High ovarian responders have the highest risk of premature progesterone rise.

OBJECTIVE: Late follicular phase progesterone elevation is a complication that affects approximately 38% of IVF cycles. There is a lack of consensus on the appropriate cut-off levels for progesterone on hCG day. Although premature progesterone rise occurs in all kinds of ovarian responses, there is a knowledge gap regarding the ovarian response with the highest risk of this phenomenon. Our study aims to assess the relative risk of each kind of ovarian response for premature progesterone rise and evaluate the prevalence of premature progesterone rise in each ovarian response. METHODS: A retrospective, cross-sectional, comparative and analytic study was performed at the Reproductive Endocrinology Department in Centro Médico Nacional 20 de Noviembre in Mexico City. All conventional-antagonist cycles were grouped according to their ovarian response and were evaluated from 2015 to 2020. Pearson's Squared-chi, Cramer's V, cross-table and the relative risk were calculated. RESULTS: The prevalence of premature progesterone rise oscillated from 20.8 to 67.9% for low and high ovarian responders, respectively. After calculating the relative risk, high ovarian responders had a 1.38 higher risk for premature progesterone rise than other groups. CONCLUSIONS: High ovarian responders have the highest risk for premature progesterone rise compared to normal and low ovarian responders. High ovarian responders have a 67.9% prevalence of premature progesterone rise.

Progesterone levels on hCG day and oocyte maturation in a Mexican IVF program.

OBJECTIVE: Does progesterone levels on hCG day influence maturation rates and number of mature oocytes during ovarian stimulation for IVF/ICSI cycles?. METHODS: A retrospective, observational, analytic, cross-sectional and cohort study was performed at the Reproductive Endocrinology Department of the Centro Médico Nacional 20 de Noviembre in Mexico City between 2015 to 2020. All female patients underwent an ovarian stimulation cycle for IVF/ICSI, either with a mild or conventional stimulation protocol. Patients were classified according to their progesterone levels, Group 1 <1.5ng/ml and Group 2 >1.5mg/ml. A Spearman Rho test, a simple linear regression model, a Principal Component Analysis and a Student's T-test, were performed. RESULTS: A total of 600 patients were included. The overall results showed that there is a positive correlation between the number of retrieved, mature oocytes and progesterone levels on HCG day. After the Principal Component Analysis we observed that poor ovarian responders had the lowest maturation rate and number of mature oocytes. While the Student's t test showed that progesterone levels beyond 1.5ng/ml are associated to a higher number of mature oocytes but not a better maturation rate. CONCLUSIONS: Higher serum progesterone levels are associated with increased retrieved and mature oocytes in high responders. At the same time, higher progesterone levels in lower responders are not associated with optimal ovarian response.

A rapidly progressive defective spermatogenesis in a Mexican family affected by spino-bulbar muscular atrophy.

Spino-bulbar muscular atrophy (SBMA) is an X-linked recessive adult progressive disorder affecting motor neurons. It is caused by a poly-glutamine tract expansion in the androgen receptor (AR) which generates protein aggregates that cannot be processed by proteasomes. A secondary mild androgen resistance is developed by AR dysfunction and patients present endocrine abnormalities including gynecomastia and poor function of testosterone in tissues; however, normally they are fertile. In this report we describe a Mexican family with three affected brothers with primary infertility caused by a progressive impairment of spermatogenesis leading to azoospermia before 40 years of age. They presented common features associated to patients affected by SMBA, such as gynecomastia, high level of CPK, muscle cramps, fasciculations, muscle wastage, and impaired swallowing. Two intracytoplasmic sperm injection (ICSI) cycles were performed in one of the patients resulting in fertilization failure. Molecular analysis of AR gene exon 1 revealed 54 CAG repeats in DNA extracted from leukocytes in affected patients and 22 repeats in the fertile non-affected brother. Severe impaired spermatogenesis of rapid progression has not been associated before to SBMA. This is the first report of assisted reproduction techniques indicated by male infertility in patients with this rare disorder. Further studies are required to confirm the unusual result of intracytoplasmic sperm injection cycles. We discuss the implications and possible pathogenesis of these unique features of SBMA in this family.

[Interobserver diagnostic agreement on digital images of hysteroscopic studies]. / Concordancia diagnóstica interobservador de imágenes digitalizadas de estudios histeroscópicos.

