Jornal Brasileiro de Reproducao Assistida最新文献

Facing a global increase in infertility rates, this study casts a spotlight on the fertility and assisted reproduction (ART) market within Brazil and Latin America, against a backdrop of considerable political and programmatic challenges. Addressing the scarcity of comprehensive studies and the variable accessibility to ART services, our objective is to unravel the growth dynamics and the disparities in ART accessibility and quality across these regions. Studies were analyzed within the PubMed, Google Scholar, and Grey Literature databases. Records retrieved from all the searches underwent screening based on title, abstract, and full-text examination. Inclusion criteria involved assessing titles, abstracts, and full texts of articles published within the past 10 years. Our study demonstrated growth in the opening of clinics and assisted reproduction centers and the performance of ART procedures in Brazil and Latin America. Despite overall low utilization rates, Brazil emerges as a pivotal contributor to the ART sector in the region. However, significant barriers such as high costs and limited insurance coverage impede access to ART treatments, underscoring the urgent need for strategic investments in research, development, and policy reform. The study underscores the critical demand for targeted interventions to enhance both accessibility and financial affordability of ART. By highlighting Brazil's role and prospective market opportunities, it calls for a collaborative approach among stakeholders to foster an enabling environment for infertility treatment, promising to stimulate new advancements and market expansion in the coming years.

Objective: To evaluate the relationship between time-lapse (TL) imaging parameters and the ploidy of human blastocysts.

Methods: This observational study retrospectively analyzes time-lapse images from 84 blastocysts tested for aneuploidies, focusing on morphokinetic evaluation based on cell division (st2, t2, t3, t4, t5, t8, tSC) and blastocyst formation parameters (tSB, tB).

Results: Among the TL parameters, t5, t2-st2, cc3 (t5-t3), t5-t2, s3 (t8-t5), and tB-tSB showed a significant association with ploidy, being shorter for euploid blastocysts. The respective median times/intervals for euploid and aneuploid embryos were as follows: t5, 46.5 vs. 49.6 (p=0.015); t2-st2, 2.5 vs. 2.25 (p=0.0236); cc3, 11.7 vs. 13.3 (p=0.046); t5-t2, 22.1 vs. 24.4 (p=0.0185); s3, 10.9 vs. 3.3 (p=0.019); and tB-tSB, 7.6 vs. 9.9 (p=0.0084). ROC curves identified a moderate predictive ability of the parameters to discern euploid embryos. Additionally, initial cytoplasmic movements prior to the first cell cleavage were noted; pattern 1 (vibration-like movements), pattern 2 (circular wave movements), or pattern 0 (the absence of detectable movements) were not significantly correlated with ploidy.

Conclusions: Euploid blastocysts reach certain cell division stages (t5, t5-t3, t5-t2, t8-t5) and blastocyst formation stages (tB-tSB) more quickly than aneuploid ones. If further studies confirm this, our results should serve as criteria for selecting embryos to be biopsied, potentially avoiding the procedure when euploidy can be predicted from morphokinetic features.

Objective: The levels of cfDNA in the semen samples of infertile men and its relationship with the level of oxidative stress, antioxidant capacity and lipid peroxidation were investigated.

Methods: Total 100 semen samples were obtained from infertile men with abnormal sperm parameters (oligoasthenospermia (n=10), oligoteratozoospermia (n=10), oligoasthenoteratozoospermia (n=10), and non-obstructive azoospermia (n=50)) and normozoospermic men. cfDNA was extracted and quantified by qPCR. Different markers related to the oxidant and antioxidant status as well as oxidative stress were measured in the seminal plasma samples of the study groups.

Results: cfDNAs content in the oligoasthenoteratozoospermia group was significantly higher than those in the controls. A significant decrease in cfDNAs was observed in the azoospermia group compared to the controls. There was a significant increase in malondialdehyde and other oxidant related markers in all patient groups rather than the normal individuals. In contrast, seminal plasma samples of all patients with abnormal semen parameters showed a significant reduction in the levels of factors associated with antioxidant capacity compared to the controls.

