The Ala307Thr polymorphism of the follicle-stimulating hormone receptor (FSHR) gene is associated with the dose of recombinant FSH received during IVF/ICSI treatment.

OBJECTIVE: Follicle-stimulating hormone (FSH) is essential for folliculogenesis, acting through the follicle-stimulating hormone receptor (FSHR) that is present on the membrane of granulosa cells. Polymorphisms in the FSHR gene may lead to an altered pattern of receptor expression on the cell surface or to changes in affinity for FSH. The aim of this prospective study was to detect any association between the follicle-stimulating hormone receptor (FSHR) gene Ala307Thr polymorphism (rs6165) and ovarian reserve, ovarian response or clinical results in IVF/ICSI treatment. METHODS: This prospective cohort study included 450 women who underwent IVF/ICSI cycles. DNA was extracted from peripheral blood, and the Ala307Thr FSHR polymorphism (rs6165) was genotyped using the TaqMan SNP genotyping assay. Participants were divided into three groups according to their Ala307Thr FSHR genotype: Thr/Thr (n:141), Thr/Ala (n=213) and Ala/Ala (n=96). The results were tested for associations with age, anti-Mullerian hormone (AMH) levels, antral follicle count (AFC), total dose of r-FSH, follicle size, number of retrieved oocytes, and clinical outcome of IVF/ICSI cycles. The statistical analyses were performed using Fisher's exact test and the Kruskal‒Wallis test. RESULTS: An association between the genotype of the FSHR (Ala307Thr) polymorphism and the dose of r-FSH was observed. Patients with the Ala/Ala genotype received a higher r-FSH dose than patients with the Ala/Thr (p=0.0002) and Thr/Thr (p=0.02) genotypes. No other correlation was observed. CONCLUSION: The Ala/Ala genotype was associated with the use of higher doses of recombinant FSH (r-FSH), suggesting that homozygosis of this allelic variant (Ala) provides lower sensitivity to r-FSH.

Noninvasive Preimplantation Genetic Testing for Aneuploidy (niPGT-A): The first Brazilian baby.

Recently, a new technology known as the Noninvasive Preimplantation Genetic Testing for Aneuploidy (niPGT-A) emerged, using cell-free DNA present in the spent culture media of human blastocysts. Unlike PGT-A, in which only trophectoderm cells are used, niPGT-A reflects the ploidy state of these cells and internal cell mass, suggesting that this new technology may be less prone to error, being more reliable than the invasive test. The aim of the present study was to report the first occurrence of childbirth following niPGT-A in Brazil.

Association between estrogen receptor 1 (ESR1) and leukemia inhibitory factor (LIF) polymorphisms can help in the prediction of recurrent implantation failure.

OBJECTIVE: To investigate an association between polymorphisms related to the implantation process that together could help in the prediction of recurrent implantation failure (RIF). DESIGN: Cohort study. SETTING: Private fertility center and reproductive genetics laboratory. PATIENT(S): Forty-four women presenting RIF, who were included in study group (RIF group), and two control groups, one with 63 women who were attended at our service and became pregnant after the first IVF/intracytoplasmic sperm injection attempt (control group I) and other with 65 fertile women who had at least two children without any treatment and no history of miscarriage (control group II). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Genotyping was performed in the intron region of TP63, VEGFA, MMP2, ESR1, and ESR2 genes and in the 3' untranslated region of the LIF gene on genomic DNA using real-time polymerase chain reaction. RESULT(S): The presence of ESR1/AA (rs12199722) and LIF/GT (rs929271) genotypes was more frequent in the RIF group, leading to a 7.9-fold increase in the chance of women presenting with RIF when compared with women who became pregnant on their first cycle of IVF/intracytoplasmic sperm injection and a 2.8-fold increase when compared with women who became pregnant without treatment. CONCLUSION(S): The association between ESR1 and LIF polymorphisms can help in the prediction of RIF.

The TP73 gene polymorphism (rs4648551, A>G) is associated with diminished ovarian reserve.

