Jornal Brasileiro de Reproducao Assistida最新文献

Objective: To establish an interaction network for genes related to premature ovarian insufficiency (POI) and insomnia, and to identify biological processes that connect POI to the physiological clock.

Methods: Previously reported lists of genes associated to POI and insomnia were contrasted and their intersection was used as input on protein-protein interaction analyses. POI-associated genes were contrasted with gene expression markers for neural circadian control and enriched pathways among their shared content were dissected.

Results: The functional network generated from the intersection between POI and insomnia gene lists pointed to the central nervous system as the most relevant cellular context for this connection. After identifying POI-associated genes that play a role in neural circadian patterns, we observed the disruption of pathways related to the hypothalamic-pituitary-gonadal axis as the major genetic link between ovarian function and circadian neural circuits.

Conclusions: These findings highlight neurological mechanisms that support the POI-insomnia interplay.

Objective: This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect gestational outcomes in euthyroid women undergoing in vitro fertilisation.

Methods: Of 428 women who underwent in vitro fertilisation assessed in this retrospective cohort study, 212 (49.5%) underwent embryo transfer on day 5 of blastulation and 216 (50.5%) on day 6. Dichotomization based on anti-thyroid peroxidase antibodies status was also performed, with 370 (86.4%) women testing negative and 58 (13.6%) testing positive. Clinical and hormonal data and rates of clinical pregnancy, miscarriage, and live births were compared between the groups.

Results: When evaluating gestational outcomes based on the day of blastulation, a statistically significant difference was observed in clinical pregnancy rates [51.4% (day 5) vs. 40.7% (day 6); p=0.033]. However, there was no significant difference in the relative frequencies of miscarriages (p=1.000), live births (p=1.000), or preterm births (p=1.000). Using Cramer's V test, a weak association was found between the day of blastulation and clinical pregnancy outcomes (V2=10.7%; p=0.027). There were no statistically significant differences between the anti-thyroid peroxidase antibodies-negative and -positive groups in terms of clinical pregnancy rates (p=0.396), miscarriages (p=0.129), and live births (p=0.129).

Conclusions: Higher rates of clinical pregnancy were observed in women who underwent embryo transfers performed on day 5 compared to those on day 6. However, no effect was observed with gestational outcomes. Further, anti-thyroid peroxidase antibody positivity did not have a statistically significant impact on gestational outcomes.

This article reports a case of Massilia timonae, an understudied Gram-negative rod, in the culture media of an embryo produced by intracytoplasmic sperm injection into the oocyte cytoplasm. Cultivation was monitored with a time-lapse technology. Microbial contamination can cause embryo developmental arrest.

Objective: To identify the feeling of helplessness in assisted reproduction patients, along with the experience in the out patient surgical center of an assisted reproduction clinic.

Methods: A prospective study of care and psychological interventions performed in the outpatient surgical center (OSC) of the assisted reproduction clinic from January 2019 to December 2022. Patients are first seen by the nursing staff. After an interview with the anesthesiologist and the attending physician, the psychotherapist presents herself and asks consent for listening/speaking, before, during and after the procedure.

Results: 1011 interviews were performed by the psychotherapist, which correspond to 47% of 2149 OSC procedures performed in the clinic during the study period. The psychotherapist was present in 595 IVF/ICSI (60%) of 1,000 procedures and 110 from 396 oocyte cryopreservation (28%), 306 (41%) from 753 transfers. The patients' observations were written in their medical records. Relevant points were shared and discussed with the staff directly.

Conclusions: The patients' speeches addressed to the psychotherapist or to the multidisciplinary team in this environment contains the utterance of their feelings, conscious and unconscious, that affect their psyche. So, the feeling of helplessness, expressed and enunciated in the statements and conducts of patients as well as the team, may go unnoticed and not receiving the necessary care. In the OSC environment they are confronted with the reality that they would so much like to avoid, that is, to use the AR technique to achieve an unconsummated desired- pregnancy.

Objective: The primary goal of this article is to analyze whether there is still room for ovarian stimulation in poor responders prescribed the long protocol.

Methods: This retrospective cohort study analyzed the medical charts of patients seen at the Vida Centro de Fertilidade, a private fertility clinic in Rio de Janeiro, Brazil, from January 2018 to June 2023. It included poor responders described based on the Bologna criteria who were first prescribed conventional treatment with an antagonist protocol, without success, and then the long agonist protocol. Statistical analysis was performed on the Statistical Package for the Social Sciences (version 20). Comparisons of continuous variables between groups were performed with the Mann-Whitney U test or Student's t-test, as appropriate. The chi-square test was used to compare categorical variables. Statistical significance was achieved when p<0.05.

