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Objective It is generally accepted that the incidence of birth defects in spontaneously conceived children ranges between 2.0-4.0%. However, several studies have shown that babies born after assisted reproductive technology (ART) procedures tend to present more congenital malformations than naturally conceived children, with 6.5% of the children born after intracytoplasmic sperm injection (ICSI) presenting birth defects. The use of high magnification sperm selection before ICSI was introduced in the early 2000s to allow the identification of spermatozoa with low risk of sperm DNA damage. Intracytoplasmic morphologically selected sperm injection (IMSI) is expected to change the incidence of congenital malformations, although data on the incidence of birth defects in children conceived after IMSI are still scarce. Methods A systematic review based on searches performed in electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) including articles published by February 2021 was conducted to identify trials comparing the neonatal outcomes of ICSI and IMSI. The outcome measured was the rate of birth defects in children born after ICSI or IMSI. Three trials were included as targets for data extraction and meta-analysis. Results Our meta-analysis included 3907 children conceived after IMSI (1280) or ICSI (2627). The incidence of birth defects was statistically different, with 2.5% (32/1280) in IMSI and 4.5% (119/2627) in ICSI (RR=0.59; 95% CI=0.40-0.87; p=0.007). The results demonstrated that IMSI decreased the incidence of structural defects compared to ICSI - 2.2% (18/830) vs. 3.8% (78/2049) - in a statistically significant manner (RR=0.58; 95%CI=0.35-0.96; p=0.04). No significant difference was observed in chromosomal abnormalities (Trisomy 13; 18; 21 and Triple X) between children conceived after IMSI (8/830) or ICSI (19/2049) (RR=1.07; 95%CI=0.47-2.43; p=0.87). Conclusions IMSI seems to be an effective tool at reducing the incidence of structural defects compared to ICSI. However, IMSI does not change the incidence of chromosomal abnormalities.

Objective To assess the relationship between human blastocyst chromosomal ploidy established by niPGT-A and increasing age. Methods This is a prospective multicenter study carried out by ten assisted reproduction centers after their embryologists acquired training and validated their results with the previous use of niPGT-A. A total of 94 couples with indication for niPGT-A due to increase maternal age, male factor, repeated implantation failures, recurrent abortion or because they requested niPGT-A were included in this study. The couples had no karyotype abnormalities. After ICSI, the embryos were cultured until blastocyst stage using one or two step culture systems, single or sequential media respectively, at 37°C in an atmosphere of 6-7% CO2 and 5-20% O2 incubators. On day 3, we re-evaluated cleavage embryos to complete cumulus cells removal. The embryos were then cultured in individual well, with 20µl of medium under oil until they reached blastocyst stage. The blastocysts were vitrified and stored in liquid nitrogen. After that, the spent blastocyst culture medium (20µl) was transferred to a PCR tube and sent for analysis in the genetic laboratory, where it was stored at -80°C until sequencing. A total of 243 samples of spent blastocyst culture medium were collected on the 5th/6th day. Cell-free DNA secreted on culture medium was amplified using NICS Sample Preparation Kit (Yikon Genomics), based on the MALBAC technology. After whole genome amplification, the DNA was measured using a Qubit 2.0 fluorometer and subjected to next generation sequencing (NGS) using Illumina MiSeq® platform. The data were analyzed using the ChromGo® software (Yikon Genomics). Results The mean age of the patients was 38±4.08 years with an interval of 20-44 years. The euploid was diagnosed in 36.4% (80/220) of cases, aneuploidy in 31.3% (69/220), and mosaicism in 32.3% (71/220; with ≥60% aneuploidy) of blastocysts. Mosaic values ranged from 29.8% to 33.8% in different age groups. Individually, the most frequent chromosomal abnormality was XXY (Klinefelter Syndrome) occurring in 18 cases, followed by chromosome 21 (trisomy/monosomy) in 8 cases. The niPGT-A data showed a ≥60% incidence of aneuploid cells in all cases of chromosomal mosaicism (n=71). Conclusion A high degree of mosaicism with aneuploidy cells was detected, and some hypotheses were suggested for this data (niPGT-A sensitivity in detecting the self-correction of chromosomal abnormalities phenomenon). However, it did not vary remarkably with age. On the other hand, euploidy levels had a negative correlation with age and aneuploidy levels had a positive relationship. This is the first report in the literature to relate chromosomal ploidy in blastocysts using niPGT-A and increasing patient age.

