％ and 19.2％,live birth rates were 80.9％,75.0％,82.7％,and 59.8％,abortion rates were 19.0％,15.0％,16.7％,40.1％; they all showed significant difference (all P＜0.05).Abortion rate in women with high bTSH level was higher than that of women with lower bTSH level,however implantation rate,live birth rate in women with high bTSH level were lower.Conclusion When bTSH level is ＞3.5 mU/L,the abortion rate were increased,but live birth rate,rate of implantation were decreased.

Complete mole in a dichorionic twin pregnancy after intracytoplasmic sperm injection / Mola hidatiforme completa em gravidez bicoriônica após injecção intracitoplasmática de espermatozoides

A dichorionic twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare and challenging situation, whose pathogenesis has not been yet fully understood. We present a case of a 39-year-old woman who underwent intracytoplasmic sperm injection with two embryos transfer. The 12-week gestation ultrasound examination revealed normal fetus and placenta with features of hydatidiform mole, leading to pregnancy termination. Autopsy and histological examinations diagnosed a complete mole coexisting with a normal fetus, and the genetic analysis showed a diploid fetus with biparental genome and molar tissue with paternal diploidy. This case highlighted that complete molar pregnancies may still occur even though pregnancy is achieved after intracytoplasmic sperm injection. A review of the literature was performed by collecting data from the few similar reported cases and by commenting on the pathogenesis of this rare condition.

Uma gravidez bicoriônica com mola hidatiforme completa e feto normal é uma situação rara e desafiadora, cuja patogênese não foi ainda totalmente compreendida. Apresenta-se o caso de uma mulher de 39 anos submetida à injeção intracitoplasmática de espermatozoides com transferência de dois embriões. Na ecografia pré-natal realizada na 12ª semana de gestação, foi identificado um embrião morfologicamente normal e uma placenta com características molares. Esta situação resultou na terminação eletiva da gravidez. A autópsia e o estudo histológico permitiram o diagnóstico definitivo de uma mola hidatiforme completa coexistindo com feto normal. A análise genética mostrou feto diploide com genoma biparental e tecido molar com diploidia paterna. Este caso ressaltou que as gestações com mola hidatiforme completa poderão ainda ocorrer, mesmo que a gravidez seja realizada após uma injeção intracitoplasmática de espermatozoides. Foram realizadas uma revisão dos raros casos descritos na literatura e uma explicação da patogenia desta condição rara.

Resultados em ciclos de fertilização in vitro de acordo com a faixa etária feminina / Outcomes of in vitro fertilization cycles based on age groups

Como frutos da participação crescente da mulher como força de trabalho nas últimas décadas, o menor interesse pela maternidade1 e a tendência de postergá-la2 ocorrem apesar de haver diminuição progressiva do potencial reprodutivo feminino, mormente depois dos trinta anos de idade.3 Estimase que 75% das mulheres que iniciam tentativas deengravidar aos trinta anos etários darão à luz um nascido vivo dentro de doze meses, e apenas 44% o farão quando o início das tentativas ocorre aos quarenta anos de idade.4 Dados menos animadores registram declínio progressivo da fecundabilidade feminina com o avanço da idade, com taxas de gestação por ciclo fértil de 24%, 17%, 12% e 5% aos 25,30, 35 e 40 anos respectivamente.5Em estudo prévio, constatou-se interferência negativa significativa da idade da mulher sobre a resposta folicular ovariana e o número de oócitosmorfologicamente maduros obtidos em ciclos de fertilização in vitro com injeção intracitoplasmática de espermatozoides ou não,6 em concordância com outros estudos.2,3,7-10 Este estudo teve como objetivos comparar as taxas de gestação e a implantação em ciclos de fertilização in vitro com injeção intracitoplasmática de espermatozoide ou sem esta, de acordo com a classificação etária adotada pela Red Latinoamericana deReproducción Asistida,11 e aferir a capacidade da idade da mulher de predizer a ocorrência de gravidez clínica após ciclos terapêuticos.

