Survey on the Impact of COVID-19 on the Practice of Assisted Reproduction in Latin America.

OBJECTIVE: To follow the impact of the SARS-CoV-2 pandemic on the practice of assisted reproductive technology in centers reporting to the Latin American Registry during 2020. METHODS: An internally validated online survey designed on the Survey Monkey platform with a maximum of 20 closed questions was sent via e-mail or WhatsApp to the clinical director of each center reporting to the Latin American Registry of Assisted Reproduction between July and December 2020. RESULTS: The number of centers responding to the survey varied during the six months. The relative contribution of Brazil to all responses was 41.4% to 45%, followed by México (16.2% to 23.8%), Argentina (8.1% to 12.6%), Colombia (7.1% to 8.2%), Chile (3.6% to 6.1%) and Peru (4.0% to 4.9%). Most centers reported stopping activities before July 2020 (81%). COVID-19 related symptoms were a criterion on their own to postpone ovarian stimulation (80.1% to 87.7% of centers). Although in July only 76 of 166 centers (45.8%) performed embryo transfers, by October 104 of 109 centers (95.4%) performed them. In survey 6 (December), 78 of 79 centers (98.7%) that had initially closed had already reopened, although 62.3% (61 of 98 centers) still performed 80% or less of their usual number of ART cycles. CONCLUSIONS: Most centers modified their clinical practice and applied specific protocols to screen their staff and patients. Suspicion of COVID-19 delayed treatments. Despite a peak of the pandemic, by December most centers were performing all ART treatments, although the number of cycles remained low compared to pre-pandemic numbers.

Assisted reproductive technologies in Latin America: the Latin American Registry, 2019.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2019? DESIGN: This was a retrospective collection of multinational data on ART performed at 196 institutions from 15 countries. RESULTS: A total of 106,918 initiated cycles, 18,133 deliveries and 21,096 births were reported. ART utilization was 24-558 cycles per million inhabitants. Women aged ≥40 years represented 32.9% of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 17.3% for ICSI and 19.5% for IVF. Overall, single-embryo transfer (SET) represented 36.2% of fresh transfers, with a 19.5% delivery rate per transfer, increasing to 30.7% for elective SET and 32.7% for blastocyst elective SET (eSET). The delivery rate for double-embryo transfers (DET) was 27.8%, increasing to 37.1% after elective DET. This 6.4% increment in deliveries between eSET and elective DET resulted in a 12-fold increase in twin births. Furthermore, overall perinatal mortality was more than two-fold higher for twin compared with singleton deliveries. The delivery rate for frozen-thawed SET reached 28.1%, most being blastocyst transfers. Of all births, 72.3% were singletons, 26.4% twins and 1.3% triplets and higher multiples. Preterm deliveries reached 14.3% for singletons and 58.1% for twins. Perinatal mortality was 7.4‰ in singletons, 17.2‰ for twins and 62.9‰ for triplets or higher. CONCLUSIONS: The number of initiated cycles has slowly increased in countries with laws or regulations facilitating access. FET cycles predominate and blastocyst SET are also increasing. The data show that, especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, eSET should be the rule.

m-Health en intervenciones para incrementar el uso de anticonceptivos en adolescentes latinas: revisión de alcance

Objetivo Mapear la forma de uso y el efecto de las tecnologías m-Health en intervenciones a fin de incrementar el uso de anticonceptivos en adolescentes latinas. Métodos Se realizó una revisión de alcance a partir de Peters M en octubre de 2021; se recuperaron artículos del 2015 a 2021 en EBSCO Host, PubMed y BVS, LILACS, SciELO, Web of Science y Scopus, en inglés, español y portugués. Resultados Se identificaron ocho artículos que emplearon las m-Health como potencializadoras. La forma de uso fue ampliamente heterogénea en dosis, intervalo e interacción. El efecto significativo para el uso de anticonceptivos fue reportado en tres diseños experimentales, con una buena aceptabilidad y viabilidad para futuros experimentos. Discusión Las m-Health ofrecen una oportunidad de incrementar el uso de anticonceptivos en adolescentes. Al momento, su efecto es controversial debido a la escasez de intervenciones de este tipo. Por lo tanto, se requieren estudios rigurosos que consideren procesos de adaptación a contextos latinos.

