Medicina Reproductiva y Embriología Clínica最新文献

The Embryology Interest Group of the Association for the Study of Reproductive Biology has established a system of embryo scoring based on the bibliography published to date and the experience of the members of the group. This article sets out the morphological characteristics evaluated at each stage, as well as updating previous editions, from oocyte to blastocyst, and their influence on the potential for embryo development and implantation. Four categories are proposed with the purpose of standardising criteria and making it easier to run multicentre studies.

Contraception allows women to avoid unplanned pregnancies. Not only should access to contraceptive methods be readily available to women, it is also important that they use the most appropriate birth control method that suits their needs and lifestyle in order to ensure proper use and continuity. This highlights the importance of contraceptive counselling, a practice that should be an integral part of the care of childbearing-age women. This document, prepared by a panel of experts representing the main healthcare professions involved in the provision of contraceptive advice in our country, describes the elements needed to offer women quality contraceptive advice using a multidisciplinary approach adapted to the specific individual needs. It includes relevant aspects, such as which women and at what time should contraceptive counselling be provided. The skills required for this counselling and the environment where contraceptive counselling should be provided, and the essential components it should cover are also included.

Introduction

Sperm morphology is a parameter closely related to the fertility of the male gamete. Various infertility-causing disorders have been associated with anomalous sperm sub-populations that may be accompanied by an altered osmolality. A pilot study was conducted to determine whether the increase or decrease in in vitro osmolality can alter the original morphology.

Material and methods

The study included 42 randomly selected patients who had been classified as normal according to WHO criteria. The samples were processed by a CASA - SCA 5.4 (Sperm Class Analyzer) (Microptic S.L, Barcelona, Spain). Seminal plasma osmolality was measured using an Advanced Osmometer 2020 3MO.

Results

The in vitro assays carried out on 30 patients showed that an osmolality increase up two times the reference value (880mOsm/kg), caused a progressive loss of sperm viability and a significant increase in macrocephalic sperm heads, with an increase in sperm volume and area. An osmolality decrease (half of the reference value, 228 mOsmol/kg) in a sample of 12 patients had no effect on sperm viability, although the sperm sub-population study showed increased micro-cephalic sperm with lower volume and cephalic area.

Discussion

Sperm morphology is acquired by sperm during the epididymal maturation. It was found that changing in vitro seminal plasma osmolality did not seem to affect it. Only extremely high values of osmolality cause the formation of macrocephalic sperm heads and a progressive loss of viability. These in vitro assays can help us to understand the biochemical seminal plasma effect in the male gamete.

Introduction

In clinical laboratory processes, the greatest number of errors usually occur in the non-technical phases, performed before and after the technical process. Failure modes and effects analysis (FMEA) is a method for managing potential failures and identifying their effects so that preventive and remedial measures may be proposed. This paper describes a FMEA conducted on the pre-technical phase of work in an assisted reproduction laboratory.

Material and methods

A multidisciplinary team drew up a list of possible failures in the activities involved in the pre-technical phase (request, preparation of the patient, collection, manipulation, identification, and transport). These items were evaluated by 17 staff members and users of the assisted reproduction laboratory to determine the potential impact on patient care of each such failure. Indices of severity, probability of occurrence, detection, and overall risk were calculated for each possible failure.

Results

The possible failures with the highest risk indices were, for the analysis function, illegible request and incorrect manipulation in the use of resources and/or techniques. For the areas of cell and tissue processing and of cryopreservation, the possible failures that obtained the highest overall risk score were errors in the administration of drugs and the request being incomplete and/or made at an inappropriate time. The largest number of possible failures were found in the activities concerning sample collection and manipulation. Twelve evaluation indicators were defined.

Discussion

This study highlights the existence of latent system failures, which may become inherent to the procedures and provoke errors, hence the importance of continuing to monitor the proposed indicators to measure results over a longer period and to evaluate the effect of the actions taken.

