Jornal Brasileiro de Reproducao Assistida最新文献

Induction of in vitro spermatogenesis may be helpful in the treatment of infertility in azoospermic individuals and those undergoing chemotherapy. Different cultivation systems have been implemented to achieve this aim. This review study aimed to investigate the application of three-dimensional culture in the induction of in vitro spermatogenesis. Relevant studies published in English were identified using PubMed using a range of search terms related to the core focus on tissue engineering of male reproductive systems, in vitro spermatogenesis, germ cell preservation, 3D culture systems for in vitro spermatogenesis, a 3D culture of testis tissue with were last updated in end of 2023. Searches were not restricted to a particular time frame or species, although the emphasis within the review is on regenerative medicine in mammalian male fertility preservation and in vitro spermatogenesis. Spermatogenesis is one of the most complicated cellular differentiation processes in the body. Significant attempts have been made to control spermatogenesis to drive differentiation of male germ stem cells toward mature sperm. Current research efforts focus on providing appropriate microenvironmental conditions to support the process of in vitro spermatogenesis by applying the principles of cell transplantation, material science, and bioengineering. Regenerative medicine may open a new avenue to patients for restoration and maintenance of normal function in spermatogenesis. The techniques reviewed are still in development, and this paper can become the primary reference for a large body of scientists developing advanced tissue engineering for male germ cells or developing the next generation of reproductive medicine.

Objective: To assess the prevalence of self-reported symptoms of endometriosis and adenomyosis among university students and identify potential predictors of these diseases among these symptoms.

Methods: This cross-sectional study was conducted at a private university in northeastern Brazil. The students were asked to complete an electronic questionnaire using a Google Form link. Participants were asked about general information, the menstrual cycle, and bleeding symptoms. The electronic questionnaire results were compared between two groups: students who self-reported endometriosis/adenomyosis (ENDO/ADENO) and students who self-reported no endometriosis/adenomyosis (NO ENDO/ADENO).

Results: Four (2.9%) students self-reported adenomyosis alone, 26 (18.6%) students self-reported endometriosis alone, and two (1.4%) students self-reported an associated diagnosis of endometriosis and adenomyosis. Participants were divided into two groups: ENDO/ADENO (n=32) and NO ENDO/ADENO (n=108). Participants in the ENDO/ADENO group reported more severe dysmenorrhea, worsening dysmenorrhea in the last 12 months, frequent absence from class, dyspareunia, and dysuria. Worsening dysmenorrhea was a predictor of endometriosis/adenomyosis in university female students (odds ratio = 5.73; 95% confidence interval, 1.91-17.22, p=0.002).

Conclusions: The assessment of menstrual cycle symptoms can be used as a screening tool for patients at risk of endometriosis/adenomyosis. The progressive worsening of dysmenorrhea in the last 12 months was a predictor of endometriosis/adenomyosis diagnosis.

Objective: Premature ovarian failure (POF) leads to infertility. Numerous researchers have endeavored to enhance ovarian function through antioxidant interventions. Extract from Vitex agnus-castus (VAC) has demonstrated a protective effect. Therefore, the objective of this study was to investigate the amelioration of ovarian function following VAC treatment in a POF mouse model.

Methods: In this investigation, 30 female NMRI mice were categorized into control, POF model (cyclophosphamide 120 mg/kg I.P), and experimental groups (100, 300, and 500 of VAC extract). Parameters such as body weight, vaginal smears, and follicular evaluation were examined. FSH, estradiol levels, free radicals, and the expression of the FMR1 gene were assessed.

Results: The microscopic assessment revealed that POF induced morphological alterations in ovarian tissue, whereas VAC treatment significantly ameliorated ovarian tissue conditions. The follicles number exhibited a significant reduction in the POF group; however, VAC led to an increase in follicular count and elevated estradiol levels in the treatment groups. Serum FSH levels displayed an elevation in the POF group, whereas the treatment groups exhibited a substantial reduction in FSH levels compared to the POF group. The expression of the FMR1 gene demonstrated upregulation in the POF group compared to the control group (p<0.05). Moreover, this expression significantly decreased in the 500-dose VAC group compared to the POF group (p<0.001). ROS generation exhibited a significant increase in the POF group, which was conversely mitigated in all experimental groups.