Conclusions: This study highlights the direct link between elevated cfDNA levels, oxidative stress, and impaired sperm parameters in men with azoospermia and oligospermia. Current data underscore the potential competence of cfDNA and oxidative stress as diagnostic tools to classify the severity of male infertility and abnormalities related to semen parameters. Our findings emphasize the importance of antioxidant therapy as an efficient strategy to reduce oxidative damage, enhance sperm quality, and improve reproductive outcomes for male partners of couples with infertility.

Objective: The incidence of monozygotic twinning (MZT) increases following ART procedures. Despite numerous studies, no definitive conclusion has been reached regarding the potential etiology of MZT after fertility treatments. This study aims to analyze the possible factors influencing the incidence of MZT gestations over an 8-year period.

Methods: This retrospective cohort study analyzed 21 autologous (patient´s own oocytes) and heterologous (donor oocytes used) ICSI cycles involving single or double embryo transfers that resulted in monozygotic gestations between 2015 and 2022 at a single IVF center. The frequency and type of monozygotic gestation were recorded and analyzed on a yearly basis.

Results: We observed a significant clustering of MZT gestations in two years (2018 and 2019) during the study period. Additionally, two cases of heterologous MZT gestation occurred following egg donation from the same donor across two different oocyte collection cycles.

Conclusions: Our observations suggest that not a single factor related to ART procedures causes MZT after fertility treatment. Maternal genetic and epigenetic factors, as well as uncontrolled environmental factors, may work synergistically to promote the occurrence of monozygotic twinning.

Objective: The accumulation of cryopreserved embryos in assisted reproductive technology (ART) centers is an important point of discussion for the clinical and scientific community. This study conducted a survey to explore in vitro laboratories' approaches to handling oocytes and embryos in the face of an ovarian hyperresponse.

Methods: We invited ART centers whose laboratories were registered in the National Embryo Production System (2018) to answer an online multiple-choice questionnaire. A total of 57 ART centers participated.

Results: Most of the ART centers were private (92.9%) and about half of them were considered medium/large business, performing at least 30 IVF cycles per month. The ART centers were asked what their concept of ovarian hyper-responsiveness was, and 76% considered more than 15-20 oocytes retrieved. Faced with an ovarian hyper-responsiveness, the main practice reported was injecting all mature oocytes and vitrifying all developed blastocysts (53%), followed by a practice of freezing half of the oocytes and injecting other half of the oocytes (35%). 9% alternated between these two protocols.

Conclusions: Injection of all oocytes followed by embryos cryopreservation is the most common approach when high order number of oocytes is collected, despite it generating many surplus embryos. The findings of this study underscore the necessity for updated consensus on the management and production of embryos, considering the multifaceted considerations involved, as laboratory efficiency and costs. The decision in such cases should focus on the balance of priorities of having a healthy newborn and the responsibility for the fate of surplus embryos.

The present systematic review aimed to evaluate the effects of Lactobacillus spp. on human semen. The review was conducted until May 2023, according to the PRISMA Statement and using Scopus and PubMed databases. The protocol was registered on PROSPERO (CRD42024519245). All published original investigation peer-reviewed articles in English and Spanish related to Lactobacillus spp. and human semen parameters were eligible. The quality assessment used The Joanna Briggs Institute (JBI) Critical Appraisal Checklist and QUIN tool. In total, 35 articles were included. Lactobacillus spp. is frequently detected in semen, and its impact on seminal quality is controversial, especially regarding the methodology used. The intake of probiotics with Lactobacillus spp. can improve semen parameters. In conclusion, Lactobacillus spp. appears to have a beneficial role in semen quality. Probiotics could have a good impact on improving semen quality; however, further studies are required.

Objective: Spontaneous abortion is a complex disorder with a significant genetic component. Identifying genetic variants influencing spontaneous abortion risk could unveil biological pathways and potential therapeutic targets.

Methods: We performed Mendelian randomization using cis- and trans-protein quantitative trait loci (pQTLs) as instrumental variables to assess causal effects of circulating proteins on spontaneous abortion. Proteins exhibiting differential expression between sexes were excluded. KEGG pathway enrichment was employed to investigate the pathways affected by susceptibility genes, while single-cell transcriptomic analysis was utilized to explore the susceptible cell types with elevated expression of these genes within the uterine endometrium.