It's known that the members of the TP53 family are involved in the regulation of female reproduction. Studies in mice showed that the TP73 gene (member of this family) plays a role in the size of follicular pool, ovulation rate and maintenance of genomic stability. In the present study we analyzed data from 605 patients with ≤ 37 years attending their first intracytoplasmic sperm injection (ICSI). The association between the TP73 polymorphism (rs4648551, A>G) and the following parameters related to ovarian reserve, like age, antral follicular count (AFC), anti-Mullerian hormone levels (AMH) and ovarian response prediction index (ORPI) was evaluated. Our results showed an association of the AA genotype with diminished ovarian reserve (AMH <1, AFC ≤9). Women presenting the AA genotype had a 2.0-fold increased risk for having AMH <1 and AFC ≤9 (OR 2.0, 95% CI 1.23-3.31, P = 0.005). Patients presenting AA genotype had the lowest levels of AMH (P = 0.02), the lowest number of antral follicles (P = 0.01) and the lowest ORPI (P = 0.007). Analyzing the alleles, we can see an enrichment of the A allele in the group of diminished ovarian reserve (OR 1.4, 95%CI 1.02-1.83, P = 0.04). To the best of our knowledge, the present study is the first to analyze this polymorphism in humans for assessing the numbers of ovarian follicles and AMH levels and, therefore, the ovarian reserve. Our findings can contribute to the use of this polymorphism as a potential marker of diminished ovarian reserve.

Correlation between semen analysis by motile sperm organelle morphology examination and sperm DNA damage.

Regression analysis of 538 semen samples demonstrated that percentages of normal nuclear sperm and all spermatozoa with abnormalities of nuclear form at high magnification had significant negative correlation with percentages of DNA fragmentation. On the other hand, there was a positive correlation between percentages of spermatozoa with nuclear vacuoles and those with DNA fragmentation.

Laser-assisted hatching of cryopreserved-thawed embryos by thinning one quarter of the zona.

Laser-assisted hatching is little documented in the literature regarding its efficacy in cryopreserved-thawed (CT) embryo transfer cycles. The aim of the present study was to evaluate in a randomized manner the efficacy of thinning one quarter of the zona pellucida of CT embryos to a depth of 50-80% of the original thickness, via laser treatment (the qLZT-AH procedure), in improving implantation and pregnancy rates. Two populations were studied: population I, patients who had all their supernumerary embryos cryopreserved, regardless of their morphology, and population II, patients at risk of ovarian hyperstimulation syndrome who had all their embryos cryopreserved. Artificial and natural protocols were used for the embryo transfers. A total of 350 laser-thinned CT embryos were compared with 352 intact zona embryos. No difference in implantation or pregnancy rate was found after using qLZT-AH in either population. These findings suggest that qLZT-AH should not be routinely performed in cryopreserved embryo programmes.

Accuracy of fetal gender determination in maternal plasma at 5 and 6 weeks of pregnancy.

OBJECTIVE: To assess the viability of the early diagnosis of fetal gender in maternal plasma before 7 weeks of pregnancy by real-time polymerase chain reaction (real-time PCR), starting at 5 weeks of pregnancy. METHOD: Peripheral blood was collected from pregnant women, starting at 5 weeks of gestation. After centrifugation, plasma was separated for fetal DNA extraction. DNA was analyzed by quantitative real-time PCR for two genomic regions, one on the Y chromosome (DYS-14) and the other shared by both sexes (ss-globin), by the TaqMan Minor Groove Binder (MGB) probe assay. The results of the examinations were compared to fetal gender determined after delivery. RESULTS: A total of 79 examinations of fetal DNA in maternal plasma were performed for 52 pregnant women. Accuracy according to gestational age was 92.6% (25 of 27 cases) at 5 weeks, and 95.6% (22 of 23 cases) at 6 weeks. These results also demonstrate that fetal DNA is present at low concentrations in maternal plasma at 5 weeks (8.5 genome equivalents (GE)/mL) and 6 weeks (34.1 GE/mL) of pregnancy. CONCLUSION: Quantitative real-time PCR and TaqMan MGB probes specific for the detection of fetal gender in maternal plasma starting at 5 weeks of gestation have good sensitivity and excellent specificity.