Recently, a new technology known as the Noninvasive Preimplantation Genetic Testing for Aneuploidy (niPGT-A) emerged, using cell-free DNA present in the spent culture media of human blastocysts. Unlike PGT-A, in which only trophectoderm cells are used, niPGT-A reflects the ploidy state of these cells and internal cell mass, suggesting that this new technology may be less prone to error, being more reliable than the invasive test. The aim of the present study was to report the first occurrence of childbirth following niPGT-A in Brazil.

Objective The present meta-analysis aimed to evaluate whether the freeze-all strategy (Freeze/All-ET) could bring about improvements in the clinical assisted reproductive technique (ART) outcomes when compared with the fresh embryo transfer strategy (Fresh-ET) in patients undergoing an ART cycle in accordance with the mean number of oocytes collected. Methods A systematic review based on electronic searches in databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) was carried out to identify randomized controlled trails (RCTs) comparing ART outcomes between fresh-embryo transfers versus elective frozen-embryo transfers up to February of 2017. Four reviewers independently evaluated abstracts, validity assessment and data extraction. Odds Ratio (OR) values with a 95% confidence interval (CI), and heterogeneity were evaluated. Results Five RCTs were included as targets for data extraction and meta-analysis purposes. The results of this meta-analysis were divided into two parts (Freeze/All-ET versus Fresh-ET): Part I- All trials in which the mean number of collected oocytes was >12 and 12 and

This study aimed to evaluate if single medium is better than sequential medium at improving ongoing pregnancy rates in patients undergoing assisted reproductive technology (ART) procedures. The data featured in this meta-analysis were extracted from four randomized controlled trials yielded from a systematic search carried out on electronic databases. The primary endpoint was ongoing pregnancy rate. Secondary endpoints included clinical pregnancy and miscarriage rates. The endpoints for ongoing pregnancy rate were also analyzed based on the time at which the embryo transfers were performed: cleavage stage (day 2/3) and/or blastocyst stage (day 5/6). There were no significant differences between single and sequential medium for clinical pregnancy (RR=1.09; 95%CI=0.83-1.44; p=0.53), ongoing pregnancy (RR=1.11; 95%CI=0.87-1.40; p=0.39), or miscarriage rates (RR=0.89; 95%CI=0.44-1.81; p=0.74). No significant difference was found for ongoing pregnancy rate (RR=1.29; 95%CI=0.93-1.78; p=0.12) between single and sequential medium when only trials in which embryos were transferred at the blastocyst stage were included. In conclusion, the choice of embryo culture approach - single or sequential medium - did not affect the ongoing pregnancy rates of patients undergoing ART cycles.

Objective To evaluate whether or not one should use a new Protocol for Endometrial Receptivity Improvement (PRIMER) based on platelet-rich plasma (PRP) and granulocyte colony-stimulation factor (G-CSF) to enhance ongoing pregnancy rates in patients with recurrent implantation failure (RIF). Methods Women undergoing IVF/ICSI were prospectively divided into two groups: - PRIMER/RIF group (n:33): patients with RIF (defined as ≥2embryo transfers (ETs) and at least 5 morphologically good embryos transferred) in which intrauterine PRP injection and subcutaneous G-CSF-injection were performed. - Control group (n:33): patients in their first IVF/ICSI attempt/cycle (without PRP or G-CSF injection). The PRP was prepared using autologous fresh-whole blood processed to increase platelet-concentration in 2 to 4 fold. All patients undergoing the PRP-treatment received 0.7ml of it through intrauterine-injection 48 hours before the ET. G-CSF (300mg/0.5ml) started simultaneously to PRP and was administered subcutaneously every week. Results Regarding implantation, clinical pregnancy and miscarriage rates, we found no statistically significant difference (18.2% versus 17.6%, p=0.90; 36.4% versus 30.3%, p=0.61 and 25.0% versus 9.0%, p=0.43, respectively). The use of PRIMER enabled RIF patients (previous ET µ: 4.0±1.5) to reach similar ongoing pregnancy and live birth rates like those patients who had their first IVF/ICSI cycle attempt (27.3% versus 27.3%, p=0.99). Conclusions Our results showed, for the first time, evidence that this therapeutic protocol (PRIMER) could be used as a feasible treatment based on biological rationale for patients with RIF, considering its promising outcomes, it is a simple procedure and not associated with patient complications.