Conclusions: Our findings underscore the potential of this extract to ameliorate POF symptoms, however, further investigations are needed.

Objective: This study aimed to examine the behavior towards the acceptance of donor egg, donor sperm, and donor embryo of Northern Thai infertile couples, separated between men and women.

Methods: A cross-sectional study was conducted at the CMEx Fertility Center, Chiang Mai, Thailand. The questionnaires consisted of sociodemographic questions and the acceptance of couples toward donor egg, sperm and embryo. The couples filled in the answers separately.

Results: A total of 250 infertile couples were assessed. There were no differences in the acceptance rate of donor egg, sperm and embryo between the men and the women. Male acceptance rates were 25.6%, 18.8%, and 18.8%, respectively; while female acceptance rates were 24.4%, 18.4%, and 19.2%, respectively. Most couples (over 70%) concordantly rejected the donation program. Around 10% of couples had discordant answers. The concordance accepted for couples for donor egg, sperm and embryo was only 20%, 13.2%, and 14.8%. Older people and those who had been infertile for a longer period were significantly more likely to accept donation programs.

Conclusions: There is no difference concerning the acceptance of donor gametes and embryo among men and women. Most participants reject the utilization of donor programs, the overall acceptance rate is relatively low. This may indicate the need for more adequate information and education for the community to enhance prevention programs rather than focus on the treatment with donor gametes or embryos.

Objective: The study aimed to evaluate the impact of CE on the expression of HOXA10 and HOXA11 during the late proliferative phase in the endometrium of infertile women.

Methods: A prospective, translational cohort study was conducted in partnership with the Hospital Universitário Antônio Pedro in Niterói and the Clínica Ginendo in Rio de Janeiro after approval by the Ethics Committee. The patients were selected to participate in the study after showing an indication for hysteroscopy. All participants were divided into three groups: infertile women with endometritis (n=10), infertile women without endometritis (n=17) and fertile women without endometritis (n=10). At hysteroscopy, two endometrial samples were obtaneid, with one sent for histopathological examination per the gynecologist's request and the other used for immunohistochemistry procedures to evaluate the expression of CD138, HOXA10 and HOXA11. CD138 was used to confirm the diagnosis of CE. The analysis of HOXA10 and HOXA11 was performed using the HScoring method for immunohistochemistry with polyclonal antibodies.

Results: Women with and without endometritis had lower HOXA10 and HOXA11 expression values than women in the control group (fertile women without endometritis).

Conclusions: The expression of HOXA10 and HOXA11 during the proliferative phase is not significantly different between infertile women with endometritis and infertile women without endometritis. Translational studies with a larger number of patients should be performed.

This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the effect of a single-dose gonadotropin-releasing hormone agonist administration in the frozen-thawed embryo transfer cycle on pregnancy outcomes. A literature search was strategically conducted using PubMed, EMBASE, and the Cochrane Controlled Trials Register. The primary outcome was the clinical pregnancy rate. The secondary outcomes combined chemical pregnancy rate, implantation rate, ongoing pregnancy rate, live birth rate, miscarriage rate, and extrauterine pregnancy rate. Out of the 1594 citations that were found, only six met the criteria for being included in the meta-analysis. The clinical pregnancy rate was higher in the treatment group than in the control group (52.05% vs. 47.29%; p=0.04; RR=1.09; 95% CI=1.00-1.18). According to subgroup analysis based on the natural cycle, the clinical pregnancy rate with the agonist administration is significantly higher (43.75% vs. 27.35%; p=0.01; RR=1.6; 95% CI=1.10-2.32). However, there was no difference between the groups in terms of artificial cycles (p=0.80; 95% CI=0.96-1.20). The secondary outcomes did not show significant differences. We concluded that supplementing with a single dose of gonadotrophin-releasing hormone agonist can marginally increase the clinical pregnancy rate, particularly in the natural cycle. Other pregnancy outcomes do not improve with the treatment.

Objective: Late follicular premature progesterone rise is a complex phenomenon encountered during assisted reproductive technology (ART) treatments; different etiologies can occur in the same patient. Low ovarian responders may be the best example, since higher FSH doses and ovarian aging-related changes may interact and generate a premature progesterone rise. This study aims to explore the correlation between progesterone levels on hCG day and the progesterone-to-follicle index and compare the progesterone-to-follicle index according to ovarian response.