Retrospective analysis of 216 in vitro fertilization cycles from January to December of 2010. Age groups were defined according to recommendations from the Red Latinoamericana de Reproducción Asistida: 34 years old or less, 35 to 39 years old and 40 years old or older. We evaluated the occurrence of clinical pregnancy (confirmed by transvaginal ultrasound in the fifth week after embryo transfer), embryo implantation and miscarriage rates. Areas below the curve (AUC-ROC) determined the ability of age to predict pregnancy after IVF/ICSI.

Oócitos aparentemente maduros injetados em telófase I apresentam piores resultados de reprodução assistida / Apparently matured oocytes injected in telophase I have worse outcomes from assisted reproduction

OBJETIVO: Avaliar o estágio de maturação nuclear de oócitos com o primeiro corpúsculo polar (CP) visível de pacientes inférteis submetidas à estimulação ovariana para injeção intracitoplasmática de espermatozoide (ICSI) e comparar os resultados da injeção intracitoplasmática de espermatozoide entre os oócitos em telófase I (TI) e metáfase II (MII), e entre aqueles em metáfase II com e sem fuso celular visível. MÉTODOS: Estudo prospectivo que incluiu 106 pacientes inférteis submetidas à injeção intracitoplasmática de espermatozoide. Foram incluídas pacientes com idade menor ou igual a 38 anos, hormônio folículo estimulante (FSH) basal menor que 10 mIU/mL e índice de massa corpórea (IMC) menor que 30 kg/m². Foram excluídas pacientes com doenças sistêmicas, com qualquer infecção ativa, tabagistas ou que fizeram uso de medicações hormonais e anti-inflamatórias hormonais e não hormonais nos últimos dois meses, previamente à programação para o procedimento de reprodução assistida. Os oócitos com extrusão do primeiro corpúsculo polar foram avaliados pela microscopia de polarização, imediatamente antes da realização da injeção intracitoplasmática de espermatozoide, e caracterizados quanto ao estágio de maturação nuclear (telófase I ou metáfase II). Os oócitos em metáfase II foram avaliados de acordo com a presença ou não do fuso meiótico. Foram analisadas as taxas de fertilização, clivagem e o número de embriões de boa qualidade no segundo dia (D2) de desenvolvimento. Os dados foram analisados comparativamente através do teste exato de Fisher. Em todas as análises foi considerado o nível de significância de 5% (p<0,05). RESULTADOS: O fuso meiótico de 516 oócitos foi visualizado através da microscopia de polarização. Dezessete dos 516 oócitos avaliados estavam em telófase I (3,3%) e 499 (96,7%) em metáfase II. Os oócitos injetados em telófase I apresentaram taxas de fertilização significativamente menores do que os injetados em metáfase II (53 e 78%, respectivamente) e não produziram nenhum embrião de boa qualidade no segundo dia. Comparando-se os oócitos com e sem fuso celular visível, não foi observada diferença significativa nos resultados de injeção intracitoplasmática de espermatozoide. CONCLUSÕES: Oócitos injetados em telófase I apresentaram menores taxas de fertilização quando comparados aos em metáfase II. É possível que a análise do estágio de maturação nuclear oocitária, por meio da microscopia de polarização, possa ser utilizada como fator de predição das taxas de fertilização pós-injeção intracitoplasmática de espermatozoide.

