[Clinical implication and frequency of the incidental finding of endometriosis during oocyte retrieval]. / Implicación clinica y frecuencia del hallazgo incidental de endometriosis durante la captura ovular.

BACKGROUND: Endometriosis is a clinical disease that is associated with poor outcomes in in vitro fertilization (IVF) programs with a decrease in oocyte retrieval, oocyte quality, implantation and pregnancy rates. When an endometrioma is diagnosed, it is indicated to remove endometrial cysts by laparoscopy or perform an aspiration before the cycle of IVF. OBJECTIVES: To evaluate the effect of endometriosis diagnosed incidentally during oocyte retrieval on the IVF outcome, as well as to establish its frequency. MATERIAL AND METHODS: Retrospective analysis of 1,000 files of patients who underwent to oocyte retrieval between January 2002 and March 2005, in the Centro Especializado para la Atenci6n de la Mujer in Mexico City. Of the total procedures tubal factor was the first indication for IVF and male factor was on second place. Only in seven patients of 1,000 oocyte retrievals was detected the presence of endometriosis fluid instead of folicular fluid. RESULTS: The prevalence of endometriosis diagnosed incidentally during oocyte retrieval was 0.7%, and the oocyte quality was 1.55 (regular). The fertilization rate for patients with endometriomas was 45% and the implantation and pregnancy rates were zero per cent while the patients without endometriomas the fertilization rate was 65% with an implantation rate of 18% and the pregnancy rate was 35%. CONCLUSION: Endometriosis is a disease that must be treated before an IVF cycle in stages III-IV and especially in presence of endometriomas because it could affect negatively IVF outcomes.

[Severe ovarian hyperstimulation syndrome treatment by decompressive paracentesis and self-transfusion of ascitis fluid]. / Tratamiento del síndrome de hiperestimulación ovárica grave mediante paracentesis descompresiva y autotransfusión de líquido de ascitis.

BACKGROUND: The ovarian hyperstimulation syndrome is a serious complication in patients who undergo controlled ovarian stimulation and for that reason all clinicians who prescribe ovulation inducing agents must be prepared to recognize and manage ovarian hyperstimulation syndrome, to prevent severe and ocasionally mortal complications. OBJECTIVE: To communicate the experience in the treatment of ovarian hyperstimulation syndrome as a complication in patients who undergo controlled ovarian stimulation. PATIENTS AND METHODS: In the present study seven patients who developed severe ovarian hyperstimulation syndrome were included, and were treated by ultrasound guided paracentesis and self-transfusion of the ascitic fluid. RESULTS: In all patients we observed a clinical improvement immediately after the drainage of ascitic fluid no hematological or infectious disease were observed after the self-transfusion. We observed a reduction in hemoglobin of 20.9% and 22.2% in the hematocrit after paracentesis and self-transfusion, meanwhile we observed an increase of 55.5% in the albumin level. Any patient developed hemodynamic disturbance after paracentesis after drainage of great volume in the paracentesis (mean of 4453.4 mL per patient). CONCLUSIONS: The drainage of ascitis by paracentesis and self-transfusion of the fluid is a good therapeutic option in patients with severe ovarian hyperstimulation syndrome in combination with intravenous fluids and administration of human albumin 25%.

[Statistical and prognostic correlation of serum levels of basal inhibin to response and follicular quality in assisted reproduction]. / Correlación estadística y pronóstica de la concentración sérica de inhibina basal con la respuesta y calidad folicular en reproducción asistida.

BACKGROUND: Inhibin B is a direct marker of ovarian reserve and one of the earliest markers of ovarian aging. It has been used in assisted reproduction programs as a serum marker that can identify an altered follicular reserve and predict a good or poor response to the stimulation with exogenous gonadotropins. OBJECTIVE: To correlate inhibin B levels with follicular response and quality of oocytes obtained through ovarian stimulation controlled in an in vitro fertilization cycle (IVFET), as well as relate it with variables such as: fertilization percentage and pregnancy rates. PATIENTS AND METHODS: In a prospective and transversal study we included 71 patients that entered the IVFET program (February-April 2005). We determined inhibin B levels at the third day of the cycle and evaluated the follicular response and the oocyte quality during the ovarian stimulation, as well as fertilization and pregnancy rates. Statistical analysis was made with Spearman's and ANOVA tests. RESULTS: We observed a positive correlation between inhibin levels and quantity of developed follicles (0.457), number of captured oocytes (0.390), and quantity of metaphase II oocytes (0.324). We observed better oocyte quality in women with inhibin levels > 251 pg/ mL, and we considered that the ones that had levels < 50 pg/mL had poor follicular response (19.71%). There was no correlation with fertilization and pregnancy rates. CONCLUSIONS: In the early follicular phase inhibin B has direct correlation with ovarian reserve. Its high levels are related to better follicular response and oocyte quality. This enzyme levels are not useful as a predictive factor of pregnancy in IVFET cycles.