Methods: We performed a retrospective, observational, analytic, cross-sectional, and cohort study at the Reproductive Endocrinology Department at Centro Médico Nacional 20 de November between January 2015 to January 2020. After verifying for normalcy, a Spearman Rho, Principal Component Analysis, and a simple linear regression model were performed. Treatment cycles were classified according to their ovarian response. Low-ovarian responders were classified according to the Bologna Criteria. Then an ANOVA test was performed to compare each group.

Results: Our results show that the progesterone-to-follicle index correlates best with progesterone levels on hCG day. Comparing all the ovarian responses, low ovarian responders have the highest progesterone-to-follicle index of the four groups.

Conclusions: Low ovarian responders produce more progesterone per follicle than regular and high responders.

Objective: Women undergoing IVF who have had a previous c-section (CS) have a lower live birth rate than those with a previous vaginal delivery. However, the precise underlying mechanisms need clarification. Does a previous CS affect the pattern of uterine contractility?.

Methods: Prospective evaluation in patients undergoing frozen blastocyst embryo transfer in medicated endometrial preparation cycles. Twenty patients were included in groups: A/nulliparous. B/previous vaginal delivery. C/ previous CS without a niche, whereas fifteen patients were recruited in group D (CS and a niche). Patients employed estradiol compounds and 800 mg vaginal progesterone. A 3D-scan was performed the transfer-day where uterine contractility/minute was recorded.

Results: Baseline characteristics (age, BMI, smoking, endometrial thickness) were similar. Mean frequency of uterine contractions/minute was similar between groups (1.15, 1.01, 0.92, and 1.21 for groups A, B, C, and D, respectively). There was a slight increase in the number of contractions in patients with a sonographic niche versus controls, not reaching statistical significance (p=0.48). No differences were observed when comparing patients with a previous C-section (regardless of the presence of a niche) to those without a C-section, either nulliparous (p=0.78) or with a previous vaginal delivery (p=0.80). The frequency of uterine contractions was similar between patients who achieved a clinical pregnancy and those who did not (1.19 vs. 1.02 UC/min, p=0.219, respectively).

Conclusions: Our study found no significant difference in the frequency of uterine contractility between patients with or without a previous C-section or sonographic diagnosed niche. Further investigation is necessary to understand the physiological mechanisms affecting implantation in patients with isthmocele.

Objective: To evaluate the correlation between serum anti-Müllerian hormone (AMH) and the number of oocytes retrieved after controlled ovarian stimulation for in vitro fertilization treatments and determine cut-off values predictive of poor and high response to stimulation.

Methods: It was performed a retrospective observational study that included 1003 cycles of controlled ovarian stimulation carried between February 2017 and December 2023 at a Medically Assisted Procreation Centre. The exclusion criteria were the following: serum AMH levels obtained more than 6 months prior to the start of the ovarian stimulation, the presence of a single ovary, non-Caucasian ethnicity, a controlled ovarian stimulation cycle performed for the purpose of oocyte donation or fertility preservation, a documented diagnosis of endometriosis, a documented history of ovarian surgery and the absence of essential data for the study in the medical records (absence of the number of oocytes obtained or the AMH value). Poor response to stimulation was defined as ≤ 3 oocytes retrieved, and high response was defined as > 15 oocytes. The correlation between variables was calculated using Spearman's correlation test and cut-off values were determined using ROC (Receiver Operating Characteristic) curves.

Results: AMH exhibited a significantly positive correlation with the number of oocytes retrieved (Spearman's correlation coefficient = 0.60, p<0.01). The predictive cut-off for poor ovarian response was 0.72 ng/mL (specificity of 95.13%, sensitivity of 43.23%), and the predictive cut-off for high ovarian response was 4.77 ng/mL (specificity of 89.86%, sensitivity of 38.22%).

Conclusions: Serum AMH proved to be a good predictor of the ovarian response to controlled ovarian stimulation for in vitro fertilization treatments, which makes it useful in supporting clinical decision-making. However, it should not be used as an absolute discriminator of poor or high ovarian response.