Objective

To determine whether there are differences in the volume and trophoblastic vascularisation at early stages of pregnancy between spontaneous pregnancies and those achieved after assisted reproduction techniques.

Methods

A prospective observational study was performed during week 9 of single pregnancies, using a trans-vaginal 3-dimensional ultrasound scan using power Doppler. The acquired volumes were analysed using the image program VOCAL –Virtual Organ Computer-Aided Analysis–, to evaluate the volume of the placenta, the vascularisation index, the flow index, and the vascularisation flow index.

Results

Of the 59 pregnant women included in the study, 32 had fertility treatments, and 27 were spontaneous pregnancies. In a comparative analysis, all the factors studied showed statistically significant differences. The measurements of these values for the assisted reproduction techniques group were significantly lower.

Conclusions

The study of the volumetric and trophoblastic vascularisation could be useful for understanding and preventing the most common placenta disorders in the assisted reproduction technique pregnancies, and it would explain some adverse prenatal outcomes in those pregnancies.

Introduction

This report shows the IVF/ICSI Registry activity of the Spanish Society of Fertility during 2012 and 2013.

Material and methods

Descriptive study of the data registered from 113 Spanish clinics during 2012, and 130 during 2013. An analysis was performed on IVF/ICSI cycles with own eggs (35,430 in 2012, and 38,591 in 2013), IVF/ICSI cycles from egg donation (7,605 in 2012 and 8,320 in 2013), frozen embryo replacement cycles (11,736 in 2012 and 14,255 in 2013), pre-implantation genetic diagnosis/screening cycles (2,744 in 2012 and 2,890 in 2013), and cryopreserved oocytes cycles (6,452 in 2012 and 8,056 in 2013).

Results

A total of 9,750 clinical pregnancies were reported in 2012 with IVF and own eggs treatment, and 9,775 in 2013 (37.9% and 37.3% pregnancy rate per embryo transfer, respectively), leading to 23.9% of multiple pregnancies in 2012 and 22.9% in 2013. By egg donation cycles, 4,569 pregnancies were obtained (53.3%) from a total of 8,571 fresh embryo transfers in 2012, and 4,607 (55.9%) from 8.238 in 2013, leading to 31,1% of multiple pregnancies in 2012 and 30,1% in 2013. In 2012, 568 (20.7%) pregnancies were obtained from 2,744 egg collections for PGD treatment, and 484 (16.7%) from 2,890 in 2013. The number of cycles performed with vitrified own eggs was 1,949 in 2012 and 2,899 in 2013.

Conclusions

Multiple pregnancy rates are still high. The data shows a significant increase of the number of cycles with cryopreserved oocytes. A high percentage of pregnancies are unknown, lacking data on their follow-up.

Since the use of assisted reproduction techniques became routine, needs have changed in the quest to optimise laboratory results, and the establishment of quality indicators and standards is now of fundamental importance. For this reason, various reference texts have been published in 2016, such as the Embryology Laboratory Indicator Quality Guidelines issued by the ASEBIR Quality Interest Group (GICa-ASEBIR) and, more recently, the Handbook of Good Clinical Practice in Assisted Reproduction issued by the SEF Ethics and Good Practices interest group (MBP-SEF). We believe it would be useful to scrutinise these indicators and determine which ones are common to the two documents. To do so, we have classified the indicators according to two variables. Firstly, by type (effectiveness and safety) and secondly, by degree of coincidence: similar (present in both documents and similarly defined); discrepant (present in both documents but with discordant definitions); and unique (only described in one of the two documents). Our analysis of the two texts shows that eight indicators of effectiveness are similar and three are discrepant. In addition, one safety indicator was found to be discrepant, two indicators were unique to the GICa-ASEBIR document and five were unique to the MBP-SEF. These results highlight the presence of significant differences in the quality indicators proposed and the need, in our opinion, for greater standardisation.

