Jornal Brasileiro de Reproducao Assistida最新文献

Objective: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, being one of the main causes of infertility. Anti-Müllerian hormone (AMH) is an important marker of ovarian reserve and has been proposed as an alternative criterion for the diagnosis of PCOS. This study verifies whether AMH and body mass index (BMI) values are predictors of pregnancy in infertile women with PCOS undergoing artificial insemination (AI), a less invasive and painless technique of assisted reproductive technologies (ART).

Methods: This retrospective observational study involved 220 women with PCOS who underwent AI between 2010 and 2022. Participants were categorized into three groups based on BMI and serum AMH levels. To categorize the three AMH classes, the 25th (4.08ng/mL) and 75th (8.99ng/mL) AMH percentiles were defined as cut-offs, and the words 'low', 'middle', and 'high' were utilized to define the groups.

Results: There was a tendency towards a decrease in reproductive outcomes (number of inseminations with positive human-chorionic gonadotropin, number of live births, and number of term births) with an increase in the BMI value. All of these outcomes were also slightly higher in women with 'middle' AMH levels compared to women with 'low' and 'high' AMH. However, none of these results were statistically significant.

Conclusions: This study suggests BMI may be an important predictive factor for pregnancy and there appears to be a range of biological normality for AMH values, where 'low' and 'high' levels of this hormone could constitute a marker of poor reproductive prognosis, in women with PCOS undergoing AI.

Objective: Morphologic assessment of an embryo is a valuable indicator for determining embryo health; however, it does not provide information on the chromosomal status of an embryo. Therefore, this study aimed to investigate the levels of Apolipoprotein A1 secreted by day-5 embryos in the spent media of euploid and aneuploid human embryos.

Methods: This study utilized 131 spent culture media samples from 22 infertile couples who were referred to the fertility clinic of Royan Institute. Following ovulation induction, retrieved oocytes were fertilized by intracytoplasmic sperm injection. For pre-implantation genetic diagnosis, embryos were frozen and thawed on days 2 to 3 and a single blastomere was isolated from each embryo for the assessment of chromosomal abnormalities by fluorescence in situ hybridization. Five days after fertilization, the levels of Apolipoprotein A1 were determined in the spent media of normal embryos, aneuploid embryos (with chromosome abnormalities), and the control group (medium without any embryos) using enzyme-linked immunosorbent assay.

Results: The Apolipoprotein A1 levels in the secretome of euploid cleavage-arrested embryos were significantly lower than those in the control group (p<0.04). However, Apolipoprotein A1 levels increased significantly in groups of euploid blastocysts, aneuploid cleavage-arrested embryos, aneuploid morulae, and aneuploid blastocysts compared to the control group (p<0.04). Furthermore, the Apolipoprotein A1 levels in the spent media of euploid early blastocysts were significantly higher compared to euploid hatching blastocysts and aneuploid blastocysts in the early, mid, and late stages (p<0.03).

Conclusions: This study highlights the significant potential of Apolipoprotein A1 as a developmental bi-omarker to distinguish between euploid and aneuploid embryos.

Objective: To investigate perception of (in)fertility, fertility-related quality of life, and depression in women undergoing assisted reproductive treatment.

Methods: Cross-sectional study, quantitative approach. The research sample comprised 89 women participating in the assisted reproduction program at the Hospital de Clínicas de Porto Alegre (HCPA) outpatient clinic. Data collection took place between August 2016 and January 2018. The tools used in the study were the Fertility Quality of Life (FertiQoL) questionnaire, Fertility Problem Inventory (FPI), Beck Depression Inventory (BDI), and a questionnaire on sociodemographic data.

Results: The mean total FertiQoL score was 66.5 ± 14.5, and it was significantly associated with depression and formal education; on average, patients with depression had a score difference of -10.7 (95CI%: -17.5;-3.8) compared to those without depression. Patients with depression reported a lower quality of life compared to those without depression in the social, treatment environment, and total treatment subscales. On the mind/body subscale, those meeting BDI criteria for depression scored 13.4 points lower on average than respondents without depression (p<0.001). The highest-scoring FPI dimension was conjugal and sexual relationship (4.5±0.79). The FPI dimensions social relationships (r= -0.77; p<0.01), conjugal and sexual relationship (r= 0.67; p<0.01), and maternity/paternity (r= -0.65; p<0.01) correlated with FertiQoL total score.

Conclusions: Women with depression who are in assisted reproductive treatment endorse lower fertility-related quality of life than their peers without depression. Assisted reproduction providers should be aware of the multiple factors involved and offer psychosocial care before, during, and after treatment.

Objective: To evaluate the effects of COVID-19 vaccination (AstraZeneca® and CoronaVac®) on anti-Müllerian hormone (AMH) levels in threatened women.

