Jornal Brasileiro de Reproducao Assistida最新文献

Objective: To evaluate the impact of infertility and Medically Assisted Procreation (MAP) on female sexuality. Human sexuality presents a multifaceted complexity, shaped by diverse factors and individual intricacies. Infertility and assisted reproductive treatments entail a prolonged and arduous journey, amplifying pre-existing sexual dysfunctions and serving as a rigorous trial of the affected women's sexuality and the resilience of couples.

Methods: This is a prospective descriptive comparative study with an analytical section, involving 140 female participants: 70 with infertility undergoing assisted reproductive technology (ART) treatment, and 70 who are fertile and had no prior history of conceiving problems. The evaluation of the sexual function of the two groups was conducted using the Female Sexual Function Index (FSFI) score.

Results: The infertile group exhibited a higher level of marital adjustment compared to the fertile cohort. A majority of participants within the infertile cohort (51.4%) presented with primary infertility and (48.6%) experiencing secondary infertility. A marginal elevation in the frequency of sexual intercourse among infertile participants was observed. The mean global score of female sexual function was (21.57±3.36) in the infertile group, which was significantly lower compared to (24.46±1.97) in the fertile group. Notably, both scores fell within the criteria for high risk of sexual dysfunction. The difference between the two groups was significant for all dimensions of FSFI.

Conclusions: Infertility and its treatments pose challenges to female sexuality, often leading to sexual dysfunction. Thus, counseling and sexological support are crucial during treatment.

Objective: To determine the carrier frequency of X-linked and autosomal recessive diseases in patients attending a human fertility institute in Colombia.

Methods: This retrospective observational study included patients and gamete donors attending a Human Fertility Institute in Colombia between January 2017 and June 2023. Sociodemographic data and results of Next Generation Sequencing laboratory panels for screening of recessive disease-causing mutations were collected and analyzed.

Results: Data from 746 samples were analyzed; 599 (80.3%) were Colombian origin individuals and 147 (19.7%) were foreigners. At least one mutation was detected in 526 (70.5%) individuals. Of note, 893 pathogenic genetic variants were identified.The genetic variants most frequently observed in all the individuals studied were associated with the following diseases (carrier frequency): alpha thalassemia (10.5%), alpha-1 antitrypsin deficiency (10%), congenital adrenal hyperplasia due to 21-hydroxylase deficiency (9.4%), cystic fibrosis (7.3%), spinal muscular atrophy type 1 (5.6%) and Stargardt disease type 1 (5.0%). The most frequent genetic variant observed in the subgroup of Colombian origin individuals was associated with alpha-1 antitrypsin deficiency (11.3%).

Conclusions: Information on the frequency of recessive diseases in Colombia is limited. This pioneering carrier genetic screening identified a high percentage of carriers for at least one recessive autosomal or X-linked in the population evaluated. Screening for recessive mutations could lead to an evolution in family planning programs and a decrease in the number of patients affected by recessive disorders. Furthermore, it could become a routine test not only in cases of assisted reproduction but also in cases of natural gestation.

Hypopituitarism is the inability of the anterior pituitary gland to properly supply the hormone levels. When this disease affects all the hormones produced by the anterior pituitary, it is called panhypopituitarism (PHP). Since pituitary-derived hormones directly influence fertility, often the assisted reproduction techniques are the only option to PHP women have a full-term pregnancy. However, not all patients diagnosed with PHP properly respond to ovulation induction. Thus, a poor response may indicate decreased ovarian reserve or reflect a deficiency in other key components of ovarian function. Here we presented a rare case of a 24-year-old woman diagnosed with PHP and poor response to previous gonadotropin therapy. In our protocol the patient received first growth hormone (GH) replacement for 5 months before starting gonadotropins. When the serum IGF-I (insulin grow factor-I) level normalized, she started ovulation induction with 225 IU/day of human menopausal gonadotropin (hMG). After the ninth day of the cycle, ultrasounds were performed every 2 days to control follicular growth. The puncture of the follicles was performed on the twentieth day of the cycle and a surprising number of 13 oocytes were collected. The oocytes were fertilized by the classical IVF method, resulting in 11 D3 embryos, of which 2 were freshly transferred. Beta hCG hormone levels were determined, and a single fetus pregnancy was confirmed. The birth was by cesarean section at 38 weeks of gestation. Therefore, we conclude that GH/gonadotropin association in ovarian stimulation may improve the follicular recruitment in PHP patients.

