Jornal Brasileiro de Reproducao Assistida最新文献

Objective: Improvements in oocyte culture conditions may enhance oocyte maturation rates. PVA has been used in tissue engineering scaffolds to provide suitable strength and adhesive properties to support cell adhesion and proliferation. The aim of the present study was to test a three-dimensional PVA matrix for human rescue oocyte maturation.

Methods: Immature human oocytes and cumulus cells were obtained from patients undergoing conventional IVF cycles. Firstly, two replicates of cumulus cells exposed to PVA-BTCA matrices were performed to assess a possible cytotoxic effect of the matrix. Next, a total of 23 immature oocytes and respective cumulus cells were split between the control and PVA-BTCA-containing culture system for rescue IVM, at 38oC and 5%CO2.

Results: Cumulus cells exposure to PVA matrix allows for cell survival and adhesion to the substrate, confirming its non-toxicity. The overall maturation rate in the PVA-BTCA culture system was 66.6% (n=10/15): 77.7% of VG (n=7/9) and 50% (n=3/6) of MI oocytes reached MII. The control culture received 8 VG oocytes, of which 37.5% (n=3) reached MI and 62.5% reached MII (n=5).

Conclusions: PVA-BTCA-containing culture system may represent an alternative for human oocyte maturation procedures.

Objective: The number of cycles performed with egg donation increases every year. In Brazil, between 2020 and 2023, 3.754 pregnancies were obtained with the aid of egg reception. The main objective of this study was to evaluate the emotional impact and psychological aspects involving treatments with heterologous oocytes.

Methods: Data was collected between January 2021 and December 2022. In total 39 receptors answered the questionnaire.

Results: All of them had partners with an average of 10.6 years of relationship (SD±5.7) and a mean of 5.3 years trying to conceive (SD±3.0). For 55.2% egg donation was a good treatment option, 31.5% thought it was a difficult decision at first but accepted it well later and 13.1% only accepted because they had no other option. Regarding reported emotions, 58.9% of participants felt calm even though 64.1% also felt anxious. In addition, 62.1% considered it important for their child's pediatrician or doctor to know that conception took place through egg donation and 67.5% agreed at least in part that it was important to tell their child how they conceived.

Conclusions: The study showed that most patients accepted egg donation as a good treatment option. Feelings such as anxiety and tranquility were presented in most patients, reflecting the variety of emotions concurrent with this process. The dilemma of whether to tell their offspring about their genetic origin was presented, in agreement with previous studies.

Objective: Many women presenting for treatment with donor sperm have never attempted conception, and are therefore presumed fertile. With no clear guidelines, treatment can be influenced by factors like patient age and costs. We aimed to explore fertility physicians' attitudes and clinical practices regarding donor sperm treatments through a global survey.

Methods: We conducted an anonymous international web-based survey of fertility clinicians. The survey addressed various aspects of donor sperm treatment in women without previous infertility.

Results: A total of 211 clinicians participated, with 63% working in private settings. The survey presented clinical scenarios for women aged 32, 37, and 40. Most clinicians (80%) recommended artificial insemination with donor sperm in a natural cycle (NC-AID) as the first-line treatment for a 32-year-old woman (52% suggested up to 3 cycles, 28% up to 6 cycles). This approach was favored by 45% for a 37-year-old and 25% for a 40-year-old. Variability was noted regarding the second-line treatment for a 32-year-old after one failed NC-AID varied (equal recommendations for ovarian stimulation with oral agents, gonadotropins, or IVF). For older women, active management was preferred: 24% recommended gonadotropins and 15% IVF for 37-year-olds, and 16% gonadotropins and 55% IVF for 40-year-olds.

Conclusions: This survey highlights the controversy surrounding the optimal approach for women with no history of infertility seeking to conceive with donor sperm. Our findings emphasize the need for further research and the development of comprehensive guidelines in this area.

