Jornal Brasileiro de Reproducao Assistida最新文献

Brazil has been facing periods of dengue epidemics for more than 40 years. Recently, the disease showed increasing numbers of diagnoses. This scenario is alarming in terms of public health, and has caused concern in specific areas of medicine, such as Assisted Reproduction. What influence does viral infection have on the success of treatments? What is the risk of acquiring the virus in the early stages of pregnancy? Various data confirm vertical transmission, although the risks are extremely low and sexual transmission of the infection seems unlikely. The aim of this article is to review the literature on the influence of Dengue infection on Assisted Reproduction treatments, with a view to advising patients who are planning to start treatment.

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: With one in ten women globally suffering from it, polycystic ovarian syndrome (PCOS) has recently emerged as one of the most common endocrine multifactorial illnesses. Each patient may not experience all the potential symptoms of PCOS, which include insulin resistance, hirsutism, acanthosis nigricans, hyperandrogenism, weight gain, etc.

Methods: Although symptomatic treatments like ovarian drilling procedures or cosmetic lotions to alleviate hirsutism do not address the underlying cause, there is still no comprehensive treatment for PCOS. It is important to take into account the psychological and occupational factors influencing the unfavourable rise in infertility.

Results: Changes in lifestyle, nutrition, prolonged diabetes medication, oral contraceptive pills, and ultimately laparoscopic surgery are obstacles to treating the syndrome. To lower the cost, time, and side effects of current treatments, polyhedral formulations must be developed in light of the aforementioned aspects. Since natural resources are being utilized widely, classes of compounds like coumarins, flavones, lignans and terpins have recently drawn the attention of researchers as a potential source of medication for therapy.

Conclusions: This article suggests a list of herbal medications that, when combined with other PCOS treatments, can be successful. These herbs may also be sufficient on their own to treat ovarian cysts naturally.

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.

This review examines the impact of Assisted Reproductive Technology (ART) on prospective parents and born children, as well as their parental relationships, considering their emotional and social context. Specific situations are analyzed, such as gynecological pathologies and heterologous treatments, such as the ROPA (Reception of Oocytes from Partner) method, and the use of gestational surrogacy, which have particular psychosocial impacts. Infertility affects approximately one-third of the global population, leading many to seek ART, which have grown in popularity over the decades. In addition to clinical concerns, the psychosocial impact of these techniques has received increasing attention, given the implications for mental health and family relationships. Based on a narrative review methodology, it analyzes experimental and observational studies on the topic, seeking to understand and evaluate the impact of ART techniques. The results highlight the emotional and ethical complexity associated with treatment decisions, from the decision to engage to these treatments to the psychosocial implications of the different available options. Anxiety and depression are common responses to the challenges faced during treatment, affecting both direct beneficiaries and their interpersonal relationships. Gestational surrogacy and heterologous treatments add layers of complexity. Regarding the impact on parental relationships and the development of children conceived through these methods, it is concluded that, despite concerns, children conceived through ART have the potential to grow and thrive as well as naturally conceived ones. This review emphasizes the importance of an inclusive and holistic approach to treating infertility, recognizing that parenthood goes beyond biological conception.´P)I?J: '+-.

Objective: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, characterized by metabolic, reproductive, and inflammatory disturbances. This study aimed to investigate the relationship between clinical features, the sonographic appearance of the ovaries, and the Delta Neutrophil Index (DNI) in women with PCOS.

Methods: This retrospective study included 60 women diagnosed with PCOS and 60 healthy controls. Clinical, laboratory, and ultrasonographic data were collected and analyzed. The Delta Neutrophil Index (DNI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and ultrasonographic parameters, including ovarian stroma/total area ratio, and ovarian volume, were compared between the groups.

Results: The study found that DNI, NLR, and PLR were significantly higher in the PCOS group compared to the control group, indicating a chronic low-grade inflammatory state. Significant differences were also observed in ovarian stroma/total area ratio, and ovarian volume between the groups. Additionally, a statistically significant relationship between acne and DNI was found in the PCOS group, while other symptoms such as infertility, hirsutism, and hair loss did not show a significant correlation with DNI.

Conclusions: This study demonstrates a clear relationship between elevated inflammatory markers and ovarian morphology in PCOS. The findings suggest that inflammation plays a significant role in the pathophysiology of PCOS, underscoring the importance of incorporating anti-inflammatory treatment strategies in the clinical management of the disease.

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.

In vitro fertilization (IVF) treatments have broadened to cover a variety of scenarios, including those involving transgender individuals or couples who wish to become parents, posing new challenges for the field of reproductive medicine. While there are limited reports of successful IVF births involving transgender men, concerns remain regarding the impact of long-term testosterone use on ovarian function, oocyte and embryo quality and IVF reproductive outcomes. This study details a case series of three trans men and cis women couples at a fertility clinic, resulting in one live birth. The couples underwent IVF with frozen blastocyst-stage embryos transferred to the cis women partners. The trans men, aged 32, 35, and 38, received ovarian stimulation with gonadotropins and dydrogesterone for pituitary suppression, and a GnRH agonist for final oocyte maturation. All had been on 250 mg of testosterone and paused treatment to resume menstrual cycles before IVF. Eggs were fertilized with donor sperm, and despite a lower-than-expected response to stimulation after short-term testosterone discontinuation, high-quality blastocysts were produced, leading to two pregnancies. Given the uncertainty regarding the long-term effects of testosterone on overall fertility, patients should be advised to consider cryopreservation before starting gender-affirming hormone therapy. Our case reports contribute to the knowledge in this area, highlighting the feasibility of oocyte collection, embryo development, pregnancies, and births in these individuals even after prolonged use of testosterone.

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: 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.