Total Fertilization Failure: A Single Center Analysis.

Our main objective was to identify the male and female parameters associated with total fertilization failure (TFF) in IVF with nonmasculine indications. The present work, IRB equivalent INS 63209, is a case-control study that evaluated all cases with TFF after conventional IVF at the Center for Human Reproduction from January 2010 to December 2019 (n = 154). As a control group, we analyzed all patients who did not experience fertilization failure after conventional IVF in the same period (n = 475). We evaluated various parameters, both male and female, assessed during infertility treatment, and only cases without masculine etiology (normal seminal parameters) were included. Ages (female and male) were not different between the groups. Moreover, AMH (anti-Müllerian hormone), semen volume, preprocessing concentration and preprocessing motility were not significantly different (P > 0.05). However, the number of collected oocytes (study versus control groups, median [25-75 interquartile]: 2 [1-5] and 5 [3-8]); MII (2 [1-4] and 5 [2-7]); and postprocessing motility (85 [70-90] and 90 [80-95]) were significantly different between both groups (P < 0.05). Furthermore, a logistic regression analysis including all significant data demonstrated that the number of collected oocytes was significantly related to IVF failure. Patients with fewer than 5 oocytes had an OR of - 1.37 (- 0.938 to - 1.827) for TFF after conventional IVF. Our results showed that a lower follicular response to controlled ovarian stimulation, evidenced by a decreased number of collected oocytes, was the most important parameter associated with IVF failure in nonmasculine infertility.

Corifollitropin alpha was not detrimental to follicular ovarian responsiveness measured by follicular output rate (FORT).

Corifollitropin alpha has been demonstrated to be non-inferior to other gonadotropins in reproductive outcomes. However, its impact on follicular ovarian responsiveness has never been evaluated. Follicular Output Rate (FORT) is an option for objective assessment of the follicular responsiveness. A prospective study was conducted with 306 infertile patients undergoing in vitro fertilisation. Ovarian stimulation protocol was performed with a single dose of 100 µg (<60kg) or 150 µg (≥60kg) corifollitropin alpha in group 1 (n = 147), and 150-300 IU/day human menopausal gonadotropin in group 2 (n = 150). Comparing ovarian stimulation between corifollitropin alpha and human menopausal gonadotropin, no differences regarding FORT were found (40.0% for group 1 versus 40.83% for group 2; p = 0.930). Patients treated with corifollitropin alpha had a higher number of embryos when compared with human menopausal gonadotropin group (3.0 for group 1 versus 2.0 for group 2; p = 0.04). Other secondary outcomes preset were similar between groups. Therefore, corifollitropin alpha can be an excellent option to simplify in vitro fertilisation treatment due to the "patient-friendly" protocol.

Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study.

OBJECTIVE: Information on the pregnancy rate after successive in-vitro fertilization (IVF) cycles and their associated costs is relevant for couples undergoing assisted reproduction treatments (ARTs). This study, therefore, sought to investigate the effectiveness and the cost-effectiveness of two ARTs, the minimal ovarian stimulation IVF (MS-IVF) compared to the conventional ovarian stimulation IVF (C-IVF) from the payer's perspective. METHODS: A 10-months follow-up prospective observational study was conducted in a sample of couples who sought ARTs in a private clinic in Southern Brazil. Women had to satisfy the Bologna Criteria and be older than 35 years. The effect outcome was pregnancy rate per initiated cycle. Medication costs were based on medical records. Costs and effect differences were estimated using seemingly unrelated regressions adjusted for the propensity score estimated based on women's characteristics. RESULTS: All 84 eligible women who agreed to participate received a total of 92 IVF cycles (MS-IVF, n=27[35 cycles]; C-IVF n=57[57 cycles]. The effect difference between MS-IVF and C-IVF was -5.1% (95%CI, -13.2 to 5.2). Medication costs of MS-IVF were significantly lower than C-IVF by €-1260 (95%CI, -1401 to -1118). The probabilities of MS-IVF being cost-effective compared to C-IVF ranged from 1 to 0.76 for willingness-to-pay of €0 to €15,000 per established pregnancy, respectively. CONCLUSIONS: Even though there were no positive effect differences between groups, MS-IVF might be cost-effective compared to C-IVF from the payer's perspective due to its relatively large cost savings compared to C-IVF. However, further investigation is needed to confirm these findings in a larger sample.

AMH as a Prognostic Factor for Blastocyst Development.

