Sperm DNA fragmentation in donors and normozoospermic patients attending for a first spermiogram: Static and dynamic assessment.

Static assessment of sperm DNA Fragmentation (SDF at the time of ejaculation or sperm thawing when cryopreserved) and the dynamic assessment of SDF (SDF assessed after T2 hr, T6 hr and T24 hr of sperm thawing) were used to establish cut-off values associated with sperm donors when compared with closely related normozoospermic patients. Cryopreserved samples from donors revealed SDF levels two times lower in comparison with the patients. Donor sperm DNA exhibited a 2.5 times higher longevity when compared with the patients. Static values of SDF after thawing of approximately 11% identify the donors with a 71% of sensitivity and 84% specificity. With respect to the dynamic assessment, SDF increases of 2.3 per hr during the first 2 hr of incubation identify the donors with 70% of sensitivity and 66% of specificity. Creating the Rate of Combined Damage (RCD) defined as the product of SDF-T0 by the increase in the damage registered during the first 2 hr of incubation (r-SDF-T0-2 ), an index of RCD = 22.2 units has an identification capacity of donors with a 78% sensitivity and 77% specificity. Such cut-off values could be used to characterise donors with high chromatin resistance to damage when meeting the above-established criteria.

Influencia del apoyo psicológico grupal en la calidad de vida, continuidad y tasas de embarazo, en tratamientos de fecundación in Vitro / The influence of group psychological support on quality of life, discontinuation and pregnancy rates in In vitro fertilization treatments

Pregunta del estudio. ¿La intervención psicológica grupal antes y durante los ciclos de Fecundación in vitro (FIV), es una herramienta eficaz para mejorar la calidad de vida, la continuidad y las tasas de embarazo? Resumen. Las mujeres que participan en un grupo de apoyo psicológico logran una mejor gestión de sus emociones durante los tratamientos, aumentando la tolerabilidad y continuidad frente a los mismos. Así mismo los grupos de apoyo han logrado una influencia positiva en las tasas de embarazo. Lo que ya se conoce. Los tratamientos de Reproducción Asistida afectan negativamente en la calidad de vida de las pacientes en general. El motivo principal de abandono de los tratamientos es el estrés, la afectación en la pareja, y los síntomas de ansiedad y depresión. Por otra parte, las modalidades de intervención psicológica grupal han logrado influir positivamente tanto en el estado emocional como en las tasas de embarazo. Diseño del estudio, tamaño y duración. Estudio de cohorte, prospectivo, 95 mujeres que inician un ciclo de Fecundación Asistida en una clínica privada de la ciudad de Sevilla (España). El proyecto se diseñó en dos etapas. 1ª Etapa: Primer ciclo de fecundación asistida, F1: inicio, F2: final. 2ª Etapa: transferencia de los embriones congelados o nuevo ciclo para aquellas mujeres que no lograron el embarazo en el primer ciclo, F3: inicio, F4: final. El estudio se llevó a cabo desde agosto 2012 hasta agosto 2013. Participantes/materiales, composición y métodos. Mujeres entre 25 y 40 años, que inician un ciclo de FIV. Las pacientes fueron captadas principalmente por vía telefónica; siendo asignadas al grupo control (CG) o al grupo de apoyo (SG). La totalidad de la muestra cumplimentó el Cuestionario de Calidad de Vida en Fertilidad (FertiQol), en el inicio (F1/F3) y tras finalización de cada ciclo realizado o transferencia de embriones congelados (F2/F4). El seguimiento se realizó durante un año y/o dos intentos. Las mujeres del SG participaron durante el primer ciclo en un Programa de Apoyo psicológico realizado en 8 sesiones grupales, de frecuencia semanal cuyo objetivo fue el ajuste emocional, la adopción de recursos adaptativos y de afrontamiento y técnicas de relajación para reducir el estrés durante el tratamiento. Resultados principales. No existen diferencias significativas entre las mujeres participantes de este estudio en cuanto a la edad o en las variables clínicas. Las mujeres del CG tienen un mayor porcentaje de tasas de abandono que las mujeres que recibieron el programa de intervención psicológica, 38 % vs. 8 %, p=0,046. La calidad de vida intergrupal al comienzo del ciclo revela diferencias estadísticamente significativas en el Core FertiQol y en cada una de las subescalas (p=0,001), obteniendo el CG valores más elevados en su calidad de vida inicial. La variación en la calidad de vida durante el transcurso del primer ciclo (F1 vs. F2), en el SG evidencia una tendencia en aumento, presentando diferencias significativas en Core FertiQol y las subescalas Emocional y Mente/Cuerpo, p=0,032, p=0,005, p=0,039, respectivamente. En tanto que en el CG se observa una tendencia a la disminución en Core Fertiqol y en cada una de las cuatro subescalas. En cuanto a la Calidad del Cuidado se observa una tendencia al aumento para el SG en el Módulo de Tratamiento (Treatment FertiQol) y la subescala Entorno con una diferencia significativa en Tolerabilidad, (p=0,001.). La tasa de embarazo logrado para el SG asciende al 64 % mientras que la tasa de embarazo logrado para el CG asciende al 48 % (p=0,668). En la primer fase del estudio las pacientes del SG presentaron tasas superiores de embarazo con respecto al CG, 48 % vs 38 % (p=0,793). La misma tendencia se observa en la segunda fase, 35 % vs. 22 % respectivamente. Limitaciones. Dadas las condiciones del estudio (ajuste temporal y sesiones grupales semanales) la asignación a un grupo u otro fue a voluntad de las participantes. Por esta misma razón la muestra se limitó a 95 mujeres, siendo de interés que futuros estudios puedan extender nuestros resultados a una población mayor. Implicaciones del hallazgo. El Cuestionario FertiQol es un cuestionario validado internacionalmente y sus resultados se pueden analizar en una perspectiva amplia e internacional. Observamos que el apoyo psico-emocional puede mejorar la calidad de vida antes y durante los tratamientos de Fecundación Asistida y disminuir a su vez las tasas de abandono. Financiación del estudio/conflicto de intereses. Este trabajo fue apoyado por Fundación Ginemed en su interés por mejorar la calidad asistencial de sus centros. No hay conflictos de intereses

