O estado regulatório da reprodução humana assistida no Brasil: da ausência de legislação ordinária ao regulamento deontológico atual / The regulatory state of assisted human reproduction in Brazil: from the absence of ordinary legislation to the current deontological regulation / El estado regulatorio de la reproducción humana asistida en Brasil: de la ausencia de legislación ordinaria a la regulación deontológica actual

Objetivo: analisar a legislação ordinária e o regramento deontológico vigentes no Brasil sobre os processos assistidos de procriação humana, considerando a investigação das repercussões no âmbito dos direitos das partes envolvidas. Metodologia: revisão bibliográfica e documental, por meio do método dedutivo, buscando a construção de apontamentos críticos quanto ao atual estado regulatório dos processos assistidos de procriação humana. Resultados: o conjunto regulatório agrega previsões normativas gerais relacionadas ao Código Civil, à Lei de Biossegurança e previsões deontológicas. Juntas, trazem conteúdos de relevância, mas, por vezes, insuficientes e não adequados às diversas circunstâncias que podem envolver a prática da fertilização in vitro, da gestação por substituição e da reprodução post mortem. Conclusão: propõe-se, a partir dos direitos reprodutivos da mulher e da autonomia das partes, a reconsideração parcial do conteúdo regulado pelo regramento deontológico, bem como a atualização das normas ordinárias.

Objective:to analyze the legislation and deontological rules in force in Brazil regarding artificial insemination in humans, considering the impact on the rights of those involved. Methods: bibliographic and documentary study using the deductive method, with the aim of critically commenting on the current state of legislation on artificial insemination in humans. Results: the legal framework includes general normative provisions related to the Civil Code, the Biosafety Law and deontological provisions. Together, they provide relevant content but are sometimes insufficient and inadequate for the various circumstances that may be associated with the practice of in vitro fertilization, surrogacy, and postmortem reproduction. Conclusion: based on women's reproductive rights and the autonomy of the parties, it is proposed to reconsider some of the contents regulated in the deontological provisions and to update the legislation.

Objetivo: analizar la legislación ordinaria y las normas deontológicas vigentes en Brasil sobre los procesos de procreación humana asistida, considerando la investigación de las repercusiones en el alcance de los derechos de las partes involucradas. Metodología: revisión bibliográfica y documental, a través del método deductivo, buscando la construcción de apuntes críticos respecto al estado normativo actual de los procesos de procreación humana asistida. Resultados: el conjunto normativo agrega disposiciones normativas generales relacionadas con el Código Civil, la Ley de Bioseguridad y disposiciones deontológicas. En conjunto, aportan contenidos relevantes, pero en ocasiones insuficientes y no adecuados a las distintas circunstancias que puede conllevar la prácticade la fecundación in vitro, la gestación subrogada y la reproducción post mortem. Conclusión: se propone, con base en los derechos reproductivos de la mujer y la autonomía de las partes, la reconsideración parcial del contenido regulado por las reglas deontológicas, así como la actualización de las normas ordinarias.

Influential factors of adverse pregnancy outcome in women with subchorionic hematoma / 中国基层医药

Objective:To investigate the influential factors of adverse pregnancy outcomes in women with subchorionic hematoma.Methods:A total of 101 women with subchorionic hematoma who received treatment in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to June 2020 were included in this study. They were divided into a control group and an adverse pregnancy outcome group according to whether there was an adverse pregnancy outcome. The epidemiological characteristics, hematoma characteristics observed on ultrasound images, and pregnancy outcomes were compared between the two groups.Results:There was no significant difference in the number of women who used assisted reproductive technology between the control and adverse pregnancy outcome groups [6 (8.0%) vs. 8 (30.7%), χ2 = 8.38, P = 0.004]. There was a significant difference in hematoma volume between adverse pregnancy outcome and control groups [(4.12 ± 0.61) mL vs. (6.36 ± 0.87) mL, t = 6.73, P = 0.009]. There was a significant difference in the number of patients who had obstetric complications between control and adverse pregnancy outcome groups [11 (14.7%) vs. 16 (61.5%), χ2 = 21.66, P = 0.001]. There was a significant difference in the number of patients who had hematomas located at the edge of the placenta between the control and adverse pregnancy outcome groups [15 (20.0%) vs. 12 (46.2%), χ2 = -4.81, P = 0.001]. Conclusion:Women who use assisted reproductive technology for pregnancy, have obstetric complications, or have a subchorionic hematoma with hematoma at the edge of the placenta are more likely to experience a miscarriage. Therefore, women of childbearing age should actively treat the primary disease and be alert to the occurrence of placental abruption.