Methods: Retrospective cohort study evaluating serum AMH before and up to three vaccination doses against COVID-19 between 2021 and 2022 at FMABC. Statistical analysis presented in Stata 14. Clinical variables were described by absolute and relative frequency, in addition to measures of central tendency and dispersion. Shapiro-Wilk test for normality. Continuous variables compared within the group using the Friedman test and, between groups, Mann-Whitney U tests (non-parametric); Chi-square and Fisher's exact tests, for categorical variables, with p<0.05.

Results: Median age of the 38 volunteers was 24 years (p25-75: 22-30) and AMH levels (ng/dl) at times 0, 1, 2 and 3 median (95% CI) were, respectively, 4.6(3.5-6); 4(2.3-5); 4.3(3-5); 4.9(2.6-6.3), p=0.726. Likewise, there was no statistically significant difference in the assessments between subgroups aged <35 and ≥35 years old and with and without exposure to COVID-19 in relation to AMH values.

Conclusions: The vaccination against COVID-19 with the AstraZeneca® and CoronaVac® vaccines did not indicate any damage to anti-Müllerian hormone values in women of reproductive age.

Objective: Quercetin is a flavonoid compound extracted from fruits and plants and is used as a natural antioxidant to prevent or treat a variety of diseases such as cancer, obesity, chronic inflammation, and reproductive system dysfunction. The aim of this study was to investigate the effects of quercetin on obesity and ovarian tissue by analyzing the expression of genes involved in the hypothalamus-pituitary-gonadal axis, including ob-Rb, ob-Ra, and brain-derived neurotrophic factor (Bdnf), neuropeptide Y (NPY), and Kisspeptin (Kiss-1).

Methods: In this experimental study, female rats were divided into three groups, and the effect of quercetin with doses of 50 and 100 mg/kg on weight and BMI was investigated. Also, the gene expression was assessed using the real-time PCR technique. The estrogen, progesterone, FSH, and LH were assessed using the chemiluminescence technique. The diameter and number of different types of follicles, corpus luteum, and blood vessels in mice were investigated. The growth indicators of the children, including the number, weight, and height and head width of the born children, were checked.

Results: Quercetin caused a decrease in BMI, a significant increase in the expression of ob-Rb, ob-Ra, and Bdnf genes, a significant decrease in the expression of NPY and Kiss-1 genes, and led to an increase in sex hormones. Quercetin improved follicular indices and increased the number of mouse embryos.

Conclusions: Probably, quercetin affects the hypothalamus-pituitary-gonadal axis by changing the expression of genes, and it helps to reduce obesity and increase fertility and better function of the reproductive system.

Objective: The aim of the study was to analyze the effectiveness of the day 3 ET strategy, and the morphology of the transferred embryos, in patients from POSEIDON and non-POSEIDON groups.

Methods: 600 cycles of patients meeting the POSEIDON criteria and 600 non-POSEIDON cycles were analyzed to determine the proportion of cycles with an ET on days 3 or 5, or FET. Then we reviewed 330 day 3 ETs to compared the developmental stage, morphology, zona pellucida thickness and implantation potential of embryos transferred on day 3 from POSEIDON and non-POSEIDON patients.

Results: Most cycles of POSEIDON patients end with ET on day 3 (42%) or without transfer (37%). In contrast, most cycle of non-POSEIDON patients end with FET (44%) and just 9% is canceled. The lowest percentage of embryos at the morula stage was recorded in POSEIDON groups III (10%) and IV (9%). The average number of cells in embryos was comparable in all groups. The largest percentage of top-quality embryos (grade A) were in POSEIDON group I (47%) .The highest implantation potential were observed in the non-POSEIDON group <35Y (28%), and in POSEIDON groups I (28%) and III (26%). The highest incidence of miscarriage was recorded in all POSEIDON and non-POSEIDON groups that included patients who were ≥35 years of age.

Conclusions: The day 3 ET strategy still seems optimal for POSEIDON patients. The prognosis depends on which Poseidon group the patient is in. The best prognosis is for group I and the worst for group IV.

Objective: To compare the number and outcomes of elective fertility preservation (FP) before and after the Covid-19 outbreak.

Methods: This retrospective study of 574 women who underwent elective FP between 01/2017-12/2021 included 123 women who underwent the procedure before and 451 who underwent it after the Covid-19 outbreak. The change in the number of women who underwent the procedure each month before and after the pandemic was calculated. The ovarian stimulation outcomes were compared between the two groups.

