RESUMO
Resumen ANTECEDENTES: La asociación entre pruebas de reserva ovárica y respuesta a la estimulación está debidamente establecida aunque su capacidad para predecir embarazo clínico y recién nacido vivo es limitada. OBJETIVO: Evaluar la utilidad clínica de la cuenta folicular antral para predecir embarazo clínico y recién nacido vivo. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en el Instituto Nacional de Perinatología, entre 2011 y 2016 en ciclos de fertilización in vitro en fresco. Se incluyeron pacientes con diagnóstico de infertilidad a quienes se efectuó, in vitro, transferencia de embriones en fresco. Variables de estudio: edad, cuenta folicular antral, concentración basal de FSH y cantidad de ovocitos capturados. Se elaboró un modelo de regresión logística. Para el análisis estadístico se utilizó el programa Statistic Package for Social Sciences (SPSS). Se consideró significativa la probabilidad de error alfa menor de 5%. RESULTADOS: Se analizaron 923 ciclos de fertilización in vitro. La cuenta folicular antral tiene predicción para detectar embarazo clínico con un área bajo la curva ROC de 0.59 y para recién nacido vivo de 0.57. El número óptimo con mayor porcentaje de embarazo clínico (9%) y recién nacido vivo (10.4%) tuvo cuenta folicular antral ≥ 8. CONCLUSIONES: Cuando la cuenta folicular antral es más o menos mayor de 8 folículos se espera mayor cantidad de embarazos clínicos y de recién nacidos.
Abstract BACKGROUND: The association between ovarian reserve test and ovarian response is well established, however, its ability to predict clinical pregnancy and the live birth is limited. OBJETIVE: Evaluate the clinical usefulness of the antral follicle count (AFC) to predict clinical pregnancy and live newborn. MATERIALS AND METHODS: Retrospective cohort study was made. In fresh IVF cycles, performed at INPer between 2011-2016. Including patients diagnosed with infertility, who underwent in vitro fertilization with fresh embryo transfer. The study variables were age, antral follicle count, basal FSH concentration and number of oocytes captured. A binary logistic regression model was performed. Statistical Package for Social Sciences (SPSS) was used for the statistical analysis. The probability of error alpha <5% was considered significant. RESULTS: A total of 923 in vitro fertilization cycles were included. The antral follicle count has a prediction for clinical pregnancy (ABC 0.59) and live birth (ABC 0.57). The optimal cut-off value with the highest percentage of clinical pregnancy (9%) and live birth (10.4%) was presented with a CFA ≥ 8. A higher pregnancy rate is reported when there is a follicular count above ≥8 follicles. CONCLUSIONS: It is expected the highest number of clinical pregnancy and live birth when the antral follicle count is for ≥8 follicles.
RESUMO
BACKGROUND: Embryo transfer is a critical point for success in IVF cycles. Many factors should be considered when performing an embryo transfer such as: embryo quality and number, soft versus rigid catheter, easy of the transfer, physician technique, ultrasound guide during transfer, among others. OBJECTIVE: Evaluate two different embryo transfer systems performed by six physicians with the same protocol. MATERIAL AND METHODS: We evaluated 308 embryo transfers performed from January 2006 to December 2008 by six physicians with two different systems. We only included patients with good quality in embryos and endometrium. Both systems were analyzed in each of the six physicians. RESULTS: Similar characteristics in number of transferred embryos, number of cells in each embryo and quality of them, were found in both groups. There were no significant differences between both systems in the characteristics of the couple nor the mentioned above. Most of the transfers n = 252 (81.81%), were realized by two of the six physicians, however, the pregnancy rate did not show significant differences between these physicians and the less experienced ones. CONCLUSIONS: With the obtained results, it could be supposed that the most influential factor in the outcome is the operator experience in the use of each system and not the system itself.
Assuntos
Transferência Embrionária/métodos , Adulto , Catéteres , Feminino , Fertilização in vitro , Humanos , Curva de Aprendizado , Gravidez , Taxa de Gravidez , Medicina Reprodutiva , Estudos Retrospectivos , Injeções de Esperma IntracitoplásmicasRESUMO
BACKGROUND: intrauterine insemination should be offered to couples with unexplained infertility, given its effectiveness and compared to in vitro fertilization and embryo transfer, is less invasive and requires less resources. It also should be offered to couples with male factor infertility in selected patients with induction of ovulation to increase the chances of pregnancy. OBJECTIVE: to determine the rate of pregnancy with intrauterine insemination in couples with infertility. MATERIAL AND METHODS: descriptive and retrospective study of 500 couples with female, male and combined infertility, primary or secondary, managed with homologous insemination, with controlled ovarian stimulation and programmed ovulation, in patients with at least one permeable salpinx, FSH <12 IU/L and > 5 x 10(6) mobile and normal sperm. Ultrasonografic follicular follow-up and ovulation triggering according to findings, performing insemination 36 hours after the shooting, with luteal phase support with progesterone. RESULTS: 1.6 cycles on average, female infertility 65.8%, 21% male and combined 13.2%, age average 32 years of women and 36 years of man, average ovarian stimulation 8 days. Pregnancy in 19.5% of the patients, of these, 65.1% under the age of 35 years, 33.3% from 35 to 40 years and 1.5% older than 40 years. Pregnancy at term 77.08%, miscarriage 11.45% and unknown resolution at 11.45%. Twin pregnancy 14.61% and high fetal order 5.7%. Pregnancy with female infertility 64%, male 22.3% and combined 13.5%. Pregnancy with endometrial <8 mm 9.8%, 8-15 mm 86.4% >15 mm 3.6%. With trilaminar endometrium 72.3%, dense 12.5%, linear 0.5%. CONCLUSION: The rate of pregnancy in intrauterine insemination hardly exceeds 20%. The determinants for this are the women age, type of infertility and endometrial characteristics. It was also noted high twin pregnancy and high fetal order.