A técnica da maternidade substitutiva: uma revisão bibliográfica / The technique of substitutive maternity: a bibliographic review / La técnica de la maternidad sustitutiva: una revisión bibliográfica

Objetivo: contribuir com reflexões acerca da maternidade substitutiva. Metodologia: realizou-se uma revisão bibliográfica sistemática, de artigos em português, em bases de dados eletrônicas (PubMed, Scielo, BVS e Periódicos CAPES), de 2015 a 2020, resultando em quatro artigos que compõem a revisão. Resultados: os quatro estudos apontam para a inexistência de legislação específica no Brasil sobre as técnicas de reprodução assistida e a maternidade substitutiva e suas consequências. Um artigo destaca a importância do envolvimento de um(a) profissional psicólogo(a) na maternidade substitutiva. Conclusão: atualmente, devido à inexistência de legislação brasileira específica, são seguidas as resoluções do Conselho Federal de Medicina sobre as técnicas de reprodução assistida e maternidade substitutiva. O(a) profissional psicólogo(a) pode contribuir no processo da maternidade substitutiva. Ressaltamos a importância de discussões e disseminação do tema.

Objective: to contribute with reflections on surrogate motherhood. Methods: a systematic bibliographic review of articles in Portuguese was conducted in electronic databases (PubMed, Scielo, BVS, and Capes Periodicals) in the last five years, with four articles comprising the review. Results: the studies showed the lack of specific legislation in Brazil on assisted reproduction techniques and surrogate motherhood and its consequences. One study pointed out the importance of the involvement of a professional psychologist in surrogate motherhood. Conclusion: due to the lack of Brazilian legislation, the citizens follow the Federal Council of Medicine's regulations on assisted reproduction techniques and surrogate motherhood. A professional psychologist can contribute to the process of substitutive motherhood. We emphasize the importance of discussions and dissemination of the theme.

Objetivo: contribuir con reflexiones sobre la maternidad subrogada. Metodología: se realizó una revisión bibliográfica sistemática de artículos en portugués en bases de datos electrónicas (PubMed, Scielo, BVS y Capes Periodicals) en los últimos cinco años, con cuatro artículos que componen la revisión. Resultados: los estudios apuntan a la falta de legislación específica en Brasil sobre técnicas de reproducción asistida y maternidad subrogada y sus consecuencias. Un artículo destaca la importancia de la participación de un psicólogo profesional en la maternidad subrogada. Conclusíon: actualmente, debido a la falta de legislación brasileña específica, se siguen las resoluciones del Consejo Federal de Medicina sobre técnicas de reproducción asistida y maternidad subrogada. El psicólogo profesional puede contribuir al proceso de la maternidad subrogada. Destacamos la importancia de la discusión y difusión del tema.

The combined effect of lifestyle intervention and antioxidant therapy on sperm DNA fragmentation and seminal oxidative stress in IVF patients: a pilot study

