Medicina Reproductiva y Embriología Clínica最新文献

The aim was to investigate the predictive value of a single serum determination of activin A and inhibin A for classifying pregnancies of unknown location (PUL) after IVF cycles in both own fresh and donated oocytes. A case–control study conducted in a University-affiliated IVF center. Pregnancy outcomes after own fresh oocytes included 12 failing PUL, 12 ectopic pregnancies (EP) and a control group of 24 singleton intrauterine pregnancies (IUP). The same scheme was followed for the oocyte donation recipients. Inhibin A, activin A, β-hCG and Progesterone (P) were determined. In the own fresh oocytes IVF, the AUC for predicting EP vs. f failing PUL were: Activin A: 0.458 and Inhibin A: 0.60. In the oocyte donation cycles, the AUC for predicting EP were: Activin A: 0.521 and Inhibin A: 0.906. Our result cannot be extrapolated to spontaneously conceived pregnancies, since values of some of these biomarkers are higher after induced ovulation compared with natural cycle. It will be necessary to continue the search of a biomarker which accurately predict pregnancy evolution.

Bisphenol A is an endocrine disruptor, a chemical substance capable of mimicking or modulating the hormonal system. It is one of the most widely produced chemicals in the world today and is found in most canned goods and plastics. The population is chronically exposed to this endocrine disruptor with oestrogenic function. Its levels in human samples are often higher than the concentrations required to obtain oestrogenic positive responses in in vitro tests. Studies on the effects of bisphenol A in male animal models suggest a negative impact on testicular function, since it produces a reduction in the number of sperm and a worse sperm motility. Bisphenol A also affects antioxidant enzymes, producing an increase in oxidative stress that can damage germ cells, and therefore the sperm, with a possible epigenetic effect through aberrant DNA methylations. These observations suggest that foetal, perinatal, or adult exposure to bisphenol A can cause negative and long-lasting effects on male fertility in adulthood, which that can also be transgenerational.

Introduction

To provide appropriate menstrual management requires knowing how women live and how it affects and imposes limitations on them, factors that are influenced by the sociocultural environment. Information on these issues as regards Spanish women is scarce.

Materials and methods

Internet survey with a sample of female volunteers aged 18-49. Details were collected on sociodemographic characteristics, contraceptive use, menstrual characteristics, the extent to which normal activity is limited, prevalence of symptoms, vital spheres affected, acceptance of menstrual suppression, and reasons for it. An analysis was made on the influence of age, use of hormonal contraception (HC) vs. non-hormonal/no method, and/or blood flows.

Results

The study included 1003 women aged 35.3 ± 8.3 years, of whom 98.7% menstruated, with 11.9% using HC to relieve menstrual discomfort. Menstrual frequency (28.9 ± 7.2 days) and duration (4.8 ± 1.3 days) decreased with age and with HC. Heavy menstrual bleeding was experienced by 23.8%, and was more common in older women and less common in those on HC. Almost all (93.4%) had menstrual symptoms (mean: 4.1 ± 2.5). The most common (>50%) were physical. Women who used HC or had less bleeding had fewer symptoms. The sexual sphere was considered to be the one most affected, with over half (56.2%) of the women expressed that they were quite/very willing to suppress menstruation, especially “for convenience/to stop worrying” (56.1%), and “to avoid experiencing symptoms” (52.3%). Acceptance was higher among women who considered that menstruation limited them to some degree.

Discussion

Menstruation has a major impact on women's lives and seems to be more related to the high frequency of symptoms than to the amount of bleeding. The sexual sphere is the one most affected. More than half of the women would be quite/very willing to suppress menstruation.

Introduction

The incidence of unintended pregnancies remains high, even among women with the previous use of contraceptives. The choice of the most suitable contraceptive method, which is influenced by the user's satisfaction, may affect the compliance.

Material and methods

Epidemiological, observational, cross-sectional and multicentre study in women aged between 18 and 29 years who had used the levonorgestrel-releasing intrauterine system Jaydess^® 13.5 mg for 6 months and visited their gynaecologist for a regular follow-up. Information was gathered during a single interview, in which four questionnaires were administered: overall satisfaction, perceived benefits, perception on the insertion process, and changes in bleeding characteristics associated with the use of Jaydess^®.

Results

The study included 840 women with a mean age of 25 years (SD: 3), of whom 29% had children, 85% were in a relationship, and 57% wanted to have children in the future. Previous use of contraceptive methods was reported by 98% (in 87% of cases, male condom). The overall satisfaction with Jaydess^® was 46.9/50 points (SD 4.7), with no significant differences between women with and without children. Main perceived benefits were comfort (87%), prevention of forgetfulness (67%), long acting (63%), and safety (62%). A reduction in the amounts and duration of bleeding were observed by 58% and 45% of participants, respectively. Around 67% of participants did not report pain or reported mild pain during Jaydess insertion.