Results: The post-Covid-19 group included significantly more single women compared to the pre-Covid-19 group (93.8% vs. 91.1%, p = 0.024). A progestin-primed ovarian stimulation protocol was followed only among the women in the post-Covid-19 group (18.8% vs. 0%, p<0.001), and their gonadotropin dose was significantly lower than that of the women in the pre-Covid-19 group (3164.6±842.87 mIU/mL vs. 3426.5±1080.63 mIU/mL, p=0.014). There were no significant group differences in ovarian stimulation duration (p=0.069), peak estradiol level (p=0.606), number of retrieved and mature oocytes (p=0.545 and p=0.364, respectively), oocyte maturity rate (p=0.719) or the number of women who cryopreserved embryos (p=0.861). High levels of basal FSH and low antral follicle counts correlated negatively with the total numbers of retrieved and mature oocytes.

Conclusions: A rapid and sustained increase in elective FP after the outbreak of the Covid-19 pandemic that significantly surpassed pre-pandemic levels was observed. There was no significant difference in FP outcomes between the two time periods.

Endometriosis is a chronic disease that affects around 10% of reproductive age women worldwide and a common cause of infertility. One of its manifestations is ovarian endometriomas, which are present in 17-44% of endometriosis patients. Endometriomas can impair fertility by mechanical stretching and local inflammation, promoting oxidative stress in the surrounding ovarian cortex that could lead to apoptosis and necrosis of early follicles. The removal of endometriomas may improve spontaneous pregnancy rates, as already demonstrated by some studies. To reduce endometriomas recurrence, it is advised to perform cystectomy followed by hormonal suppression. However, this approach is unfeasible in patients desiring pregnancy. At the same time, cystectomy poses a threat to ovarian reserve and, therefore, to controlled ovarian stimulation. Women who have endometriomas surgically removed are at risk to have diminished response to ovarian stimulation if in vitro fertilization is needed in the future.

Objective: To compare the clinical outcomes, including pregnancy rate, live birth rate, and miscarriage rate between vaginal progesterone Cyclogest suppository and Crinone vaginal progesterone gel as LPS in frozen-thawed embryo transfer in Intra-Cytoplasmic Sperm Injection (ICSI) cycles.

Methods: In this comparative retrospective chart review, 283 women who had frozen-thawed embryo transfer were assessed. The patients were divided into two groups based on the route of progesterone administration used as LPS. When the endometrial thickness reached ≥8mm, vaginal progesterone Cyclogest 400 mg/twice daily suppository was administered in one group; in another group, vaginal progesterone Crinone 8% 90 mg daily was administrated until a positive pregnancy test was confirmed. This was continued for 10-12 weeks after embryo transfer when fetal heart activity was detected by ultrasonography.

Results: The patients' characteristics in the two groups were matched and there was no significant difference. The biochemical and clinical pregnancy, miscarriage, and live birth rates were similar-4.7% vs. 2.7%, p=0.464; 26.1% vs. 23.3%, p=0.638; 13.3% vs. 9.6%, p=0.410; 15.6% vs. 16.4%, p=0.872, respectively; there was no statistically significant difference between the vaginal progesterone Cyclogest group and the Crinone progesterone group.

Conclusions: Clinical pregnancy, biochemical pregnancy, miscarriage, and live birth rates were similar between both groups. Moreover, vaginal progesterone Cyclogest and Crinone 8% gel are equally effective in providing support during the luteal phase for both blastocysts and cleavage-stage embryos in CET.

Objective: Different aspects of the functions of free fatty acid (FFA) in seminal plasma and their implications on male fertility are known. However, the profile of FFA in seminal plasma in asthenozoospermic patients following antioxidant therapy has not been studied.

Methods: In this case-control study, the total antioxidant capacity (TAC) and FFA profile of the seminal plasma were determined in 80 patients (29 normozoospermic volunteers and 51 asthenozoospermic men) who were treated with antioxidants for three months.

Results: The TAC level in normozoospermic men was significantly higher than in asthenozoospermic men before and after antioxidant therapy with even lower values after the treatment (p=0.0001). The most abundant identified FFAs in seminal plasma were palmitic acid, vaccenic acid, eicosatrienoic acid, stearic acid, and myristoleic acid. Palmitic acid was lower in asthenozoospermic patients (p=0.0001), and antioxidant treatment restored its level to near-control levels. Compared to normozoospermic controls, the level of eicosatrienoic acid is significantly lower in asthenozoospermia patients before (p=0.01) and after treatment (p=0.0001). Additionally, following oral antioxidant supplementation, the FFA pattern in asthenozoospermic patients changes to the pattern observed in normozoospermic men. However, these changes are not statistically significant.

Conclusions: The TAC level in asthenozoospermic patients after antioxidant treatment did not change to the levels in the control group; it even dropped to a lower level following three months of treatment. Antioxidant treatment can change the level of the FFA compositions of seminal plasma.