ABSTRACT Purpose: Sperm DNA fragmentation (SDF) and seminal oxidative stress are emerging measurable factors in male factor infertility, which interventions could potentially reduce. We evaluated (i) the impact of lifestyle changes combined with oral antioxidant intake on sperm DNA fragmentation index (DFI) and static oxidation-reduction potential (sORP), and (ii) the correlation between DFI and sORP. Materials and Methods: We conducted a prospective study involving 93 infertile males with a history of failed IVF/ICSI. Ten healthy male volunteers served as controls. Semen analysis was carried out according to 2010 WHO manual, whereas seminal sORP was measured using the MiOXSYS platform. SDF was assessed by sperm chromatin structure assay. Participants with DFI >15% underwent a three-month lifestyle intervention program, primarily based on diet and exercise, combined with oral antioxidant therapy using multivitamins, coenzyme Q10, omega-3, and oligo-elements. We assessed changes in semen parameters, DFI, and sORP, and compared DFI results to those of volunteers obtained two weeks apart. Spearman rank correlation tests were computed for sORP and DFI results. Results: Thirty-eight (40.8%) patients had DFI >15%, of whom 31 participated in the intervention program. A significant decrease in median DFI from 25.8% to 18.0% was seen after the intervention (P <0.0001). The mean DFI decrease was 7.2% (95% CI: 4.8-9.5%; P <0.0001), whereas it was 0.42% (95%CI; -4.8 to 5.6%) in volunteers (P <0.00001). No differences were observed in sperm parameters and sORP. Based on paired sORP and DFI data from 86 patients, no correlation was observed between sORP and DFI values (rho=0.03). Conclusion: A 3-month lifestyle intervention program combined with antioxidant therapy reduced DFI in infertile men with elevated SDF and a history of failed IVF/ICSI. A personalized lifestyle and antioxidant intervention could improve fertility of subfertile couples through a reduction in DFI, albeit controlled trials evaluating reproductive outcomes are needed before firm conclusions can be made. Trial registration number and date: clinicaltrials.gov NCT03898752, April 2, 2019.

Effect of adjuvant growth hormone during luteal phase on in-vitro fertilization-embryo transfer outcome / 中国医师杂志

Objective:To investigate the effect of growth hormone (GH) supplementation during luteal phase one cycle before ovulation induction in patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods:IVF-ET pregnancy-assisted patients who underwent long-term Gonadotropin Releasing Hormone-agonist (GnRH-a) protocol from January 1, 2019 to June 30, 2020 were collected from the Reproductive Center of Hunan Provincial Maternal and Child Health Hospital. Among them, 106 patients (GH group) were added with GH during luteal phase one cycle before ovulation induction, and 212 patients (control group) were not added with GH. Ovulation induction and pregnancy outcome were compared between the two groups.Results:(1) There was no statistically significant difference in primary infertility/secondary infertility rate, infertility years, age, and transplant cancellation cycle rate between the two groups (all P>0.05). (2) There were no significant differences in the number of oocytes obtained, MII oocytes, two pronucleus (2PN) oocytes, high-quality embryos and average number of transplanted embryos between GH group and control group (all P>0.05). The total amount of Gn in control group and GH group was (2 109.75±555.75)IU and (1 863±610.52)IU, respectively, with statistically significant difference ( P<0.05). (3) The embryo implantation rate of the control group and GH group was 43.73%(129/295) and 60.42%(87/144), respectively, with statistically significant difference ( P<0.05). The clinical pregnancy rates of the control group and GH group were 58.79%(107/182) and 71.91%(64/89), the difference was statistically significant ( P<0.05). The spontaneous abortion rate of early pregnancy in control group (4.67%, 5/107) was slightly higher than that in GH group (3.12%, 2/64), but there was no significant statistical difference ( P>0.05). Conclusions:For patients with normal ovarian response, adding small dose of growth hormone during luteal stage one cycle before controlled hyperovulation can improve the embryo implantation rate and clinical pregnancy rate, and reduce the amount of Gn, which is beneficial to patients.

Social representation of reproductive biotechnologies among nurses working in sexual and reproductive health / Representación social de biotecnologías reproductivas entre enfermeras que trabajan en salud sexual y reproductiva / Representação social das biotecnologias reprodutivas entre enfermeiros que atuam na saúde sexual e reprodutiva

ABSTRACT Objectives: to compare the social representations of reproductive biotechnologies among sexual and reproductive health nurses, and their links with professional practice. Methods: an analytical, comparative, qualitative research, supported by the Theory of Social Representation, carried out in May/2014-February/2015, with 32 nurses from the city of Rio de Janeiro. Semi-structured interview, analyzed by ALCESTE® software. Results: nurses not active in assisted human reproduction represent reproductive biotechnologies as unnatural methods of human reproduction, assessing the practice in this field as generalist and bureaucratic. Those who work represent as auxiliary and supporting nature for heterosexual couples, considering the innovative and specialized practice. Final considerations: each group presented specific contents and dimensions about reproductive biotechnologies. The representations are centered on moral, normative and ideological personal values, anchored in the traditional conceptions of human and family reproduction, but also collective, acquired in the professional routine, showing group identity and its distinct practices considering reproductive biotechnologies.