[Intrafollicular levels of sexual steroids and their relation with the antioxidant enzymes on the oocyte quality in an in vitro fertilization program]. / Las concentraciones intrafoliculares de esteroides sexuales y su correlación con las enzimas antioxidantes en la calidad de los ovocitos en un programa de fertilización in vitro.

OBJECTIVE: To establish a correlation between intrafollicular superoxide dismutase enzyme concentrations, activity with oestradiol levels, and the effects on oocyte quality and maturity. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: Forty-one patients underwent IVF-ET program. The ovarian stimulation protocol was made with recombinant FSH and GnRH antagonists. All follicles were aspirated one by one, and the follicular fluid was stored at a -20 degrees C room temperature. We retrieved 120 follicular fluids and performed the measurement of oestradiol and superoxide dismutase enzyme on each follicular fluid and its correlation with fertilization and cleavage rates. Statistical analysis was carried out with ANOVA, t Student, chi2 and P Pearson tests. RESULTS: Patients' mean age was of 33.74 +/- 5.04 years, the mean of enzyme activity was of 76.89%, and the mean concentration of superoxide dismutase enzyme was of 68.71 UI/L. According to oocyte quality or maturity, no statistical differences were observed when comparing oestradiol levels with superoxide dismutase enzyme concentrations. But when we analized both variables, we observed a positive correlation in metaphase 2 oocytes (p = 0.236). When we correlated the superoxide dismutase enzyme activity with oestradiol concentrations in relation to oocyte quality, a positive correlation in good quality oocytes was observed too (p = 0.218). We perceived a strong correlation between SOD concentrations and oestradiol intrafollicular measurements in good quality oocytes. COMMENTS: Oocyte maturity and development are conditionated by a close relationship between SOD and intrafollicular oestradiol.

[Usefulness of luteinizant hormone levels to determine the oocyte quality]. / Utilidad de las concentraciones de la hormona luteinizante para determinar la calidad ovocitaria.

OBJECTIVE: To evaluate the luteinizing hormone serum preovulatory levels and correlate them with the embryo number and quality, and with the fertilization and clavage rates. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: We included 286 patients that underwent to IVF-ET program, we excluded patients with no mesurement of LH preovulatory levels, or patients that in the oocyte retrieval we do not found oocytes. The protocols for pituitary inhibition were: stop Lupron, long luteal phase and GnRH antagonist, the ovarian stimulation was realized with recombinant FSH. The studied variables were: LH preovulatory levels, number and quality of oocytes, fertilization and clevage rates and embryo quality. Statistical analysis was done with p Pearson and ANOVA tests. RESULTS: The mean age for patients was 34 +/- 3.96 years, the principal factor of infertility was tubal and pelvis pathology. The mean LH preovulatory levels were 2.19 +/- 1.83 UI/L by patient, we observed a negative correlation between LH levels and number of oocytes retrieved (p = -0.157, IC 99%), and the correlation between LH levels and number of metaphase 2 oocyte was negative too (p = 0.113, IC 95%). We observed greater levels of LH (3.15 UI/L) in the degenerated oocytes during oocyte retrieval. We did not found a statistical correlation between fertilization and cleavage rates with LH levels. LH preovulatory levels of 0.85 UI/L could predict good quality oocytes with a sensitivity of 72% and specificity of 25%. CONCLUSIONS: Normogonadotrophic patients without deep suppression of gonadotrophins by the use of GnRH analogues, high LH preovulatory levels correlates with a less number of oocytes, and with degenerated oocytes. Preovulatory LH levels of 0.85 UI/L could predict good quality oocytes.

[Analysis of results of intrauterine insemination performed once or twice per stimulated cycle]. / Análisis de los resultados de la inseminación artificial realizada en una o dos ocasiones por ciclo estimulado.