Determinação precoce do sexo fetal pela análise do DNA no plasma materno / Early determination of gender by analysis of fetal DNA in maternal plasma

OBJETIVO: avaliar a possibilidade do diagnóstico precoce do sexo fetal no plasma materno pela técnica da reação em cadeia da polimerase em tempo real (PCR em tempo real) a partir da 5ª semana de gestação. MÉTODOS: nesse estudo prospectivo foi coletado sangue periférico de gestantes com feto único a partir da 5ª semana de gestação. Após centrifugação do sangue, 0,4 mL de plasma foi separado para extração de DNA fetal. O DNA foi analisado em duplicata por PCR em tempo real para duas regiões genômicas (uma do cromossomo Y e outra comum a ambos os sexos) pelo método de TaqMan®, o qual utiliza um par de primers e uma sonda fluorescente. Foram excluídos da amostragem os casos que evoluíram para aborto. Para o cálculo da sensibilidade e especificidade, usamos o método de comparação com padrão-ouro, que foi o sexo ao nascimento. RESULTADOS: foram realizados 79 exames de DNA fetal no plasma materno de 52 gestantes. O resultado dos exames foi comparado com o sexo da criança após o parto. O índice de acerto conforme a idade gestacional foi de 92,6 por cento (25 de 27 casos) na 5ª semana, conferindo sensibilidade de 87 por cento e 95,6 por cento (22 de 23 casos) na 6ª semana, com sensibilidade de 92 por cento. A partir da 7ª semana de gestação o acerto foi em 100 por cento (29 de 29 casos). A especificidade foi de 100 por cento independente da idade gestacional. CONCLUSÕES: a técnica de PCR em tempo real para detecção do sexo fetal a partir da 5ª semana no plasma materno possui boa sensibilidade e excelente especificidade. Houve concordância do resultado em 100 por cento dos casos em que o diagnóstico foi masculino, independente da idade gestacional, e no caso de feminino, a partir da 7ª semana de gestação.

PURPOSE: to verify the viability of early diagnosis of fetal gender in maternal plasma by the real-time polymerase chain reaction (real-time PCR) starting at the 5th week of pregnancy. METHODS: peripheral blood was collected from pregnant women with single fetus starting at the 5th week of gestation. After centrifugation, 0.4 mL plasma was separated for fetal DNA extraction. The DNA was analyzed in duplicate by real-time PCR for two genomic regions, one of the Y chromosome and the other common to both sexes, through the TaqMan® method, which uses a pair of primers and a fluorescent probe. Patients who aborted were excluded. RESULTS: a total of 79 determinations of fetal DNA in maternal plasma were performed in 52 pregnant women. The results of the determinations were compared to fetal gender after delivery. Accuracy according to gestational age was 92.6 percent (25 of 27 cases) at 5 weeks with 87 percent sensitivity, and 95.6 percent (22 of 23 cases) at 6 weeks with 92 percent sensitivity. Starting at the 7th week of pregnancy, accuracy was 100 percent (29 of 29 cases). Specificity was 100 percent regardless of gestational age. CONCLUSION: real-time PCR for the detection of fetal gender in maternal plasma starting at the 5th week of gestation has good sensitivity and excellent specificity. There was agreement of the results in 100 percent of the cases in which male gender was diagnosed, regardless of gestational age, and from the 7th week of gestation for female gender diagnosis.

Critérios para definir o número de embriões a serem transferidos em fertilização in vitro / Criteria to determine the number of embryos to be transferred in in vitro fertilization

Os autores fazem revisão sobre o impacto das técnicas de reprodução assistida na incidência de gravidez múltipla, relacionando seu impacto médico-social. Baseado na experiência pessoal no Centro de Reprodução Humana "Sinhá Junqueira" e na revisão da bibliografia atual, são feitas considerações sobre o número de embriões a serem transferidos em ciclos de FIV

Effects of vaginal progesterone administration starting on the day of oocyte retrieval on pregnancy rates.

