Medicina Reproductiva y Embriología Clínica最新文献

Chemotherapy is the main treatment in cancer; nevertheless it induces the abnormal activation of primordial follicles that remain quiescent in the ovaries since birth, thus producing early ovarian failure due to the incessant consumption of the ovarian reserve. Some experimental treatments have recently demonstrated how to avoid the primordial follicle consumption, and prevent the loss of follicles during chemotherapy treatment. Although its use has been tested in experimental and controlled studies, more scientific evidence is necessary to demonstrate its applicability in humans. In this review, different drugs in co-treatment with chemotherapy able to preserve fertility in animal models are presented, acting on the primordial follicle activation pathway.

Introduction

Embryo development is a very complex process and depends not only on the culture system but also on the entire environment of the in vitro fertilization laboratory (IVF). That is why the correlation between the contaminants present in the IVF laboratory and the specific harmful effects on human gametes and embryos is necessary but scientific evidence, especially on early stages of development, is insufficient.

Materials & methods

Therefore, information and data on how these contaminants could affect the health of oocytes and embryos has been compiled, making an extensive literature search. Types of contaminants, sources, environmental control and the harmful effects they can cause are described.

Results

Different types of particles (PM) and volatile organic compounds (VOCs) could affect cellular structures interrupting cellular communication, modifying viability and changing their molecular profile, making them more vulnerable to hereditary mutations. Some adverse effects on embryonic maturation, morphology, segmentation, blastocyst development, hatching and implantation are described, which are related to negative clinical results.

Discussion

Despite the existing scientific evidence on how pollutants are detrimental to reproduction and development, the literature is scarce and dispersed. This literature provides an idea about the extent of the damage that pollutants can produce and the chemical or molecular mechanisms that could be involved. More studies with similar designs are needed to investigate further, especially about VOCs.

The existence of couples with chronic infectious diseases that have reproductive dysfunction pose a non-theoretical risk of contamination, so their approach must be multidisciplinary using standard protocols.

During the last decade, increased attention has been paid to the development of new treatment approaches in assisted reproduction. It is crucial to establish a safe, effective and comfortable stimulation regimen to increase acceptability and reduce patients’ treatment stress and the high dropout rate that occurs after a failed treatment.

The present study aimed to describe the acceptance and results of a novel treatment regimen, consisting of Corifollitropin alfa (CFT) for ovarian stimulation (OS) and oral Desogestrel (DSG) for control of endogenous LH rise in oocyte donors (OD) who had a previous OS cycle with CFT and GnRH-antagonist (ANT) for LH suppression. This retrospective, cohort study, was performed in a private infertility clinic including 42 oocyte donors between April 1st 2016 and April 1st 2017. To evaluate the degree of acceptability of the DSG treatment cycle, a satisfaction questionnaire was used (EFESO questionnaire). When analyzing results, the degree of satisfaction observed with the novel stimulation protocol was high, without finding significant differences between both groups of treatment related to clinical variables.

Introduction

Advanced age reproduction has become a social reality associated to medical complications.

Material and methods

Data were collected from 2578 women, all over 40 years-old, who gave birth in 9 public hospitals in Spain between 2015 and 2016. Data from those pregnancies, as well as those from Spanish National Registry, were used to evaluate the pregnancy and the obstetrics outcomes.

Results

Up to 33.3% of the pregnancies analysed were from using assisted reproduction techniques, and according to the National Registry, 79.5% of them were obtained by egg donation. The incidence of positive aneuploidy screening was 7.8%, with a malformation rate of 5.07%. Gestational diabetes was also detected in 13.98%. Hypertensive events occurred in 5.37%, and 2.87% cases were diagnosed with intra-uterine foetal growth retardation. As regards the newborns, 18.9% weighed less than 2500 g, and 2.63% less than 1500 g. There were 15.5% preterm deliveries, with 12.32% between 32 and 37 weeks, 2.08% between 28 and 32 weeks, and 0.7% less than 28 weeks. The incidence of intra-uterine foetal death was 0.48%. A total of 33.09% caesarean sections were performed. An unfavourable Apgar Score (<7) was observed in 13.75% of the newborns, and maternal pospartum complications appeared in 7.86% of the cases. There were 5.59% twin pregnancies in the women in the study.

Conclusions

The analysis of these perinatal results confirms that advanced age pregnancy is a risk situation. There is a need of an adequate counselling before using assisted reproduction techniques, and specific obstetrics care follow-up seems unquestionable.

Objective

To establish the effects of vitamin D supplementation on the lipid profile in women with polycystic ovary syndrome and vitamin D deficiency.

Material and methods

A randomised double-blind study was conducted on women with polycystic ovary syndrome and vitamin D deficiency (concentrations less than 20 ng/mL), who were assigned to receive 5,000 IU daily of vitamin D or paraffin oil for 12 weeks. General characteristics, hormonal concentrations and lipid profile values before and after treatment were compared.

Results

For the final analysis, 169 women were selected, 84 women in group A (cases) and 85 women in group B (controls). No significant differences were found between the groups in the general characteristics, sex hormone concentrations, or vitamin D (P=ns). After supplementation, the patients in group A showed a decrease in the concentrations of total cholesterol, triglycerides and low-density lipoproteins (P<.05). No significant differences were observed in high-density lipoprotein concentrations (P=ns). Vitamin D concentrations increased significantly (P<.0001). No significant differences in lipid profile were observed in these parameters in patients in group B (P=ns).