OBJECTIVE: To compare double homologous versus only one intrauterine insemination (IUI) by stimulated cycle. PATIENTS AND METHOD: In a prospective, comparative study 138 patients were included, who underwent to intrauterine insemination; not inclusion parameters were: patients with cancelled cycles by poor response or by ovarian hyperestimulation syndrome risk. Patients were divided in two groups: Group 1 (N = 69) one insemination at 36 hours after human gonadotrophin chorionic hormone (hCG) and group 2 (N = 69) two inseminations 24 and 48 hours after hCG. Sperm separation was done with swim up, wash and resuspended or isolate techiques, and ovarian stimulation was done with recombinant FSH, menotrophins or clomiphene citrate. Statistical analysis was made by T Student and chi2 tests. RESULTS: The overall pregnancy rate was 13.04% per cycle; and seminal characteristics after seminal preparation were similar. We observed better pregnancy rates in the patients with ovulatory dysfunction and endometriosis (14.9% and 18.2%). No differences were established in pregnancy rates when patients were compared in function to seminal preparation. CONCLUSIONS: Double IUI at 24 and 48 hours after hCG has the same results in pregnancy rates than only one IUI correctly indicated 36 hours after hCG, but the costs increases in double insemination.

[Success' determinant variables in assisted reproduction]. / Variables determinantes del exito en la reproducción asistida.

OBJECTIVE: To perform a statistical analysis with variables that have influence on pregnancy rates to establish a prognostic factor of each one. PATIENTS AND METHODS: We performed a retrospective, descriptive, and observational study with 240 patients that underwent to IVF-ET program. The analyzed variables were: infertility factor, ovarian stimulation protocol, age of patients, basal hormonal levels, oestradiol preovulatory levels, endometrial characteristics, fertilization rate, number and quality of oocytes, number and quality of embryos, and difficulty of the embryo transfer. RESULTS: The mean age of the patients was 34 +/- 4.42 years old. Tubal and pelvic pathologies were the main infertility cause. During the statistical analysis we observed that the only variables with differences regarding pregnancy were the number of cells in the embryo (7.18 vs 5.9), the fertilization rate (58.3 vs 50.1%), and the number of transferred embryos. With the logistic regression analysis we observed that the number of cells on each embryo had a relative risk of 1.37 (CI 95%; 1.15-1.63), and that the number of transferred embryos had one of 1.63 (CI 95%; 1.10-1.58). CONCLUSIONS: There are many variables that influence the pregnancy rates, but with our results we consider that the embryo quality, its characteristics and the number of transferred embryos could predict better the possibilities of pregnancy in IVF-ET programs.

[Results' analysis of estradiol and progesterone supplementation in luteal phase vs progesterone alone in an assisted reproduction program]. / Análisis de los resultados de la administración complementaria de estradiol y progesterona en la fase lútea contra progesterona sola en un programa de reproducción asistida.

OBJECTIVE: To correlate estradiol and progesterone concentrations in luteal phase with pregnancy rates, and to determine the real value of estradiol administration during luteal phase support. PATIENTS AND METHODS: In a prospective and comparative study, 69 patients who underwent IVF-ET program were divided in two groups: group 1 (n = 32) received luteal phase support only with progesterone and group 2, (n = 37) luteal phase support with estradiol and progesterone. Ovarian stimulation was made with recombinant FSH and GnRH analogues (agonists or antagonists) and 24 hours after oocyte retrieval we began luteal phase support: group 1 progesterone (in oily solution) 100 mg/day IM, and group 2 same progesterone doses plus 2 mg of estradiol valerianate. Statistical analysis was performed using students' t- test and ROC curves. RESULTS: No statistical differences were observed in age, preovulatory estradiol levels, oocytes retrieved, fertilization rates, number of embryos transferred, or difficulty of embryo transfer among groups. The overall pregnancy rate was of 34.78% per cycle, no significant differences were observed among groups (37.5 vs 32.43%). We observed greater incidence of miscarriage in group 2 (4.35 vs 0%), without statistical significance. When comparing estradiol levels and pregnancy outcomes, higher levels were observed in the pregnancy group (403.3 vs 221.85 pg/mL) on day 7 post-transfer. Same results were reported for progesterone levels (107.04 vs 240.76). We determined that estradiol levels on day 7, higher than 244 pg/mL, could predict pregnancy with sensitivity of 58% and specificity of 70%, whereas progesterone levels greater than 108.6 ng/mL had specificity and sensitivity of 50 and 70%, respectively. CONCLUSIONS: We couldn't determine any advantage with estradiol supplementation during luteal phase support; however, measurement on day 7 of estradiol and progesterone allowed a greater predictive accuracy of pregnancy outcome.