PURPOSE: Vaginal progesterone administration starting on the day of oocyte retrieval induced a decrease in uterine contraction frequency on the day of embryo transfer (ET) as compared with preovulatory values. Uterine relaxation before ET is likely to improve outcome by avoiding displacement of the embryo from the uterine cavity (Fanchin, Righini, de Ziegler, Oliviennes, Ledée, Frydman: Fertil Steril 2001;75:1136-1140). The objective of the present study was to determine whether the early use of vaginal progesterone on the day of oocyte retrieval may alter the embryo implantation and pregnancy rates. METHODS: A total of 103 patients were submitted for ovarian stimulation with GnRH-a and recombinant FSH (Puregon, Organon) for the application of invasive assisted reproduction techniques (ICSI). The patients were divided into two groups in a prospective and randomized manner: Group A (n = 51) where application of vaginal progesterone started (Utrogestan, Besins International) at the dose of 400 mg from the evening of the day of oocyte retrieval, and Group B (n = 52) started to apply vaginal progesterone at the same dose but from the evening of embryo transfer (2nd day). RESULTS: The age of Group A patients (34.2 +/- 4.6) was similar (p = 0.50) to that of Group B patients (34.8 +/- 4.9). The number of oocytes retrieved and at metaphase II from Group A patients (10.6 +/- 6.9 and 7.8 +/- 6.0; respectively) did not differ significantly (p = 0.84 and p = 0.49, respectively) from the number of oocytes retrieved and metaphase II from Group B patients (10 +/- 5.6 and 6.7 +/- 4.7, respectively). Also, there was no difference (p = 0.48) in number of embryos transferred to Group A patients (2.7 +/- 0.8) versus Group B patients (2.7 +/- 0.9). Embryo implantation and pregnancy rates for Group A patients (12.6 and 27.4%, respectively) were equal (p = 0.98 and p = 1.0, respectively) to those for Group B patients (13.4 and 28.8%, respectively). CONCLUSION: Vaginal progesterone at the dose of 400 mg started on the day of oocyte retrieval did not increase implantation or pregnancy rates when compared to the same dose started on the day of embryo transfer.

Psychological evaluation test after the use of assisted reproduction techniques.

PURPOSE: The emotional changes provoked by the use of assisted reproduction techniques (ART) may trigger important psychological reactions. The objective of the present study was to develop a psychological evaluation test (PET-ART) in order to identify the occurrence of psychological problems and to facilitate their treatment. METHODS: A total of 128 women were submitted to PET-ART of the Center for Human Reproduction, "Sinhá Junqueira" Maternity Foundation, after application of IVF/ICSI program at least once. The causes of infertility were male-related in 45% of cases, female-related in 48%, and both male- and female-related in 7%. Infertility was primary in 79% of cases and secondary in 21%. The mean age of the women was 34.5 +/- 5.2 years and the mean age of the men was 37.9 +/- 6.8 years. The PET-ART was evaluated using a questionnaire with 15 questions selected in order to detect emotional reactions caused by infertility. The responses were assigned four grades with respect to intensity (1 = mild intensity; 2 = medium intensity; 3 = high intensity; and 4 = maximum or unbearable intensity). The sum of the responses corresponded to PET-ART score ranging from 15 to 60 points. The reliability of the questionnaire was evaluated by the alpha coefficient of Cronbach. RESULTS: The PET-ART identified five questions receiving 50% or more responses of the high/maximum intensity type (sum of the percentages of responses with a score of 3 and 4). The questions were the following: 1--The waiting time before being submitted to a pregnancy test (82.8% of the patients); 2--A negative result of the pregnancy test (77.3% of the patients); 3--The degree of anxiety in a new attempt to obtain pregnancy (76.5% of the patients); 4--Finding the money necessary for the repetition of the IVF/ICSI techniques (66.4% of the patients); 5--The possibility of collecting few eggs, or of forming or not an embryo in the laboratory is an expectation that makes me anxious (57.8% of the patients). The mean PET-ART was 33 +/- 6. The alpha coefficient of Cronbach was 0.757. CONCLUSIONS: The PET-ART was an efficient tool for the identification of women with emotional changes provoked by the application of ART and for the planning of their treatment. However, a general psychological approach was developed for each emotional factor regardless of PET-ART.