Objective To map the use and effect of m-Health technologies on interventions to increase contraceptive use in Latino adolescents. Methods A low scope review was performed from Peters M in October 2021; articles from 2015 to 2021 were recovered in EBSCO Host, PubMed and BVS, LILACS, SciELO, Web of Science and Scopus, in English, Spanish, and Portuguese. Results We identified eight articles that used m-Health as potentiators. The form of use was widely heterogeneous in dose, interval, and interaction. The significant effect on contraceptive use was reported in three experimental designs with good acceptability and feasibility for future experiments. Discussion m-Health offers an opportunity to increase contraceptive use in adolescents. At the moment its effect is controversial due to the scarcity of interventions of this type. Therefore, rigorous studies that consider processes of adaptation to Latino contexts are required.

Assisted reproductive technologies in Latin America: the Latin American Registry, 2019.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2019? DESIGN: This was a retrospective collection of multinational data on ART performed at 196 institutions from 15 countries. RESULTS: A total of 106,918 initiated cycles, 18,133 deliveries and 21,096 births were reported. ART utilization was 24-558 cycles per million inhabitants. Women aged ≥40 years represented 32.9% of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 17.3% for ICSI and 19.5% for IVF. Overall, single-embryo transfer (SET) represented 36.2% of fresh transfers, with a 19.5% delivery rate per transfer, increasing to 30.7% for elective SET and 32.7% for blastocyst elective SET (eSET). The delivery rate for double-embryo transfers (DET) was 27.8%, increasing to 37.1% after elective DET. This 6.4% increment in deliveries between eSET and elective DET resulted in a 12-fold increase in twin births. Furthermore, overall perinatal mortality was more than two-fold higher for twin compared with singleton deliveries. The delivery rate for frozen-thawed SET reached 28.1%, most being blastocyst transfers. Of all births, 72.3% were singletons, 26.4% twins and 1.3% triplets and higher multiples. Preterm deliveries reached 14.3% for singletons and 58.1% for twins. Perinatal mortality was 7.4‰ in singletons, 17.2‰ for twins and 62.9‰ for triplets or higher. CONCLUSIONS: The number of initiated cycles has slowly increased in countries with laws or regulations facilitating access. FET cycles predominate and blastocyst SET are also increasing. The data show that, especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, eSET should be the rule.

Embarazo subsecuente en la adolescencia: causas, consecuencias y posibles soluciones / Subsequent pregnancy in adolescence: Causes, consequences and possible solutions

Introducción: México se encuentra en los primeros lugares de embarazo en la adolescencia entre los países de la Organización para la Cooperación y el Desarrollo Económico. Por lo tanto, el embarazo de primera vez y subsecuente representa un problema sanitario con impacto negativo en el desarrollo de la adolescente y su hijo, por lo que es necesario estudiar el fenómeno a fin de prevenirlo y contribuir al mejoramiento de las condiciones de salud y vida de dos grupos vulnerables (adolescentes e hijos). Desarrollo: las causas del embarazo subsecuente son diversas, implican aspectos relacionados con el entorno familiar y comunitario, el acceso a los servicios de salud y el nivel educativo. Aunque no es exclusivo de un estrato social, se presenta con mayor frecuencia en adolescentes de bajos recursos. Las consecuencias son de índole físico, psicológico, económico y social, y agudizan las condiciones negativas de salud y las mencionadas como causas, con riesgo de que se repita y se perpetue el problema. Conclusiones: las intervenciones basadas en la atención centrada en la persona han mostrado efectos positivos en la conducta anticonceptiva de las adolescentes. Su adopción e implementación en países en desarrollo amerita la suma de esfuerzos interinstitucionales e interdisciplinares de forma vertical y transversal, con sentido bidireccional, a fin de hacer cambios significativos en la prevención de este fenómeno.

Introduction: Mexico ranks in the first places of teenage pregnancy among the countries of the Organisation for Economic Co-operation and Development. For this reason, the first and subsequent pregnancy represents a health problem with a negative impact on the development of the adolescent girl and her child, which is why it is necessary to study the phenomenon, in order to prevent it and to contribute to the improvement of health and living conditions of two vulnerable groups (adolescents and children). Development: The causes of subsequent pregnancy are diverse, involving aspects related to the family and community environment, as well as access to health services, and the educational level. Although it is not exclusive to a social stratum, it occurs more often in low-income adolescents. The consequences are of a physical, psychological, economic and social nature, and they exacerbate the negative health conditions and those mentioned as causes, with the risk of repeating and perpetuating the problem. Conclusions: Person-centered interventions have demonstrated positive effects on the contraceptive behavior of adolescents. Its adoption and implementation in developing countries deserve the sum of inter-agency and interdisciplinary efforts in a vertical and cross-cutting manner with a two-way sense of making significant changes in the prevention of this phenomenon.