The study investigates artifacts in Next-Generation Sequencing (NGS) used for Preimplantation Genetic Testing for Aneuploidy (PGT-A) and their contribution to the high rates of mosaicism reporting. Modern PGT-A can detect mosaicism by analyzing copy number variations (CNVs) in embryonic biopsies, yet distinguishing true mosaicism from artifacts remains challenging. In a cohort of 22 embryos, NGS profiles revealed recurring artifacts on chromosomes 7, 11, 16, and 19. These artifacts likely result from errors in DNA amplification for NGS library preparation, potentially leading to false mosaicism diagnosis. The study utilized DNA extracted from trophectoderm biopsies, spent culture media, and whole blastocyst samples, with CNV analysis performed using BlueFuse Multi software. Quality control parameters such as DLR noise, read count, and quality score were considered, confirming that technical inconsistencies contribute to the observed artifacts. Findings align with prior research, suggesting the need for improved NGS protocols to minimize these errors. Enhanced internal validation and adoption of new technologies could reduce false-positive rates and improve clinical decision-making in PGT-A.

Objective: Emotional stress leading to cortisol release is an important infertility factor in females. Increased cortisol levels can significantly affect tight junction proteins and dysregulate the implantation process. This study investigated the effect of exogenous synthetic Cortisol (Hydrocortisone) on the expression of specific genes encoding several junctional proteins in the endometrial epithelial cells.

Methods: Following endometrium sampling from 25 participants, the biopsied tissue was digested and filtered through a cell strainer to prepare endometrial epithelial cells. After confluency, cells were treated with 50, 100, and 200 nM hydrocortisone concentrations and incubated for 24, 48, and 72 hr with repeated treatments every 24hr. qPCR analysis of 4 tight junction genes, including CLDN3, CLDN4, ZO-1, DSG1, and CDH1 was performed. Gene expressions were reported using a relative quantification method.

Results: Higher tight junction gene expression was evident at higher concentrations of Hydrocortisone. A significant increase in expression of CLDN3, CLDN4, ZO-1, DSG1 and CDH1 was observed at 100 nm concentrations of Hydrocortisone compared with the control group during different treatment durations.

Conclusions: In conclusion, Hydrocortisone treatment (at 100 nm concentration) significantly increased the expression of tight junction genes, suggesting that the blastocyst cannot infiltrate the endometrium readily, thus preventing implantation. Glucocorticoids can disrupt implantation by influencing tight junction molecule expression. Thus, the physicians must further investigate the effect of glucocorticoids treatments on implantation.

This systematic review and meta-analysis aimed to evaluate the benefit of GnRH agonist (GnRHa) in reproductive outcomes among women with adenomyosis undergoing IVF. The utility of GnRHa protocols for controlled ovarian stimulation (COS) and fresh embryo transfer, and the pretreatment with GnRHa before frozen-thawed embryo transfer were evaluated. The search spanned studies published in MEDLINE and Embase databases up to April 2024. Eight retrospective studies were included. The use of long GnRHa and antagonist protocol before COS exhibited significantly higher implantation rate compared to ultra-long GnRHa (OR 1.1, 95% CI 0.69-1.77 and OR 1.98, 95% CI 1.04-3.75, respectively), although no significant differences were observed in clinical and live birth rates. However, antagonist compared to long GnRHa protocol before COS improved live birth rate (OR 2.59, 95% CI 1.03-6.52). Pretreatment with GnRHa before FET among women with adenomyosis did not improve reproductive outcomes. In conclusion, there is no evidence regarding benefit of long or ultra-long GnRHa protocol before COS or before FET among women with adenomyosis undergoing IVF. In fact, the use of long GnRHa seem to worsen reproductive outcomes compared to antagonist protocols. Prospective trials are needed to assess the potential benefit of GnRHa among women with adenomyosis seeking fertility.

Objective: Salpingectomy has been one of the most performed surgical procedures in gynecological practice worldwide. Common indications include ectopic pregnancy and salpingitis (for example symptomatic hydro or pyosalpinx). This rising trend in salpingectomy has been associated with a rising concern over its potentially damaging effect on ovarian reserve due to possible concomitant damage of ovarian blood supply given the proximity of tubal and ovarian arteries.

Methods: This is a prospective cohort Study including eighty cases of infertile women with a previous unilateral or bilateral hydro salpinx and indicated for salpingectomy or tubal ligation attending the outpatient clinic at assisted reproduction unit, Al-Azhar University. The results were obtained in the period from February 2020 to December 2022.

Results: The present study was conducted on 80 patients. The mean and (SD) values for age were 25.5 (5.2) years old with a minimum of 18 and a maximum of 34 years old. More than half of patients (58.8%) had bilateral Hydrosalpinx while 41.2% had unilateral hydrosalpinx. Whether preor post-operatively, there was no statistically significant difference between median number of antral follicles in patients with unilateral and bilateral hydrosalpinx. There was no statistically significant change in the mean of AMH levels post-operatively (p-value=0.147, effect size=0.035) in both unilateral and bilateral groups. There was no statistically significant change in median number of Antral follicles post-operatively (p-value=0.456, Effect size=0.167) in both unilateral and bilateral groups.