RESUMEN Objetivo: comparar las representaciones sociales de las biotecnologías reproductivas entre enfermeras que trabajan en salud sexual y reproductiva y sus vínculos con la práctica profesional. Métodos: investigación analítica, comparativa, cualitativa, sustentada en la Teoría de la Representación Social, realizada en mayo/2014-febrero/2015, con 32 enfermeras de la ciudad de Rio de Janeiro. Entrevista semiestructurada, analizada por el software ALCESTE®. Resultados: las enfermeras no activas en reproducción humana asistida representan las biotecnologías reproductivas como métodos antinaturales de reproducción humana, evaluando la práctica en esta área como generalista y burocrática. Quienes laboran representan como auxiliares y ayudantes de la naturaleza para parejas heterosexuales, considerando la práctica innovadora y especializada. Consideraciones Finales: cada grupo presentó contenidos y dimensiones específicas sobre biotecnologías reproductivas. Las representaciones se centran en valores personales morales, normativos e ideológicos, anclados en las concepciones tradicionales de reproducción humana y familiar, pero también colectivas, adquiridas en la rutina profesional, mostrando la identidad grupal y sus prácticas diferenciadas ante las biotecnologías reproductivas.

RESUMO Objetivo: comparar as representações sociais das biotecnologias reprodutivas entre enfermeiros que atuam na saúde sexual e reprodutiva, e seus nexos com a prática profissional. Métodos: pesquisa analítica, comparativa, qualitativa, amparada pela Teoria da Representação Social, realizada em maio/2014-fevereiro/2015, com 32 enfermeiros do município do Rio de Janeiro. Entrevista semiestruturada, analisada pelo software ALCESTE® . Resultados: enfermeiros não atuantes na reprodução humana assistida representam biotecnologias reprodutivas como métodos antinaturais de reprodução humana avaliando a prática nesta área como generalista e burocrática. Os que atuam representam como auxiliares e coadjuvantes da natureza para casais heterossexuais, considerando a prática inovadora e especializada. Considerações finais: cada grupo apresentou conteúdos e dimensões específicas sobre biotecnologias reprodutivas. As representações estão centradas em valores pessoais de caráter moral, normativos e ideológicos, ancorados nas concepções tradicionais de reprodução humana e família, mas também coletivos, adquiridos no cotidiano profissional, evidenciando identidade grupal e suas distintas práticas diante das biotecnologias reprodutivas.

Fertility preservation in breast cancer with oral progestin: is it an option? A pilot study / Preservação da fertilidade com progestágeno oral em pacientes com câncer de mama: é uma opção? Estudo-piloto

ABSTRACT Objective To compare the effectiveness of oral progestins and injectable gonadotropin-releasing hormone antagonist medication in cancer fertility preservation in patients with breast cancer. Methods A cross-sectional study with 40 breast cancer patients submitted to cancer fertility preservation, who were divided into two groups according to histochemical analysis of progesterone receptors to define luteinizing hormone block: if positive, use of gonadotropin-releasing hormone antagonist, if negative, use of oral progestins. The mean age, medication days, antral follicle count, number of oocytes in metaphase II and the occurrence of ovarian hyperstimulation syndrome were compared. Results A total of 20 patients both in the group using gonadotropin-releasing hormone antagonist, and in the group with oral progestins, respectively, had a mean age of 33.9 (32-35.8) and 33.8 (32-35.6) years; days of medications of 11 (9.7-12.3) and 12.8 (11.6-13.9), p=0.037; antral follicle count of 9 (7.11-12) and 8.5 (6-11.9), p=0.370; metaphase II oocyte number of 4 (2.1-9.8) and 7.5 (3.1-10), p=0.348; and ovarian hyperstimulation syndrome of 2 (10%) and 5 (25%) cases, p=0.212. Conclusion The use of oral progestins, in spite of requiring longer treatment time, is effective in relation to the protocol with gonadotropin-releasing hormone antagonist, and offers greater comfort at a lower cost in breast cancer patients with negative progesterone receptors, submitted to cancer fertility preservation.