PURPOSE: To evaluate the nuclear maturation stage and the presence of meiotic spindles of in vivo matured oocytes from infertile women undergoing stimulated cycles for intracytoplasmic sperm injection (ICSI) and compare intracytoplasmic sperm injection outcomes between oocytes in telophase I (TI) and metaphase II (MII), and the ones with and without visible meiotic spindle. METHODS: A prospective and controlled study with 106 infertile patients who underwent ovarian stimulation for intracytoplasmic sperm injection purposes. Patients aged 38 years or less, with basal follicle stimulating hormone (FSH) less than 10 mIU/mL and body mass index (BMI) less than 30 kg/m². Were included patients presenting any systemic diseases, any active infection, smokers or patients who had been using hormonal medications and hormonal and nonhormonal anti-inflammatory drugs for the past two months prior to the assisted reproduction procedure were excluded. The oocytes with the first polar body extruded (in vivo matured oocytes) were imaged by polarization microscopy immediately before intracytoplasmic sperm injection and characterized according to nuclear maturation stage (telophase I and metaphase II) and to the presence of a meiotic spindle. We analyzed the fertilization rates, cleavage, number of good quality embryos on the second day (D2) from oocytes on telophase I versus those in metaphase II, and metaphase II visible spindle versus non-visible ones. Data were analyzed comparatively by Fisher's exact test. The level of significance was set at 5% in all analyses (p<0.05). RESULTS: The meiotic spindles of 516 oocytes were imaged using polarization microscopy. From the 516 oocytes analyzed, seventeen were in telophase I (3.3%) and 499 (96.7%) in metaphase II. The oocytes injected in telophase I had significantly lower fertilization rates than those injected in metaphase II (53 and 78%, respectively) and produced no good quality embryos on day 2. When the oocytes with and without a visible meiotic spindle were compared, there was no significant difference in the intracytoplasmic sperm injection results. CONCLUSIONS: Oocytes injected in telophase I showed lower fertilization rates when compared to those in metaphase II. It is possible that the analysis of oocyte nuclear maturation by polarization microscopy can be used as a predictor of fertilization after intracytoplasmic sperm injection.

Injeção intracitoplasmática de espermatozóides: questões éticas e legais / Intracytoplasmatic sperm injection: ethical and legal questions

O presente trabalho enfoca a técnica da fertilização in vitro por meio de injeção intracitoplasmática de espermatozóide (ICSI), abordando seus aspectos técnicos, bem como, questões éticas e legais que permeiam tal prática. Essa técnica se diferencia das demais por corresponder à injeção de um único espermatozóide vivo no citoplasma do ovócito, sendo uma das principais alternativas atuais para a infertilidade masculina, principalmente nos casais em que o homem tem uma diminuição significativa na quantidade ou na motilidade dos espermatozóides. Vale ressaltar, que as técnicas de reprodução assistida vêm se desenvolvendo rapidamente, dando ensejo a questões polêmicas, como as relativas ao início da vida embrionária e à manipulação genética, o que implica que se deve refletir sobre este assunto, levando-se em consideração os limites éticos. Nesse sentido, é preciso, urgentemente regulamentar o tema, mesmo com os progressos alcançados pelo novo Código Civil e pela Lei de Biossegurança.

This article focuses on the in vitro fertilization technique that uses intracytoplasmatic sperm injection and addresses both the technical and ethical and legal aspects of this. This technique differs from others as it involves the injection of a single live sperm into the cytoplasm of the oocyte and is one of the principal alternative treatments for male infertility, mainly for couples where the man has a significantly reduced sperm-count or sperm-mobility. It is worth pointing out that rapid advances are being made in assisted reproduction and this has given rise to controversial issues relating to the beginning of embryonic life and genetic manipulation. It is thus important to reflect on this subject and consider where ethical boundaries lie. There is therefore urgent need for regulation in this area, despite the advances already achieved by the new Civil Code and Biosafety Law.

Criopreservação de oócitos: pode ser considerada uma rotina na prática clínica?: uma revisão sistemática / Oocyte cryopreservation: can it be considered a routine in the clinical practice?: a systematic review

Considerando o grande interesse observado, os avanços nas técnicas para preservação da fertilidade feminina e levando em conta que a criopreservação de oócitos é uma atraente estratégia para preservação da fertilidade, foi realizada uma revisão sistemática para comparar a criopreservação de oócitos com outros métodos já estabelecidos para este intuito. Foram buscadas referências em dois bancos de dados (Medline e Lilacs), e identificados 869 estudos, mas nenhum deles conseguiu preencher os critérios de inclusão. Ainda há um longo caminho para este método ser incorporado à prática clínica.

Considering the great interest observed; the advancement of techniques to preserve female fertility and that oocyte cryopreservation is an attractive strategy to fertility preservation, this systematic review was conducted in order to compare the cryopreservation of oocytes with other already established methods. References were searched in two databases (Medline and Lilacs). A total of 869 studies were identified, however none of them could compare oocytes cryopreservation with other techniques to preserve female fertility. There is still a long way to go to integrate it into a routine clinical procedure.