Variaçäo da concentraçäo espermática entre amostras obtidas após curto intervalo de tempo / Variation in the eperm concentration between samples obtained with brief time interval

A probabilidade de gestaçao com o uso das técnicas de reproduçao assistida está ligada com o número de espermatozóides móveis (EM) recuperados após o preparo do esperma. Em geral, aceita-se como ideal no programa de inseminaçao intra-uterina a obtençao de no mínimo 5.0 milhoes de EM/ml, e no programa de fertilizaçao in vitro convencional 1.5 milhoes de EM/ml. A obtençao de uma segunda amostra é sempre aconselhada quando se supoe que esses valores nao sejam atingidos. Este estudo compara a concentraçao de EM a fresco, após a utilizaçao de idêntica técnica de capacitaçao (gradiente de Percoll) entre duas amostras de esperma colhidas de 20 pacientes com intervalo de uma a três horas. A concentraçao de EM/ ml no sêmen a fresco na primeira amostra foi de 2.92 + 2.86 milhoes versus 11.78 + 13.05 milhoes na segunda amostra (p = O.001, Wilcoxon). Por outro lado, a concentraçao de EM/ml após o processo de capacitaçao na primeira amostra foi de 2.81 + 2.36 milhoes versus 5.16 + 4.60 milhoes na segunda amostra (p = O.021, Wilcoxon). Em conclusao, o número de EM obtidos no sêmen a fresco e a pós-capacitaçao numa segunda amostra (p = O.021 Wilcoxon). Em conclusao, o número de EM obtidos no sêmen a fresco e a pós-capacitaçao numa segunda amostra foi significativamente superior ao encontrado na primeira amostra, justificando a conduta de se obter uma nova amostra, caso a primeira seja insuficiente para a utilizaçao das técnicas de reproduçao assistida.

O valor preditivo de uma única determinaçäo de ß-hCG plasmático em gestaçöes obtidas por fertilizaçäo in vitro e transferência de embriöes / The predictive value of single plasma ß-hCG determination on pregnancies achieved by in vitro fertilization and embryos transfer

Neste estudo foi testada a hipótese de que a determinaçao do beta hCG plasmático no 14a. ou 15a. dia, após a transferência embrionária num programa de fertilizaçao in vitro (FIV), pode predizer o curso da gravidez. As amostras de sangue foram obtidas de 48 pacientes que engravidaram no programa de FIV. As determinaçoes de beta-hCG foram realizadas por enzimaimunoensaio (Serozyme, Serono). Em 23 casos de gestaçoes únicas que evoluíram até o nascimento, a média dos valores plasmáticos de beta-hCG (mu = 265 ñ 153 mUI/ml) foi significativamente maior (p < 0.05, teste de Mann-Whitney) do que naquelas observadas em 12 gestaçoes simples que abortaram (mu = 149 ñ 139 mUI/ml). Por outro lado, 13 gestaçoes múltiplas que evoluíram até o nascimento mostraram uma média dos valores plasmáticos de beta-hCG (mu = 435 ñ 130 mUI/ml) significativamente superior (p < 0.O1, teste de Mann-Whitney) às obtidas na populaçao com gestaçao única. Os resultados sugerem que a determinaçao dos níveis plasmáticos de beta-hCG no 14a. ou 15a. dia após a transferência de embrioes pode predizer dentro de certos limites as populaçoes com maior risco de abortamento e de gestaçoes múltiplas.

Donation of oocytes as treatment for infertility in patients with premature ovarian failure. Awarded the "Nicolau de Moraes Barros" prize for gynecology