Introduction

The indications for intrauterine insemination using the partner's sperm (IUI-H) are currently the subject of debate. To follow the progress of the implantation and efficacy in daily practice is key to defining its current role within the human assisted reproduction techniques.

Material and methods

This descriptive study presents data from the IUI-H and intrauterine insemination by donor sperm (IUI-D) Register compiled by the Spanish Fertility Society (SEF) from the years 2012 and 2013. These data were compared with those of the previous 6 years. The SEF register is voluntary and collects data aggregated per clinic, monitoring more than 20% of these clinics in situ. Less than half (42.4%) of the clinics registered with the Spanish Health Ministry participated in the 2012 SEF registers, with 50.3% in 2013. A total of 28,596 cycles were analysed during 2012 (21,561 IUI-H cycles and 7,035 IUI-D cycles), with 29,550 being analysed during 2013 (22,025 IUI-H cycles and 7,525 IUI-D cycles).

Results

The overall pregnancy rates per cycle were similar to those obtained during previous years for IUI-H (2012: 12.4%; 2013: 12.6%) and for IUI-D (2012: 20.1%; 2013: 21%). In 2012 11.3% (303) were multiple pregnancies with IUI-H and 11.6% in 2013. The IUI-D multiple pregnancy rate was 13.2% in 2012 and 11.5% in 2013. Miscarriages occurred in 22% of the IUI-H pregnancies with a known outcome in 2012, and in 20.9% of the 2013 pregnancies. With IUI-D these values were 22.7% in 2012 and 21.8% in 2013.

Conclusions

IUI is a fully consolidated technique, with stable results in recent years, although this technique results in high number of multiple pregnancies in our country.

The present study describes the implementation of a carrier screening test for autosomal recessive and X-linked diseases in an Oocyte Donation Programme (donors and male partners of the recipients). The Next-Generation Sequencing (NGS) based test covered 200 genes (68 genes by complete sequencing of the coding region and 132 sequenced by a targeted mutation analysis) associated with 314 diseases (277 recessive autosomal diseases and 22 X-linked). The results obtained after 2.5 years showed a high degree of acceptance (implementation rate > 80%). Among participants, 56.4% (761/1350) were identified as carriers of at least one gene mutation. It was also identified that 1.9% of donor candidates were carriers of X-linked diseases, and for this reason were excluded from the Oocyte Donation programme. The mean carrier burden was 0.84 mutations per sample. There were 3.4% of preassigned donor-recipient matches with a high reproductive risk for transmitting a severe autosomal-recessive genetic condition to their offspring (cystic fibrosis, classical congenital adrenal hyperplasia, autosomal-recessive non-syndromic sensorineural deafness, alpha thalassemia, familial Mediterranean fever, Niemann-Pick disease, thyroid dyshormogenesis type 6 and cartilage-hair hypoplasia). The definitive matching was made taking into account the genetic results. A carrier state for an autosomal recessive condition was not an exclusion criterion for the Oocyte Donation programme, although it implied the assignation of the donor to a recipient whose male partner was not a carrier for the same recessive condition. Genetic counselling at different stages of the clinical process was essential in order to achieve the purposes of decreasing anxiety in the gamete donors and recipient couples, to achieve a high understanding of the results, and to give appropriate recommendations about their own reproductive risk or that of their relatives, when necessary.

The sperm integrity is essential to ensure reproductive competence. Several studies have shown that ejaculated sperm exhibit changes associated with apoptosis, in particular externalisation of phosphatidylserine, decreased MMP integrity, and DNA fragmentation.

The classification of magnetically activated cells with Annexin V microspheres recognises phosphatidylserine residues externalised on the surface of apoptotic spermatozoa. In addition, the use of Annexin V microspheres to select non-apoptotic spermatozoa reduces the percentage of altered cells with DNA fragmentation and aneuploidy, improving the possibility of pregnancy after assisted reproduction techniques.

In this review, our objective is to evaluate the possible value of activated cell magnetic classification technology in infertile patients undergoing assisted reproduction techniques.