Results: We found a better response among patients on the agonist than on the antagonist protocol in terms of number of follicles larger than 14 mm on the day of trigger (3.17 versus 2.1; p<0.05), number of eggs on the day of retrieval (3.5 versus 1.37; p<0.05), number of mature eggs (2.67 versus 1.37; p<0.05), and number of embryos after fertilization on the first day of development (1.87 versus 0.8; p<0.05). This protocol's cancellation rate was slightly lower (0.03 versus 0.43; p<0.05).

Conclusions: The long protocol still yields positive results in poor responders who were previously prescribed the antagonist protocol.

With the improvement in survival and the reduction in morbidity related to sickle cell disease (SCD), aspects related to reproductive health are emerging as a priority in the care of affected people. We conducted a systematic review looking for evidence describing the functional ovarian reserve levels in women with sickle cell disease. To locate studies, a search was performed in electronic databases, in addition to preprint servers and reference lists of selected publications. Two independent reviewers searched, and the risk of bias in the selected studies was assessed using the Newcastle-Ottawa scale. 1,086 records were initially retrieved, and one article was identified after consulting the reference lists of the screened articles, only four articles met the eligibility criteria. The quality of evidence was rated very low due to the design of the studies; however, the risk of bias was considered low. These are recent studies published between 2015 and 2021, whose main methodology was a cross-sectional or case-control study. All studies reported lower anti-mullerian hormone levels in women with sickle cell disease. Although lower, anti-mullerian hormone levels were within the normal range in young women with sickle cell disease only with supportive care, in those who used hydroxyurea, a decrease in ovarian reserve was observed. support insufficient evidence support a causal relationship between sickle cell disease and reduced ovarian reserve. From anti-mullerian hormone values a trend towards lower levels in women with sickle cell disease compared to healthy women, as reported in the four studies evaluated. Studies that analyze the ovarian reserve based on imaging and biochemical parameters are an important future focus.

Objective: This study aims to investigate whether alterations in sperm DNA fragmentation rates are more frequent when Krüger strict morphology is ≥4% (normal).

Methods: The retrospective study included 132 participants from March 2020 to November 2021. Participants were divided into two groups based on the inclusion criteria: normal and abnormal Krüger strict morphology, with a mean age of 40 years. Seminal analyses were conducted following the guidelines outlined in the 6th edition of the Manual for Examination and Processing of Human Semen (2021). The sperm chromatin dispersion test was used.

Results: The results did not reveal a statistically significant difference between Krüger strict morphology and Sperm DNA Fragmentation Index correlation (p<0.05) between the normal and abnormal morphology groups (p<0.05) and in Seminal Parameters. Sperm concentration is lower when Krüger strict morphology is < 4% (abnormal) (p=0.007).

Conclusions: In conclusion, abnormal Krüger strict morphology does not have a higher predisposition to increased sperm DNA fragmentation.

Objective: To use hashtag and content analysis to determine the prevalence, authorship, and types of fertility-related and oncofertility information shared on Instagram in Brazil.

Methods: Eleven fertility-related hashtags were chosen according to https://www.tagsfinder.com/: #infertility, #ivf, #endometriosis, #tryingotconceive, #maternity, #humanreproduction, #pregnancy, #invitrofertilization, #assistedreproduction, #pregnant, #difficulttogetpregnant. For oncofertility, the hashtags were #cancerandpregnancy, #oocytecryopreservation), #oncofertility, and #fertilitypreservation. Posts receiving over 20 comments in March 2021 were analyzed for topic and content. They were divided into six categories (educational, patient experience, outreach, emotional, social support, and coping mechanisms) before being analyzed by three authors. Authorship was divided into healthcare professionals (HCP) and lay people (LP). Posts not written in Brazilian Portuguese, videos, reposts of another account, and commercial posts were excluded.

Results: A total of 220 posts with fertility-related terms were analyzed. HCP accounted for 52% (n=114) and LP for 48% (n=106). Most HCP posts were made by medical doctors (n=78; 68.4%) and fertility clinics (n=27; 23.6%). Authorship analysis (HCP vs. LP) for each hashtag was as follows: #infertility (35% vs. 65%), #ivf (35% vs. 65%), #endometriosis (45% vs. 55%), #tryingtoconceive (65% vs. 35%), #maternity (LP 100%), #humanreproduction (20% vs. 80%), #pregnancy (95% vs. 5%), #invitrofertilization (50% vs. 50%), #assistedreproduction (5% vs. 95%), #pregnant (85% vs. 15%), #difficulttogetpregnant (5% vs. 95%). The category breakdown was as follows: 39% educational, 19% emotional, 16% social support, 13% patient experience, 9% coping, and 4% outreach. A total of 98 posts with #oncofertility were retrieved. Most (77.5%; n=62) were written by HCP. They fell into the following categories: 55% educational, 15% patient experience, 12.5% emotional, 11.2% support, and 3.2% coping.

Conclusions: Both HCP and LP write about major fertility topics on Instagram. Oncofertility appears to gain less attention. In Brazil, educational content, followed by emotional content, prevails on Instagram.