Medicina Reproductiva y Embriología Clínica最新文献

Introduction

Conventional ovarian stimulation with daily injections of FSH for oocyte donors, besides the discomfort of the medication, involves a great demand of time. Treatments need to be simplified without losing effectiveness and safety. Corifollitropin alpha (Elonva) enables the first 7 injections of FSH to be replaced with one single injection.

Objective

To compare the effectiveness and convenience of corifollitropin alpha (Elonva) compared to daily recombinant FSH (rFSH) in the ovarian stimulation of oocyte donors.

Materials and methods

An analysis was performed on 90 cycles of Elonva and 96 cycles of rFSH. The statistical analysis included the Student t-test for means and the chi-squared test for percentages. Effectiveness has been evaluated through reproductive effectiveness defined as the total number of live births in relation to the total number of mature eggs. An analysis was also performed on variables, such as number of mature oocytes, percentage of viable embryos, implantation rate, and clinical pregnancy rate per embryo transfer. Comfort has been evaluated by the number of visits to the clinic for medication administration.

Results

Significant differences were only found in the number of injections administered to donors (3.20 Elonva vs. 8.55 rFSH, P<.005). Reproductive effectiveness was 5.61 vs. 5.49, with implantation rate 44.44 vs. 44.34, and clinical pregnancy 56.25 vs. 58.73. There no significant differences in any of variables analysed, including the mean cost. No cases of OHSS or adverse drug reactions were observed.

Conclusions

The use of corifollitropin alpha in oocyte donors offers the same reproductive effectiveness and is more convenient for the donor compared to stimulation with daily rFSH.

Introduction

According to international research, estimates of prevalence of sexual abuse during childhood indicate an average of 10% in men and 20% in women, although these percentages are subject to variability. In Spain, through a sample of 2,000 respondents, they found a prevalence of sexual abuse in 19% (23% women and 15% men) within the general population.

The American Society for Reproductive Medicine recommends the relative exclusion of those gamete donors with a history of sexual abuse whom has not been treated by a professional. The aim of the study is to assess the suitability of the process of donation by candidates identified as victims of sexual abuse.

Material and method

The study was performed in a Spanish assisted reproduction hospital during the years 2014-2015, with a total of 170 candidates evaluated (90% female/10% male). The assessment protocol is that the donor medical evaluation is followed by a psychological evaluation prepared by psychologists of the recommended unit by the Group of Psychology of the Spanish Fertility Society. A semi-structured clinical interview was used and a specific question for detection of sexual abuse was added.

Results

All candidates responded to the question about sexual abuse. A total of 8% of the sample (100% female, 85% Spanish, 92% single, 39% with secondary education, 38% college, 69% gainfully employed and 69% with altruistic motivation for the donation) confirmed being a victim of some form of abuse. After a more specific psychological assessment in sexual abuse and trauma, all donors were accepted in the donation program.

Conclusions

The detection of sexual abuse in all its variations, from inadvertent touching to rape, is considered necessary in gamete donors. The aim is to provide emotional care to donors and ensure their suitability in the process.

The subject and the procedure of receiving gametes as an option for parenthood can have a strong emotional impact on a couple. Knowing that their children will not have the same genes involves a major change in the experience of becoming parents. It therefore requires profound consideration. In addition to this, the individual partners and/or the couple will need psychological intervention to address a number of personal issues. The authors recommend that, prior to receiving gametes and embryos, patients should attend a series of counselling sessions that will focus on: 1) Assessment of the impact that infertility problems have had on the lives of patients, both individually and as a couple. 2) Grief management before receiving gametes. 3) Information, discussion and support. 4) Time to reflect and decide. 5) The necessary action required once the decision has been made.

Endometriosis is a prevalent and polymorphic disease in which fertility may be impaired. Some patients may have an ovarian reverse loss, compromising their reproductive future, even with assisted reproduction techniques.

Early diagnosis and accurate follow-up are essential to avoid endometriosis consequences, not only on fertility, but also on quality of life. Professionals from different fields need an adequate training and collaboration with other specialists. For integrated fertility preservation, measures for preventing recurrence (mainly oral contraception), individualised surgery indications, ovarian tissue conservative surgical techniques and, in selected cases, oocyte vitrification should be considered.

