Medicina Reproductiva y Embriología Clínica最新文献

Introduction

Corifollitropin alpha helps in reducing the number of injections per cycle, which could result in a decrease in the emotional burden and the subsequent improved adherence to treatment. The aim of this study is to compare the results of ovarian stimulation treatment for IVF using long-acting recombinant FSH and recombinant FSH daily administration in patients with normal response prognosis.

Material and methods

A retrospective study was conducted between 2013 and 2014 on 310 patients with normal response prognosis undergoing their first cycle of ICSI. A comparative study was performed between two stimulation protocols: the study group was composed of 125 patients, in whom stimulation was performed with corifollitropin alpha, followed, if necessary, by FSH-r from the eighth day. The control group was composed of 185 patients, who received FSH-r daily from the beginning. Pituitary braking to prevent spontaneous ovulation was done with GnRH antagonist from the 5th day of stimulation, after visualisation of a follicle> 14 mm. We compared the results of the stimulation cycle by analysing the days of stimulation, the number of follicles between 14-16 mm and greater than 16 mm, oestradiol, and the thickness of the endometrial line at the time of induction of ovulation, the number of oocytes obtained and the maturational stage, ICSI fertilization rate and the number of embryos obtained, embryos transferred, discarded and cryopreserved. A comparison was made between pregnancy rate, the cancellation rate, the presence of ovarian hyperstimulation syndrome and other complications.

Results

Pregnancy rates were similar in both groups (per cycle initiated, 33.6% in the study group vs. 36.4% in the control group). No differences were found in the variables analysed in the stimulation cycle and in the number of complications between both groups, with only 4 patients being cancelled due to the risk of ovarian hyperstimulation in the study group, with no differences with the control group (3.2 vs. 5.9%).

Conclusions

In patients with a normal response prognosis, controlled ovarian stimulation with corifollitropin alpha, shows no statistically significant differences with conventional treatment, and represents a comfortable alternative for the patient, since it improves adherence to treatment in those with established normal response prognosis.

The biological relevance of sperm contribution to the embryo has currently been shown to go beyond a mere transmission of the paternal genome. New findings have revealed that spermatozoa carry a complex and multifunctional population of RNA with a wide range of implications in spermatogenesis, fertilisation, and embryogenesis. Accordingly, the consideration of these molecules as a simple residual pool of earlier processes has been left behind. Besides the coding RNAs, the role of non-coding RNAs has started to be untangled and integrated within the global cell processes, demonstrating their relevance in cellular regulation and epigenetics. Comparative high-throughput expression studies have provided a general impression on the differences in the sperm transcriptome between populations. Hence, a new diagnostic value related to these RNAs has emerged. In this review, an overview of biosynthesis, functions and biological mechanisms of different subtypes of sperm RNAs is presented. The relevance of these molecules during spermatogenesis, their role after fertilisation, and their potential value as fertility biomarkers are also discussed.

Introduction

In vitro fertilisation (IVF) cycles that take advantage of the natural cycle (NC) of the patient have become an alternative to the protocols of controlled ovarian stimulation (COS), and are a cheaper and easier option. Our objective is to analyse the clinical and laboratory results obtained in our centre on 287 cycles performed in pure natural cycles.

Material and methods

A retrospective analysis was carried out on 287 natural cycles performed in our centre between September 2013 and May 2016.

Results

A total of 287 cycles were performed on 108 patients with a mean age of 40.7 years, a mean FSH of 12.2 mU/mL, and 1.5 previous cycles of unsuccessfully performed IVF. Egg retrieval (ER) was achieved in 194 cycles (67.6%), with a mean of 1.1 oocytes by (ER), and a fertilisation rate of 69.6%. Embryo transfer was achieved in 70 of the 287 cycles (24.4%) with an implantation rate of 23.7%. Analysed globally, the pregnancy rate was 6.97% per cycle started, 10.3% per ER, 28.6% per transfer, and 18.5% per patient.

Discussion

A high percentage of IVF cycles performed in natural cycle are cancelled without reaching embryo transfer. However, analysing the results obtained by ER and transfer, they are an alternative, simple, economical, and slightly aggressive, with acceptable results if we consider their frequent indication in a population of poor prognosis, where more aggressive options do not improve the expectations.

Introduction

Recruitment and selection of gamete donors has become during the years a challenge for doctors and psychologists due to the importance of selecting the best candidate. But, is there a donor female and male profile? The objective of this study is to investigate the socio-demographic and motivational characteristics of female and male gamete donor candidates at a fertility clinic in order to find a prediction profile for donors and to detect how their characteristics change over time.