[Correlation between follicle levels of superoxide dismutase and oocyte quality, fertilization rates and embryo development]. / Correlación entre las concentraciones intrafoliculares de la superóxido dismutasa y la calidad ovocitaria, las tasas de fertilización y el desarrollo embrionario.

BACKGROUND: The intraovarian oxidative balance is important during oocyte development, and fertilization. It has been proposed that one of the most important enzymes in the follicle is the superoxide dismutase (SOD). OBJECTIVE: To correlate levels and percentage of SOD activity in follicular liquid with quality, fertilization and embryo development in a group of patients submitted to in vitro fertilization. MATERIAL AND METHODS: We obtained 120 follicular liquids from oocytes aspirated in 41 patients during an IVF program and then we followed the development of each oocyte separately. We measured the activity and concentration of SOD in the follicular liquid, and we evaluated the following variables: quality and maturity in the oocytes, as well as fertilization rate, segmentation rate and pregnancy. The statistical analysis was made with ANOVA test and Pearson test. RESULTS: In the analysis of the results, we observed a higher percentage of activity in the SOD in oocytes with good quality (3 and 4) in comparison with poor quality oocyte (1 and 2) (89 and 82% vs 75 and 61% p<0.05). We observed higher concentrations and activity of SOD in oocytes with a good fertilization rate and segmentation (p<0.05). When we analyzed the variables in function of pregnancy, we observed that the embryos that were transferred and developed pregnancy had higher concentrations and activity of SOD than embryos that did not develop pregnancy. CONCLUSIONS: Elevated levels and high percentage in the activity of SOD are associated with a better quality in the oocyte, and a good embryo development, influenced by the oxidative balance.

[Value of the morphological characteristics of polar body as a predictive factor of embryo development]. / Valor de las caracteristicas morfológicas del cuerpo polar como factor de predicción del desarrollo embrionario.

OBJECTIVE: To determine the relation between polar body quality and perivitelline space with fertilization and segmentation rates and embryo quality. STUDY: Prospective and descriptive. MATERIAL AND METHODS: Sixty-one patients underwent the in vitro fertilization and embryo transfer program (IVF-ET). The intracytoplasmatic sperm-injection (ICSI) was applied for insemination. Controlled ovarian hyperstimulation was made with recombinant FSH. Oocytes were evaluated 4-6 hours after retrieval and polar body, perivitelline space, and pellucid zone were assessed too. Fertilization was evaluated 17 hours after ICSI, and segmentation rates were analyzed at 48 and 72 hours. The number of blastomeres and quality of each embryo was assessed prior transference. Statistical analysis was done with chi2 test. RESULTS: We evaluated 883 oocytes, of which 43.8% had a normal polar body, 54.9% had a normal perivitelline space, and 69% a normal pellucid zone; 57% of retrieved oocytes with normal polar body developed an adequate fertilization rate, and oocytes with abnormal polar body had fertilization in less than 20%. Embryo cleavage was adequate in oocytes with normal polar body, in the abnormal oocytes was less than 20%, and 79% of the oocytes with fragmented polar body did not developed in embryo. There were not significant differences in fertilization rates and segmentation when compared with the pellucid zone and perivitelline space. CONCLUSIONS: Oocyte quality has a great influence on fertilization and embryo development. One of the most important variables is the polar body quality, which correlates adequately with fertilization and embryo cleavage.

[Azoospermia : In vitro fertilization results, using testicular biopsy and cryopreserved spermatozoa]. / Azoospermia: resultados en reproducción asistida con el uso de biopsia testicular y espermatozoides criopreservados.