RESUMO Objetivo Comparar a efetividade dos progestágenos orais em relação à medicação injetável antagonista de hormônio liberador de gonadotrofina na preservação da fertilidade oncológica de pacientes com câncer de mama. Métodos Estudo transversal com 40 pacientes com câncer de mama submetidas à preservação da fertilidade oncológica, que foram divididas em dois grupos, conforme análise histoquímica dos receptores de progesterona, para definir o bloqueio de hormônio luteinizante: se positivos, uso de antagonista de hormônio liberador de gonadotrofina; se negativos, uso de progestágenos orais. Comparou-se média de idade, dias de medicações, contagem de folículos antrais, número de oócitos em metáfase II e ocorrência de síndrome do hiperestímulo ovariano. Resultados Vinte pacientes, tanto no grupo com uso de antagonista de hormônio liberador de gonadotrofina, quanto no grupo com progestágenos orais, respectivamente, apresentaram média de idade de 33,9 (32-35,8) e 33,8 (32-35,6) anos; 11 (9,7-12,3) e 12,8 (11,6-13,9) de dias de medicações com p=0,037; contagem de folículos antrais de 9 (7,11-12) e 8,5 (6-11,9), com p=0,370; número de oócitos metáfase II de 4 (2,1-9,8) e 7,5 (3,1-10), com p=0,348, e síndrome do hiperestímulo ovariano de 2 casos (10%) e 5 casos (25%), com p=0,212. Conclusão O uso de progestágenos orais, apesar de necessitar de maior tempo de tratamento, é efetivo em relação ao protocolo com antagonista de hormônio liberador de gonadotrofina e oferece maior conforto com menor custo em pacientes com câncer de mama com receptores de progesterona negativos, submetidas à preservação da fertilidade oncológica.

Clinical features and fertility outcomes of rare patients with globozoospermia syndrome / 中国医师杂志

Objective:To observe the clinical characteristics and reproductive outcome of patients with globozoospermia syndrome (also called round-headed spermatozoa).Methods:The data of 5 patients with round-headed spermatozoa and 20 healthy men in the reproductive center of Shanxi Maternal and Child Hospital and Shanxi People′s Hospital from July 2016 to March 2020 were collected. Among them, the wife was healthy. The peripheral blood chromosome, AZF gene, semen routine and morphology, sex hormone series were detected for the man, and the outcome of intracytoplasmic sperm injection (ICSI) was observed for the patients.Results:The average length of infertility in 5 patients with round-headed sperm was (4.4±1.8)years, and the round-headed sperm rate of 5 patients were all over 95% (including 1 case with round-headed sperm rate of 99%, 3 cases with round-headed sperm rate of 98%, and 1 case with round-headed sperm rate of 96%). The chromosome, AZF gene of 5 patients were normal. The sperm motility [progressive motility(PR) rate+ non progressive motility (NP) rate] of patients with globozoospermia syndrome was significantly lower than that of the healthy control group ( P<0.05). There was no significant difference in sex hormone, sperm count, sperm density, PR(%) and sperm DNA fragmentation rate compared with normal fertility group ( P>0.05). All the 5 patients were treated by assisted reproductive technology with ICSI. Two patients were pregnant, including one patient with abortion and one patient with singleton. Conclusions:There are no other abnormal phenotypes in patients with round-headed spermatozoa except for the low morphology and motility of round headed spermatozoa. Assisted reproductive technology may be an effective way to assist pregnancy.

Are specialized sperm function tests clinically useful in planning assisted reproductive technology?

CASE STUDY 40-year-old male patient and 32-year-old female partner, with a history of primary infertility of two years duration. The workup revealed idiopathic mild oligoasthenotheratozoospermia, and no apparent female infertility factors. The couple has failed three intrauterine insemination (IUI) cycles, planning more IUI cycles but also considering in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Avance genético y políticas de anonimato / Genetic advance and anonymity policies / Avanço genético e políticas de anonimato

Resumen En los últimos años se ha incrementado en Argentina la cantidad de tratamientos de reproducción asistida con donación de gametos (óvulos y/o espermatozoides). La filiación por técnicas de reproducción asistida heterólogas interroga la tradicional "herencia de sangre" objeto de estudio privilegiado de las ciencias sociales. En las últimas décadas, el paradigma sobre el anonimato de los donantes ha cambiado en muchos países. A su vez, se ha sugerido que los rápidos y generalizados avances en las pruebas genéticas podrían modificar las políticas de anonimato. ¿Cuáles son las consecuencias de fundamentar la revelación de la información genética/identificatoria sobre la base del mayor acceso que posibilitan los test genéticos? La presente reflexión parte de dos vertientes: la pública - que analiza las paradojas que encierra el articulado del nuevo Código Civil y Comercial (2015) - y la íntima, que ubica las coordenadas sobre las que se inscribe la transmisión singular de los orígenes.