Discussion

Young women showed high satisfaction regarding the use of Jaydess^®, and deemed it comfortable and safe. The main change observed during the use of Jaydess^® was a reduction in the amount of menstrual bleeding.

The high rate of unwanted pregnancies results in a high social and economic impact worldwide. One of the most important strategies to reduce this problem is to increase the use of long-acting reversible contraceptive (LARC) methods, due to their efficacy, cost-effectiveness and the independence that these methods provide to their users. LARC methods have been shown to be safe for most women, regardless of age and parity. Kyleena^® is the new LARC option. A new levonorgestrel intrauterine system (LNG-IUS) containing 19.5 mg of levonorgestrel and provides a high contraceptive efficacy over 5 years of use, with a cumulative 5-year Pearl Index of 0.29. Its small size allows a narrower insertion tube to be used and is more suitable for nulliparous women or those women with a narrower cervical canal. In addition to the contraceptive efficacy, Kyleena^® may benefit users by providing a reduction in the duration and volume of menstrual bleeding. Many women and healthcare providers have shown certain resistance to intrauterine contraception due to the existence of misperceptions towards these methods. It is important to overcome these barriers, providing contrasted and truthful information about all existing methods, so that health professionals can provide complete contraceptive counselling for all women. This review approaches the clinically relevant aspects of the new LNG-IUS 19.5 mg Kyleena^® method and the benefits it can provide to women.

Introduction

This document analyses the outcomes due to the legislative changes in 2014 and 2015, which introduced mandatory participation in the Spanish Fertility Society register of artificial insemination, which is officially taken as the National Register of assisted human reproduction activity, henceforth RNA-Register SEF.

Material and methods

The RNA- Register SEF data on conjugal and donor insemination (AI-C and AI-D, respectively) for 2014 and 2015 are analysed and compared with the data for previous years. Participation was mandatory for Spanish assisted reproduction centres. Aggregate data were compiled for each centre, and in situ monitoring was carried out on the data provided from over 15% of them. More than 75% of the centres authorised by the Spanish Ministry of Health, Social Services and Equality supplied data during this period. In 2014, a total of 40,177 cycles were analysed (28,204 cycles of AI-C and 11,973 cycles of AI-D). The corresponding figures for 2015 were 38,903 cycles: 26,959 of AI-C and 11,944 of AI-D).

Results

No changes were observed in the overall rate of gestations per cycle, either for AI-C (13.0% in 2014 and 13.5% in 2015) or for AI-D (20.3% in 2014 and 20.6% in 2015). There were 12.3% and 11.1% multiple pregnancies obtained by AI-C in 2014 and 2015, respectively. Similar results were obtained by AI-D, for which the multiple gestation rates were 12.1% and 12.2% in 2014 and 2015, respectively. Of the gestations produced by AI-C, 16.5% resulted in miscarriage in 2014, and 18.7% in 2015. With the donor technique, 16.7% resulted in miscarriage in 2014, and 18.7% in 2015.

Conclusions

The mandatory participation in RNA- Register SEF has shown that, far from being an outmoded technique, artificial insemination is widely used in Spain, and remains effective over time.

Introduction

This document presents the IVF/ICSI activity records of the National Activity Register-Spanish Fertility Society Register for the years 2014-2015. These were the first two years of mandatory participation in this Register for assisted reproduction centres in Spain.

Material and methods

The data analysed corresponded to the cycles carried out in 225 Spanish centres in 2014, and in 231 in 2015. The following IVF/ICSI cycles were studied: with own fresh oocytes, 51,591 in 2014 and 53,679 in 2015; with fresh donor oocytes, 16,630 in 2014 and 14,655 in 2015. Cycles with embryo cryopreservation totalled 21,007 in 2014 and 23,692 in 2015. PGD/PGS cycles totalled 5,242 in 2014 and 7,045 in 2015, and cycles with cryopreserved oocytes, 6,692 in 2014 and 8,138 in 2015.

Results

In IVF/ICSI with own fresh oocytes, a total of 12,576 clinical gestations were obtained in 2014 and 12,041 in 2015, representing pregnancy rates by fresh embryo transfer of 36.6% and 36.4%, respectively. Of these pregnancies, 21.3% were multiple in 2014 and 20.8% in 2015. In IVF/ICSI with fresh donor oocytes, 13,083 fresh transfers were performed in 2014 and 12,211 in 2015, which in 2014 resulted in 7,275 clinical gestations (55.6%) of which 28.1% were multiple, and in 2015 resulted in 6,653 (54.5%) of which 25.7% were multiple. In 2014, of the 1,689 transfers for PGD, 776 gestations were obtained (45.9%) and in 2015, of the 1,935 transfers, 917 gestations were obtained (47.4%). In 2014, 641 transfers were made with embryos from vitrified own oocytes and 5,372 with vitrified donated oocytes. In 2015, the corresponding figures were 712 and 6,416.