Testicular sperm extraction (TESE) by open testicular biopsy, has become, since the introduction of the ICSI in 1992, the corner stone in treatment for azoospermia. This study reports the outcome of patients with open testicular biopsy for ICSI procedure indicated by azoospermia. 16 patients with azoospermia (12 obstructive and 4 non obstructive). The open testicular biopsy was performed prior the controlled ovarian hyperstimulation (COH) protocols of their couples, in two of the 16 patients no sperm were found in the biopsy, and the other 14 patients were admitted to 18 ICSI cycles, and the testicular samples were cryopreserved until oocyte capture. The controlled ovarian hyperstimulation (COH) was individualized in each case in accordance to the characteristics of each patient: 12 patients were used the long luteal phase GnRH agonist protocol, ultrashort protocol (Flare up) in one patient, GnRH antagonist in four, and the last one with endometrial preparation for cryopreserved embryo transfer. The mean of oocytes recovered was 11.71 +/- 7.24 oocytes per patient with a recovery rate of 72.64%. The fertilization rate was 49.35 +/- 29.24 and were transfered an average of 3 embryos per patient with a range between 1 and 5 embryos. In 18 cycles, 7 pregnancies occurred, four singles, one twin, one triple and one biochemical pregnancy. In conclusion the testicular sperm extraction (TESE) by open testicular biopsy is a good option for patients with azoospermia usually it achieves an adequate sample of testicular tissue with high possibilities of sperms recovery, in our study we obtained appropriate sperms in fourteen of sixteen patients for the ICSI procedure with good fertilization and pregnancy rates.

[Fertilization rate analysis as a predictive variable for an in-vitro fertilization program success]. / Análisis de la proporción en la tasa de fertilización como una variable predictiva del éxito en un programa de fertilización in vitro.

OBJECTIVE: Determining if fertilization rates can be used as a predictive factor for pregnancy induction in ETIVF-ICSI programs. TYPE OF STUDY: Retrospective, observational and descriptive. MATERIALS AND METHODS: Six hundred and seventy nine cycles of the in vitro fertilization program, using long protocol hypophyseal suppression, stop, or antagonsits, were included. Ovarian stimulation was carried out with menotropines or recombinant FSH. Those patients whose cycle was stopped due to the lack of follicular development were excluded. Variables under study were: age, fertilization percentage, pregnancy rate, pre-ovulatory estradiol levels, number and quality of captured oocytes, transferred embrios and endometrial thickness on the day of transference and the presence of pregnancy. The Pearson P Test with a 95% confidence interval and the Student T Test used to establish differences with a 95% confidence interval statistical analyses were applied. RESULTS: Six hundred and seventy nine cycles were studied, 487 of which used the conventional fertilization method, and 192 used the ICSI method. Mean age among patients was 34 +/- 1.1 years old, with pre-ovulatory estradiol levels of 4,023 +/- 1,134 pg/mL, the average quantity of captured oocytes was 11.7 +/- 3.2 with a capture rate of 69.6%. Mean fertilization rates averaged 54% with a 20.7% pregnancy rates using the transference method. After analyzing the fertilization rate in each group, a statistically significant linear correlation was observed (P = 0.547, CI 95%) with the pregnancy rate. After assigning patients to two different groups: conventional IVF and ICSI, a higher positive correlation was observed (P = 0.827, CI 99%) in the first group. No significant differences were observed in the remaining parameters between both groups, excepting oocyte maturity, where greater prophase I and metaphase II percentages were observed in the ICSI group. When 50% fertilization was taken as the cutting point, a 78.19% negative predictive value was determined, with a 25% positive predictive value, 77.5% sensitivity, and 25.6% specificity. CONCLUSIONS: A fertilization percentage greater than 50% can be used as a pregnancy predicting factor in in vitro fertilization programs.

[Statistical correlation between a transference test and embryonic transference in an assisted reproduction program]. / Correlación estadística entre una prueba de transferencia y la transferencia embrionaria en un programa de reproducción asistida: análisis de los resultados.

OBJECTIVE: Determining if a statistical correlation can be established between those variables observed during the transference test performed before ovarian stimulation and those obtained during the real embryo transference. TYPE OF STUDY: Clinical retrospective. MATERIALS AND METHODS: Ninety four female patients included in the IVF-ET were studied and a transference test previous to ovarian stimulation was performed. The following parameters were considered in this test: hysterometry, type of catheter, degree of difficulty, and person performing it. A total of 117 embryonic transferences were carried out, and the same parameters observed during the test were measured. The chi square test was used for the statistical analysis. RESULTS: The most commonly used kind of catheter was the Cook Soft Pass (n = 92), and a statistically significant correlation was observed with the one used during the real transference (n = 94). Concerning the degree of difficulty, the transference test resulted complicated in 4.2% of the cases, difficult in 31.6% of them, and easy in 64.2% of them, presenting a statistical correlation with the real transference, where the procedure resulted complicated in 1.7% of the patients, difficult in 32.4% of them, and easy in 65.8%. In addition, and with the intention of ruling out the medical factor, we tried to have the same person performing the transference test and the real procedure, and a statistically significant correlation was also observed. Pregnancy rate per transference was 27.4%. When an association between the difficulty of a real transference and pregnancy rates was tried, no statistical association between an easy or a difficult transference was observed. CONCLUSIONS: Embrionic transference is a fundamental phase for IVF-ET programs. However, a variety of factors can influence this procedure, some are medical and others are mechanical. Our results allow us to conclude that there is a statistical correlation between those variables observed during the real embryonic transference and the test, so the latter can be considered as a very useful element in the integral in vitro fertilization process, which prevents the real transference from becoming a blind procedure.