Celebrating 30 years of ART in Latin America; and the 2018 report.

OBJECTIVE: What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018?. DESIGN: Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS: Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (fresh + FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSIONS: The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.

Celebrating 30 years of ART in Latin America; and the 2018 report.

RESEARCH QUESTION: What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018? DESIGN: Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS: Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (fresh + FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSION: The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.

Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula.

OBJECTIVE: To introduce a new double-lumen intracervical cannula designed to allow a single-step hysteroscopic myomectomy with nonfragmented complete fibroid extraction after cold enucleation of submucosal type 2 fibroids, avoiding complications related to the use of energy and hypo-osmolar solutions. DESIGN: Video article depicting the use of a new double-lumen intracervical cannula for single-step hysteroscopic cold myomectomy, according to our institutional care guidelines and after obtaining the patient's informed consent. (The publication of this video has been authorized by the Institutional Ethics Committee of CES University in Medellín, Colombia.) SETTING(S): Private infertility clinic. PATIENT(S): A 45-year-old woman with abnormal uterine bleeding consisting of polymenorrhea and hypermenorrhea, nonresponsive to medical treatment, caused by three type 2 (FIGO leiomyoma subclassification system) submucosal fibroids of 17, 15, and 13 mm with more than 80% of intramyometrial component. INTERVENTION(S): Hysteroscopic enucleation of three submucosal fibroids performed by blunt dissection using the 30° Bettocchi hysteroscope's bevel under continuous observation of the avascular subcapsular plane of the fibroids. Once full enucleation was attained, cervical dilatation to 12 mm with Hegar plugs was performed followed by intracervical placement of a newly designed double-lumen intracervical cannula that allows the concomitant introduction of the Bettocchi diagnostic hysteroscope and a 5-mm laparoscopic tenaculum into the uterine cavity for complete nonfragmented fibroid extraction under direct visualization. MAIN OUTCOME MEASURE(S): Complete and unfragmented fibroid extraction in a single intervention, absence of surgical complications, and postoperative course. RESULT(S): Ambulatory hysteroscopic myomectomy of three submucosal type 2 fibroids was successfully performed by blunt enucleation and complete nonfragmented fibroid extraction using the double-lumen intracervical cannula. The total operative time was 32 minutes, and the total amount of distension media (normal saline) used was 800 mL with a liquid balance of 50 mL. No surgical or anesthesia-related complications occurred. In the postsurgical evaluation, the patient classified her pain as minimal, giving it a score of 1 on a pain scale of 1 to 5 (in which 1 is the lowest and 5 the highest pain perception). When asked about the level of satisfaction with the surgical procedure, the patient reported the highest degree of satisfaction with a score of 5 on a satisfaction scale of 1 to 5 (in which 1 is the lowest and 5 the highest satisfaction). The patient reported having postsurgical regular menstrual cycles every 28 days and 3 bleeding days without hypermenorrhea. CONCLUSION(S): An efficient hysteroscopic myomectomy of submucosal type 2 fibroids with deep intramyometrial component can be performed with complete and nonfragmented fibroid extraction in a single intervention by using a newly designed double-lumen intracervical cannula. This technique allows the completion of the surgery without the need of a resectoscope, electrosurgery, or hypo-osmolar uterine distension media, thus avoiding potential complications such as thermal-induced myometrial injury and hyponatremia; a second surgical intervention will not be required because the fibroid enucleation is complete. The procedure can be performed with the use of a diagnostic hysteroscope that is widely available in gynecologic practices. (Acknowledgment: The authors thank Dr. David Olive for the invaluable help and guidance with this surgical technique and video article.).