OBJECTIVE: To investigate the relationship between AMH blood levels and the likelihood of blastocyst formation. METHODS: Two hundred ninety-two patients, 22-44 years of age, undergoing routine explorations during spontaneous cycles that preceded assisted reproductive technologies at our Center, were studied. As the present study did not require previous submission to our Institutional Review Board. Serum AMH and FSH levels were measured and laboratory data was obtained after ovulation induction with an antagonist protocol. Participants were sorted into two different groups paired by age. The first group (No Blasto; n=219) involved women having no blastocyst formation; the second group (Yes Blasto group; n=73) was made up of those women who were considered eligible to undergo 5 days of embryo culture. Furthermore, we analyzed blastulation rate. Patients were divided according to the rate of blastocyst formation <0.43 (n=36) and ≥ 0.43 (n=37). The Statistical analysis was performed using SPSS version 20.0. We ran Student's t-test for independent samples and Pearson's correlation. A P < 0.05 was considered significant. RESULTS: AMH levels were statistically different (P=0.002) between the YES and NO blasto groups. Number of oocytes, MII oocytes and embryos were higher in Yes Blasto group. FSH levels were similar between the groups (P=0.149). Pearson correlation coefficient shows that the rate of blastocyst formation is inversely correlated to AMH levels. CONCLUSIONS: We conclude that patients that were considered eligible to undergo blastocyst formation have higher levels of serum AMH, however too high concentration of this hormone can be harmful to blastocyst development.

The effect of the levonorgestrel-releasing intrauterine system and the copper intrauterine device on subendometrial microvascularization and uterine artery blood flow.

OBJECTIVE: To evaluate the effect of the levonorgestrel intrauterine system (LNG-IUS) and TCU 380A on the subendometrial vascularization and the uterine artery blood flow during the midluteal phase. DESIGN: Prospective clinical trial. SETTING: Teaching hospital. PATIENT(S): The trial included 27 patients who received the LNG-IUS compared with 25 patients who received the TCU 380A. INTERVENTION(S): The subendometrial blood flow was evaluated using power Doppler analysis, uterine artery pulsatility index (PI), and resistance index (RI) just before inserting the intrauterine device in the midluteal phase and 3 months after. MAIN OUTCOME MEASUREMENT(S): Power Doppler analysis, PI, RI, and endometrial thickness. RESULT(S): There were no significant differences in subendometrial vascularization between the groups. Pulsatility index and RI variability (before and after) increased and endometrial thickness reduced in LNG-IUS users. We used the multiple logistic regression model to examine the potential confounding bias (age and parity). The LNG-IUS was independently associated with increased PI. CONCLUSION(S): No subendometrial microvascularization difference was found between the groups. It is the first direct evidence that LNG-IUS reduced uterine artery blood flow, even after controlling for age and parity.

Histeroscopia no programa de fertilizaçäo assistida do Hospital de Clínica de Porto Alegre / Histeroscopy in an assisted fertilization program of Hospital de Clínicas Porto Alegre

OBJETIVOS: estudo prospectivo, com a realizaçao de histeroscopia em pacientes que seriam submetidas a fertilizaçao in vitro (FIV). MATERIAL E MÉTODOS: foram analisadas 39 histeroscopias realizadas em 39 pacientes no período entre novembro de 1995 a fevereiro de 1996. RESULTADOS: Vinte e quatro pacientes (61,5 por cento) apresentaram alguma anormalidade à histeroscopia, sendo endometrite a lesao mais prevalente (15,4 por cento) seguida por sinéquias e pólipos (10,3 por cento cada). Onze casos (28 por cento) apresentaram alguma patologia intra-uterina, embora tivessem histerossalpingografia normal. CONCLUSOES: a histeroscopia deve ser realizada em todas as pacientes com indicaçao de Fertilizaçao Assistida a fim de que sejam excluídas patologias uterinas.

Incidência de Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres assintomáticas promíscuas e nåo-promíscuas / Incidence of Chlamydia trachomatis and Neisseria gonorrhoaea in no-promiscuous asymptomatic women and in promiscuous asymptomatic women

Levando-se em conta a importância epidemiólogica da Chlamydia trachomatis e da Neisseria gonorrhoeae e das possíveis complicaçöes proveninentes destes patógenos, os autores investigaram 110 mulheres que visitaram o Serviço de Orientaçåo e Planejamento Familiar no período de fev/1987 a fev/1988. As pacientes foram dividiadas em dois grupos. O primeiro era composto por mulheres assintomáticas nåo promíscuas e o segundo por assimtomáticas promíscuas. Foi coletado do canal endocervical para cultura de gonococo e para pesquisa de Clamídia. O grupo de mulheres assintomáticas mostrou a incidência de 4 por cento para Chlamydia trachomatis e de 2 por cento para Neisseria gonorrhoeae; já que o grupo de assintomáticas promíscuas apresentou Clamídia em 11,67 por cento das amostras e gonococo em outras 8,33 por cento. Os autores concluíram que Chlamydia trachomatis e Neisseria gonorrhoae podem ser isoladas de mulheres assintomáticas (promíscuas ou nåo-promíscuas), porém nåo eståo significativamente associadas com a promiscuidade