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Background: Assisted reproduction has revolutionized the field of reproductive medicine, giving hope to many couples who face difficulties conceiving naturally. In this case, fresh oocytes and devitrified oocytes play a fundamental role in fertility treatments.Methods: Descriptive, retrospective and observational study in which the records of the HISPAREP reproduction clinic of the Spanish hospital were analyzed in the period from 2020 to 2022.Results: A total of 136 blastocysts that reached day 5 were studied compared to 8 embryos that were blocked before reaching blastulation. Of this, 76 oocytes were fresh, of which 97.4% reached day 5 (74) and the remaining two were blocked. Of the vitrified ones, a total of 68 were devitrified and of these 91.2% reached D5. Of the correctly fertilized oocytes, 96.5% (136) reached blastocysts compared to 5 that were blocked and 3 that were blocked from those that were not fertilized. Regarding the fertilization rate of fresh oocytes, a total of 76 was obtained, which is equivalent to 100%, and of the devitrified oocytes, 65 were fertilized (95.6%) and 3 were not fertilized (4.4%). With a variation of 6.2% in the blastocyst rate, between fresh and devitrified oocytes.Conclusions: There is no significant difference in the reproductive results of fresh and vitrified oocytes. It is necessary to try to carry out more studies with a larger sample size to obtain more conclusive results. The reproductive outcomes of fresh oocytes and oocytes devitrified using fresh sperm and frozen sperm are similar. With this, fresh oocytes have a slightly higher probability of implantation.
RESUMO
Background: The decrease in ovarian reserve has become one of the main causes of infertility. Recent studies have sought to improve the reproductive outcomes of these women through adjuvant treatments. In patients undergoing assisted reproduction treatments, exogenous Dehydroepiandrosterone (DHEA) or prasterone acts as a precursor to testosterone in the follicular fluid, which increases steroidogenesis and the number of primary and antral follicles.Methods: A quantitative, quasi-experimental case series study was carried out in the clinical area of assisted reproduction from August 2021 to March 2022. All women included were over 34 years and categorized as POSEIDON IV. They were supplemented with 100 mg of DHEA one month prior to the follicular capture. Data was collected from the records of the patients who met the inclusion criteria, including the antral follicle count on the first three days of the menstrual period before the supplementation and one month after. Finally, the number of metaphase II oocytes and blastocysts obtained were analyzed.Results: There were 22 women underwent controlled ovarian stimulation; there was a difference in antral follicle count from 5±2.1 SD to 8.23?±4.29 SD (p=0.004) and MII oocytes 3.25±2.31 to 4.53±3.27 (p=0.04) before DHEA and after DHEA, respectively.Conclusions: DHEA or prasterone supplementation can be used as an adjuvant treatment in women of the POSEIDON IV group one month before the ovarian stimulation to improve their reproductive outcome.
RESUMO
Resumen ANTECEDENTES: La trombosis del seno venoso representa el 1% de los eventos vasculares cerebrales; su incidencia es de 5 casos por cada millón de habitantes y su mortalidad es del 10%. Los senos sagital superior y venoso transversal son los más afectados. El embarazo es un factor de riesgo especial pues la trombosis se registra en el 0.01% de las gestaciones. CASO CLÍNICO: Paciente de 40 años, primigesta, con embarazo gemelar bicorial biamniótico de 33.6 semanas. Se ingresó al servicio de Urgencias debido al diagnóstico de preeclampsia con criterios de severidad, con presión arterial de 160-100 mmHg y transaminasemia. Se le indicó tratamiento antihipertensivo y sulfato de magnesio intravenoso. Se decidió la finalización del embarazo por cesárea. Al cuarto día poscesárea tuvo disminución de la fuerza en ambos brazos, pérdida del tono muscular en los miembros pélvicos, cefalea holocraneana y alteración del estado de alerta (Glasgow de 14). Mediante resonancia magnética se evidenció la oclusión del seno longitudinal superior e isquemia en la región parieto occipital izquierda. Se le administraron anticoagulantes y analgésicos con los que evolucionó adecuadamente; se dio de alta sin complicaciones. CONCLUSIONES: La trombosis del seno venoso implica un reto cuando no se tiene una alta sospecha diagnóstica en pacientes con signos y síntomas neurológicos y, más aún, cuando se agregan factores de riesgo protrombóticos, como el embarazo y el puerperio. El diagnóstico oportuno brinda la oportunidad de iniciar el tratamiento adecuado y disminuir los síntomas y comorbilidades.