Study question: Is attending a psychological support group before and during an assisted in In Vitro Fertilization (IVF) treatment a useful tool in, improving quality of life, continued participation and pregnancy rates? Summary answer: Women who participate in a support group improve their quality of life, continue with their treatment and a higher percentage achieve a pregnancy. What is known already: Assisted reproduction treatments negatively affect patients´ quality of life. The principal cause of treatment discontinuation is stress, relational strain and symptoms associated with anxiety and depression. However, psychological intervention in the form of support groups has been demonstrated to have a positive influence on both emotional wellbeing as well as pregnancy rates. Study design, size, duration: Cohort Study, Pilot, 95 women who are beginning an assisted reproduction cycle in a private clinic in Seville (Spain). The project was designed in two stages. 1st Stage: first cycle of IVF (F1 start, F2: end). 2nd Stage: transfer frozen embryos transfer (FET) or new cycle of IVF, for women who failed pregnancy in the first cycle (F3: start, F4: end).The study was undertaken from August 2012 to August 2013. Participants/materials, setting, methods: Women between 25 and 40 years old, who are commencing an IVF cycle. The patients were primarily recruited by telephone; they were assigned to a control group (CG) or to a support group (SG) according to their availability. All of the members of the sample group completed the Fertility Quality of Life Questionnaire (FertiQol) at the beginning (F1/F3) and end of each cycle or frozen embryos transfer (F2/F4). The follow-up took place over a one-year period and/or two attempts. The women from the SG took part, during the first cycle, in a psychological support programme, which took the form of eight group sessions, which took place on a weekly basis and the emphasis of which was emotional well-being, the adoption of behaviour modification and coping strategies, and relaxation techniques aimed at stress reduction. Main results and the role of chance: The ages and clinical variables of the women who participated in the study did not differ significantly. The women from the CG ha a higher drop-out rate than those who took part in the psychological support programme, 38% vs. 8%, p=0.046. The between-group comparison from the initial Quality of Life assessment reveals statistically significant differences in the Core FertiQol and in each of the subscales (p=0.001), with the CG initially obtaining higher quality of life scores. The quality of life of the SG tended to increase over the course of the first cycle (F1 vs. F2), with significant differences being found in the Core FertiQol and in the Emotional and Mind-Body subscales, p=0.032, p=0.005, p=0.039, respectively. Equally, the scores in the Core FertiQol and the four subscales of the CG tended to decrease. In terms of Quality of Care, in the SG a tendency towards an increase is observed in the Treatment FertiQol and the Environment subscale with a significant difference visible in the Treatment Tolerability, p=0.001. This suggests that psychological support improves the patients´ ability to manage their emotions and affords a greater ability to tolerate the burden of the treatment on daily life. Core FertiQol and Total FertiQol for the second cycle IVF or FET reveal similar trends in both groups. In this second cycle or frozen embryo transfer, neither of the groups received psychological support. The total number of pregnancies from both attempts among the group of patients who received the eight psychological support sessions increases to 65%, while the women from the control group obtained a pregnancy rate of 48%, p=0.668. The patients from the SG also achieved superior pregnancy rates during the first fertility treatment in comparison to those from the CG, 49% vs. 39%, p=0.793. Limitations, reasons for caution: Given the conditions of the study (time constraints and weekly group sessions), the participants were able to decide whether they were assigned to one group or the other. The average quality of life from the initial questionnaire (FertiQol) of those who agreed to participate in the SG was significantly lower in comparison to those from the CG. These findings might lead us to believe that those women who perceive psychological distress are more receptive to receiving additional support. Nonetheless, later evaluations also indicate that those patients, who began with an optimal state of mind, experienced a fall in their quality of life during the treatment and had a higher discontinuation rate. Wider implications of the findings: Given that FertiQol is an internationally validated questionnaire, these results can be evaluated within a broad and international perspective. On the other hand, it is interesting to observe how patients, who are at a higher risk of emotional problems can benefit from psychological support, and how those patients who initially do not appear to be at risk of developing emotional problems, but are then unsuccessful in their treatment have high drop-out rates. This could indicate the importance of psychological-emotional support being integrated into assisted reproduction clinical practice. Study funding/competing interest: The Ginemed Foundation, in accordance with their objective to improve the quality of the care available in their centres, funded this study. There are no competing interests

Equivalent seminal characteristics in human and stallion at first and second ejaculated fractions.

Sperm quality was assessed in normozoospermic human (n = 10) and Spanish breed stallion (n = 10) after sperm fractionation during ejaculation. The first ejaculated fraction was separated from the second. A third sample was reconstituted using equivalent proportion of both fractions (RAW). Fraction 1, Fraction 2 and RAW semen were incubated for 30 min at 37°C to homogenise the impact of iatrogenic damage between both species. Sperm concentration, motility and sperm DNA damage were assessed in each fraction and RAW semen. The results showed two important facts: (i) spermatozoa confined at Fraction 1 exhibit superior parameters than those included at Fraction 2 in both species, and (ii) there is a certain level of concordance between species in the proportion of benefit observed when Fraction 1 is compared to RAW semen. Altogether, these results call into question whether the standard practice of whole ejaculate collection can be considered the best strategy when using male gametes for artificial insemination. In fact, the reconstituted RAW semen exhibits poorer semen characteristics than those found in Fraction 1.