Medicina Reproductiva y Embriología Clínica最新文献

Introduction. Artificial insemination is a widely used assisted reproduction technique, despite controversy over its usefulness. This document presents the data from the National Register of Activity in Assisted Human Reproduction (RNA – Register SEF), for Artificial Insemination during 2018 and 2019.

Material and methods. The data for conjugal and donor artificial insemination (AI-C and AI-D respectively) collected by the RNA – Register SEF during 2018 and 2019 was analysed and compared with data obtained in previous years. Participation was mandatory for Spanish assisted reproduction centres and annual aggregate data was collected by centre and in situ monitoring carried out at random on data provided by more than 15% of participating centres. A total of 34,100 cycles were analysed in 2018 (21,467 AI-C cycles and 12,633 AI-D cycles) and 32,548 cycles in 2019 (18,948 AI-C and 13,564 AI-D cycles).

Results. No significant differences were observed in the overall gestation rate per cycle, either for AI-C (2018: 13.1%; 2019: 12.8%) or for AI-D (2018: 19.0%; 2019: 18.8%). In 2018, 11.6% of the pregnancies obtained through AI-C were multiple pregnancies. Similar figures of 9.9% were obtained in 2019. Similar results have been observed in AI-D, where the multiple gestation rate was 10.7% in 2018 and 8.9% in 2019. In pregnancies obtained with AI-C, 17.8% resulted in miscarriage in 2018 and 16.3% in 2019. With the donor technique, 18.0% resulted in miscarriage in 2018 and 18.0% in 2019.

Conclusions. Despite a slight increase in the number of participating centres, a decrease is observed in the use of AI-C, but this trend does not occur with AI-D.

In the last decades we have experienced, a worldwide steep increment on the demand of assisted reproductive treatments (ART). Therefore, the necessity to improve the performance of ART has been crucial to increase the pregnancy outcomes. Although research has pronominally focused on identifying the proper ovarian stimulation improving condition in IVF laboratories, luteal phase has possibly been the field in which research has been unproportionally deficient. Despite the strong evidence on the importance of the luteal phase support in IVF fresh and frozen cycles, there is still a lack of homogeneity on the best route of progesterone (P4) administration, the dose, and the surveillance of the luteal phase, suggesting that future research may be needed in this field. Independently on the ovarian stimulation (OS) or the frozen embryo transfer (FET) techniques, mostly vaginal and parenteral P4 are prescribed nowadays. However, in recent years the oral and subcutaneous administration of P4 were introduced and demonstrated to be safe and as efficient as the other routes. At this time point, the decision on which P4 route and dose should be used, in a tailored patient-approach, is still controversial, especially considering the safety and the tolerability of the P4 treatment. The aim of this narrative review is to provide evidence on the latest innovation on the luteal phase surveillance and management and to describe the different treatment options for the luteal support, not only in fresh, but also in frozen embryo transfer cycles which demonstrate an exponential increase the last decade.

This document aims to review current knowledge and provide clinical and microbiological recommendations on assisted reproductive treatment for couples with transmissible infectious diseases, based on the available scientific evidence.

Introduction

The primary aim of this systematic review is to evaluate the available current scientific evidence on non-invasive PGT-A (niPGT-A) in regards to cell free DNA (cf-DNA) detection in spent culture media (SCM), cf-DNA amplification, and concordance rates against conventional PGT-A.

Search Methods

We performed an exhaustive systematic search through major databases for original experimental research, from a period of conception to March 2020, using a combination of the following search words: blastocele/blastoceol fluid, blastoscentesis, cell-free DNA embryo, embryo aneuploidy preimplantation, embryo biopsy preimplantation, noninvasive pgt, preimplantation diagnosis, spent embryo culture media, and trophoectoderm (TE) biopsy.

Results

Our search yielded 26 studies for a qualitative and 15 for quantitative analysis. Our main results report that cf-DNA is detectable in SCM in 100% of ART (IVF/ICSI) treatments at a rate of 44.4-100% per sample. The average concentration of cf-DNA is 37.42 ng/μL. General concordance rates between cf-DNA and TE biopsy range from 54.9 to 100% (average 78.32% ± 14.55). We found important discrepancies between niPGT-A methodologies carried out by different ART centers, such as culture volume, SCM storage temperature, women embryo donors' age, embryo quality, use of negative/sham controls, time of SCM collection, and genetic analysis platforms/systems.

Conclusions

There are many ways in which niPGT-A may be optimized, according to current scientific evidence. However, there are many important questions that remain unanswered in order to standardize niPGT-A as routine practice in ART.

Introduction

In the current context, The National Health System Assisted Reproduction working teams need to coordinate themselves to ensure that the waiting list management is equitable and efficient avoiding great inequalities between centers. To this end, prioritization criteria must be protocolized and agreed according to quality standards, and these protocols must be followed with total transparency by all professionals. The aim of this study is to analyze with the Hanlon methodology different conditions that can be prioritized in assisted reproduction programs.