After more than 20 years of use of preimplantation genetic tests for aneuploidies (PGS/PGT-A) there are still many problems related to the efficiency of this technique, most of them still without an adequate solution (Gleicher et al., 2018; Homer, 2019). From the clinical point of view, the benefits attributed to invasive PGT-A in the selection of euploid embryos remain controversial, especially due to the lack of scientific proof of its effectiveness in increasing live birth rates in various clinical situations, such as patients with advanced age, repeated implantation failures or recurrent miscarriages. In addition, evidence-based medicine also severely criticizes the rare randomized trials analyzing the clinical use of invasive PGT-A (Orvieto, 2016). If these criticisms were not enough, and undoubtedly one of the most important, it would be difficult to accurately assess the presence of embryonic mosaicism creating significant levels of false positive results, and worse, causing a real possibility of discarding healthy embryos. This makes the clinical application of PGT-A as a risky approach (Munne et al., 2017; Spinella et al., 2018). Another problem, not less important, would be the obligation to perform PGT-A by experienced embryologists, since otherwise the embryonic loss due to biopsy would be a frequent fact, something usually estimated below 10% but in some laboratories it may reach up to 30% of biopsied embryos (Munne, 2018). On the other hand, there are doubts about the future risks of invasive action of the usually 5-10 cell removed during biopsy for genetic diagnosis. Would there be repercussions for the health of these children? In animals, there are data suggesting that embryonic biopsies could be linked to changes in fetal neural tube or adrenal development (Wu et al., 2014; Zeng et al., 2013). Recently, Xu et al. (2016) described noninvasive chromosomal screening (NICS) by obtaining and sequencing free DNA dripped by embryos in the culture medium (without the need of embryo biopsy) creating a new non-aggressive and elegant perspective to preimplantation genetic diagnosis.

Objective A variety of studies randomizing women/cycles or oocytes/embryos has been carried out to compare different culture media for culturing embryos up to cleavage or blastocyst stages showing controversial results. A recent systematic review suggested that data in the literature are insufficient to conclude the best culture medium for embryo quality, pregnancy and implantation. The objective of this study was to evaluate whether there is any difference between two commercial culture media regarding clinical outcomes after IMSI cycles. Methods A total of 120 patients, ≤39 years of age, undergoing ART treatment submitted to the IMSI program were prospectively broken down and randomized into two groups: Group I (Cook media) and Group II (Vitrolife media). Results Our data demonstrated that there was no difference using all the media from Cook or all the media from Vitrolife, for culturing embryos till day 2, in the bench incubator at low O2 concentration, in relation to fertilization, embryo quality, pregnancy and implantation rates (p>0.05). Conclusion Both culture media used, Cook medium and Vitrolife medium, for the IMSI procedure and for later embryo culture with transfer on the second day, are equally effective and can be used depending on the ease and availability of acquisition.

Certain gene polymorphisms are associated with implantation failure and pregnancy loss. Studies of leukaemia inhibitory factor (LIF) gene polymorphisms are scarce. The LIF single nucleotide polymorphism (SNP) thymine (T)/guanine (G) (rs929271) was studied in women to determine whether an association existed with pregnancy outcomes after intracytoplasmic sperm injection (ICSI); 411 women who underwent ICSI were recruited. DNA was extracted from the peripheral blood, and the LIF gene SNP T/G (rs929271) was genotyped using real-time polymerase chain reaction. Participants were divided into three groups according to their LIF genotype: T/T (n = 168), T/G (n = 202) and G/G (n = 41). All IVF and ICSI procedures were carried out under the same clinical and laboratory conditions. The ICSI cumulative results (from fresh plus frozen cycles) of each genotype group were analysed. The G/G genotype in women was associated with a higher implantation rate (T/T: 15.9%, T/G: 16.2%, G/G: 27.0%; P < 0.05), ongoing pregnancy rate/patient (T/T: 31.5%, T/G: 36.1%, G/G: 53.7%; P < 0.05) and ongoing pregnancy rate/transfer (T/T: 18.5%, T/G: 20.2%, G/G: 36.7%; P < 0.05). LIF SNP T/G (rs929271) seems to be a susceptibility biomarker capable of predicting implantation efficiency and pregnancy outcomes.

