Medicina Reproductiva y Embriología Clínica最新文献

Objective

The aim of this systematic review and meta-analysis is to study the efficacy of Dehydroepiandrosterone in patients with normal ovarian reserve undergoing in vitro fertilization treatment.

Design

Systematic review and meta-analysis.

Setting

Centers for reproductive care.

Patients

Patients with normal ovarian reserve (NOR) undergoing in vitro fertilization treatment and previously supplemented or not with DHEA.

Intervention

A comprehensive electronic literature search was conducted in Pubmed, the Cochrane Library and Web of Science up to March 2021. Randomized controlled trials studying the effect of DHEA supplementation on reproductive outcomes in patients with normal ovarian reserve were included.

Main outcome measures

The outcomes of interest were miscarriage rate, clinical pregnancy rate and live birth rate per embryo transfer.

Results

DHEA supplementation, compared with placebo or no treatment, was associated with a significant decrease in miscarriage rate (OR = 0.30, 95% CI: 0.10–0.93; p = 0.04) in DHEA group. In contrast, there were no statistically significant differences in live birth rate (OR = 1.52, 95% CI: 0.8–2.89; p = 0.2) or clinical pregnancy rate (OR = 1.19, 95% CI: 0.73–1.95; p = 0.47) per embryo transfer. There were also no statistically significant differences in the number of oocytes (MD = 0.66 95% CI: - 0.04–1.36; p = 0.07) or metaphase II oocytes retrieved (MD = 0.32 95% CI: − 0.12–0.76; p = 0.16) in one IVF cycle between the two groups.

Conclusions

Our study suggested that DHEA supplementation could improve the miscarriage rate in NOR patients who underwent IVF treatment. However, no increase in clinical pregnancy rate, live birth rate or number of oocytes retrieved per IVF cycle could be demonstrated.

Introduction

The aim of this review is to learn about the current situation of artificial intelligence for clinical use in assisted reproduction based on a study of the limitations that have been found.

Search Methods

An exhaustive review is carried out through databases such as PubMed, Elsevier and the library of scientific societies, searching for original articles, using a combination of keywords such as Artificial intelligence, FIV, ART.

Results

There are algorithms capable of analysing different seminal parameters, among which the concentration, motility and morphology of human sperm stand out, and it is on this last parameter where the fundamental role of artificial intelligence is focused. Moreover, algorithms are being developed with static images or time-lapse sequences both at different specific points of embryo development and at specific periods.

Conclusions

Much of the literature is retrospective, so most of the algorithms appear to be in the early stages. In the commercial world, there is also a need for corroborative studies. The limitations often encountered are, in addition to the nature of the study, getting an explainable algorithm, introducing other parameters that also affect the outcome and the data set. It is therefore necessary to conduct randomised controlled trials in different clinics in which explainable algorithms are presented that through the analysis of different parameters achieve reliable results for clinical practice.

Background and objective

The endometrium is a dynamic tissue that undergoes changes throughout the menstrual cycle, including morphological, biochemical and molecular changes, necessary for a successful embryo implantation process. When insufficient endometrial thickness occurs embryo implantation takes place near the spiral arteries in the endometrial basal layer with high blood flow and high oxygen tension which leads to excess production of oxygen free radicals, a fact that can interfere with embryo implantation and development (Catt and Henman, 2000). Thus, an adequate assessment of this situation is essential to achieve an ongoing pregnancy.

Patients

In this article, we present the clinical cases of 2 patients with insufficient endometrium and how we have managed their situation through hysteroscopic and pharmacological treatment.

Results

Pregnancies have been achieved in both clinical cases. One of the patients had an eutocic delivery at 32nd week of pregnancy and a healthy child of 2,100 grams was born. The other patient is still pregnant.

Conclusions

The prevalence of thin endometrium according to published studies is between 2.4% and 8.5% of women (Ribeiro et al., 2018; Kasius et al., 2014). Multiple studies have shown a correlation between thin endometrium, low implantation rates and lower percentages of ongoing pregnancy. A minimum endometrial thickness of 7 mm is suggested to increase these percentages.

Introduction

The early stages of human embryonic development prior to implantation have been extensively studied to improve reproductive outcomes. However, subsequent events are unknown. In vitro advances have allowed extended culture of embryos up to day 14, considered the legal limit. We aim to review aspects related culture conditions, morphogenesis events, potential applications of extended culture of human embryos as well as some ethical issues surrounding this topic.

Materials and methods

This literature review was carried out using different databases and websites by screening articles.

Results and discussion

Extended culture consists of culturing embryos up to day 14 of development. This requires specific culture conditions of temperature and gas concentration, as well as a medium composition that is different from that used in clinical practice in IVF laboratories. In addition to having made it possible to document in vitro the morphological events and structures of the embryo after implantation, the study of mosaic embryos at these hitherto hidden stages could provide valuable information for clinical practice. All this has been achieved within the 14-day limit, but due to scientific progress this can be considered restrictive and different reasons have been put forward why it should be extended.

Conclusions

Although prolonged culture has provided a better understanding of the events occurring between implantation and gastrulation, culture conditions must be improved to optimise the technique, and once this is achieved, consideration should be given to extending this limit. Furthermore, alternatives to the use of embryos, such as the development of embryos from stem cells, should be further explored. All of this could have a future clinical application in terms of choosing the best embryos or finding out about diseases that affect pregnancy and lead to miscarriage.

Objective

Are there differences in serum progesterone levels between different routes of exogenous progesterone administration for artificial endometrial preparation?