[Initial values of human chorionic gonadotropin as a prognostic variable of pregnancy evolution in assisted reproduction]. / Valores iniciales de la gonadotrofina coriónica humana como pronóstico de la evolución del embarazo en reproducción asistida.

INTRODUCTION: In assisted reproduction programs, once a pregnancy has been achieved, the power of predicting its evolution is important for the medical team as well as for the patient. The determination of pregnanediol or of placental protein 14 levels has been postulated as a predictive factor, however, the determination of hCG is, seemingly, the most adequate parameter for the detection of early developmental alterations during pregnancy. OBJECTIVE: To determine those predictive values of hCG which establish a prognosis concerning the evolution of pregnancy through the analysis of the values of this hormone on post-transference days 14 and 16, as well as to determine hCG values for multiple pregnancies. MATERIAL AND METHODS: Data from 88 patients participating in the in vitro fertilization program, in whom pregnancy was achieved, were retrospectively analyzed, and hCG levels were determined on post-transference days 14 and 16. Results were analyzed by the ANOVA test in order to compare mean values, & ROC were used to determine sensitivity and specificity. RESULTS: The patients were divided in three groups: 1) pregnant for more than 26 weeks; 2) pregnant for less than 26 weeks; and 3) chemical pregnancy. Significant differences in hCG levels on post-transference days were observed among these groups of patients. The levels of hCG, on post-transference day 14, 113 IU/L, and on day 16, 403 IU/L, presented, respectively, an 80% and 79% specificity, while the greater than 200.33 IU/L hCG increase offers a sensitivity and specificity of 80% and 83%, respectively, for a pregnancy of more than 26 weeks. In order to consider hCG levels as predictive for a high fetal order pregnancy, it was observed that hCC levels of 270.42 UI/L on day 14 present a sensitivity of 91% with a specificity of 64%, and levels higher than 837.14 IU/L on day 16 offer a sensitivity and specificity of 91% and 62%, respectively. CONCLUSIONS: The determination of hCG levels greater than 113 IU/L on day 14 and greater than 403 IU/L on day 16 offer adequate sensitivity and specificity as predictive factors for pregnancy evolution beyond the 26 GW, while hCG levels of 270.42 and 837.14, respectively, on days 14 and 16 offer a very high sensitivity (91%) for multiple pregnancy.

[Unexpected failed fertilization in vitro: ICSI reinsemination or ICSI indication for subsequent cycles]. / Falla inesperada en la fertilización in vitro convencional: reinseminación con ICSI o indicación de ICSI en ciclos subsecuentes.

The objective was to determine if intracytoplasmatic sperm injection (ICSI) for "rescue" of unexpected failed conventional insemination should be carried out for therapeutic or diagnostic purposes, that is, as a predictor for performing ICSI as a standard treatment in subsequent cycles. A retrospective clinical study was carried in 26 patients who showed unexplained fertilization failure on a first conventional IVF attempt, and reinsemination by ICSI was performed. We compared these results with those of 13 of the 26 patients who underwent a second attempt in which ICSI was used as the only insemination technique. A fertilization rate of 46.27% was achieved with reinsemination by ICSI but none resulted in pregnancy (0%). Fertilization was achieved with ICSI in all patients with previous fertilization failure and a pregnancy rate of 38.46%. Patient characteristics, cycle characteristics, sperm parameters or oocyte quality did not differ significantly between two groups. In conclusion, the ICSI reinsemination technique can give good fertilization rates but the potential of the generated embryos to achieve pregnancy seems to be low. In addition, it can be demonstrated that these patients have good possibilities of obtaining a pregnancy in a following cycle using ICSI.