Assisted reproductive techniques in Latin America: The Latin American Registry, 2017.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive techniques performed in Latin America during 2017. DESIGN: Retrospective collection of multinational data on ART performed in 188 institutions from 15 Latin American countries. RESULTS: We are reporting 93,600 initiated cycles, 16,976 deliveries and the birth of 20,404 babies. ART utilization was 221 cycles/million inhabitants (15 to 535). Despite women aged ≥40 represented 30.5% of fresh IVF/ICSI, after removing freeze-all cycles, delivery rate per oocyte retrieval was 19.9% for ICSI and 20.2% for IVF. Overall, single embryo transfer (SET) represented 26.9% of fresh transfers, with 18.2% delivery rate per transfer; increasing to 32.3% in elective SET. Delivery rate in double embryo transfers (DET) was 28.3% increasing to 37.3% with elective DET. This 5% increment in births in eDET over eSET resulted in10-fold increase in twin births, almost 3 weeks' shorter gestations and 3-fold increase in perinatal mortality. Delivery rate in frozen/thawed SET, reached 25.5% increasing to 30.8% with DET; the majority being blastocysts transfers. Of all births, 67% were singletons, 31.4% twins, and 1.6% triplets and higher. Overall, preterm deliveries reached 9.5% in singletons, 64.3% in twins and 97.9% in triplets; and perinatal mortality was 9.4‰ in singletons, 25.3‰ in twins, and 63.3‰ in high-order multiples. CONCLUSIONS: The number of initiated cycles slowly increases. Frozen embryo transfers, blastocyst transfers and SET are also increasing. Our data shows that especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, elective SET should be the rule.

Assisted reproductive technology in Latin America: the Latin American Registry, 2017.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) carried out in Latin America during 2017. DESIGN: Retrospective collection of multinational data on ART carried out in 188 institutions from 15 Latin American countries. RESULTS: In this study, 93,600 initiated cycles, 16,976 deliveries and 20,404 births reported. Utilization of ART was 221 cycles per million inhabitants (15 to 535). Women aged 40 years and above represented 30.5% of fresh IVF and intracytoplasmic sperm injection (ICSI); however, after removing freeze-all cycles, delivery rate per oocyte retrieval was 19.9% for ICSI and 20.2% for IVF. Overall, single embryo transfer (SET) represented 26.9% of fresh transfers, with 18.2% delivery rate per transfer, increasing to 32.3% in elective SET. Delivery rate in double embryo transfers (DET) was 28.3% increasing to 37.3% with elective DET. This 5% increment in births in elective DET over elective SET resulted in a tenfold increase in twin births, gestational periods almost 3 weeks' shorter and a threefold increase in perinatal mortality. Delivery rate in frozen-thawed SET reached 25.5% increasing to 30.8% with DET, most being blastocyst transfers. Of all births, 66.9% were singletons, 31.4% twins and 1.6% triplets and higher. Overall, preterm deliveries reached 9.5% in singletons, 64.3% in twins and 97.9% in triplets; perinatal mortality was 9.4‰ in singletons, 25.3‰ in twins and 63.3‰ in high-order multiples. CONCLUSIONS: The number of initiated cycles has slowly increased. Frozen embryo transfers, blastocyst transfers and SET are also increasing. Our data show that, especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, elective SET should be the rule.

Embryo development after vitrification of immature and in vitro-matured equine oocytes.

Effects of meiotic stage and cumulus status on development of equine oocytes after vitrification was evaluated. Immature oocytes with corona radiata (IMM); in vitro-matured oocytes with corona radiata (MAT CR+); and in vitro-matured oocytes denuded of cumulus (MAT CR-) were vitrified using the Cryotech® method. Warming medium was equilibrated either in 5% CO2 or Air. IMM oocytes underwent in vitro maturation after warming. Recovery, survival, and maturation rates, and cleavage and blastocyst rates after ICSI, were evaluated. Recovery was higher for oocytes warmed in CO2- than Air-equilibrated medium (86 ± 3 vs. 76.9 ± 4%, respectively). Maturation for all vitrified-warmed oocyte treatments (37 ± 6.5 to 45.9 ± 5.8%) was not different from control (50 ± 4.1%), except for MAT CR- CO2 (20.3 ± 4.6%). Cleavage for MAT CR- CO2 and Air groups was similar to control (67.7 ± 12.1, 71.4 ± 8.1, and 78 ± 5.3%, respectively). One blastocyst was produced (MAT CR + CO2), representing the first equine blastocyst reported after vitrification of an in vitro-matured oocyte.