Material and methods

A transversal predictive design and a comparative design were used, and 1338 women and 137 men donor candidates at the Alicante IVI Center in Spain in the 2007–2013 period participated in the study. Data were obtained from semi-structured interviews.

Results

Being younger, in active employment and having a partner increases the likelihood of women becoming donors. Similarly, if women candidates have completed secondary or university education, do not smoke and have a partner, it is more likely they will be determined as suitable candidates in the psychological assessment. However, there does not appear to be a defined profile for men. The profile for a financially compensated donor candidate has shown significant changes over time; changing from being in active employment to being unemployed, but the motivations have remained the same.

Discussion

These findings can be a valuable tool which can lead to improvements in the selection process for financially compensated gamete donor candidates.

Prior to the publication of the new procedure regulating assisted reproduction in the National Health System (Order SSI/2065/2014), a questionnaire was sent to the 376 assisted reproduction centres accredited up to 12/31/2012 by the Spanish Ministry of Health and Consumer Affairs, of which 94 were publicly owned. A response was obtained from 73 of these public centres, representing a participation of 77.66%. In these centres, a total of 17,757 cycles were performed with homologous artificial insemination and 2421 with donor semen. In 35 centres, 16,584 in vitro fertilization - intracytoplasmic injection cycles were performed, which taking into account the Spanish population it represented a number of cycles started in public centres of 356/1,000000 inhabitants during 2014, a value significantly lower than the European mean (1,269 cycles/1,000,000 inhabitants). Oocyte donation was carried out in only 5 Autonomous Communities, while male and female preservation took place in 10. Only the study and diagnosis of sterile couples was carried out in 9 of the centres. In addition, the Castilla-León, Castilla la Mancha, Cantabria, and the Canaries Islands Communities lacked a biological risk laboratory. Pre-implantation diagnosis was not carried out in Asturias, Balearic Islands, Castilla La Mancha, Extremadura, or Navarra. There was a program of embryo donation in 7 centres in 6 Autonomous Communities.

In conclusion, there is a wide heterogeneity in the clinical practice between the different Autonomous Communities, and conflicts between health resources and the demand of users. It is intended to solve these problems with the implementation of this basic portfolio.

A shorter questionnaire will be used in the same centres within two years, asking for any changes in their centres after the incorporation of the new order.

Introduction

Multinucleation is a common phenomenon in in vitro human embryos and is associated with a poor outcome. Time-lapse monitoring of embryo development allows a continuous and detailed observation of fertilisation and cleavage events. An evaluation is presented on the impact of the presence of multinucleation on embryo morphokinetics, developmental ability, and implantation potential.

Material and methods

A retrospective cohort study was conducted on a total of 5540 embryos cultured in a TL system (Embryoscope®, Unisense Fertilitech®) from 763 ICSI cycles performed between 2012 and 2014. Presence of multinucleation in all developmental stages was assessed. Embryo replacement was performed on D + 3. Multinucleated embryos were cultured to the blastocyst stage and cryopreserved for subsequent transfer.

Results

Approximately one quarter (23.6%) of the studied embryos showed multinucleation. Multinucleated embryos showed altered morphokinetic parameters compared to the non-multinucleated ones. The multinucleated embryos that reached the blastocyst stage (18%) were cryopreserved. No differences in the developmental ability were observed compared to the multinucleated type or percentage of multinucleated cells. There was a 39.1% implantation rate of the blastocysts obtained from multinucleated embryos.

Discussion

Time-lapse monitoring of embryo development allows a better detection of the multinucleation phenomenon. The presence of multinucleated cells is associated with changes in the morphokinetics and a reduced developmental ability. However, multinucleated embryos that reach the blastocyst stage can be replaced, and have a high implantation potential.

Bisphenol A is an endocrine disruptor, namely a chemical substance able to alter the hormonal system, as well as being a chemical that is used as a monomer or additive in the plastic industry. The population is continually being exposed to this endocrine disruptor substance with oestrogenic function. Its levels in human samples are often higher than the concentrations required to obtain positive oestrogenic responses in in vitro tests, which could have adverse effects on female reproductive medicine. In fact, this review summarises the studies that show how bisphenol A induces alterations and damages during foetal development and female fertility in adulthood.