Resultados perinatales en pacientes con hipertensión arterial sistématica crónica en el Instituto Nacional de Perinatología / Perinatal results in patients with chronic hypertension at Instituto Nacional de perinatología

Son muchas las causas de hipertensión crónica y cualquiera puede encontrarse en una embarazada, informando la literatura una incidencia entre 1 y 3 por ciento.En la gran mayoría el pronóstico para el embarazo es bueno, si bien los riesgos del retardo del crecimiento fetal, muerte fetal tardía y abruptio placentae tienen una mayor incidencia que en la población sana, el principal peligro es la superposición de la preeclampsia, que aumenta marcadamente la mortalidad perinatal, así como las complicaciones maternas que caracterizan a dicha entidad. El presente estudio pretende valorar los resultados perinatales en pacientes con hipertensión arterial sistémica crónica en el Instituto Nacional de Perinatología entre 1996 y 1997. Se detectó un total de 66 pacientes, de las cuales 54.5 por ciento tenían una edad entre los 30 y 40 años, 71.2 por ciento presentaban una evolución menor de cinco años, 95.4 por ciento presentaban hipertensión esencial, la incidencia encontrada de preeclampsia sobreagragada fue de 34.8 por ciento, sólo se presentó un caso de desprendimiento prematuro de placenta normoinserta (DPPNI), en cuanto a la resolución del embarazo, 80 por ciento fue por vía abdominal y 19.7 por ciento por vía vaginal. En los recién nacidos, sólo 10.6 por ciento presentó bajo peso al nacer, 89.2 por ciento presentó una valoración de Apgar adecuada, y el porcentaje de productos pretérmino fue sólo de 13.6 por ciento. Se concluye que el bajo peso al nacer y la valoración de un Apgar bajo, está asociado con un deficiente control prenatal y por consiguiente un inadecuado control de la presión arterial, lo que conlleva a un mayor número de complicaciones perinatales.

Perspectiva perinatal de la cardiopatía y embarazo. Revisión de 1169 embarazos / Pregnancy complicated by maternal heart disease. A review of 1169 pregnancies

Objetivo. Presentar la experiencia obtenida en el Instituto Nacional de Perinatología en el control prenatal multidisciplinario de las mujeres con padecimiento cardiaco que se embarazan. Material y método. En forma retrospectiva, se analizaron los expedientes de 1093 mujeres con diagnóstico confirmado de cardiopatía, seleccionándose 1169 embarazos (un gemelar doble) que cumplieron con los criterios de inclusión establecidos en el protocolo de estudio. En 53 mujeres se habían resuelto dos embarazos en la institución, en 10 fue el tercer embarazo y en una con cardiopatía reumática tipo estenosis mitral, se resolvieron cuatro gestaciones. La mayoría de las pacientes fueron referidas del Instituto Nacional de Cardiología "Ignacio Chávez" para su atención perinatal. Resultados. La cardiopatía reumática fue la más frecuente (60.30 por ciento), seguidas por la de origen congénito (33.10 por ciento). De las cardiopatías reumáticas, la doble lesión mitral ocupó el primer lugar (42.13 por ciento) y entre las congénitas, la comunicación interventricular (32.81 por ciento). 124 pacientes eran portadoras de prótesis valvular cardiaca [87 mecánicas y 40 biológicas, (tres pacientes utilizaban doble prótesis)]. En 312 embarazos se presentaron una o más complicaciones, de las cuales el retardo en el crecimineto intrauterino (7.52 por ciento) fue la más común. En 29 gestantes se presento descompensación cardiovascular. Hubo 30 abortos espontáneos y siete muertes fetales. En 977 (83.57 por ciento) el embarazo se resolvió entre la semana 37 y 41 de gestación, la vía de nacimiento en el 64.8 por ciento fue vaginal. El peso de lo neonatos vivos tuvo un promedio de 2864.4 ñ 5266.9 gramos. Se presentaron ocho defunciones maternas: cinco con cardiopatía congénita (cuatro Eisenmenger, una tetralogía de Fallot) y tres con cardiopatía reumática (una de ellas con prótesis de tipo mecánico). 19 recién nacidos murieron en la etapa neonatal temprana. La frecuencia de bajo peso al nacer fue de 8.46 por ciento. Dos neonatos presentaron cardiopatía congénita