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Objective: Recently, it has been discussed whether or not mosaic embryo transfers should be performed since they might result in viable pregnancies, although they often end up being discarded. We report a case of successful pregnancy, after a mosaic embryo transfer from an in vitro matured egg and frozen PESA sperm., Case Description: Tests performed on a female aged 40 years and a male aged 37 years seeking fertility treatment found she had an adequate ovarian reserve and patent fallopian tubes. He had a history of cryptorchidism and inguinal hernia repair. The spermogram showed azoospermia, and testicular ultrasound showed an atrophic left testicle and a normal right testis. The vas deferens was palpated during physical examination. Intracytoplasmic sperm injection with percutaneous epididymal sperm aspiration (PESA) was indicated. Two cycles of IVF after controlled ovarian stimulation with follitropin delta was performed. In the first cycle, seven mature eggs were inseminated, two fertilized normally, resulting in one blastocyst biopsied and analyzed by NGS with complex aneuploid results. In the second cycle, frozen sperm from PESA was used. Three eggs were inseminated on the day of the procedure (resulting in 2 blastocysts), and three in vitro matured eggs were inseminated after 24 hours (resulting in 1 blastocyst). NGS analysis showed two complex aneuploid embryos and one 40% low-level trisomy 20 aneuploid mosaicism (+20) for the post 24-hour embryo. A mosaic embryo transfer was performed, resulting in clinical pregnancy and birth of a healthy baby girl with a normal blood karyotype., Discussion: Mosaic embryo transfer is a topic for discussion. Certain levels of mosaicism do not seem to pose risks to the development of the fetus.

Research Question: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020?, Design: Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries., Results: Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages (p<0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages (p≤0.041), including oocyte donation (p=0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 (p=0.0004) and women aged ≥40 (p=0.0353)., Conclusions: Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

Objective: Oocyte cryopreservation enables the storage of genetic material, especially in situations where the ovarian function is compromised, also for women desiring to postpone maternity. Before 2012, oocyte cryopreservation was still experimental, and the success of the procedure was uncertain; however, it was the only possibility that women had for fertility preservation. Thus, we aim to report a case of a birth after 13 years of elective oocyte cryopreservation., Case Description: At 49 years of age, the patient returned to our reproductive center with the desire to get pregnant, using oocytes that had been frozen for 13 years. The endometrium was prepared, and the oocytes were thawed using the slow procedure method. Four of the six oocytes thawed survived (66%) and were inseminated; three fertilized and started their development. The transfer of two embryos on the third day of development was performed. Clinical pregnancy was confirmed via ultrasound and came to term with the birth of a healthy boy., Discussion: Although the vitrification procedure has shown to be a better cryopreservation technique when compared to slow freezing, the latter represented an important role when patients wanted to cryopreserve oocytes in the early 2000s. Even many years later, this technique reveals its efficacy, preserving the viability and quality of oocytes stored in nitrogen tanks. After a literature review, this case seems to be the largest interval between oocyte cryopreservation and its use, with achieved pregnancy, in Brazil.

With the growing understanding of in vitro fertilization and reproductive technology, the magnitude of studies related to embryonic evolution has also increased. The optimization of embryo selection is crucial to minimize the risk of multiple pregnancies and to guarantee successful implantation and pregnancy. On the second day of culture, the four-cell embryo can be shaped into different arrangements, such as tetrahedral and planar. Previous studies have shown that mammalian embryos have a tetrahedral shape and that any deviation from this ideal configuration can negatively affect blastocyst development. A few studies have also found that planar embryos would be linked to negative predictors of success for reaching the blastocyst stage and its good quality. Therefore, it seems that tetrahedral should be preferred over planar-shaped embryos for embryonic transfers, but there is still little understanding and evidence about this subject. Thus, the objective of the present paper was to review the available literature on study tendencies to compare tetrahedral and planar-shaped embryos considering their effect on implantation and pregnancy results.

Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.