RESUMO
Resumen ANTECEDENTES: el patrón de referencia para evaluar la infertilidad masculina es el análisis seminal, aunque es incapaz de detectar la fragmentación del ADN espermático relacionado con resultados reproductivos adversos. OBJETIVO: analizar la relación entre los parámetros seminales y la fragmentación del ADN espermático, y valorar la utilidad del seminograma como predictor de fragmentación. MATERIALES Y MÉTODOS: estudio retrospectivo y observacional efectuado en pacientes del Instituto de Ciencias en Reproducción Humana Vida con problemas de fertilidad. Análisis seminal e índice de fragmentación del ADN (DFI) mediante el test de dispersión de la cromatina espermática. RESULTADOS: se estudiaron 206 pacientes: 43 (20.9%) con espermas normales y 163 (79.1%) con algún parámetro seminal alterado. En los individuos con espermas normales, 8 (18.6%) tuvieron fragmentación moderada y quienes resultaron con al menos un parámetro seminal alterado 49 (30.1%) reportaron fragmentación moderada y 22 (13.5%) fragmentación crítica. Se encontró una correlación negativa entre el índice de fragmentación del ADN y la movilidad, vitalidad y concentración (p<0.0001). No se encontró correlación alguna con el resto de los parámetros seminales. Las medias de fragmentación aumentaron conforme se incrementó el número de parámetros alterados. La razón de momios de fragmentación moderada y crítica en pacientes con oligozoospermia fue de 2.2 y 1.9; con astenozoospermia 8.0 y 26.2; con necrozoospermia 10.5 y 18.8; y con ≥ 3 alteraciones seminales 4.6 y 14.2, respectivamente. CONCLUSIONES: en pacientes con astenozoospermia, necrozoospermia u oligozoospermia o con ≥ 3 parámetros seminales alterados se recomienda realizar el estudio de fragmentación del ADN.
Abstract BACKGROUND: the reference pattern to evaluate male infertility is a semen analysis: although it is unable to detect sperm DNA fragmentation related to adverse reproductive outcomes. OBJECTIVE: to analyze the relationship between seminal parameters and sperm DNA fragmentation as well as assess the usefulness of semen analysis as predictor of fragmentation. MATERIALS AND METHODS: retrospective, observational study performed in patients of the Instituto de Ciencias en Reproducción Humana Vida with infertility problems. Semen analysis and sperm DNA fragmentation index (DFI) using the sperm chromatin dispersion test. RESULTS: 206 patients were studied: 43 (20.9%) with normal sperm and 163 (79.1%) with an impaired seminal parameter. Of the individuals with normal sperm, 8 (18.6%) had moderate fragmentation and those who had at least one seminal parameter impaired 49 (30.1%) reported moderate fragmentation and 22 (13.5%) critical fragmentation. We found a negative correlation between the DNA fragmentation index and the motility, vitality and concentration (p<0.0001). We found no correlation whatsoever with the remaining seminal parameters. The fragmentation measurements increased as the number of impaired parameters increased. The odds ratio of moderate and critical fragmentation in patients with oligozoospermia was 2.2 and 1.9; with asthenozoospermia 8.0 and 26.2; con necrozoospermia 10.5 and 18.8; and with ≥ 3 seminal impairments 4.6 and 14.2, respectively. CONCLUSIONS: in patients with asthenozoospermia, necrozoospermia or oligozoospermia or with ≥ 3 impaired seminal parameters, we recommend performing a DNA fragmentation test.