BACKGROUND: Hysteroscopic studies are of the most used methods to examine the uterine cavity in patients that present abnormal uterine hemorrhage as well as those patients with infertility. The use of hysteroscopic studies during reproductive cycles has increased the successful of pregnancy rates. Up to date, there are not many studies evaluating the inter-observer agreement in the diagnosis of different uterine pathology when using a hysteroscopic study. OBJECTIVE: To evaluate the inter-observer agreement in the diagnosis of uterine pathology when using digitalized images in hysteroscopic studies made by residents of gynecological endoscopy. MATERIALS AND METHODS: A cross-sectional, descriptive and observational study was made including 28 images of hysteroscopic studies selected by at least two of three experts in hysteroscopy, who determined that they were adequate to do a diagnostic impresion. From a total of four residents, two were selected using a randomized sampling. The images were shown to each resident in a randomized presentation and the diagnosis agreement was evaluated. Kappa test was used to evaluate the interobserver agreement with 95% confidence interval. RESULTS: The interobserver agreement obtained by Kappa test for different images for diagnosis of uterine pathology were: normal uterine cavity (κ = 0.81 with CI 95%, 0.56-1.00), endometrial polypus (κ = 0.71 with CI 95%, 0.33-1.00), submucous myoma (κ = 0.71 with Cl 95%, 0.33- 1.00), intrauterine adherences (κ = 0.84 with Cl 95%, 0.52-1.00), uterine septum (κ = 0.76 with CI 95%, 0.43-1.00) and endometrial hyperplasia or potential endometrial cancer (κ = 0.87 with Cl 95%, 0.61-1.00). CONCLUSIONS: The interobserver agreement using digitalized images in the diagnosis of different uterine pathology from hysteroscopic studies made by residents of endoscopic surgery was high and very high in all cases.

[Effect of administration of recombinant LH on the 5th day versus the 8th day in ovarian stimulation cycles]. / Efecto de la administración de LH recombinante en día 5 contra día 8 en ciclos de estimulación ovárica.

BACKGROUND: Ovarian stimulation is a key component in assisted reproduction techniques. Supraphysiologic levels secondary to hormonal stimulation with high doses of exogenous hormones affect endometrial receptivity, the function of the corpus luteum, ovulation and embryo quality. The use of stimulation protocols called "minimal stimulation" may have a beneficial effect in achieving pregnancy. OBJECTIVES: To evaluate the clinical efficacy (pregnancy rate) of rLH treatment on Day 5 (minimum group "A") vs. Day 8 (minimum group "B") of the ovarian stimulation cycle. MATERIAL AND METHODS: Cohort, retrospective, pilot study. Two groups of 22 patients each who received minimal stimulation "A" or "B" (control group) in the period from April to August 2010. RESULTS: No statistically significant difference in the following variables: age, FSH, estradiol and basal follicles. The median of mature follicles at the shooting day, the minimum group "A" was 3 vs. 2 for low B, the number of oocytes at metaphase II: Minimum group "A" 37/65 (57%) vs. 24/38 (63 %) at minimal group "B". Patients with grade 1+ quality embryos were 7 in minimal group "A" vs. 6 in the minimal group "B". In the minimal group "A", the pregnancy rate per started cycle was 27.3% and 37.5% for transfer, in the minimal group "B", the pregnancy rate per started cycle was 22.7% and per patient transfer which underwent 25%. CONCLUSIONS: Receiving the minimal stimulation protocol "A" has a 15% higher risk of becoming pregnant, compared with minimal group "B" based on pregnancy rate per transfer, for the sample size, the p value was 0.32.

[Genetic variants associated to male infertility in Mexican patients]. / Variantes genéticas asociadas con infertilidad masculina en pacientes mexicanos.

Recently Mexican Federation of Obstetrics and Gynecology Colleges (Federación Mexicana de Colegios de Obstetricia y Ginecologia, FEMECOG) published the Mexican guideline forthe management of male infertility, which suggests performing genetic laboratory tests as part of diagnosis and management of infertile patients and states that these should receive genetic counseling. This paper reviews the genetic approach proposed by Mexican guideline. A systematic review of medical literature was performed in Pubmed and Web of Knowledge from 1980 to 2012 in order to find reports of genetic variants associated to male infertility in Mexican patients. Also it is discussed the current knowledge of these variants, their clinical implications and finally the guidelines and recommendations for their molecular diagnosis. Most genetic variants in Mexican infertile patients are chromosome abnormalities. In relation to other variants there is only a report of Y chromosome microdeletions, repeated CAG in androgen receptor and more common mutations in CFTR, and other article reporting mutations in CFTR in patients with congenital absence of vas deferens. Little is known about the genetics of Mexican infertile patients apart from chromosome abnormalities. However, the contribution of genetics as etiology of male infertility is taking more relevance and currently the consensual management of infertile male should include the screening of genetic background. This review pretends to be a quick guide for clinicians who want to know about reports of genetic variants related to male infertility in Mexican population and how to approach their diagnosis.