Objective: To investigate the effects of five coital lubricants including KY jelly, Durex, Pre-seed, Vaseline, and Baby oil on sperm motility and vitality.

Methods: Raw semen samples from 20 normozoospermic donors were incubated in vaginal fluid simulant (VFS) controls and a 10% concentration of KY jelly, Durex, Pre-seed, Vaseline, and Baby oil. The sperm motility and vitality were evaluated immediately after mixing (0 minutes) and at 30 and 60 minutes.

Results: Sperm motility significantly decreased immediately after mixing in all coital lubricants. Pre-seed demonstrated sperm parameters comparable to VFS at any incubation time. KY jelly, Vaseline, and Baby oil reduced the progressive sperm motility at a certain time, both 30 and 60 minutes in KY jelly, at only 30 minutes in Baby oil, and at only 60 minutes in Vaseline. Durex showed a significant decrease in sperm motility at any incubation time and significantly deteriorated sperm vitality at 60 minutes while other lubricants did not affect sperm vitality.

Conclusions: Pre-seed was the coital lubricant that had the least negative effect on sperm. It can be an appropriate coital lubricant for the couple who are trying to conceive when lubricant is indicated. In contrast, KY jelly and Durex are the coital lubricants that should be avoided, especially Durex which had the worst effect on both sperm motility and vitality.

Objective: To develop and evaluate the effectiveness of a 3D-printed prototype to hold semen straws during the freezing process under safe and reproducible conditions.

Methods: A prototype capable of holding ten straws in liquid nitrogen vapor (LN2) was 3D printed. A second support that is commonly used was assembled from pieces of expanded polyethylene (EPS), respecting the identical distance between the straws and the LN2 surface. Temperatures were registered with a thermocouple placed inside a straw. Semen samples were frozen in the presence of cryoprotectant using the prototype (n=20) and the EPS support (n=20) in two independent series of measurements. Sperm parameters (motility, vitality, and DNA fragmentation) were measured for fresh and frozen-thawed samples.

Results: The temperature cooling curves measured on the prototype were remarkably reproducible. The prototype material withstood over 300 freezing cycles without damage. The mean motility and vitality of fresh (64.2%, 72.0%) and frozen-thawed (25.7%, 38.8%) samples were significantly different (p<0.001) using either support. Recovery rates of motility, vitality, and sperm DNA fragmentation in frozen-thawed sperm samples were equal regardless of straw position on the prototype or support type used.

Conclusions: The developed device allows a homogeneous, quantifiable, reproducible cooling of the straws in liquid nitrogen vapor. The recovery rates are comparable to those reported in the literature for both tested supports. The designed 3-D printed prototype favors the safe handling of the straws, an explicit way of describing freezing conditions, and a better intra-operator and inter-laboratory reproducibility of the cryopreservation process.

During human in-vitro culture, morphological microscope analysis is routinely used to select embryos with the highest implantation potential for transfer, aiming for successful pregnancy and healthy live birth. This evaluation includes blastomere number, size, fragmentation, multinucleation, blastocyst (BL) expansion, and the inner-cell mass and trophectoderm appearance. However, this method requires removing embryos from the incubator, exposing them to non-physiological conditions such as fluctuations in pH, temperature, gases concentrations, as well as significant inter-observer variability. Continuous embryo culture using time-lapse monitoring (TLM) has revolutionized embryo evaluation by allowing continuous, real-time tracking of embryo development from fertilisation to blastocyst formation. This reduces the need to remove embryos from the incubator and helps maintain stable culture conditions. The monitoring system typically includes a standard incubator with an integrated microscope coupled to a digital camera, capturing images at regular intervals that are processed into a video for analysis. Despite its advantages, accurately predicting implantation rates in humans remains challenging. Recently, artificial intelligence (AI) has emerged as promising tool to objectively evaluate human embryos. AI can analyse large datasets, including embryological, clinical, and genetic information, and assist in individualizing treatment protocols. Integrating AI with TLM could improve embryo selection and enhance overall success rates. This paper explores the potential benefits of combining TLM and AI in reproductive and embryology laboratories, highlighting their potential to improve the outcomes of human ART.