Abstract In recent years, the number of assisted reproduction treatments with the donation of gametes (ovules and/or sperm) has increased in Argentina. The filiation by heterologous assisted reproduction techniques interrogates the traditional "blood inheritance" object of privileged study of the social sciences. In recent decades, the donor anonymity paradigm has changed in many countries. In turn, it has been suggested that rapid and widespread advances in genetic testing could modify anonymity policies. What are the consequences of substantiating the disclosure of genetic/identifying information based on the greater access that genetic tests allow? This reflection is based on two aspects: the public aspect - which analyzes the paradoxes contained in the articles of the new Civil and Commercial Code (2015) - and the intimate one, which locates the coordinates on which the singular transmission of the origins is inscribed.

Resumo Nos últimos anos, o número de tratamentos de reprodução assistida com doação de gametas (óvulos e/ou espermatozoides) aumentou na Argentina. A filiação por técnicas de reprodução assistida heteróloga interroga a tradicional "herança sanguínea", objeto de estudo privilegiado das ciências sociais. Nas últimas décadas, o paradigma do anonimato dos doadores mudou em muitos países. Por sua vez, sugeriu-se que avanços rápidos e generalizados em testes genéticos poderiam modificar as políticas de anonimato. Quais são as consequências de fundamentar a revelação das informações genéticas/de identificação com base no maior acesso que o teste genético torna possível? Esta reflexão parte de duas vertentes: a pública, que analisa os paradoxos dos artigos do novo Código Civil e Comercial (2015); e a íntima, que determina as coordenadas sobre as quais se inscrevem a transmissão singular das origens.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

Influence of hepatitis B virus infection on assisted reproductive technology and related prevention measures / 临床肝胆病杂志

Hepatitis B virus (HBV) infection is prevalent in China. With the rapid development of assisted reproductive technology (ART) in recent years, more and more couples with infertility and HBV infection choose ART to promote pregnancy. No conclusion has been reached on the influence of HBV infection on ART procedure and the health status of offspring. This article reviews the influence of HBV infection on ART from the aspects of sperm and oocyte function, laboratory environment, pregnancy outcome, and health of offspring and discusses the prevention measures during ART for people with HBV infection, in order to provide a reference for developing scientific management systems and preventing disease transmission.

Epigenetics of Male Fertility: Effects on Assisted Reproductive Techniques

During the last decades the study of male infertility and the introduction of the assisted reproductive techniques (ARTs) has allowed to understand that normal sperm parameters do not always predict fertilization. Sperm genetic components could play an important role in the early stages of embryonic development. Based on these acquisitions, several epigenetic investigations have been developed on spermatozoa, with the aim of understanding the multifactorial etiology of male infertility and of showing whether embryonic development may be influenced by sperm epigenetic abnormalities. This article reviews the possible epigenetic modifications of spermatozoa and their effects on male fertility, embryonic development and ART outcome. It focuses mainly on sperm DNA methylation, chromatin remodeling, histone modifications and RNAs.

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.

Live birth after uterus transplantation in China: a case report and literature review / 中华器官移植杂志

Objective@#To explore the therapeutic feasibility of uterus transplantation for uterine infertility.@*Methods@#Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management.@*Results@#The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well.@*Conclusions@#In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.

Live birth after uterus transplantation in China :a case report and literature review / 中华器官移植杂志