Endometriose mínima e técnicas de reprodução assistida: uma revisão / Minimal endometriosis and assisted reproduction techniques: a review

Objetivo: avaliar os resultados, disponíveis na literatura, do tratamento da endometriose mínima ou leve por técnicas de reprodução assistida. Material e Método: foram considerados os trabalhos que mostraram relação positiva entre essas técnicas, associadas ao tratamento cirúrgico, tratamento clínico e não-tratamento, com o aumento das taxas de implantação, gravidez e nascimentos vivos. Conclusões: endometriose mínima ou leve leva a uma diminuição das taxas de fecundidade; a ressecção dos focos de endometriose por laparoscopia parece melhorar estas taxas, assim como a estimulação do ovário com gonadotrofinas melhora as taxas de fecundidade sem melhorar taxas de gravidez clínica. A IIU associada com estimulação ovariana também melhora os resultados reprodutivos, enquanto os resultados de ICSI não são alterados pela endometriose mínima ou leve. São inconclusivos os resultados de FIV e de IIU sem estimulação ovariana associados à patologia.

Objective: the objective of this paper was to assess the results available in the literature of the treatment of minimal or mild endometriosis by assisted reproduction techniques. Methods: the studies that showed positive association between ART, related to surgical treatment, clinical and non-treatment, with the increased rates of implantation, pregnancy and live births. Conclusions: minimal or mild endometriosis leads to adecrease in fertility rates; the resection of the foci of endometriosis by laparoscopy seems to improve these rates, just as ovarian stimulation with gonadotrophins improves fertility rates without improving clinical pregnancy rates. The IUI associated with ovarian stimulation also improves the reproductive outcomes, while the results of ICSI are not altered by minimal or mild endometriosis. The results are in conclusive for IVF and the results of IUI without ovarian stimulation associated with pathology.

Sperm retrieval techniques in azoospermic patients: PESA, MESA, TESA, TESE and MICROTESE / Técnicas de recuperação de espermatozoides em pacientes azoospérmicos: PESA, MESA, TESA, TESE e MICROTESE

Azoospermia is defined as the absence of mature spermatozoa in semen analysis after centrifugation. The causes of azoospermia may be related to spermatogenesis defects and classified as non-obstructive azoospermia, or to the obstruction of the efferent ducts of the genital tract and classified as obstructive azoospermia. Before the development of intracytoplasmic sperm injection, in 1992, men with non-treatable obstructive azoospermia or non-obstructive azoospermia could not become biologic fathers. Intracytoplasmic sperm injection has dramatically changed this scenario, as it allows obtaining an embryo using a single sperm cell. Since then, sperm obtained from different sources have been used for intracytoplasmic sperm injection, and the techniques used for sperm retrieval are microsurgical epididymal sperm aspiration (MESA) or percutaneous epididymal sperm aspiration (PESA) for patients with obstructive azoospermia, and testicular sperm aspiration (TESA), testicular sperm extraction (TESE) or testicular microdissection for non-obstructive azoospermia patients. This article discusses these techniques, and their indications and results.

A azoospermia, ausência de espermatozoides no exame do sêmen ejaculado após centrifugação, é a mais grave condição envolvendo um homem com infertilidade. Pode ser classificada em obstrutiva ou não-obstrutiva, dependendo de sua etiologia. Antes do desenvolvimento da técnica de injeção intracitoplasmática de espermatozoides, esses homens não tinham a possibilidade de serem pais biológicos. A partir da injeção intracitoplasmática de espermatozoides, esses pacientes passaram a ter a chance da paternidade desde que se recuperassem espermatozoides do epidídimo ou do testículo para serem injetados nos oócitos. Nas azoospermias obstrutivas usamos as técnicas de microsurgical epididymal sperm aspiration (MESA) ou percutaneous epididymal sperm aspiration (PESA), e, nos casos de azoospermia não?obstrutiva, as técnicas de testicular sperm aspiration (TESA), testicular sperm extraction (TESE) ou microdissecção testicular. Neste artigo revisaremos as técnicas, indicações e resultados.

