Jornal Brasileiro de Reproducao Assistida最新文献

Objective: To explore the knowledge concerning the impact of age on fertility in Thai women among fertile and subfertile women.

Methods: A cross-sectional study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand. The questionnaires consisted of sociodemographic questions and knowledge pertinent to the impact of age on fertility. Both fertile and subfertile women completed the same questionnaire anonymously.

Results: A total of 500 women were included in the study, with two hundred and fifty in each group. The majority of women in both the fertile and subfertile group correctly identified the most fertile age of women (84.8% vs. 84.4%, p=0.902) and the impact of age on infertility treatment (73.2% vs. 84.0%, p=0.003). However, only one-fifth of the participants in both groups correctly identified the age that their fertility starts to decline, show a marked decline and ends. Most women in both groups chose the answer that overestimates their fertility potential. Moreover, 10.8% of subfertile women believed that fertility is not dependent on age and 16.0% believed that age does not affect the success rate of infertility treatment.

Conclusions: The overall knowledge of women regarding the impact of age on fertility is relatively poor with no difference between fertile and subfertile women. These findings may indicate an urgent need to increase this area of knowledge in the population.

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder with the underlying consequence of ovarian cysts, anovulation, and endocrine variation affecting women. According to the World Health Organization (WHO) estimation over 116 million women (3.4%) are affected by PCOS worldwide. It is typified by polycystic ovaries, hyperandrogenism, and ovulatory dysfunction. Pharmacological interventions that treat symptoms but may have fewer side effects are frequently used in conventional treatments. As a result, interest in herbal medicinal plants and formulations as additional or alternative PCOS therapies is developing. This review explores the safety and efficacy of various herbal remedies traditionally used in the management of PCOS. Each of the herbs mentioned in this review offers unique benefits. This review gives a comprehensive idea about PCOS, its causes and symptoms. It also explores formulations like capsules, tablets, syrups, and nano drug delivery system medicines for PCOS. According to studies, these herbal medicines can improve insulin resistance, lower testosterone levels and restore menstrual regularity while causing fewer negative effects than conventional therapy.

Objective: Frozen embryo transfer in humans, especially at the blastocyst stage, provides a valid alternative to fresh embryo transfer. However, protocols for blastocyst vitrification are not yet standardized; for example, exposure to the first equilibration solution before vitrification commonly ranges from 2-3 minutes at 37°C or 2-15 minutes at room temperature. This study compared the clinical and neonatal outcomes involving vitrified-warmed blastocysts.

Methods: The main aim of this prospective study was to compare the clinical and neonatal outcomes for 831 warmed blastocysts, returned in 585 frozen embryo transfers with two exposure times to the equilibration solution at room temperature: (A) 7-8 minutes and (B) 9-10 minutes.

Results: The patients' characteristics were comparable between the two groups with no significant difference in their mean age, the average number of blastocysts transferred, basal Follicle Stimulating Hormone, body mass index (BMI), infertility duration, primary infertility, or endometrial thickness. The survival and clinical pregnancy rates of the vitrified-warmed laser collapsed blastocysts were not different between the two groups. The overall miscarriage rate was significantly lower in the 7-8 minute compared to the 9-10-minute equilibration group (A: 7.6% versus B: 14.2%, p<0.05). Live birth, multiple gestation and neonatal outcomes were similar between the two groups.

Conclusions: Our results indicate that the equilibration time can affect the efficiency of the cryopreservation process of human blastocysts.

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.

Selective Serotonin Reuptake Inhibitors are the most prescribed class of medications in cases of depression. This article discusses the main findings on their effects on male fertility, considering semen parameters and sperm function. This systematic review of the literature delves into the adverse effects of the main SSRIs on male fertility. The software package PRISMA was used to organize the search using keywords related to the research question. The search yielded a total of 125 studies. After the abstracts were read, 18 articles were selected for further analysis. The review ultimately included ten articles about the adverse effects of this class of antidepressants on male fertility, which included decreases in serum testosterone levels, reduced sperm production, decreased sperm reserves in the epididymis, and increased sperm transit time in the tail of the epididymis. The articles included in this review indicated that this class of antidepressants may have adverse effects on male fertility. However, a randomized clinical trial is needed to evaluate the mechanisms of spermatogenic failure and the underlying causes of these effects.

Objective: To evaluate Dydrogesterone's effectiveness in PPOS protocols for IVF/ICSI or oocyte cryopreservation, focusing on LH surge suppression and metaphase II oocyte yield.