Objective To explore the therapeutic feasibility of uterus transplantation for uterine infertility .Methods Retrospective analysis was performed for the diagnosis ,treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed .The recipient was a 22-year-old woman with a congenital absence of uterus and vagina .Previously she underwent vaginal reconstruction and the donor was her mother . The specific procedures included donor/recipient screening , ethical argumentation ,assisted reproductive technology of obtaining frozen embryos , Vinci robot-assisted uterine procurement ,orthotopic replacement & fixation of retrieved uterus , revascularization;immunoregulation &monitoring of transplanted uterine recipient , assisted reproductive technology after transplantation and gestational management .Results The durations of donor and recipient surgeries were 360 and 530 min respectively .No complications of recipient or donor occurred during the perioperative period .First menstruation occurred at 40 days post-transplantation and regularly thereafter .Pregnancy occurred after embryo transfer at 31 months post-transplantation .No rejection episodes occurred after transplantation or during gestation .Caesarean delivery occurred near gestational week 34 .The boy weighed 2000 grams at birth and the mother remained well . Conclusions In conjunctions with literature review , uterine infertility may be treated by modified uterus transplantation .And a new path is paved for healthy pregnancy of women with uterine infertility .

Clinical outcome of late preterm twins and the influence of different ways of conception on their clinical outcomes:a retrospective study / 中国新生儿科杂志

Objective To study the difference of clinical outcome between late preterm twins (LPT) and late preterm singletons (LPS),and the influence of assisted reproduction technology (ART) or natural conception on the clinical outcomes of LPT.Method The data of late preterm infants born in the Beijing Obstetrics and Gynecology Hospital between January 2016 and January 2018 were retrospectively collected.Infants were assigned to LPT group or LPS group according to twins or singleton status.The differences of the demographic data,morbidity,oxygen therapy rate,respiratory support rate,mortality,hospitalization rate and hospitalization time between LPT and LPS were compared.In order to analyze the effects of different ways of conception on LPT,LPT was further divided into assisted reproduction technology (ART) subgroup and natural pregnancy subgroup.Result A total of 1 824 late preterm infants were included in the study,including 582 cases of LPT and 1 242 cases of LPS.The birth weight and body length of LPT were lower than those ofLPS [(2572±395)gvs.(2614±413)g,P＜0.05;(46.5±1.1)cm vs.(47.5 ± 1.0)cm,P ＜0.01],while the cesarean delivery rate of LPT was higher than that of LPS [90.7％ (528/582) vs.39.9％ (496/1 242),P ＜ 0.01].The incidence of respiratory distress syndrome (RDS) in LPT was higher than that of LPS [5.2％ (30/582) vs.3.6％ (45/1 242),P ＜ 0.05],and the length of hospitalization of LPT was also longer than that of LPS[(8.9 ±3.1)d vs.(7.2 ±2.9)d,P ＜0.01],the differences were statistically significant.There were no significant differences between groups in neonatal pneumonia,apnea,hypoglycemia,sepsis,neonatal necrotizing enterocolitis (NEC),grade Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,bronchopulmonary dysplasia (BPD),oxygen therapy rate,respiratory support rate and mortality rate.There was also no significant difference between ART subgroup and natural pregnancy subgroup in gestational age,gender,cesarean section rate,birth weight,and birth length (P ＞ 0.05).There was no significant difference in RDS,pneumonia,apnea,hypoglycemia,sepsis,NEC,Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,BPD,oxygen uptake rate,respiratory support rate,mortality rate and hospitalization time between the two subgroups (P ＞ 0.05).Conclusion The birth weight and birth length of LPT are lower than those of LPS,and the incidence of RDS is higher.The hospitalization time of LPT is also longer than that of LPS.It is necessary to strengthen the high-risk management of twin pregnant women and post-natal management of LPT.

Comparison of clinical outcomes of frozen-thawed blastocysts derived from non-pronucleus or two pronucleus zygotes / 中华妇产科杂志

