Jornal Brasileiro de Reproducao Assistida最新文献

Objective: To compare the clinical outcomes, including pregnancy rate, live birth rate, and miscarriage rate between vaginal progesterone Cyclogest suppository and Crinone vaginal progesterone gel as LPS in frozen-thawed embryo transfer in Intra-Cytoplasmic Sperm Injection (ICSI) cycles.

Methods: In this comparative retrospective chart review, 283 women who had frozen-thawed embryo transfer were assessed. The patients were divided into two groups based on the route of progesterone administration used as LPS. When the endometrial thickness reached ≥8mm, vaginal progesterone Cyclogest 400 mg/twice daily suppository was administered in one group; in another group, vaginal progesterone Crinone 8% 90 mg daily was administrated until a positive pregnancy test was confirmed. This was continued for 10-12 weeks after embryo transfer when fetal heart activity was detected by ultrasonography.

Results: The patients' characteristics in the two groups were matched and there was no significant difference. The biochemical and clinical pregnancy, miscarriage, and live birth rates were similar-4.7% vs. 2.7%, p=0.464; 26.1% vs. 23.3%, p=0.638; 13.3% vs. 9.6%, p=0.410; 15.6% vs. 16.4%, p=0.872, respectively; there was no statistically significant difference between the vaginal progesterone Cyclogest group and the Crinone progesterone group.

Conclusions: Clinical pregnancy, biochemical pregnancy, miscarriage, and live birth rates were similar between both groups. Moreover, vaginal progesterone Cyclogest and Crinone 8% gel are equally effective in providing support during the luteal phase for both blastocysts and cleavage-stage embryos in CET.

Objective: Many cancer survivors may experience irreversible infertility due to chemotherapy treatment for childhood cancer. In this study, spermatogenesis development was evaluated following the grafting of fresh and frozen-thawed testicular tissue from neonatal mice to the epididymal fat of adult mice.

Methods: After bilateral castration of recipient mice, fresh or frozen-thawed neonatal testis tissues were grafted into the epididymal fat of the mice. Grafted testicular tissue was evaluated eight weeks after implantation using H&E staining, real-time PCR, immunofluorescence staining, and TUNEL assay. Blood was drawn from recipient mice to determine testosterone, FSH, and LH levels.

Results: A gradient of different types of germ cells, from spermatogonia to elongated spermatids was observed. The upregulation of meiotic and post-meiotic genes and proteins in fresh and frozen grafted groups confirmed the progression of meiosis and post-meiosis in grafted tissues. There were no significant differences in the expression of apoptosis and necrosis genes between the grafted and non-grafted control groups. Additionally, no significant differences were observed between the control and experimental groups in hormonal assessments.

Conclusions: The optimal hormonal and temperature conditions of the epididymal fat could support spermatogenesis in grafted immature testicular tissue. This grafting technique could pave the way for fertility preservation.

Objective: The study focused the contraceptive efficacy of hydro-ethanolic (60:40) extract (HEE) of Caesalpinia pulcherrima leaves in human and rat sperm samples by in vitro study.

Methods: Six young fertile adult males were selected for semen collection. Sperm samples were collected from six adult rat also by chopping the epididymis along with the collection of testicles, epididymis, and liver. The semen, sperm, and tissue samples were grouped into control, 1, 2, and 4 mg HEE exposed categories. Sensitive spermiological sensors, androgenic key enzymes, oxidative stress, and metabolic toxicity markers were assessed according to standard protocols. Human semen samples, rat sperm samples and metabolic tissue samples were divided into 16 test tubes in all of the above groups to find out the direct effect of the extract on such sensors in concentration and duration dependent manner.

Results: Spermiological sensors both in human and rat were decreased significantly (p<0.05) in concentration and duration dependent manner after in vitro exposure of HEE against the control group. Testicular ∆5,3β-hydroxysteroid dehydrogenase, 17β-hydroxysteroid dehydrogenase, superoxide dismutase, and catalase activities were significantly (p<0.05) decreased, and level of the end product of lipid oxidation-peroxidation was elevated (p<0.05) in rat after extract charging. No general toxicity imposition of the said extract indicated by the activities of hepatic transaminases. Phytochemical screening was done by qualitative and liquid chromatography-mass spectrometry analysis.

Conclusion: Extract focused the promising male contraceptive potentiality at 2 mg/ml concentration. Mode of action will be unfolded from running in vivo study very shortly.

Objective: To compare the efficacy and safety of PPOS and CPOS in high-responder patients undergoing COS for IVF.

Methods: This one-year prospective, randomized, controlled trial included 86 high-responder patients. They were divided into PPOS (n=44) and CPOS (n=42). Both groups underwent COS with hormonal injections, and various parameters, such as LH surge, cycle cancellation rates, birth rates, implantation rates, and more, were measured and compared.