The National Health System Assisted Reproduction working teams need to coordinate themselves to ensure that the waiting list management is equitable and efficient avoiding great inequalities between centers.

Material and methods

A working group composed of 9 experts from public centers located in 7 autonomous communities have identified 14 conditions susceptible to prioritization by means of modal analysis through brainstorming. These conditions have been evaluated with the Hanlon methodology, scoring the magnitude, severity, feasibility and effectiveness of each condition, adapting the model to the specific circumstances. Based on the score obtained for each of the conditions, 4 levels of priority have been established and the maximum deadlines for their attention.

Results

Recently diagnosed oncological diseases in both, men and women should be given absolute priority, and procedures must be performed in less than one month. Urgent care (1–6 months) should be provided to people with oncological diseases who have overcome the disease and women over 39 years with low ovarian reserve. Less urgent care (6–9 months) is required for non-oncological diseases, endometriosis, and women aged over 39 years.

Conclusions

The health authorities should use this information when establishing maximum waiting times if the purpose is to maintain the equity of the public system.

Each assisted reproduction center should analyze the demanding care population and features in order to establish its self-prioritization systems.

Background

Infertility is a condition that affects around 15% of couples worldwide. Despite the growing demand for Assisted Reproductive Techniques (ART), there are still differences in access to them among countries due to several socioeconomic factors. Because of legal and cultural differences comparison still complex.

Objectives

Analyze the relationship between certain socioeconomic variables and access to ART in the autonomous region of Spain.

Material and methods

We used the National Registry of Activity-Registry of the Spanish Fertility Society (RNA-RSEF) data from the year 2017 from which the TRA variables were obtained by autonomous region. We also accessed statistics National Institute (INE) date-base to extract a number of women aged between 20–49 years old and 17 socioeconomic variables sorted by autonomous region. A univariate correlation analysis was carried out by autonomous region between socioeconomic variables and those of TRA, both globally and by private and public centers.

Results

A direct correlation of GDP per capita and the number of total IVF cycles with own oocytes per million women was observed by autonomous region. There is also an inverse correlation of this variable with the percentage of adults who didn't achieve higher education, as well as the population with a lack of space at home and the number of IAC carried out in public centers. On the other hand, the percentage of multiple birth in private centers is directly correlated with job satisfaction and free time. The total percentage of women over 40 who undergo this therapy is inversely correlated with the difficulties of the population to make ends meet.

Conclusion

Access to ART in Spain could increase if the population socioeconomic status improved as well as the information available of them.

In recent years, folliculogenesis in women has been shown to occur in a wave-like pattern, with two or three waves of follicular development during one menstrual cycle. Moreover, it has been shown that follicles formed beyond the follicular phase have similar ovulation potential, opening new windows for assisted reproductive treatment (ART). Thus, the double stimulation strategy has been proposed as an attractive alternative to obtain a higher number of eggs and embryos in a shorter period of time, which would theoretically increase the cumulative live birth rate and reduce the time to pregnancy. In this protocol, controlled ovarian stimulation (COS) is performed twice in the same menstrual cycle, taking advantage of both the follicular and the luteal phase. The results obtained so far indicate that luteal phase stimulation is not inferior to follicular phase stimulation. Additionally, the double stimulation protocol has proved to be as safe as conventional COS, while improving reproductive outcomes when compared to single follicular phase stimulation. In this context, it also emerges as an interesting option for emergency fertility preservation in oncologic patients. However, the absence of randomized controlled trials and cost-effective analysis raises important concerns that need to be addressed in depth via well-designed studies.

Objectives

To analyze the pregnancy, live birth, and miscarriage rates of the IVF/ICSI cycles in women with low levels of AMH, compared to patients with normal levels of this hormone.

Methods

We carried out an observational and retrospective study with the data of the patients treated in 2017 and 2018 in the Assisted Reproduction Section of La Paz University Hospital (LPHU), comparing 223 low responder patients (AMH < 0.5 ng/ml and AMH 0.5–1,1 ng/ml) with 408 from the control group of normo-responder patients (AMH 1.1–3 ng/ml). Chi-square and Kruskal–Wallis tests were used.

Results

Pregnancy rate was lower in the AMH < 0.5 group(14.5%), compared to the control group (35.5%) (p = 0.014). No significant differences were observed comparing abortion rate and live birth rate between the study groups. At an older age, the pregnancy rate and live birth rate decreased significantly (p = 0.007 and p = 0.019). At lower levels of AMH, the number of expected and obtained oocytes, mature oocytes, and total embryos were also smaller, there were a higher rate of blank punctures and a lower rate of vitrified embryos.

Conclusion

Patients with low ovarian reserve have a lower pregnancy rate compared to patients with a normal ovarian reserve. AMH plays a key role as an ovarian response marker in IVF cycles, although age is one of the factors that should be considered.