Discussion

Vitamin D supplementation in women with polycystic ovary syndrome and vitamin D deficiency leads to a significant decrease in the concentrations of cholesterol, triglycerides and low-density lipoproteins, without affecting high-density lipoprotein concentrations.

Introduction

Endometrial physiology and embryo quality greatly depend on the age of the patient, thus, the main objective of this study is to measure the pregnancy rates (by human !-Gonadotropin) in women older and younger than 40 years of age.

Materials and methods

A retrospective, case-control study was conducted in which 306 IVF cycles performed on patients between 24 and 58 years of age by conventional In-Vitro Fertilisation or intracytoplasmic sperm injection in the reproductive medicine unit of Hospital Ángeles.

Pedregal in Mexico City between January 2015 and January 2018.

Results

The total population of 306 cycles included 161 patients >40 years and 139 were < 39. In the >40 population, 22.3% had a positive !-fraction, compared to 28.27% in the < 39 population. As for the embryo transfer (ET) day, it was found that an ET in day 5/6 showed the highest pregnancy rates, specifically when compared against day 2 ET in patients under 39 years of age (P = .029).

Conclusions

When comparing embryo transfer day 2 vs. day 5/6, a statistically significant difference was found in the pregnancy rates in patients over 40 and less than 39 years of age.

Introduction

Approximately 50% of infertile couples that wish to have children will need assisted reproductive techniques involving ovarian stimulation. This technique affects oocyte and embryo quality through the development of follicles of different sizes and functional stages, thus creating hormonal patterns that differ from the natural follicular cycle. Many researchers employ the term premature luteinisation to describe the case of patients who, in cycles of ovarian stimulation, present with higher levels of progesterone (P) when ovulation is triggered. However, the pathophysiological effect of this elevation is uncertain. This study examines the pathophysiology of premature luteinisation, analysing its influence on oocyte quality.

Material and methods

A comparison is made of the outcomes for donated oocytes, according to whether they were obtained from ovarian stimulation cycles with or without premature luteinisation, as defined by the following markers: index of prolonged P luteinisation; P/number of follicles; P/oestradiol; and P/oocytes. In addition, a stepwise linear regression model was constructed, in which the dependent variable was levels of P when ovulation was triggered, and the candidate variables, the follicular markers shown to be significant in univariate regression analysis.

Results

No differences in pregnancy rates were recorded when the embryos were obtained from cycles with or without premature luteinisation, regardless of the marker considered. After fitting a stepwise multiple linear regression model for the dependent variable P when ovulation was triggered, the variables included in the model were P/number of follicles and the number of follicles.

Conclusions

It is concluded that the premature luteinisation observed in cycles of ovarian stimulation seems to be the consequence of the growth of multiple follicles, on the one hand, and of the development of ovarian follicles that have a metabolic pattern which differs from that of natural cycle follicles, on the other. It is also concluded that high levels of P are not prejudicial to oocyte quality and that their negative effect on the results of assisted reproduction could arise in the endometrium.

Introduction

Homologous artificial insemination (HAI) is an assisted reproductive technology used as a first option in those couples that do not become pregnant. A study was performed on the outcomes of HAI cycles in this centre in order to compare the results with those of the SEF (Spanish Fertility society) and other studies. The degree of association between pregnancy and different variables related to male and female factors was also determined.

Material and method

The following variables were collected retrospectively about the HAI cycles carried out between 2001 and 2017: woman's age, percentage of progressively motile sperm, total motile sperm count (TMSC), percentage of morphologically normal sperm, pregnancy (yes or no), abortion (yes or no) and multiple pregnancy (yes or no). Rates of pregnancy / cycle, pregnancy / couple, abortion, live births / cycle, multiple pregnancy and accumulated pregnancy were calculated, depending on the different variables collected. In addition, a bivariate statistical analysis was carried out between pregnancy and different male and female variables in order to establish an association between them.

Results

A total of 3,477 HAI cycles were carried out. The pregnancy/cycle rate obtained was 10.18%, and per couple it was 29.70%. The total abortion rate was 22.60% and multiple pregnancy rate was 6.78%. The accumulated pregnancy rate was 38.56%. A statistically significant association (P < .05) was found between pregnancy and TMSC. No statistically significant relationship was found in the other variables studied (age of the woman, morphology, or initial progressive motility).

Discussion

Pregnancy/cycle rates were higher with TMSC ≥ 10 million/mL, with sperm morphology ≥ 4, with initial progressive motility ≥ 32%, and in women under 40 years, which coincide with the results published in other studies. However, only TMSC could be considered as a predictor of success in the HAI due to the statistically significant relationship obtained in this study between TMSC and pregnancy.

The total abortion rate was very similar to the SEF abortion rate in recent years. However, the multiple pregnancy rate in the present study is significantly lower than the rate of other Spanish centres.

Although the HAI has not shown major changes in recent years, it is a simple, cheap and safe technique with an accumulated pregnancy rate similar to the results obtained with other types of more complex and expensive assisted reproductive technology.