Material and methods

This prospective, observational, single-centre study included 9 infertile female patients who underwent cycles of artificial endometrial preparation between January and June 2019 with different progesterone formulations (3 cycles in 2 patients; 2 cycles in 2 patients; and 1 cycle in 5 patients). Oestrogen stimulation was followed by vaginal progesterone 400 mg every 12 h (first cycle), subcutaneous progesterone 25 mg every 12 h (second cycle), and intramuscular progesterone 50 mg every 24 h (third cycle). Progesterone therapy was continued for 5 days and daily serum progesterone was recorded. The primary outcome was day 5 serum progesterone.

Results

Day 5 mean ± standard deviation serum progesterone levels after vaginal, subcutaneous, and intramuscular administration were 14.6 ± 5.5, 47.9 ± 22.3, and 60.3 ± 65.5 ng/mL, respectively (p = 0.032 across routes). From day 1 to day 5, the coefficients of variation for serum progesterone were 66% and 75% with the vaginal and subcutaneous routes, respectively, indicating low variability, and 146% with the intramuscular route, indicating high variability. Two linear regression models were conducted: a normal linear regression model, which found no significant effect of administration route on serum progesterone, and a mixed-effects linear regression model, which also showed no statistically significant differences between routes.

Conclusion

All routes of progesterone administration showed satisfactory day 5 mean serum progesterone levels, regardless of administration route.

The male factor plays a decisive role in reproduction and, despite being an area that has been extensively studied, there are events that remain unknown, such as sperm DNA fragmentation. This cause of infertility has been the subject of study during the last decades and has been associated with poor semen parameters and low reproductive outcomes. Among the techniques that have emerged to mitigate this problem is the innovative field of microfluidics. Microfluidic-based devices have been developed to be applied as sperm selection methods, reporting promising results in the non-invasive selection of sperm of higher quality, and less DNA fragmentation. The nature of these devices lies in sperm self-selection by simulating an in vivo environment. The present review discusses the mechanisms responsible for sperm DNA fragmentation and its implication in the field of assisted reproduction introducing, in addition, microfluidics as a potential application for human sperm selection.

Background and objective

The available literature suggests that longer periods of male abstinence have a negative effect on reproductive outcomes. However, the low sample size of the available studies and the lack of consensus make further research necessary in order to establish an optimal abstinence period to improve the reproductive possibilities of each couple. The aim of this study was to estimate the influence of male sexual abstinence period on reproductive outcomes after IVF and ICSI.

Material and methods

This retrospective, observational, multicentre, cohort study has the largest sample size to date, 7789 embryo transfers were included in the study. The study participants were divided into 4 quartiles according to their period of abstinence: Q1 (0–3 days abstinence), Q2 (3–4 days), Q3 (4–5 days) and Q4 (> 5 days abstinence). The outcome measures used were: gestation rate (biochemical, clinical and evolutionary), VUR delivery rate and miscarriage rate (biochemical and clinical) calculated per single embryo transfer and for the total number of embryo transfers for each patient.

Results

Biochemical gestation rate (adjusted Odds Ratio (ORadj): 2.943, p = .022), clinical gestation rate (ORajd: 2.649, p = .028), evolutionary gestation rate (ORadj: 3.637, p = .005) and VUR delivery rate (ORadj: 3.008, p = .021) were significantly higher in the third quartile when compared to the first quartile. Clinical gestation (ORadj: 0.192, p = .010) was significantly lower in the fourth quartile when compared to the first quartile.

Conclusions

A period of sexual abstinence of more than 4 and up to 5 days significantly increases biochemical, clinical and evolutionary gestation rates and VUR delivery rate. A period of abstinence longer than 5 days appears to worsen reproductive outcomes.

In this paper, we analysed In Vitro Fertilization (IVF) data from the registry of the Spanish Society of Fertility (SEF). This registry is not complete until 2014, when it started to be mandatory, as a part of the clinics did not report until that year. Also, information on patients is very limited. Our first purpose was to estimate the number of births obtained by IVF in Spain for the period 1999–2019, correcting for non-participation. In this sense, we stressed the importance of estimating the number of pregnancies with unknown evolution and the demand for IVF by non-resident women in the country, to arrive at a correct estimate of the weight of IVF in total births. We also discuss what kind of improvements could make this registry more useful, for the purposes of demographic and social analysis, but also to be able to better measure the effectiveness of these techniques. This paper shows the limits of having only aggregated data. In the near future, the SEF registry will become individual, and it is hoped that it can be even more useful in determining the impact of IVF and to what degree public demand is fulfilled.

Background and objectives

The registry of In Vitro Fertilization (IVF) in Spain is not complete until 2014. Here we reconstruct the series of cycles for the period 1999–2019 correcting for non-participation which allows us to estimate the weight of births from IVF in Spain, taking also into account pregnancies with unknown evolution as well as the demand of women residing abroad. We also discuss what kind of improvements could make this registry and the corresponding reports made by the Sociedad Española de Fertilidad (SEF) more useful, for the purposes of demographic and social analysis, in the light of the transition to an individual registry in upcoming years.

Materials and methods

We use SEF reports on IVF and information on comparable registries for other countries and for Catalonia. We use also the Spanish Fertility Survey of 2018 to check the results of our estimates.

Results

We estimate that in year 2019 around 6.5% of births in Spain correspond to IVFs, very close to the figure for Denmark, the European country with the highest level. The proportion of deliveries lost to follow-up was high in the 2000s, over 20%, but lowered in the 2010s down to less than 10% and we estimate that in year 2019 around 35% of cycles were for women residing abroad. These estimates correlate well with what we observe from the Spanish Fertility Survey of 2018.

Conclusions

Using data on IVF in Spain for demographic analysis is harder than it should be, which forces to conduct a very thorough analysis of the reports and to make guess estimates in order to obtain useful results. Also, the aggregate nature of the registry considerably limits the analysis. We hope that the individual register which will start hopefully in 2