Although patients must be informed of the benefits of pregnancy at a young age, this is often a non-realistic option. Oocyte vitrification is an effective alternative to postpone maternity, but its efficacy is related to the age of the woman and to the quantity and quality of the oocytes obtained. Publications related to preservation in endometriosis are scarce, and extrapolating data from other kinds of patients, although inexact, is the only available reference.

Oocyte vitrification in public health systems should have some cost-benefit conditions. It should be offered in cases with a real risk of ovarian reserve loss, but when there are adequate conditions to achieve an ovarian stimulation response to be able to obtain a sufficient number of oocytes. Patients with endometriosis will be candidates for vitrification if they fulfil two conditions: 1) bilateral endometrioma of more than 4 cm, or post-surgical recurrence of endometriosis, and 2)- age ≤ 35 years and ovarian reserve markers excluding low ovarian reserve (AMH > 1 ng/ml; antral follicle count > 5; FSH > 10 mg/ml). As 10 vitrified oocytes should be considered a sufficient number, a maximum of 2 cycles will be offered to reach this number. Follow-up of these cases will allow an evaluation of the efficacy and efficiency of this policy to be made in the future.

Insulin receptor substrate-2 (IRS-2) gene suppression induces an alteration of hypothalamic-ovarian axis as a result of central leptin resistance induction. IRS-2^−/−females mice are characterised by persistent anovulation, accompanied by the absence of the oestrous cycle, which results in a marked reduction in fertility (pregnancy rate: 9% IRS-2^−/− vs. 100% IRS-2^wt). Sodium tungstate (Na₂WO₄) has demonstrated its ability to reverse the leptin resistance state through an inhibition of phosphatases involved in the signalling pathway of several cytokines. The objective of this work is to present an experimental approach to determine a potential interest towards Na₂WO₄ in the reproductive ability of anovulatory IRS-2^−/− female mice.

Material and methods

Na₂WO₄ was administered in drinking water (2 g/L) to female mice. The oestrous cycle was assessed through vaginal smears, and pregnancy rates were measured after mating with IRS-2^wt males.

Results

Lack of oestrous cycle was confirmed in the mice during the pre-treatment period. After 7 days of treatment all animals showed delayed cycle phases (oestrous and meta-oestrous) in vaginal smears, indicating a recovery of normal ovulatory cycle. At the end of the study, after mating with competent IRS-2^wt male, 80% of females treated with Na₂WO₄ were pregnant. These results show a fertility recovery, as opposed to the pregnancy rate described in untreated IRS-2^−/− (9%).

Conclusions

For the first time, a description is presented of the direct effect of Na₂WO₄ in the restoration of ovarian function and fertility in IRS-2^−/− female mice.

Infertile men show a higher proportion of apoptotic spermatozoa in ejaculate, and have a negative impact on the assisted reproduction techniques (ART) results. An adequate sperm selection which eliminates the apoptotic spermatozoa could improve the results. The objective of the study was to evaluate the effect of eliminating apoptotic spermatozoa in the ejaculate by density gradient (DG) and Magnetic Activated Cell Sorting (MACS) processing of sperm on the pregnancy rate (PR) and new born rate (NBR) after intrauterine insemination (IUI).

A prospective observational and analytical study was performed on 566 cycles of IUI in 326 couples, from June 2012 to March 2014 in the Reproductive Medicine Service of Dexeus Women's Health comparing a study group (MACS) and a control group (Non-MACS). The preparation of the semen sample in both groups was by DG, and in the MACS group, the post capacitation fraction was processed using annexin V columns.

The PR and NBR obtained in MACS group were 16.2% and 12.9%, respectively versus 17.7% and 15.3% in Non-MACS group. No significant differences were observed.

Our results suggest that MACS used in IUI without a clinical indication does not improve the results in either the pregnancy rate or new born rate. The use of annexin V columns in other techniques, or specific indications cannot be ruled out. Further prospective randomised studies are needed in order to determine the advantages of MACS in ART.

A retrospective study was conducted to evaluate the effect of the Laser Assisted Hatching by Thinning (LAHT) according to the results of the pregnancy rate, implantation rate and miscarriage rate. The study was carried out with two groups of patients who had undergone treatment by IVF/ICSI and according to patient age.

A total of 308 cycles were performed on women of 38 years or more, randomly divided in two groups; group A:154 cycles without LAHT (No-LAHT), and group B: the remaining 154 cycles in which all pre-embryos were transferred were subjected to LAHT. These two groups in turn were further subdivided into 4 groups according to the age: No- LAHT 38 and 39 years, LAHT 38 and 39 years, No-LAHT ≥ 40 years, and LAHT ≥ 40 years.