Results: The study revealed that LH surge occurred in 2.3% of the PPOS group and 2.5% of the CPOS group, with no significant difference (p=0.9). The cycle cancellation rates were 9.1% for PPOS and 10% for CPOS. Birth rates were 57% for PPOS and 54% for CPOS. Implantation rates were 45% for PPOS and 49% for CPOS. There was no significant difference in the duration of stimulation (PPOS: 11.30±1.96 days, CPOS: 11.41±2.02 days, p=0.807) or the total FSH used (PPOS: 2888.95±791.80IU, CPOS: 2808±834.52IU, p=0.655). The PPOS group had a mean of 19.58±8.07 retrieved oocytes, while the CPOS group had a mean of 21.87±10.02, showing no significant difference (p=0.807). Similarly, there was no significant difference (p=0.376) in the number of mature (MII) oocytes between the PPOS group (15.67±6.23) and the CPOS group (17.08±7.96). Post-trigger LH levels were significantly lower in the PPOS group (PPOS: 49.68±27.54IU/L, CPOS: 71.83±43.43IU/L, p-value 0.007), indicating LH surge suppression. Neither group reported cases of ovarian hyperstimulation syndrome (OHSS).

Conclusions: PPOS and CPOS offer similar outcomes in high-responder individuals undergoing COS for IVF, except for lower post-trigger LH levels in the PPOS group. Importantly, neither group experienced ovarian hyperstimulation syndrome (OHSS).

Due to its documented records and technological achievements, in vitro embryo creation technology is still honored worldwide forty years after Louise Brown's birth on July 25, 1978. The World Health Organization (WHO) reports that one in six people globally who are of reproductive age may have infertility at some point in their lives. In this environment, it has become noteworthy for couples or patients to want to become pregnant through operations carried out by Assisted Human Reproduction Centers (AHRCs). This continual quest for AHRCs has already been demonstrated in Brazil, where data from the National Embryo Production System (SISEMBRIO) show that as of 2022, there were around 192 clinics nationally that offered AHRC services, and a total of 284,210 frozen embryos. The ethical conundrums that these techniques provide persist notwithstanding their remarkable success in helping patients achieve clinical pregnancies and viable embryos. The absence of legislation on reproductive assistance is another significant factor pertaining to Brazilian regulatory resolutions. As a result, clinics, hospitals, and sperm banks operating in this field are required to adhere to guidelines created by the Federal Council of Medicine (CFM). The first resolution was published on September 30, 1992. In light of the aforementioned, acquiring and keeping an eye on the standards that the CFM has developed over time helps enhance knowledge of the moral and legal framework that governs Brazil. Thus, the current study attempts to provide a comparative analysis of Brazilian ethical norms regarding the use of assisted human reproduction technology.

Objective: To determine the frequency of pregnancy in patients submitted to uterine artery embolization (UAE) for the treatment of uterine leiomyomas who undergo medical follow-up at a clinic in Belo Horizonte.

Methods: This study consists of a retrospective cohort study. It is based on data analysis of electronic medical records of patients who underwent the embolization procedure for uterine leiomyomas between March 2003 and March 2018.

Results: Out of a total of 587 patients who underwent the UAE procedure to treat leiomyomas, 150 expressed an interested in becoming pregnant. Among these patients, 88 successfully achieved pregnancy, representing a frequency of 58.7%. Among the symptoms and signs analyzed prior to the procedure, menorrhagia (97%) and dyspareunia (71%) were the most commonly observed in the analyzed patients. According to race/ethnicity, the majority (n=39) of the patients identified themselves as brown, and the intramural location (96%) was the most frequent.

Conclusions: The study showed that 58.7% of the women who underwent UAE and expressed an interest in becoming pregnant were able to achieve pregnancy, with a 13.6% loss rate. However, further studies are needed to elucidate the key variables that contribute to the increased likelihood of pregnancy after leiomyoma embolization procedure, as well as the effectiveness of symptoms reduction and the actual improvement in pregnancy rates.

Objective: To investigate the perspectives of infertile couples regarding embryo cryopreservation throughout assisted reproduction treatment.

Methods: The convenience sample included infertile couples undergoing assisted reproduction treatment. They responded to a questionnaire specifically designed to gauge views and opinions on cryopreservation of surplus embryos. Statistical analysis was conducted using SPSS, employing the Mann-Whitney U and Fisher's exact tests (p<0.05).