Introduction

The anti-Mullerian hormone (AMH) is considered an extremely useful biochemical marker in the field of Assisted Reproduction. This study evaluates the method for the determination of AMH (ECLIA Roche Diagnostics) in follicular fluid specimens. The main objective is to determine its use as a predictive marker of reserve and response to controlled ovarian stimulation, in serum and follicular fluid, as well as the cut-off point for diagnosis of low ovarian response in our population.

Material and methods

The levels of follicle-stimulating hormone (FSH), oestradiol, and serum AMH were determined on day 3 of the cycle in 100 patients being submitted to assisted reproduction techniques, together with the concentration of AMH in follicular fluid aspirated during the ovarian puncture. A count was also made of antral follicles under baseline conditions and the number of oocytes retrieved after treatment. All these patients complied with the inclusion criteria for IVF/ICSI techniques as per the guidelines for Assisted Reproduction of the Andalusian Health Service.

Results

Positive relationships were detected between AMH (both serum and follicular) and the antral follicle count [AFC] (r = 0.69 and r = 0.83, respectively), as well as ovarian response (r = 0.62 and 0.87, respectively) with P < .01. The correlation was negative for FSH with values of r = 0.31 and r = 0.19, respectively with P < .05. The cut-off point calculated using the area under the curve (ROC) for the detection of low ovarian response (< 5 oocytes retrieved) was 0.83 for serum AMH and 0.81 for concentrations of follicular AMH.

Conclusions

The ECLIA method by Roche Diagnostics for the quantitation of AMH in follicular fluid specimens is considered validated. The AMH concentration in either serum or follicular fluids is shown to be a better predictor of ovarian reserve and ovarian response than FSH, and the cut-off points established in our population for the detection of women with low response expectations, and therefore low probability of reproductive success, and those with high responses, in order to prevent ovarian hyperstimulation syndrome.

Introduction

Gonadotropin-releasing hormones are not only more comfortable as an assisted reproduction treatment, but also have the pharmacokinetics that could benefit poor responders to ovarian stimulation. A comparison is made with the results from the use of corifollitropin in patients with cycles produced with conventional gonadotropins.

Material and methods

An analysis was performed on the results obtained after stimulating the same group of patients with low ovarian reserve, according to Bologna criteria, with conventional gonadotropins versus corifollitropin alpha. The number of mature oocytes collected was the primary study variable.

Results

It was found that the use of corifollitropin alpha in patients with a diagnosis of low ovarian response is at least as effective as the conventional gonadotropin regimens given daily.

Discussion

With our results it can be conclude that offering corifollitropin to poor responders is at least as efficient as conventional gonadotropins, but it adds several advantages in terms of comfort and dosage.

Objective

An updated review is presented on some biochemistry and osmolality reference values in seminal plasm. These values were also compared with the seminogram values.

Material and methods

A study was made of 37 normal seminal plasma from patients attending the Sterility and Assisted Reproduction Service of our Hospital. The mean patient age was 34.4 years, with a 95% confidence interval (CI) from 32.5 to 36.3. The reference values of the biochemical parameters were obtained using a Beckman-Coulter AU 5800 chemistry analyser and a Cobas-Mira II analyser. Seminal plasma osmolality was measured using an Advanced Osmometer 2020 3MO.

Results

The mean concentration for the biochemical parameters were: total proteins 3.87 g/dl (95% CI; 3.5-4.3), albumin 0.67 g/dl (95% CI; 0.52-0.82), glucose 6.11 mmol/l (95% CI; 5.35-6.67), fructose 13.5 mmol/l (95% CI; 11.7-15.3), sodium 122 mmol/l (95% CI; 119-125), potassium 23 mmo/l (95% CI; 22-25), choride 41 mmol/l (95% CI; 37-44), calcium 27.1 mg/dl (95% CI; 23.7-30.5), magnesium 10.9 mg/dl (95% CI; 9.18-12.7), phosphorous 68.1 mg/dl (95% CI; 58.6-77.6), and zinc 1.5 mmol/l (95% CI; 1.25-1.73). The reference values for the calculated osmolality were 422 mOsmol/Kg (95% CI; 407- 439). Na, K, Ca, Mg, and Zn parameters showed a significant positive correlation with the quality semen criteria (sperm concentration, motility, and sperm morphology/ejaculate)

Conclusions

An updated review is presented on reference values of some biochemical parameters in seminal plasma using new automated analysers. This may be useful to study the relationship between different pathologies and the biochemical and osmolality values in seminal plasma. A significant correlation has been calculated between these biochemical parameters and the quality semen values.