Methods: A retrospective, comparative, single-center study of 550 IVF/ICSI and 186 oocyte cryopreservation cycles was conducted from January 2018 to December 2020. Exclusion criteria included endometriosis, previous ovarian surgery, ovarian insufficiency, and abnormal FSH/LH levels. Patients received either Follitropin delta (Rekovelle®) or Menotropin (Menopur®). LH surge blockade was achieved with GnRH antagonist (Cetrotide®) or DYG (Duphaston®). Primary outcome was incidence of premature LH surge; secondary outcomes included follicle size on hCG day, metaphase II oocytes, cancelled cycles, and OHSS. ANCOVA analyses were used, with partial squared Eta as the effect size index.

Results: Premature LH peak with early follicular rupture occurred in 2 cases in Group 1 (Ant) and 3 cases in Group 2 (DYG), without statistical significance. LH levels on trigger day showed no difference (Ant: 2.63 - SD 1.15 vs. DYG: 2.47 - SD 1.22). Oocyte maturation at metaphase II (MII) stage was similar (6.28 - SD 4.72 vs. 6.71 - SD 4.53). Follicle size differed: fewer follicles ≥ 18 mm in Ant group (3.33 - SD 2.06 vs. 4.19 - SD 2.53; p=0.001), but more 15-17 mm follicles (p=0.024). No moderate to severe OHSS occurred in patients with AMH >3 ng/mL.

Conclusions: DYG is an eligible tool for IVF/ICSI cycles intended to freeze-all and oocyte preservation, embryo banking, and preventing OHSS in patients with high AMH levels.

Objective: To examine the impact of PRDL on mouse oocyte developmental competence.

Methods: This study was conducted on 6-8-week-old female Swiss albino mice in which different doses of PRDL were administered for three days during superovulation. Oocytes were assessed for quality, and subsequently, embryos derived from these oocytes were evaluated at the blastocyst stage. Simultaneously, oocytes were also exposed to PRDL during in vitro maturation and examined for their spindle and activation potential.

Results: Compared to control group, the total cell number of blastocysts in the PRDL group increased. Nevertheless, the incidence of apoptosis was comparable between the groups. However, direct exposure at 10 µM significantly increased spindle abnormalities compared to those in the control group (p<0.05).

Conclusions: Short-term PRDL exposure at a therapeutic dose is not detrimental to oocyte developmental potential in vitro. Although the current study confirmed the safety of PRDL in a mouse model, further studies involving long-term exposure are warranted, as patients receive PRDL treatment for extended periods of time.

Objective: Clinical validation of sperm selection device ZyMōt™ for standard IVF.

Methods: The pre-clinical validation of ZyMōt™ included several steps. First, split semen preparation compared density gradient centrifugation (DGC) to ZyMōt™ with primary outcome fraction and absolute number of progressive motile sperm. Second, sibling oocytes were fertilized with sperms prepared with DGC and sperms selected by ZyMōt™, primary endpoint fertilization rate, utility rate, embryo development pace quality. After this, DGC was replaced by ZyMōt™, first without centrifugation steps, and then with a five-minute centrifugation step and subsequent media change prior to gamete co-incubation. Endpoint was assessment of key performance indicators against previous results using DGC for standard IVF.

Results: ZyMōt™ resulted in purer sperm selection compared to DGC (fraction progressive motile sperm 97.2±3.1% vs. 83.0±14.1%, p<0.01). Fertilization of sibling oocytes resulted in similar fertilization rates and utility rates, and no differences in embryo development pace or quality. However, after changing sperm selection protocol from DGC to ZyMōt™ for standard IVF for all fresh semen samples with motile sperm, the fertilization rates and utility rates were significantly reduced, and cases of total failure of fertilization increased substantially. Adding five-minute centrifugation and media change after centrifugation to the sperm selection protocol restored fertilization rate, including total failure of fertilization rate, to normal.

Conclusions: To conclude, the ZyMōt™ sperm selection device is suitable for standard IVF only after inclusion of five minutes centrifugation and subsequent media change prior to gamete co-incubation.

Gestational trophoblastic diseases (GTD) comprise a heterogeneous group of disorders arising from genetic anomalies occurring during fertilization in twin pregnancies and often may be associated with assisted reproductive techniques. An exceedingly rare presentation of GTD is a twin pregnancy hydatidiform mole with a co-existing fetus, condition which may be an important cause of complications for the mother and the fetus. A 36-year-old woman (G2, P0, A1) underwent a friendly controlled ovarian stimulation (COS) followed by intrauterine insemination (IUI) for assisted reproductive purposes, resulting in a twin pregnancy initially characterized by two gestational sacs. However, one sac failed to progress and instead degenerated into molar trophoblastic disease, while the other sustained a normal fetus with regular growth. At 33 weeks gestation, the patient developed preeclampsia, necessitating delivery via cesarean section at a tertiary care facility. Reproductive-assisted procedures may be linked to cases of trophoblastic disease. Additionally, the presence of cystic lesions warrants a wide differential diagnosis, with magnetic resonance imaging serving as a valuable tool for accurate assessment and differentiation of structures.