ABSTRACT
La mejor comprensión de la fisiología reproductiva y la disponibilidad de más y mejores recursos diagnóstico/terapéuticos permiten individualizar la estimulación ovárica y hacerla más efectiva (mejores resultados), eficiente (en menos tiempo y con dosis más bajas), segura (con menos y más leves complicaciones), cómoda (menos molestias y autonomía) y accesible (para más personas, a menores costos). Con tecnología de ADN recombinante se dispone ahora de todas las gonadotrofinas e incluso algunas con formas moleculares modificadas para aumentar la duración de acción y disminuir el número de inyecciones. El esquema más utilizado es el de FSH recombinante junto con antagonistas de GnRH. Hay indicaciones específicas para agregar LH o coadyuvantes como hGH o andrógenos transdérmicos. La estimulación ovárica, además de infertilidad, se usa para la preservación de la fertilidad. Cada vez se implementan más estrategias como acumulación de óvulos, esquemas no convencionales (random start, DuoStim y otros) junto a vitrificación ovular, estudio genético preimplantatorio, transferencias embrionarias diferidas y la investigación continúa. Se pronostican mejoras en un futuro próximo, entre otras antagonistas por vía oral y estudio genético de pacientes para diagnosticar mutaciones o polimorfismos de gonadotrofinas y sus receptores. Aunque ya es factible individualizar la estimulación y volverla más efectiva, segura y amigable, así como ofrecer otras opciones a pacientes de mal pronóstico.
Due to an increased understanding of reproductive physiology and to the availability of more and better diagnostic/therapeutic agents, ovarian stimulation through individualization, has become more effective (improved results), efficient (shorter span and lower doses), safe (less and milder complications), comfortable (less discomfort and dependance) and affordable (for more people at lower cost). All gonadotrophins are now available by recombinant DNA technology, including some modified compounds for specific purposes such as longer action and fewer injections. The most popular ovarian regime uses recombinant FSH and GnRH antagonist. There are precise indications for adding LH or adjuncts like hGH or transdermal androgens. Besides infertility, ovarian stimulation is also indicated for fertility preservation. Strategies like oocyte accumulation, non-conventional stimulation protocols (random start, DuoStim and others), oocyte vitrification, preimplantation genetic testing, freeze-all, deferred embryo transfer for particular cases are becoming popular, and the research still goes on. Future advances like oral GnRH antagonists, and the study of mutations and polymorphisms for gonadotropins and its receptors are foreseen. Today through individualization, ovarian stimulation is safe, effective and friendly, also we can offer good options to bad prognosis patients
Subject(s)
Humans , Female , Ovulation Induction/trends , Infertility/therapy , Fertility PreservationABSTRACT
La preservación de la fertilidad es la aplicación de estrategias médicas y de laboratorio para preservar la descendencia genética parental en adultos o niños en riesgo de esterilidad. El cáncer es la principal indicación de preservación de fertilidad en pacientes en edad reproductiva. En las últimas décadas ha incrementado la incidencia de cáncer en adolescentes. Los tratamientos oncológicos también han mejorado significativamente, por lo que hoy es posible la curación en un amplio porcentaje de pacientes. La mayoría de los niños y adolescentes con cáncer se convierten en sobrevivientes a largo plazo, lo que aumenta el interés en los efectos del tratamiento del cáncer sobre la fertilidad. Las condiciones sociales, económicas y culturales también son determinantes para decidir el momento que una pareja busque promover su fertilidad. Además, otras patologías o incluso fármacos para prevención del rechazo de órganos trasplantados pueden afectar la fertilidad y, por tanto, tales pacientes