The overall results showed pregnancy and implantation rates of No-LAHT vs LAHT (29.9 versus 37.7%, P = .185; 19.6 versus 27.1%, P = .051 respectively. The results by age group showed significant differences in pregnancy and implantation rates in 38 and 39 years No-LAHT and LAHT groups: 32.1 versus 46.9%, P = .033; 20.8 vs 35.0%, P = .004, respectively.

This study shows the effectiveness of the LAHT technique in women of the 38 and 39 years group of patients, showing the best results in pregnancy and implantation rates.

No beneficial effect of isolated LAHT (no PGD) was found from greater than 40 years, which could be due to the presence of embryonic chromosomal abnormalities in this patient group.

Introduction

Endometriosis is a disease characterised by the presence of endometrial cells outside the uterine cavity, leading to negative effects on the fertility of the woman. However, the mechanism whereby this occurs remains unclear.

Objective

A retrospective observational case-control study was conducted to compare the results of IVF/ICSI in women with endometriosis and male factor infertile couples, with the aim of finding evidence on the impact of endometriosis on the IVF/ICSI outcomes.

Material and methods

A study was carried out from 2009 to 2014, in which a total of 821 first cycles were performed on 156 patients with endometriosis, and 665 patients in whom the cause of infertility was due to pathology in their partner (male factor), and were considered as the control group. Ovarian stimulation parameters and IVF/ICSI outcomes were studied.

Results

Endometriosis patients required higher doses of FSH stimulation, subsequently yielding fewer oocytes and mature oocytes, although fertilisation rates were higher in these patients than in those with male factor. All cryopreservation parameters analysed were higher in male factor. No statistically significant results were obtained in other parameters analysed, such as the implantation rate, although the pregnancy and live birth rates analysed, especially the accumulated rate (fresh transfers + cryotransfers) were higher in all cases in the male factor, but without significance.

Discussion

This study suggests that endometriosis affects the success of IVF/ICSI by reducing the ovarian response to controlled stimulation, but neither oocyte quality nor endometrial receptivity are affected. It may be necessary to determine the factors that cause the decrease in ovarian follicle reserve, such as previous surgery, extent of disease, or previous drug treatments.

Introduction

One of the additional tests for the diagnosis of male infertility is the study of sperm DNA fragmentation. One reason that may explain the damage of the DNA molecule is oxidative stress. This is caused by free oxygen radicals, among which is the superoxide anion (O₂^{. −}).

Objective

To measure the oxidative stress excess in semen samples and the impact on sperm DNA fragmentation.

Material and methods

A total of 78 samples from patients and donors were evaluated. Each one was classified into one of four levels (EO1, EO2, EO3 or EO4) according to the level of oxidative stress found using the NBT-test (detection of superoxide anion). Sperm concentration and DNA fragmentation index (at t0, t2, t6, and t24 h during incubation at 37 °C) were calculated for each sample using the sperm chromatin dispersion test (SCD).

Results

There were no significant differences between results of the four groups in the baseline DNA fragmentation index (t0 h). When the dynamic process was studied, an increase in the fragmentation index could be observed (the first two hours remained stable). This increase varied depending on the levels of oxidative stress. The DNA fragmentation index (DFI) remained stable for less time as the levels of oxidative stress increased. There is a particular time where the velocity becomes the same in all the groups.

Discussion

No significant correlation was found between the levels of oxidative stress and the baseline DFI. However, the behaviour of the fragmentation dynamics of the samples varied depending on the levels of oxidative stress.

Conclusions

These results enhance the importance of understanding DNA fragmentation from a dynamic point of view rather than a static process of the baseline DFI. Samples with higher levels of oxidative stress showed a rapid increase in their DFI during the first hours after ejaculation compared with the stability shown in the rest of the samples.

As a result of innovations in cancer diagnosis and treatment, cancer survival rates have increased during last years, and there are increasingly more cancer survivors of reproductive age who want to have children. However, oncological treatment techniques such as chemotherapy or radiotherapy can cause reduced fertility or sterility in both men and women.

Although oncological patients may benefit from oocyte and semen donation, they can also rely on fertility preservation techniques. These techniques include oocyte vitrification and semen cryopreservation, as well as other less used techniques and those still under development.

Fertility preservation in cancer patients should be an option to be taken into account from the day of diagnosis.