Objective To evaluate the application value of the blastocysts derived from non-pronucleus (0PN) zygotes by the good quality blastocyst formation rate and the clinical outcomes of frozen-thawed blastocyst transfers. Methods The good quality blastocyst formation rate derived from 0PN zygotes was compared with that derived from2 pronucleus(2PN)zygotes in in vitro fertilization(IVF)or intracytoplasmic sperm injection (ICSI) cycles from January 2015 to December 2016. In addition, the clinical pregnancy, embryo implantation and live birth rates of frozen-thawed blastocyst transfers with blastocysts derived from 0PN and 2PN zygotes were analyzed on corresponding dates. Results (1)In IVF cycles, the high quality blastocysts formation rate of 2PN embryos was significantly higher than that of 0PN (46.64% versus 42.42%, P<0.01). In ICSI cycles, the high quality blastocysts formation rate of 2PN embryos was markedly higher than that of 0PN(41.96% versus 21.73%, P<0.01).(2)In frozen-thawed embryo transfer cycles for IVF, the clinical pregnancy, implantation and live birth rates of D5 0PN blastocysts were significantly higher than those of D6 2PN(52.64% versus 46.78%, 49.91% versus 41.20%, 46.54% versus 39.56%, all P<0.05), however, the abortion and newborn abnormal rates of D5 0PN blastocysts were lower than those of D6 2PN blastocysts(17.37% versus 23.36%, 1.31% versus 4.21%, both P<0.05); the clinical pregnancy, implantation and livebirth rates of D5 2PN blastocysts were significantly higher than those of D5 0PN(59.73% versus 52.64%, 55.95% versus 49.91%, 53.03% versus 46.54%, all P<0.05), but newborn abnormal rate was a little higher than that of D5 0PN(3.90% versus 1.31%, P<0.05);the clinical pregnancy, implantation and live birth rates of D5 2PN blastocysts were significantly higher than those of D6 2PN(59.73% versus 46.78%, 55.95% versus 41.20%, 53.03% versus 39.56%, all P<0.05), and the abortion rate of D5 2PN blastocysts was lower than that of D6 2PN blastocysts(18.23% versus 23.36%, P<0.05). Conclusions Although the blastocysts derived from 0PN could be transffered, the blastocysts derived from 2PN zygotes are preferred in all cycles. In IVF cycles, the good quality blastocysts derived from 2PN or 0PN zygotes will be transferred.

Value of anti-Müllerian hormone in predicting pregnant outcomes of polycystic ovary syndrome patients undergone assisted reproductive technology / 中华妇产科杂志

Objective Explore the value of anti-Müllerian hormone(AMH)in predicting pregnant outcomes of polycystic ovary syndrome (PCOS) patients undergone assisted reproductive technology. Methods The study totally recruited 1697 patients who underwent the first in vitro fertilization (IVF) or intracytoplasmic sperm injection(ICSI)cycle in Sun Yat-sen Memorial Hospital from the January 2014 to December 2015. The patients were divided into two groups based on the age<35(n=758)and≥35 years old (n=939), compare the basic data and pregnant outcomes of controlled ovarian hyerstimulation. Spearman correlation method was conducted to analyze the relations between AMH and clinical outcomes. The logistic regression method and partial correlation analysis were used to judge the main factors which determine pregnancy outcomes by controlled the confounding factors. The receiver operating characteristic curve (ROC)was used to evaluate the predictive sensitivity and specificity of AMH. Results In the group of PCOS patient younger than 35 years, AMH were correlated with the number of antral follicles(r=0.388)and retrieved oocytes (r=0.235). When the effect of total dosage and starting dosage of gonadotropin were controlled, AMH was still significantly associated with the number of retrieved oocytes(P<0.05). AMH had no predictive value for the clinical pregnancy of PCOS patient younger than 35 years (area under ROC curve=0.481, P=0.768). In the group of PCOS patient≥35 years old, AMH were correlated with the number of antral follicles (r=0.450), retrieved oocytes (r=0.399), available embryo (r=0.336) and high quality embryo(r=0.235). When the effect of total dosage and starting dosage of gonadotropin were controlled, the correlations were still significant between those indexes(all P<0.05). AMH had no predictive value for the clinical pregnancy of PCOS patient≥35 years old(area under ROC curve=0.535, P=0.560). However, the clinical pregnancy rate of the group of PCOS patient≥35 years old was slightly higher than the control group (P=0.062). Conclusions AMH has no predictive value for the pregnancy outcome of PCOS patient. The pregnancy rate of PCOS patient≥35 years old is slightly higher than the younger group, because the PCOS patient may have better ovarian reserve.

Advancement in diagnosis and treatment of heterotopic cornual pregnancy / 中国医师杂志

Heterotopic cornual pregnancy (HCP) is a rare special type of ectopic pregnancy.The incidence rate has risen in recent years due to the development of assisted reproductive technology.Currently there is insufficient evidence to recommend any single treatment modality,and the decision should be based on such factors as clinical presentation,surgeon's expertise,imaging feature,and the patients'preference.This article reviews the etiology,diagnosis and treatment related to HCP.