son susceptibles de orientación sobre preservación de la fertilidad. El éxito en los programas de reproducción asistida y en los tratamientos oncológicos brindan alternativas para preservar la fertilidad. En esta primera Opinión de Grupo de Expertos Mexicanos en Preservación de la Fertilidad hemos evaluado pacientes oncológicas que son candidatas a preservación de fertilidad: jóvenes con riesgo de compromiso de su fertilidad por el tratamiento oncológico, pero con reserva ovárica suficiente y pronóstico vital aceptable. También se consideraron casos especiales como la preservación social, en casos de conceptualización sexual diferente, así como los aspectos legales y éticos básicos
Fertility preservation is the application of medical and laboratory strategies to preserve parental genetic offspring in adults or children at risk of sterility. Cancer is the main indication of fertility preservation in patients of reproductive age. In recent decades, the incidence of cancer in adolescents has increased. Cancer treatments have also improved significantly, making cure possible today in a large percentage of patients. Most children and adolescents with cancer become long-term survivors, increasing interest in the effects of cancer treatment on fertility. Social, economic and cultural conditions are also decisive in deciding when a couple seeks to promote their fertility. Furthermore, other pathologies or even drugs for the prevention of rejection of transplanted organs can affect fertility and, therefore, such patients are susceptible to guidance on fertility preservation. Success in assisted reproduction programs and cancer treatments provide alternatives to preserve fertility. In this first Opinion of the Group of Mexican Experts on Fertility Preservation, we have evaluated oncological patients who are candidates for fertility preservation: young people at risk of compromising their fertility due to oncological treatment, but with sufficient ovarian reserve and acceptable vital prognosis. Special cases such as social preservation were also considered, in cases of different sexual conceptualization, as well as the basic legal and ethical aspects
Subject(s)
Humans , Male , Female , Infertility/prevention & control , Fertility Preservation/methods , Organ Sparing Treatments/methods , Neoplasms/therapy , Risk Factors , Practice Guidelines as Topic , Fertility Preservation/standards , MexicoABSTRACT
OBJECTIVE: In this study, we report an experience of 59 natural-cycle IVF combined with in vitro oocyte maturation (IVF/M) cycles in patients with PCOS requiring IVF recruited based on limitations to afford a conventional IVF treatment in a 9-years period. Results of IVF/M were compared with 164 cycles of IVF in PCOS patients. MATERIAL AND METHODS: In IVF/M cycles only hCG priming was used before oocyte recovery, with in vitro maturation of immature oocytes in a commercial medium. In conventional IVF group, recombinant FSH (rFSH) and GnRH agonist/antagonist for ovarian stimulation were used. In both groups, fertilization was achieved by intracytoplasmic sperm injection (ICSI) of mature oocytes and fresh embryos transferred at day 2 or day 3. RESULTS: In all IVF/M cycles oocytes and transferable quality embryos were obtained, only in 6 IVF/M cycles mature oocytes were obtained at oocyte capture day. Clinical pregnancy rate per cycle was 39.0% vs 53.6% (p = 0.0682) and delivery rate per cycle was 30.5% vs 42.6% (p = 0.1209) in IVF/M and conventional IVF respectively. Patients with ovarian hyperstimulation syndrome (OHSS) were 0% in IVF/M vs 6.7% in conventional IVF (p = 0.0399). CONCLUSION: Our experience in a private clinic in Mexico suggests that IVF/M can be a useful initial strategy to treat PCOS patients requiring IVF with comparable delivery rates to conventional IVF and a decreased risk of ovary hyperstimulation. IVF/M may be indicated to patients with limited resources paying without insurance for their infertility treatment.