RESUMO
Resumen OBJETIVO: primario, determinar la influencia de la obesidad paterna en la tasa de embarazo, implantación, aborto y de recién nacido en casa en pacientes que reciben tratamientos de fertilización in vitro con ICSI. El objetivo secundario: determinar el efecto del índice de masa corporal del padre en la calidad seminal y embrionaria y en la tasa de fertilización. MATERIALES Y MÉTODOS: estudio retrospectivo, comparativo y observacional al que se incluyeron ciclos ICSI con transferencia embrionaria. Los ciclos se dividieron en 3 grupos según el IMC paterno: peso normal (18.5-24.99 kg/m2), sobrepeso (25-29.99 kg/m2) y obesidad (≥ 30 kg/m2). RESULTADOS: se estudiaron 365 ciclos consecutivos en fresco en los que se encontró un incremento significativo en la tasa de aborto en pacientes con obesidad comparados con el grupo sano (39.0 vs 12.9, p = 0.02), y una significativa disminución en la tasa de recién nacido en casa (38.6 vs 23.6; p = 0.04), además de menor tasa de embriones de excelente calidad, sin afectar la tasa de fertilización con ICSI. CONCLUSIONES: los resultados demuestran que aun cuando las tasas de embarazo e implantación son elevadas en pacientes con sobrepeso y obesidad con técnicas de alta complejidad o ICSI, el desarrollo embrionario, la tasa de aborto y tasa de recién nacido en casa se ven afectados por el incremento del IMC paterno.
Abstract OBJECTIVE: The aim of the present study was primarily to determine the influence of paternal obesity on pregnancy, implantation, abortion and take home baby rates in patients undergoing in vitro fertilization with ICSI. Secondly, to determine the impact of paternal body mass index (BMI) on semen parameters, fertilization rate and embryo quality. MATERIALS AND METHODS: Retrospective, comparative and observational study. 352 cycles of ICSI with embryo transfer were included. They were divided in three groups based on male BMI: Normal (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), and obesity (≥30 kg/m2). RESULTS: Male obesity was associated with a significant increased miscarriage rate when compared with the normal group (39.0 vs 12.9, p = 0.02) and a significantly lower take home baby rate (23.6 vs 38.6, p = 0.04). We also found a lower rate of top quality embryos, without affecting fertilization with ICSI. CONCLUSION: Our results demonstrate that even though pregnancy and implantation rates are elevated when ICSI is performed in overweight and obese patients, embryo development, miscarriage and take home baby rates are affected with increased paternal BMI.
RESUMO
BACKGROUND: Identification of the best embryos to transfer is a key element for success in assisted reproduction. In the last decade, several morphological criteria of oocytes and embryos were evaluated with regard to their potential for predicting embryo viability. The introduction of polarization light microscopy systems has allowed the visualization of the meiotic spindle and the different layers of the zona pellucida in human oocytes on the basis of birefringence in a non-destructive way. Conflicting results have been reported regarding the predictive value in ICSI cycles. OBJECTIVE: To assess the predictive ability of meiotic spindle and zona pellucida of human oocytes to implant by polarized microscopy in ICSI cycles. MATERIAL AND METHODS: Prospective and observational clinical study. 903 oocytes from 94 ICSI cycles were analyzed with polarized microscopy. Meiotic spindle visualization and zona pellucida birefringence values by polarized microscopy were correlated with ICSI cycles results. RESULTS: Meiotic spindle visualization and birefringence values of zona pellucida decreased in a direct basis with increasing age. In patients aged over the 35 years, the percentage of a visible spindle and mean zona pellucida birefringence was lower than in younger patients. Fertilization rate were higher in oocytes with visible meiotic spindle (81.3% vs. 64%; p < 0.0001), as well as embryo quality (47.4% vs. 39%; p=0.01). Fertilization rate was higher in oocytes with positive values of birefringence (77.5 % vs. 68.5% p=0.005) with similar embryo quality. Conception cycles showed oocytes with higher mean value of zona birefringence and visible spindle vs. no-conception cycles (p<0.05). CONCLUSIONS: Polarized light microscopy improves oocyte selection, which significantly impacts in the development of embryos with greater implantation potential. The use of polarized light microscopy with sperm selection methods, blastocyst culture and deferred embryo transfers will contribute to transfer fewer embryos without diminishing rates of live birth and single embryo transfer will be more feasible.
