ABSTRACT
O objetivo desta meta-análise foi avaliar o efeito da assisted hatching (AH) sobre os resultados dos ciclos de reprodução assistida: gravidez clínica, nascimento vivo, gestação múltipla, aborto e implantação embrionária, sendo avaliados os artigos publicados em periódicos indexados ao PubMed por dois autores independentes. Foram levantados 51 ensaios clínicos controlados que avaliaram o efeito da AH, sendo 40 excluídos, resultando em 11 artigos completamente avaliados. Não houve diferença significativa na taxa de gestação clínica (44,41 versus 41,30%; p=0,19, AH versus controle, respectivamente) e na taxa de nascimento vivo (36,33 versus 34,79%, p=0,63), porém, foi identificada uma tendência de aumento na taxa de gestação múltipla (18,44 versus 15,02%, p=0,05). Também não foi identificada diferença significativa na taxa de aborto (6,66 versus 6,21%, p=0,83), mas observou-se um aumento significativo na taxa de implantação embrionária (24,32 versus 21,23%, p=0,02). A partir desses resultados, pode-se concluir que, até o momento, não existe evidência suficiente para suportar o uso da AH de rotina para ciclos de reprodução assistida com transferência de embriões frescos, uma vez que não houve aumento na taxa de gravidez clínica e/ou na taxa de nascimento vivo.
The aim of this meta-analysis was to evaluate the effect of assisted hatching on the outcome of assisted reproduction cycles: clinical pregnancy, live birth, multiple pregnancy, abortion and embryonic implantation, by assessing articles published in journals indexed in PubMed by two independent authors. Fifty-one controlled trials that evaluated the effect of assisted hatching were analyzed, and 40 of them were excluded, resulting in 11 articles fully assessed. There was no significant difference in clinical pregnancy rate (44.41 versus 41.30%, p=0.19, assisted hatching versus control, respectively), and in the live birth rate (36.33 versus 34.79%, p=0.63), but we identified a trend toward increased rate of multiple pregnancies (18.44 versus 15.02%, p=0.05). We also did not identify any significant difference in the rate of abortion (6.66 versus 6.21%, p=0.83), but a significant increase in the rate of embryo implantation was observed (24.32 versus 21.23%, p=0.02). From these results, we have concluded that, until now, there is not sufficient evidence to support the use of assisted hatching for routine assisted reproduction cycles with fresh embryo transfer, since there has not been an increase in clinical pregnancy rate and/or the rate of live birth.
Subject(s)
Humans , Female , Pregnancy , Controlled Clinical Trials as Topic/methods , Fertilization in Vitro/methods , Embryo Implantation/physiology , Laser Therapy , Pregnancy Rate , Pregnancy, Multiple , Reproductive Techniques, Assisted , Embryo Transfer , Zona Pellucida/physiologyABSTRACT
La acrosina, es uno de los componentes principales del acrosoma, presenta actividad similar a la tripsina, y es liberado luego de la reacción acrosómica (RA). El objetivo del presente trabajo fue estudiar la inducción de la RA en espermatozoides de ratón con zonas pelúcidas homólogas y heterólogas. Espermatozoides de ratón capacitados por 2 horas en medio IVF suplementado con albúmina, heparina y suero sintético a 37 ºC y 5% CO2 fueron incubados en ausencia de Zona Pelucida (ZP) o en presencia de solubilizados de ZP aisladas de ratón (0,78 mg/ml) y alpaca (0,78 mg/ml y 2,35 mg/ml). La RA se evaluó mediante inmunocitoquímica con anticuerpo monoclonal anti-acrosina humana C5F10 a intervalos de 1 hora durante 4 horas. Los resultados obtenidos en espermatozoides de ratón evidencian un incremento significativo (p< 0,05) de la reacción acrosómica inducida con ZP homóloga y heteróloga.
Acrosin is one of the principal components in the acrosome, has trypsin-like activity and is secreted after the Acrosome Reaction (RA). The aim of this study was to study the induction of the acrosomal reaction in mouse sperms with homologous- Pellucid Zone and heterologous- Pellucid Zone. Mouse sperms were capacitated by two hours in IVF medium, supplemented with albumin, heparin and synthetic serum to 37 °C and 5% CO2, and before they were incubated in absence of ZP and in present of solubilized ZP from mouse (0,78 mg/ml) and alpaca (0,78 mg/ml y 2,35 mg/ml). The RA was evaluated through immunocytochemistry with monoclonal antibodies anti-human acrosin C5F10 within intervals of 1 hour during four hours. The results show a significant increase (p<0,05) in acrosome reaction induced with homologous-ZP and heterologous-ZP.