Subject(s)
Fertilization in Vitro/methods , In Vitro Oocyte Maturation Techniques/methods , Infertility, Female/therapy , Adult , Female , Humans , In Vitro Oocyte Maturation Techniques/economics , Infertility, Female/etiology , Oocyte Retrieval/methods , Ovulation Induction/methods , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/diagnosis , Pregnancy , Pregnancy Rate , Young AdultABSTRACT
BACKGROUND: Poor implantation rates continue to be the determinant factor for results in assisted reproductive techniques; many factors are thought to be involved including embryo quality, endometrial receptivity and embryo transfer. Assisted hatching has been proposed as a technique to improve implantation rates in selected groups of patients, especially with poor prognosis. OBJECTIVE: To evaluate the impact of the laser assisted hatching performed with quarter technique in patients with poor prognosis. MATERIAL AND METHODS: Prospective, controlled and randomized clinical study. The study group included patients with poor prognosis: maternal age ≥ 38 years, basal FSH ≥ 12.0 mUl/mL, two or more previous FIV/ ICSI failures. The control group don't received neither assisted reproductive techniques. RESULTS: We registered 303 cycles: n=1 54 in study group (laser assisted hatching) and n = 149 in control group. Clinical pregnancy (40.1 vs 19.7%) and implantation (17.5 vs 8.3%) rates were significant higher in laser assisted hatching group, there were not significant differences between multiple pregnancy (13.11 vs 10%) and miscarriage (14.7 vs 17.2) rates. CONCLUSION: Laser assisted hatching with quarter technique improves pregnancy and implantation rates in poor prognosis patients.
Subject(s)
Embryo Implantation , Embryo Transfer/methods , Lasers , Reproductive Techniques, Assisted , Abortion, Spontaneous/epidemiology , Adult , Female , Humans , Pregnancy , Pregnancy Rate , Pregnancy, Multiple/statistics & numerical data , Prognosis , Prospective StudiesABSTRACT
BACKGROUND: It is estimated that 15% of couples living in industrialized countries are infertile, ie have failed to conceive, reproductive age, after 12 months ormore of regular intercourse without contraception. During the past decade has increased the demand for fertility treatments because they believe are moreeffective now. OBJECTIVE: To unify the therapeutic approach and service to patients and set a precedent for a Mexican Official Standard respect and support for the legislation of these procedures. METHOD: Consensus by technical experts group panel with the participation of 34 national centers accredited for use in assisted reproduction. He organized seven workshops with the following themes: 1) selection of patients for assisted reproduction treatment, 2) schemes controlled ovarian stimulation for assisted reproduction techniques of high complexity, 3) preparation and egg retrieval technique, 4) transferembryo; 5) luteal phase supplementation; 6) indications and techniques of cryopreservation and 7) informed consent. Each table had a coordinator who wrote and presented the findings to the full, it made a number of observations until they reached unanimity of criteria, which are reflected in this document. RESULTS: Patient selection for assisted reproduction techniques is the first step of the process. Proper selection lead to success, in the same way that a bad pick up for failure. In the case of egg donation the most important recommendation is that only one to two embryos transferred in order to reduce multiple pregnancy rates and maintaining high pregnancy rates.
Subject(s)
Reproductive Techniques, Assisted/standards , Blastocyst , Corpus Luteum Maintenance , Cryopreservation/methods , Embryo Disposition , Embryo Transfer/standards , Female , Gonadotropins/administration & dosage , Gonadotropins/isolation & purification , Gonadotropins/pharmacology , Humans , Infertility, Female/etiology , Infertility, Female/therapy , Infertility, Male/etiology , Infertility, Male/therapy , Informed Consent , Insemination, Artificial/standards , Male , Oocyte Donation/standards , Oocyte Retrieval/methods , Oocyte Retrieval/standards , Ovary , Ovulation Induction/methods , Ovulation Induction/standards , Patient Selection , Pregnancy , Pregnancy Rate , Progesterone/administration & dosage , Progesterone/pharmacology , Semen Preservation/methods , Semen Preservation/standards , Testis , Tissue Preservation/methods , Tissue Preservation/standardsABSTRACT
BACKGROUND: Intracytoplasmic sperm injection (ICSI) is highly effective for the control of male factor infertility. The sperm selected for ICSI may have structural abnormalities undetectable to 400x as nuclear vacuoles, decreasing rates of pregnancy and implantation. Recent studies show that with intracytoplasmic morphologically selected sperm injection (IMSI), at higher magnification (> 6,600x), increases pregnancy and implantation rates in patients with repeated failure to ICSI. OBJECTIVE: To compare the results of the injection of selected motile sperm organelle morphology examination (MSOME) for IMSI, instead of the use of ICSI in patients with repeated failure to ICSI. PATIENTS AND METHOD: Prospective, observational cohort study. Since February 1, 2010 was administered IMSI to couples with at least two failed cycles of ICSI, and analyzed the first 30 cycles in patients under 38 years of good ovarian reserve. This study group was compared with the last 30 cycles of ICSI performed before that date, in patients with similar clinical characteristics. The IMSI was performed with a magnification of 7,676 increases for evaluation and sperm selection. RESULTS: The groups had similar clinical characteristics. The pregnancy rate with IMSI was better than with ICSI (63 vs. 50%), the difference was not significant for the size of the sample, although the trend is clear and clinically significant in favor to IMSI. The implantation rate with IMSI (44.8%) showed statistically significant differences vs. ICSI (29.7%). No significant differences in abortion rates. CONCLUSIONS: IMSI significantly improves the implantation rate in patients with repeated failure to ICSI.