Conclusions

The number of cycles recorded has increased significantly, due to legislative changes that make participation in this Register mandatory. Particularly notable is the increase in donor cycles with vitrified oocytes. The rate of multiple gestation remains high.

Introduction

The addition of electronic witnessing technologies as a quality control element in the human assisted reproduction treatments can increase their safety, by reducing the risk of mistakes. However, the impact of the inclusion of these elements in the patients’ perceived safety and quality is still unknown, as well as whether it translates into an improved experience when undergoing an in vitro fertilization treatment.

Material and methods

A survey was conducted on 200 patients, attending a private assisted reproduction unit located in Lisbon, Portugal, between January and July 2016. Participants were asked to give a numerical value to 6 sentences, depending on their level of agreement with them, in order to reflect their perception about the safety and quality of the assisted reproduction techniques, and the electronic witnessing technology.

Results

Despite the high confidence level on the quality and safety of assisted reproduction treatments procedures, they consider that undergoing an in vitro fertilization treatment produces anxiety. Consequently, patients value positively the addition of an electronic witnessing element, and consider it increases their overall confidence in in vitro fertilization procedures. This trend is increasingly marked in ‘novel’ patients, who have had no previous exposure to assisted reproduction treatments, when compared with experienced patients that have undergone one or more treatments.

Discussion

Patients show a strong interest in electronic witnessing technologies. It is, thus, important to produce evidence, in our geographical context, addressing their cost and effect upon the quality of assisted reproduction treatments procedures.

Introduction

Use is made of computer-assisted sperm morphometry analysis (ASMA) in order to analyse sub-populations as a function of several pathologies.

Material and methods

A total of 703 patients were classified into 7 pathology groups, and their sperm sub-populations were analysed. Pathology groups were classified into infertility, male factor stress (anxiety, insomnia and/or depression), diabetes mellitus type 1 or 2, varicocele, urogenital infections, oncological patients, and other endocrine diseases. Morphological analysis was performed using the semen analyser system SCA 5.4 (Sperm Class Analyzer) (Microptic S.L., Barcelona, Spain). Pre-treatment and staining method used has been previously described by this group.

Results

Automatic human sperm morphology showed that the study of sperm sub-populations has a clinical usefulness in the diagnosis of varicocele. Higher values of 30% elongated sperms had a sensitivity of 37% and a specificity of 79% (1.54 odds ratio with a 95% confidence interval from 1.05 to 2.26). Furthermore, groups of infertility, stress, and diabetes showed new sperm sub-populations which had not been described previously, so they could become a new diagnostic tool.

Discussion

The coefficients of variation of sperm morphology were decreased using automation, enabling the study sperm subpopulations in different pathologies. There is a diagnostic usefulness for varicocele. There could be a prediction to choose the best assisted reproductive technique for infertility patients. However, for the rest of groups new sperm subpopulations could be identified that could make it a diagnostic tool, but requires a higher casuistry to conclude the study.

Introduction

Under recent changes in Spanish law, assisted reproduction centres must inform the National Registry of Activity-SEF Registry of their activity and of the results obtained since 2014. The present study analyses the repercussions of these legislative changes on determining the specifications for 32 quality indicators described in the UNE 179007 standard.

Material and methods

A state-of-the-art method was applied to data obtained from the SEF Register (2010-2013), participation in which is voluntary, and from the National Registry of Activity-SEF Registry administered by the Ministry of Health, Social Services and Equality, participation in which has been mandatory since 2014. For each year of the study period, the method used was that described by Buño et al. (2008) for calculating the quality specification at a desirable level. In short, this corresponds to the quality level reached by 75% of the best laboratories (the 25th percentile of the distribution of values for each of the indicators analysed). The 95% confidence interval of the 25th percentile was calculated to determine the margin of error of this estimate.

Results

The imprecision of the studied specifications has decreased, as information was available from almost all the ART centres in Spain. Our results corroborate the robustness of the state-of-the-art method, with 85% (26/32) of the quality indicator specifications remaining stable over time. Significant changes were only observed in 6 indicator specifications. The 2 specifications that increased significantly were “Survival rate to cryopreservation of embryos from donated and own fresh oocytes” and “Percentage of embryos in evolution or used”. On the other hand, there were significant decreases for “Mean number of pre-embryos transferred fresh from own oocytes”, “Percentage of gestation by embryo transfer from fresh own oocytes” and “Multiple gestation rate in IVF/ICSI cycles”.

Discussion

The significant increases observed in the specifications of some indicators reflect changes in clinical practice. Nevertheless, it is necessary to improve the validity of some UNE quality indicators, since with their current formulation, the quality of the treatment provided cannot be determined.