Research question: What are the trends and impact of new technologies on the effectiveness and safety of assisted reproductive technology (ART) performed in Latin America during 2021?

Design: This was a retrospective collection of cycle-based multinational data obtained from ART procedures performed by 204 accredited institutions in 16 countries.

Results: In total 127,351 initiated cycles resulted in 20,032 deliveries and 22,708 births. ART utilization showed great variability, from 623.5 cycles/million inhabitants in Uruguay to fewer than 35 in Guatemala and El Salvador. The proportion of women aged ≥40 years increased to 35.8%, while that of women ≤34 years dropped to 23.9%. Nonetheless, the proportion of single-embryo transfers (SET) increased from 11.9% in the previous decade to 42.4% in 2021. Of 22,708 babies born, 76.8% were singletons, 22.3% twins and 1.0% triplets or more. Intracytoplasmic sperm injection represented 84.5% of fertilization techniques, and blastocyst transfer increased from 49.6% in 2016 to 79.3% in 2021. The delivery rate after fresh blastocyst elective SET was significantly higher than after the transfer of one frozen embryo from a freeze-all cycle (p<0.0001). The number of aspirations leading to preimplantation genetic testing has increased 2.8 times in 5 years and significantly increased delivery rates/transfer at all ages, including in oocyte donation (p≤0.002), and reduced miscarriage in women ≥35 years old. In oocyte donation, delivery rates after the fresh transfer of embryos from vitrified-warmed oocyte cycles generated similar outcomes to frozen embryo transfer. Perinatal mortality increased from 7.7 ‰ in singletons to 21.3 ‰ in twins.

Conclusions: The systematic collection of cycle-based multinational data contributes to cooperative sustained development and helps implement evidence-based reproductive decisions.

Objective: There is a rising demand for assisted reproductive medicine, including sperm, oocyte and embryo donation. Besides medical and legal considerations, genetic testing, including carrier screening for multiple autosomal and X-linked recessive disorders plays an essential role in evaluating hereditary risk among donors and therefore exclude them from the donation process.

Methods: A retrospective study was conducted on oocyte donors from a private clinic of assisted reproduction who underwent genetic testing between June 2014 and September 2023. Pre and post-test procedures were performed at the private clinic while karyotyping and carrier screening for Cystic Fibrosis, Fragile X syndrome and Spinal Muscular Atrophy were performed at the Genetic Unit of Faculty of Medicine, University of Porto.

Results: Among 581 donors, 81 women were excluded from the donation process since 5/563 had an alteration in karyotype, 57/581 were carriers of a Cystic Fibrosis Transmembrane conductance Regulator pathogenic variant or had a 5T allele, 11/394 had Survival of Motor Neuron 1 deletion and 8/426 had an intermediate or premutation allele in Fragile X Messenger Ribonucleoprotein gene. While recommendations from fertility societies advocate for comprehensive screening, opinions differ on the mandatory implementation of expanded carrier screening.

Conclusions: In conclusion, the genetic tests and the pre and post-test counseling is imperative to optimize reproductive outcomes in the oocyte donation process.

Objective: This study aimed to explore the potential protective effects of adipose-derived mesenchymal stem cell secretome (ASE) on oxidative stress triggered by Bisphenol-A (BisA) exposure in testicular mitochondria and sperm quality of rats.

Methods: Testicular tissue mitochondria and sperms were exposed to BisA (8 μM) and ASE (50 or 100 μg). ∆Ψm (mitochondrial membrane potential), reactive oxygen species (ROS) levels, antioxidant biomarkers, and sperm parameters were measured.

Results: BisA elevated biomarkers of oxidative stress in mitochondria, while the levels of antioxidant activity and ∆Ψm decreased significantly. BisA harmed the morphology, survival rate, and mobility of the spermatozoids. ASE lowered malondialdehyde contents and ROS generation in the mitochondria, increased ∆Ψm, and reversed sperm quality.

Conclusions: These data indicated that ASE effectively reduced BisA-induced damage to mitochondria and enhanced sperm quality by averting oxidative stress.