Valor de la cuenta folicular antral como predictor de éxito en ciclos de fertilización in vitro / Value of the antral follicular count as a predictor of success in in vitro fertilization cycles

Resumen ANTECEDENTES: La asociación entre pruebas de reserva ovárica y respuesta a la estimulación está debidamente establecida aunque su capacidad para predecir embarazo clínico y recién nacido vivo es limitada. OBJETIVO: Evaluar la utilidad clínica de la cuenta folicular antral para predecir embarazo clínico y recién nacido vivo. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en el Instituto Nacional de Perinatología, entre 2011 y 2016 en ciclos de fertilización in vitro en fresco. Se incluyeron pacientes con diagnóstico de infertilidad a quienes se efectuó, in vitro, transferencia de embriones en fresco. Variables de estudio: edad, cuenta folicular antral, concentración basal de FSH y cantidad de ovocitos capturados. Se elaboró un modelo de regresión logística. Para el análisis estadístico se utilizó el programa Statistic Package for Social Sciences (SPSS). Se consideró significativa la probabilidad de error alfa menor de 5%. RESULTADOS: Se analizaron 923 ciclos de fertilización in vitro. La cuenta folicular antral tiene predicción para detectar embarazo clínico con un área bajo la curva ROC de 0.59 y para recién nacido vivo de 0.57. El número óptimo con mayor porcentaje de embarazo clínico (9%) y recién nacido vivo (10.4%) tuvo cuenta folicular antral ≥ 8. CONCLUSIONES: Cuando la cuenta folicular antral es más o menos mayor de 8 folículos se espera mayor cantidad de embarazos clínicos y de recién nacidos.

Abstract BACKGROUND: The association between ovarian reserve test and ovarian response is well established, however, its ability to predict clinical pregnancy and the live birth is limited. OBJETIVE: Evaluate the clinical usefulness of the antral follicle count (AFC) to predict clinical pregnancy and live newborn. MATERIALS AND METHODS: Retrospective cohort study was made. In fresh IVF cycles, performed at INPer between 2011-2016. Including patients diagnosed with infertility, who underwent in vitro fertilization with fresh embryo transfer. The study variables were age, antral follicle count, basal FSH concentration and number of oocytes captured. A binary logistic regression model was performed. Statistical Package for Social Sciences (SPSS) was used for the statistical analysis. The probability of error alpha <5% was considered significant. RESULTS: A total of 923 in vitro fertilization cycles were included. The antral follicle count has a prediction for clinical pregnancy (ABC 0.59) and live birth (ABC 0.57). The optimal cut-off value with the highest percentage of clinical pregnancy (9%) and live birth (10.4%) was presented with a CFA ≥ 8. A higher pregnancy rate is reported when there is a follicular count above ≥8 follicles. CONCLUSIONS: It is expected the highest number of clinical pregnancy and live birth when the antral follicle count is for ≥8 follicles.

[Unselective single embryo transfer: chances of pregnancy related to operator experience]. / Transferencia no selectiva de embrón único: posibilidades de embarazo relacionadas con la experiencia del operador.

BACKGROUND: Selection of best quality embryo aims to achieve higher success rate, the pregnancy is unique and therefore obstetric risks are reduced. OBJECTIVE: To evaluate the pregnancy rate with no transfer of selected single embryo (TSSE) three days versus the experience of the physician performing the embryo transfer. PATIENTS AND METHODS: A retrospective, cross-sectional observational study in 159 patients Mexican Fertility Center in CEPAM protocol in vitro fertilization any indication, other ovulatory disorders and who was only possible obtain an embryo to be transferred in three day. For the analysis were grouped according to age, number of cells of the embryo transfer day and the doctor performed. Continuous variables are reported as means and standard deviations and univariate logistic regression was performed to determine statistical significance. Categorical variables were evaluated in frequencies and percentages. The calculations were performed with the software JMP. RESULTS: Protocol of single-embryo transfer not selected in three day pregnancy rate of 17% was obtained, with lower rates in women over 40 years of age and older embryos of more than 9 cells but also higher rate abortion. More experienced doctors achieved better pregnancy rates. CONCLUSION: This is the first study in Mexican population to assess the possibility of pregnancy with single embryo transfer in selected post-harvest with a three day success rate of 17% and first-order variables: number of cells on the day of transfer and experience of the physician who performed the procedure.

[Report of the seminal characteristics in patients with consecutive pregnancy to intrauterine insemination and his perinatal complications]. / Influencia del estudio seminal en el éxito de la inseminación intrauterina y en las complicaciones perinatales.