Results: MMP9 and DC-SIGN were associated with increased spontaneous abortion risk (OR=1.11(1.03-1.19), P=3.70x10-3; OR=1.09(1.02-1.16), p=9.89x10-3), while HBAZ and NELL1 had protective effects (OR=0.96(0.94-0.99), p=5.20x10-3; OR=0.94(0.9-0.98), p=8.54x10-3). Additionally, TMM85 conferred higher spontaneous abortion risk (OR=1.06(1.02-1.1), p=4.72x10-3). Pathway analysis highlighted sphingolipid binding, chemorepellent activity, and tumor necrosis factor receptor activity. Single-cell transcriptomics revealed that MUL1, EMC4, NDC80, and SELL genes exhibit higher expression levels within uterus cells, and these susceptibility genes displayed elevated expression levels in leukocytes, mature NK T cells, and T cells in the uterus.

Conclusions: Our integrated multi-omics analysis identified genetic variants influencing spontaneous abortion risk and their downstream molecular mechanisms, providing insights into potential therapeutic targets. The implicated pathways and cell types may guide future investigations into the pathogenesis of spontaneous abortion.

Objective: Acyclovir is an antiviral drug that is used to treat herpes virus infections and acts by inhibiting viral DNA synthesis. While antiviral drugs are designed to inhibit viral replication, some have been found to have immunomodulatory effects beyond their direct antiviral action. Acyclovir has been documented to induce cytotoxicity and DNA mutation. Cytotoxic agents are well-documented to damage male gonadal functions. Therefore, it has become imperative to examine the effects of acyclovir on male reproductive physiology.

Methods: Eighteen adult male Wistar rats were randomly grouped into three groups: control (distilled water), low-dose (10 mg/kg acyclovir), and high-dose (40 mg/kg acyclovir). After 21 days of oral treatment, serum, testicular homogenate, and epididymal sperm suspension were collected and analyzed. Serum and testicular oxidative stress markers (SOD, MDA, GPx, and CAT), hypothalamic-pituitary-gonadal hormones (GnRH, LH, FSH, and testosterone), sperm parameters, and testicular histoarchitecture were examined. In addition, inflammatory cytokines (IL-1β, IL-6, IL-10, TNF-α) and lactate dehydrogenase enzymes were evaluated from the serum.

Results: Acyclovir (40 mg/kg) caused a significant increase in serum inflammatory cytokines (TNF-α, IL-6), LDH, and MDA, while the testicular and serum antioxidant enzymes were reduced when compared with controls. Acyclovir (40 mg/kg) also decreased serum GnRH, LH, FSH, and testosterone levels, as well as testicular testosterone, and negatively affected sperm count, sperm motility, and sperm morphology. Histopathological examination showed that acyclovir caused edematous seminiferous tubules with degenerated spermatogenic cells and scanty sperm cells.

Conclusions: Acyclovir induced testicular damage by promoting inflammatory response, oxidative damage, and endocrine disruption.

Objective: This study explores the influence of seasonal variations on embryo morphokinetics and the outcomes of intracytoplasmic sperm injection (ICSI) cycles.

Methods: This retrospective cohort study, performed in a private university-affiliated IVF center from March 2019 - March 2023, included 1,292 intracytoplasmic sperm injection cycles (ICSI) cycles and 8,376 injected oocytes. Cycles and were split depending on the season in which oocyte collection was performed: Spring (n=462 cycles), Summer (n=176 cycles), Autumn (n=258 cycles), and Winter (n=396 cycles). Embryos were cultured in a time-lapse imaging (TLI) incubation system, and embryo morphokinetics and laboratory and clinical outcomes were compared between the groups.

Results: A slower morphokinetic development was observed in embryos derived from cycles performed in the winter compared to those from cycles performed in other seasons, while embryos derived from cycles performed in the summer exhibited faster embryo development. Significantly longer time to complete synchronous divisions t8-t5 (s3) and second (cc2, t3-t2) and third cell cycles (cc3, t5-t3) were also observed among embryos derived from winter cycles, whereas embryos formed during summer presented shorter cycles. Embryos from cycles performed during summer exhibited a significantly higher KIDScore compared to those from winter cycles. Significantly higher implantation rate was observed in cycles performed in the summer, followed by those performed in the spring.

Conclusions: These findings suggest a potential influence of seasonal factors on embryo development and implantation success. The study underscores the importance of considering seasonal variations and their potential biological impacts on assisted reproductive technologies.