Results: The study included 187 couples, with average ages of 35 years for women and 38 years for men. A total of 182 couples (97.3%) agreed with the practice of freezing surplus embryos and, the desire to increase the odds of pregnancy within the same ovarian stimulation cycle was the main motivation (89%). Almost 40% of participants said they might consider embryo donation to other couples for assisted reproductive treatment. However, less than 20% of volunteers (15.38% of women and 12.08% of men) expressed the desire to donate for research purposes. Women with higher levels of education were significantly (p<0.05) more likely to support the donation of surplus embryos for research. Gender, religion, and education did not influence (p>0.05) the respondents' perspectives regarding the beginning of life and posthumous conception.

Conclusions: Embryo cryopreservation provides infertile couples with hope however, the fate of surplus embryos remains controversial. A careful approach with appropriate regulation is necessary to ensure safe and ethical practices.

The aim of this study is to present a panel that includes the main bacterial genera associated with endometritis. We conducted a search using the terms "endometritis women" OR "female endometritis" OR "pelvic inflammatory disease" AND bacteria* OR "uterine microbiome" in two databases: PubMed and Web of Science, without language or publication year restrictions. The panel is based on an analysis of 40 studies published over the past 38 years. We identified 31 bacterial genera, with the following five being the most frequently cited: Chlamydia and Ureaplasma with 11.03% each, Streptococcus and Mycoplasma with 9.56% each, and Enterococcus with 8.09%. Regarding its etiological aspects, we found that bacterial infection is the most prevalent cause of the disease, occurring because of invasive procedures such as curettage, cesarean section, or insertion of intrauterine devices (IUDs), among others. These events facilitate the entry of pathogenic microorganisms into the uterus, resulting in an inflammatory response and subsequent development of endometritis. The main techniques used to detect these pathogens were microbial culture, Polymerase Chain Reaction (PCR), and Next-Generation Sequencing, with microbial culture being the most employed, followed by PCR or a combination of both techniques. This diversity of techniques has significantly expanded our understanding of the presence and identification of microorganisms associated with the pathophysiology of endometritis. Therefore, it is understood that these findings serve as a foundation for further investigations of microorganisms related to endometritis, and such analyses will help to clarify the relationship between endometritis and the bacteria that cause it.

Objective: Different aspects of the functions of free fatty acid (FFA) in seminal plasma and their implications on male fertility are known. However, the profile of FFA in seminal plasma in asthenozoospermic patients following antioxidant therapy has not been studied.

Methods: In this case-control study, the total antioxidant capacity (TAC) and FFA profile of the seminal plasma were determined in 80 patients (29 normozoospermic volunteers and 51 asthenozoospermic men) who were treated with antioxidants for three months.

Results: The TAC level in normozoospermic men was significantly higher than in asthenozoospermic men before and after antioxidant therapy with even lower values after the treatment (p=0.0001). The most abundant identified FFAs in seminal plasma were palmitic acid, vaccenic acid, eicosatrienoic acid, stearic acid, and myristoleic acid. Palmitic acid was lower in asthenozoospermic patients (p=0.0001), and antioxidant treatment restored its level to near-control levels. Compared to normozoospermic controls, the level of eicosatrienoic acid is significantly lower in asthenozoospermia patients before (p=0.01) and after treatment (p=0.0001). Additionally, following oral antioxidant supplementation, the FFA pattern in asthenozoospermic patients changes to the pattern observed in normozoospermic men. However, these changes are not statistically significant.

Conclusions: The TAC level in asthenozoospermic patients after antioxidant treatment did not change to the levels in the control group; it even dropped to a lower level following three months of treatment. Antioxidant treatment can change the level of the FFA compositions of seminal plasma.

Objective: To study the reliability and effectiveness of the percutaneous sperm retrieval technique.

Methods: We retrospectively analyzed the records of 123 consecutive patients with obstructive azoospermia who underwent percutaneous sperm retrieval and intracytoplasmic sperm injection (ICSI) using Percutaneous Epididymal Sperm Aspiration (PESA) with or without a rescue Testicular Sperm Aspiration (TESA). We compared patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed. In addition, the rate of adequate sperm retrieved for ICSI and reproductive outcomes between the groups and literature were compared. The primary outcome was the rate of adequate sperm retrieved for ICSI; the secondary outcomes were reproductive.

Results: The successful sperm retrieval was 157 in 157 attempts, with a cumulative sperm retrieval rate of 100%, whether the first or repeated retrieval attempt. The clinical pregnancy rate in patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed was 36/108 (33.3%) vs. 15/29 (51.7%) (Pearson chi2(1) = 3.3088; p = 0.085), respectively. Other reproductive outcomes (fertilization rate, cleavage rate, and biochemical pregnancy) were also similar in both groups.

Conclusions: PESA associated with or without rescue TESA is a reliable and effective strategy either for retrieving sperm for ICSI, demystifying the concerns about the reliability of repeated PESA, or for reproductive results. This information is reassuring, especially but not exclusively to places with limited resources.