Um total de 7 ciclos de transferência de embriöes provenientes da doaçäo de oócitos foram realizados em 5 pacientes portadoreas de insuficiência ovariana precoce. As doadoras possuíam idade inferior a 35 anos, e as receptoras, apresentavam idade média de 38,6 anos. No esquema de sincronizaçäo entre doadora e receptora usou-se um ciclo semiprogramado com pílula, seguido de estimulaçäo da doadora com citrato de clomifeno e gonadotrofina menopausal humana. As receptoras foram facilmente acopladas com as doadoras através de um modelo flexível de doses crescentes de valerianato de estradiol. O número médio de oócitos doados foi de 3.14, a taxa de clivagem embrionária média de 80,2 por cento, sendo o número médio de embriöes transferidos de 2.57. A taxa de implantaçäo embrionária foi de 22,2 por cento. As gestaçöes clínicas ocorreram em 57,1 por cento dos ciclos. Provavelmente, essa série é a primeira apresentada na literatura nacional sobre a doaçäo de oócitos no tratamento da infertilidade em pacientes com insuficiência ovariana precoce

A ultra-sonografia endometrial como fator preditivo de gravidez num programa de fertilizaçäo in vitro / Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme

A espessura e padräo endometrial foram analisados por ultrasonografia em 100 ciclos estimulados para fertilizaçäo "in vitro" no dia da administraçäo do hormônio gonadotrófico coriônico (hCG). Em 86 ciclos empregou-se para a estimulaçäo ovariana um esquema semiprogramado com pílula + citrato de clomifene + gonadotrofina menopausal humana (hCG), e nos 14 ciclos restantes usou-se um análogo do hormônio liberador de gonadotrofinas GnRH/leupro-lide) na forma de bloqueio de longa duraçäo seguido de hMG. No dia do hCG a espessura e o padräo endometrial foram avaliados por um ultrasom Ultramark 4 (ATL) com transdutor vaginal de 5 MHz. A espessura endometrial foi significativamente inferior (p = 0.03) nos ciclos semiprogramados (8.8 ñ 2.0 mm) do que a observada no grupo com análogo do GnRH (10.2 ñ 2.0mm). A distribuiçäo dos padröes I (multicamada ou "3 linhas") e II (inteiramente homogêneo, hiperecogênico em relaçäo ao tecido miometrial) em ambos os protocolos de estimulaçäo näo foram significamente diferentes (p = 0.91). A espessura endometrial no dia do hCG no grupo com padräo I (µ1 = 8.9 ñ 2.1 mm) foi similar (p = 0.76) a observada no padräo II (µ2 = 9.0 ñ 1.9 mm). Além disso, a espessura endometrial nas pacientes que engravidaram (µg = 8.5 ñ 2.2 m) näo diferiu (p = 0.22) das näo gravidas (µng = 9.0 ñ 1.9 mm). Näo houve diferença entre a incidência de gravidez nos grupos com padräo endometrial I e II (p = 0.42). Em conclusäo, os dados deste trabalho näo evidenciaram um valor preditivo de gravidez para a análise ultrasono-gráfica da espessura e refringência endometrial no dia do uso de hCG em ciclos de FIV

Qual o número ideal de embriöes a ser transferido para o útero após fertilizaçäo in vitro? / What the number of embryos to be transferred fot the utero after in vitro fertilization

Atualmente, está bem estabelecido que a transferência de diversos embriöes após fertilizaçäo "in vitro" (FIV) leva a uma maior taxa de gravidez do que quando se transfere apenas um único embriäo. Contudo, a transferência de um número elevado de embriöes acarreta o aumento da incidência de gestaçöes múltiplas. Os objetivos deste estudo foram avaliar as repercussöes do número de embriöes transferidos sobre as taxas de gravidez e de gestaçöes múltiplas num programa de FIV. Além disso, propor um número ideal de embriöes para ser transferido ao útero discutindo-se as soluçöes alternativas para os problemas decorrentes da formaçäo de um número excessivo de embriöes. Um total de 177 ciclos de FIV realizados em 138 casais foram analisados entre janeiro de 1991 e março de 1992. A taxa de gravidez por transferência de 1(n=29), 2(n=30), 3(n=20), 4(n=41), 5(n=20) embrioes foi respectivamente de 3.4 por cento (gestaçöes : 1), 30 por cento (gestaçöes + 9), 45 por cento (gestaçöes : 9), 39 por cento (gestaçöes : 16) e 35 por cento (gestaçöes : 7). Näo houve diferença significativa na taxa de gravidez (p=0.15), quando se transferiu e ou 4 embrioes. Por outro lado, a ocorrência de gestaçöes multifetais foi a seguinte: quando foram transferidos 2 ou 3 embriöes 22.2 por cento de Gêmeos, para 4 embriöes 25 por cento de Gêmeos e 6.25 por cento de trigêmeos, sendo que com 5 embriöes obserou-se 14.28 por cento de trigêmeos. Em conclusäo, a transferência de um número maior que 3 embriöes näo acarreta a subsequente elevaçäo das taxas de gestaçöes, apenas propicia o aumento da incidência de gestaçöes multifetais. Os embriöes excedentes devem ser criopreservados para uma posterio transferência, isto até que uma adequada tecnologia para criopreservaçäo de oócitos esteja estabelecida