Abstract BACKGROUND: Venous sinus thrombosis accounts for 1% of cerebral vascular events; its incidence is 5 cases per million population and its mortality is 10%. The superior sagittal and transverse venous sinuses are the most affected. Pregnancy is a special risk factor since thrombosis is registered in 0.01% of pregnancies. CLINICAL CASE: A 40-year-old primigravida patient with a 33.6 week biamniotic twin pregnancy. She was admitted to the Emergency Department due to the diagnosis of preeclampsia with severity criteria, with blood pressure of 160-100 mmHg and transaminasemia. She was prescribed antihypertensive treatment and intravenous magnesium sulfate. It was decided to terminate the pregnancy by cesarean section. On the fourth post-cesarean day she had decreased strength in both arms, loss of muscle tone in the pelvic limbs, holocranial headache and altered alertness (Glasgow of 14). Magnetic resonance imaging showed occlusion of the superior longitudinal sinus and ischemia in the left parietooccipital region. He was administered anticoagulants and analgesics with which he evolved adequately; he was discharged without complications. CONCLUSIONS: Venous sinus thrombosis implies a challenge when there is no high diagnostic suspicion in patients with neurological signs and symptoms and, even more so, when prothrombotic risk factors are added, such as pregnancy and puerperium. Timely diagnosis provides the opportunity to initiate appropriate treatment and reduce symptoms and comorbidities.
RESUMO
Resumen ANTECEDENTES: En Obstetricia, las imágenes en espejo son artefactos ecográficos infrecuentes que, potencialmente, pueden confundirse con embarazos heterotópicos y propiciar errores diagnósticos e intervenciones iatrógenas. Estas imágenes ficticias se generan por la existencia de una superficie reflectora como, por ejemplo, el intestino distendido o la vejiga repleta. CASO CLÍNICO: Paciente de 39 años, con embarazo por fertilización in vitro, que asiste a evaluación ecográfica del primer trimestre. En la ecografía de rutina a las 11 semanas se observó una imagen en espejo y en la resonancia magnética: útero gestante con una estructura retrouterina hipoecoica, sin feto en el interior. La imagen ecográfica en espejo volvió a reproducirse en el tercer trimestre. El embarazo llegó a término y finalizó por vía abdominal, sin que pudieran demostrarse las estructuras que se advirtieron en la resonancia magnética. CONCLUSIONES: Las imágenes en espejo se han reportado en ultrasonidos de diversas localizaciones pero pocos en la Obstetricia. Todo hizo suponer que la superficie reflectora fue la estructura hipoecoica retrouterina observada, transitoriamente, en la resonancia magnética.
Abstract BACKGROUND: In obstetrics, ultrasonic artifactual mirror images are infrequent, but potentially dangerous since they can be mistakenly interpreted as heterotopic pregnancies, precluding diagnostic errors and iatrogenic interventions. These images require a reflection surface such as dilated bowl or plenty bladder to be generated. OBJECTIVE: We report a first trimester scan ghost twin, diagnosed since first trimester of pregnancy. CLINICAL CASE: 39-year-old patient, with pregnancy due to in vitro fertilization, who attends ultrasound evaluation of the first trimester. Routine ultrasound at 11 weeks showed a mirror image and magnetic resonance imaging: a pregnant uterus with a hypoechoic retrouterine structure, with no fetus inside. The ultrasound mirror image reproduced again in the third trimester. The pregnancy came to an end and ended by abdominal route, without being able to demonstrate the structures that were noticed on the MRI. CONCLUSION: Very few reports of obstetric ultrasound mirror images have been reported. We hypothesize that the transient retrouterine hypoecogenic structure observed by MRI was the reflective surface that create the ghost twin image.