Genitourinary malformations in neonates conceived by human assisted reproductive technologies / Malformações do aparelho geniturinário em recém-nascidos concebidos por técnicas de reprodução humana assistida

Objective: To identify genitourinary malformations among children conceived by assisted reproductive techniques in a population of pregnant women seen at a tertiary hospital in the city of Sao Paulo, Brazil. Methods: A descriptive and retrospective study with data collected from 238 pregnant women who underwent assisted reproduction techniques, including the classic in vitro fertilization and intracytoplasmic sperm injection, and gave birth to 322 children at the Hospital Israelita Albert Einstein. Results: The mean maternal age for classic in vitro fertilization was 34 years and for intracytoplasmic sperm injection was 34.8 years. There was an increase in malformed children with older maternal age, but with no statistical significance. Thirty-four malformed newborns were found (10.6%) and 10 (29.4% of malformed children) presented genitourinary malformations. Conclusions: Several genitourinary malformations were found in children following techniques of human assisted reproduction and there was a tendency to malformation in children as maternal age increased.

Objetivo: Identificar a ocorrência de malformações geniturinárias entre crianças concebidas por técnicas de reprodução humana assistida em uma população de gestantes atendida em hospital terciário da cidade de São Paulo, Brasil. Métodos: Estudo descritivo e retrospectivo a partir de dados coletados de 238 gestantes submetidas a técnicas de reprodução assistida, que incluíram fertilização in vitro clássica e microinjeção intracitoplasmática de espermatozóides, e que deram à luz a 322 crianças na maternidade do Hospital Israelita Albert Einstein. Resultados: A média de idade materna foi de 34 anos para fertilização in vitro clássica e 33,8 anos para microinjeção intracitoplasmática de espermatozoides, notando-se um aumento de crianças malformadas com o aumento da idade materna, porém sem significância estatística. Foram encontrados 34 recém-nascidos com malformações (10,6%) dos quais 10 (29,4% dos malformados) apresentavam malformações do aparelho geniturinário. Conclusões: Em recém-nascidos de técnicas de reprodução humana assistida foram identificadas diferentes malformações geniturinárias, com uma tendência ao aumento de crianças malformadas com o aumento da idade materna.

Effect of double activation on the development of frozen-thawed oocytes after intracytoplasmic sperm injection / 中华妇产科杂志

Objective To investigate the influence on developmental potential of frozen-thawed rabbit oocytes with double assisted activation followed by intracytoplasmic sperm injection (ICSI). Methods A total of rabbit oocytes were collected and thawed after vitrification cryopreservation. Among all oocytes were cultured for 1 hour followed by ICSI. 156 Survived oocytes were divided into 5 groups randomly. I0634 single activation: 30 oocytes were added with calcium ionomycin ( I0634 ) at 5 μmol/L for 5 minutes;SrCl2single activation: 26 oocytes were added with strontium chloride at 10 mmol/L for 10 minutes;10634 double activation: 33 oocytes were activated by I0634 twice;SrCl2 double activation: 28 oocytes were activated by strontium chloride twice. Control group: 39 oocytes were not added with any activators. The rate of fertilization, cleavage and blastocysts formation were observed and compared between various groups. Result The rates of fertilization, cleavage and blastocysts formation were in group of SrCl2 single activation were higher than those of I0634 single activation group without statistical difference (54% vs. 33%, 27% vs. 17%, 8% vs. 3%, P <0.05 ). However, those above rates in double activation by I0634 were higher significantly than those of single I0634 activation (82% vs. 33%, 55% vs. 17%, 15% vs. 3%, P < 0.05). The rates of fertilization (61%) was higher and the rate of cleavage (21%) and blastocysts formation (7%) were lower in group of SrCl2 double activation in comparison with group of SrCl2 single activation without reaching statistical difference (P<0.05 ). Notably, the rates of fertilization, cleavage and blastocysts formation in I0634 double activation group were higher than those in group of SrCl2 double activation with statistical difference (82% vs. 61%, 55% vs. 21%, 15% vs. 7%, P<0.05). Conclusion It might enhance the potential of fertilization of oocytes and early embryo development treated by double activation following ICSI, however, those activated oocytes demonstrate rapid cleavage.