Taxas de clivagem embrionária após inseminaçäo de oócitos com espermatozóides capacitados no fluido folicular / Rate of cleavage after oocytes insemination with spermatozoa capacitated in follicular fluid

A finalidade este estudo foi comparar as taxas de clivagem de embriöes após inseminaçäo de oócitos com espermatozóides capacitados na presença ou näo de fluido folicular. No primeiro experimento, um total de 67 oócitos foram inseminados com espermatozóides que tiveram parte do procedimento de capacitaçäo com incubaçäo curta em fluido folicular (21 oócitos - experimento I) e espermatozóides capacitados com uso de apenas o meio de cultura Menezo B2 (46 oócitos - controle). Näo houve diferença (p=0.89) entre o número de embriöes obtidos: 13 (experimento I) e 29 (controle). No segundo experimento, um total de 49 oócitos foram inseminados com espermatozóides que tiveram todo o procedimento de capacitaçäo realizado com fluido folicular num tempo de incubaçäo longo (13 oócitos - experimento II) e espermatozóides capacitados com o uso de apenas o meio de cultura Menezo B2 (36 oócitos - controle). Näo houve diferença (p=0.31) entre o número de embriöes obtidos : 7 (experimento II) e 25 (controle). A ausência de diferenças entre as taxas declivagem nos dois experimentos informa que o fluido é um meio capaz de preparar adequadamente os espermatozóides, propiciando o fenômeno de capacitaçäo adequado. Contudo esta açäo do fluido näo é superior a observada com o uso de um meio de cultura comum com o Menezo B2

Técnicas de capacitaçäo espermática / Sperm capacitation techniques

Os autores estudaram diversas tecnicas de capacitacao espermatica: camada, sedimentacao-migracao ou swin-up, la de vidro, colunas de albumina, descontinuo gradiente de Percoll ou Nycodenz. O significado pratico do emprego destas tecnicas e discutido em relacao as caracteristicas previas das amostras de esperma.

Inseminaçäo artificial homóloga com espermatozóides capacitados no fluido folicular humano / Homologous artificial insemination with spermatozoa capacited in human follicular fluid

No presente trabalho, os autores avaliaram um novo metodode preparo do esperma atraves da migracao dos espermatozoides em fluido folicular humano. Um total de 14 pacientes com esterilidade conjugal por fator cervical, fator masculino ou esterilidade sem causa aparente foi submetido a um ciclo de inseminacao artificial homologa, com as espermatozoides sendo capacitados com o fluido folicular humano. Obteve-se uma taxa de gravidez de 14,28 por cento por ciclo de inseminacao.

Pode o tipo da inseminaçäo ser determinado pelo volume do material injetado no útero? / Can the insemination type be determined by the volume of injected material into the uterus?

Para se verificar se o tipo de inseminacao e determinado pelo volume do material injetado no utero, um grupo de 10 pacientes foram submetidas a um exame radiografico simples, logo apos a injecao na regiao fundica do utero de diferentes volumes de contrates. Os dados mostraram que volumes de 0,4 ml a 1 ml rotulariam a inseminacao como utero-tubaria, enquanto a inseminacao intra-uterina pura apenas ocorreria em volumes de 0,2 ml, e em algumas ocasioes comvolumes de 0,3 ml. Tal fato poderia explicar as variacoes dos resultados da inseminacao como metodo terapeutico em infertilidade.