BACKGROUND: It is reported that pregnancies achieved through assisted reproductive techniques have increased risk of complications. There is doubt as to whether this increase is attributable to the underlying infertility or to the assisted reproduction techniques. Postcapacitation seminal parameters have been mentioned as determinants of success. OBJECTIVES: To describe semen parameters of patients at the Mexican Fertility Center (CEPAM) who achieved pregnancy with intrauterine insemination and compare the causes of perinatal morbidity and mortality with those of the general population. PATIENTS AND METHODS: A descriptive, retrospective (2004-2009), analytical and longitudinal study based on analysis of intrauterine insemination cycles that achieved pregnancy with prenatal care and childbirth. The variables studied were: pregnancy, obstetric complications and postcapacitation semen parameters. For the analysis the data was divided according to sperm morphology. The results were analyzed using SPSS-20. Continuous variables were reported as means, and their standard deviations and logistic regression as univariate to determine the statistical significance. The categorical variables were evaluated in frequencies and percentages. RESULTS: 133 cases were analyzed, 78% with normal morphology over 4%, mean semen parameters: 0.63 mL volume, density 82.72 million/mL, progressive motility 88.5% and normal morphology over 4% of 5.93%. The 16.6% of pregnancies were twins. 18.5% was abortion, 69% was cesarean section and 30% vaginal delivery. No differences were found in any of the variables when comparing normal sperm morphology groups lower and higher than 4%, except in patients with abortion. There was no increased incidence of perinatal complications than in the general population. CONCLUSIONS: Perinatal complications incidence is similar to the general population, except in multiple pregnancy. There is more success in intrauterine insemination when the postcapacitation morphology is over 4%.

[Assisted hatching following embryo implantation failure]. / Eclosión asistida en pacientes con falla previa en la implantación embrionaria.

BACKGROUND: Assisted hatching in reproduction techniques has improved the successful implantation rates in certain groups of patients with poor prognosis. This study focuses on its effect in groups of patients with previous implantation failure and according to age groups. OBJECTIVE: Compare the pregnancy rates of patients who turned to this technique following an implantation failure using in vitro fertilization with those of patients who did not use assisted hatching before another attempt of in vitro fertilization and according to specific age groups. MATERIAL AND METHOD: Cases of patients using assisted hatching in our Center between January 2008 and December 2009 were studied. The results were compared in terms of age in three groups: group I, >35 years; group II, 35-39 years, and group III, > 40 years. RESULTS: Patients in group II had better pregnancy rate (30%) than those in groups I and III (16.98 and 20.83%, respectively). When comparing the results of the group of patients using assisted hatching with those of the group that did not, the first reported a 20% pregnancy rate versus no pregnancy in the other group.

[Evaluation of two transfer embryo systems performed by six physicians]. / Evaluación de dos sistemas de transferencia de embriones.

BACKGROUND: Embryo transfer is a critical point for success in IVF cycles. Many factors should be considered when performing an embryo transfer such as: embryo quality and number, soft versus rigid catheter, easy of the transfer, physician technique, ultrasound guide during transfer, among others. OBJECTIVE: Evaluate two different embryo transfer systems performed by six physicians with the same protocol. MATERIAL AND METHODS: We evaluated 308 embryo transfers performed from January 2006 to December 2008 by six physicians with two different systems. We only included patients with good quality in embryos and endometrium. Both systems were analyzed in each of the six physicians. RESULTS: Similar characteristics in number of transferred embryos, number of cells in each embryo and quality of them, were found in both groups. There were no significant differences between both systems in the characteristics of the couple nor the mentioned above. Most of the transfers n = 252 (81.81%), were realized by two of the six physicians, however, the pregnancy rate did not show significant differences between these physicians and the less experienced ones. CONCLUSIONS: With the obtained results, it could be supposed that the most influential factor in the outcome is the operator experience in the use of each system and not the system itself.

[Intrauterine insemination results in the Specialized Center for Women's Care]. / Resultados de inseminación intrauterina en el centro especializado para la atención de la mujer.

BACKGROUND: intrauterine insemination should be offered to couples with unexplained infertility, given its effectiveness and compared to in vitro fertilization and embryo transfer, is less invasive and requires less resources. It also should be offered to couples with male factor infertility in selected patients with induction of ovulation to increase the chances of pregnancy. OBJECTIVE: to determine the rate of pregnancy with intrauterine insemination in couples with infertility. MATERIAL AND METHODS: descriptive and retrospective study of 500 couples with female, male and combined infertility, primary or secondary, managed with homologous insemination, with controlled ovarian stimulation and programmed ovulation, in patients with at least one permeable salpinx, FSH <12 IU/L and > 5 x 10(6) mobile and normal sperm. Ultrasonografic follicular follow-up and ovulation triggering according to findings, performing insemination 36 hours after the shooting, with luteal phase support with progesterone. RESULTS: 1.6 cycles on average, female infertility 65.8%, 21% male and combined 13.2%, age average 32 years of women and 36 years of man, average ovarian stimulation 8 days. Pregnancy in 19.5% of the patients, of these, 65.1% under the age of 35 years, 33.3% from 35 to 40 years and 1.5% older than 40 years. Pregnancy at term 77.08%, miscarriage 11.45% and unknown resolution at 11.45%. Twin pregnancy 14.61% and high fetal order 5.7%. Pregnancy with female infertility 64%, male 22.3% and combined 13.5%. Pregnancy with endometrial <8 mm 9.8%, 8-15 mm 86.4% >15 mm 3.6%. With trilaminar endometrium 72.3%, dense 12.5%, linear 0.5%. CONCLUSION: The rate of pregnancy in intrauterine insemination hardly exceeds 20%. The determinants for this are the women age, type of infertility and endometrial characteristics. It was also noted high twin pregnancy and high fetal order.