Subject(s)
Sperm Injections, Intracytoplasmic/methods , Spermatozoa/ultrastructure , Adult , Awards and Prizes , Cell Separation , Cohort Studies , Embryo Implantation , Female , Gynecology , Humans , Male , Mexico , Obstetrics , Pregnancy , Pregnancy Rate , Prospective Studies , Spermatozoa/abnormalities , Treatment FailureABSTRACT
Se realizó un estudio clínico para evaluar la efectividad y efectos colaterales clínicos y en metabolismo lipídico de un preparado anticonceptivo hormonal combinado que contiene 75 mcg. de gestodeno y 30 mcg. de etinilestradiol. Se incluyeron 30 mujeres mexicanas en edad reproductiva, las que se estudiaron en periodo de 12 meses acumulando un total de 360 meses-mujer. El preparado fue eficaz puesto que no se presentaron embarazos en el lapso estudiado. Los efectos clínicos secundarios fueron más leves y menos frecuentes a los observados con otros anticonceptivos orales disponibles. En lo referente al metabolismo de los lípidos no se observaron los cambios adversos más frecuente detectados con el empleo de progestágenos previamente disponibles. Al igual que otros estudios, este trabajo concluye que el nuevo preparado, gestágeno más etinilestradiol, es altamente eficaz como anticonceptivo, con baja incidencia de efectos colaterales y debido a su inteferencia sobre metabolismo lipídico, es particularmente indicado para casos de alto riesgo de desarrollar patología asociada a alteraciones en el metabolismo de lis lípidos
Subject(s)
Humans , Female , Ethinyl Estradiol/metabolism , Ethinyl Estradiol/pharmacokinetics , Lipids/pharmacokinetics , Lipids/metabolism , Progestins/metabolism , Progestins/pharmacokinetics , Contraceptives, Oral, Combined/metabolism , Contraceptives, Oral, Combined/pharmacokineticsABSTRACT
Se presentan los resultados de un estudio multicéntrico, abierto, nacional en el que 300 pacientes ambulatorias que padecían mastopatía fibroquística (MFQ), fueron valoradas tras el tratamiento con bromocriptina durante tres meses consecutivos a dosis de 5,0 mg y 7.5 mg diarios. Se observó una remisión total de la mastalgia en 88% de los casos y de la tensión mamaria subjetiva en 89.9%. Se produjo también una remisión parcial de los quistes y nódulos en 50% de los casos, traducida como disminución en número, tamaño y consistencia de los mismos. La tolerancia a la bromocriptina fue buena en general, con 6% de abandonos por efectos indeseables, en forma de náusea, vómito, cefalea e hipotensión; en 26% de los casos hubo efectos secundarios leves que no impidieron la continuación del tratamiento; en el resto la tolerancia fue perfecta