Conclusions: The unilateral and bilateral salpingectomy in patients with normal ovaries has no detrimental effect on ovarian reserve.

Objective: It has been observed that faster developmental kinetics are linked with a higher number of embryo cells, improved blastocyst development, and increased rates of implantation and pregnancy. However, the embryonic morphokinetics' predictive value for biochemical pregnancy (BP) outcomes has been minimally investigated. The objective of this study was to investigate whether embryos leading to BP behave morphokinetically differently than those leading to positive or negative pregnancy result.

Methods: This case-control study performed in a private university-affiliated IVF center, included 1248 transferred embryos from 753 women undergoing ICSI cycles between March 2019 and April 2022. Patients were split into three groups according to the pregnancy outcome: Biochemical Group (n=30 cycles/54 transferred embryos), consisting of patients with a BP; Positive Group (n=255 cycles/444 transferred embryos), consisting of patients with a positive pregnancy result (clinical pregnancy); and Negative Group (n=468 cycles/750 transferred embryos), consisting of patients with a negative pregnancy result. Kinetic markers from the point of insemination were recorded in the EmbryoScope incubator.

Results: Embryos resulting in BP behaved similarly to those embryos resulting in a clinical pregnancy. Embryos resulting in a negative pregnancy showed significantly slower embryo development and KIDScore ranking compared to both Biochemical and Positive groups.

Conclusions: Embryos that resulted in a BP did not display evidence of abnormal morphokinetics on time-lapse imaging. Further research is needed to identify factors that can predict and prevent biochemical pregnancy.

Objective: To explore whether post-embryo transfer (ET) air travel affects in vitro fertilization (IVF) outcomes, addressing the growing concern in medical tourism where patients frequently travel for fertility treatments.

Methods: This retrospective study was conducted at a private fertility clinic in São Paulo, Brazil, and included 2,135 embryo transfers performed between January 2019 and March 2022. Patients were divided into two groups: individuals who presumably traveled by airplane after ET (Group 2) and those who did not (Group 1). Data were analyzed for demographics, embryo transfer characteristics, and IVF outcomes. Relative risk was estimated using Poisson regression models, adjusting for age and treatment reasons. Significance was set at p<0.05.

Results: 17.94% of patients traveled by plane post-ET. No significant differences were found between the groups in terms of pregnancy (Group 1: 61.99%, Group 2: 62.14%, p=0.94), implantation (Group 1: 34.58%, Group 2: 38.65%, p=0.28), or miscarriage rates (Group 1: 28.51%, Group 2: 32.50%, p=0.32). A sub-analysis of single embryo transfers and top embryos also showed no statistical differences.

Conclusions: Post-ET air travel did not negatively impact IVF treatment outcomes. Further prospective studies are recommended to confirm these findings.

Objective: This article reports the case of a healthy nulliparous woman, 34 years old, weighing 70 kg with a BMI of 23.67 kg/m2, who was using an ENG 68 mg implant for contraception and was experiencing amenorrhea. She presented with 19 antral follicles on initial ultrasound (US) and desired social fertility preservation. Follicular phase controlled ovarian stimulation (COS) was initiated with the administration of corifollitropin alfa (CFA) 150μg on day 1, followed by an overlapping dose of CFA 100μg on day 5. US monitoring began on the ninth day of stimulation, and a trigger shot with recombinant chorionic gonadotropin (rhCG) 250μg was administered on day 11 when six follicles measured ≥16 mm. Follicular aspiration (FA) occurred 36 hours later, resulting in the retrieval of 13 oocytes; 11 were metaphase II (MII) and were vitrified. Luteal phase COS began one day after the first FA, using CFA 150μg. The trigger was administered again on day 11, with rhCG 250 μg, when eight follicles were ≥16 mm, followed by FA 36 hours later, resulting in the retrieval of six MII oocytes, all of which were vitrified. Our report is the first to highlight that a woman attempting fertility preservation while using an ENG implant for contraception may benefit from LH suppression during COS. Additionally, it proposes a novel protocol that applies CFA in overlapping doses, aiming for comfort and lower cost.