Perhaps with the intention of obtaining larger amounts of free-DNA, some groups are routinely postponing and establishing free-DNA collection in culture medium for Noninvasive preimplantation genetic testing for aneuploidies (niPGT-A) to day 6 for all blastocysts. A meta-analysis served as the basis for such decision, since statistically similar live birth rates were observed when the transfers of euploid blastocysts were performed on day 5 versus day 6 However, the euploidy analysis was conducted in only two studies However, after including the two more studies we performed a new meta-analysis that clearly showed the risks of losing live births with the decision of adopting the 6th day as the endpoint for gathering free-DNA. We would be losing 1.71x more live births.

Objective To investigate an association between polymorphisms related to the implantation process that together could help in the prediction of recurrent implantation failure (RIF). Design Cohort study. Setting Private fertility center and reproductive genetics laboratory. Patient(s) Forty-four women presenting RIF, who were included in study group (RIF group), and two control groups, one with 63 women who were attended at our service and became pregnant after the first IVF/intracytoplasmic sperm injection attempt (control group I) and other with 65 fertile women who had at least two children without any treatment and no history of miscarriage (control group II). Intervention(s) None. Main Outcome Measure(s) Genotyping was performed in the intron region of TP63, VEGFA, MMP2, ESR1, and ESR2 genes and in the 3′ untranslated region of the LIF gene on genomic DNA using real-time polymerase chain reaction. Result(s) The presence of ESR1/AA (rs12199722) and LIF/GT (rs929271) genotypes was more frequent in the RIF group, leading to a 7.9-fold increase in the chance of women presenting with RIF when compared with women who became pregnant on their first cycle of IVF/intracytoplasmic sperm injection and a 2.8-fold increase when compared with women who became pregnant without treatment. Conclusion(s) The association between ESR1 and LIF polymorphisms can help in the prediction of RIF.

Objective: The aim of this study was to investigate the relationship between herpesvirus-associated ubiquitin-specific protease (HAUSP A/G, rs1529916), tumor protein p53 (TP53 Arg/Pro, rs1042522), leukemia inhibitory factor (LIF G/T, rs929271), glycoprotein 130 (gp130 A/T, rs1900173) and vascular endothelial growth factor (VEGF G/A, rs1570360) polymorphisms and recurrent implantation failure (RIF) in Brazilian women. Subjects and Methods: A total of 120 women with RIF (i.e. those with ≥5 cleaved embryos transferred and a minimum of 2 failed in vitro fertilization/intracytoplasmic sperm injection attempts) were included. The control group involved 89 women who had experienced at least 1 live birth (without any infertility treatment). DNA was extracted from the peripheral blood of all participants, and the abovementioned single-nucleotide polymorphisms (SNPs) were genotyped by real-time polymerase chain reaction. The data were evaluated using Fisher's test. Results: A significant difference between the RIF and control groups was found in the VEGF gene where the GG genotype showed a 2.1-fold increased chance of not being included in the RIF group, while the presence of an A allele increased this risk 1.6-fold. No significant differences were found for the other polymorphisms. Conclusion: This study showed an association between the VEGF -1154G/A polymorphism and RIF in Brazilian women.

OBJECTIVE KPIs have been employed for internal quality control (IQC) in ART. However, clinical KPIs (C-KPIs) such as age, AMH and number of oocytes collected are never added to laboratory KPIs (L-KPIs), such as fertilization rate and morphological quality of the embryos for analysis, even though the final endpoint is the evaluation of clinical pregnancy rates. This paper analyzed if a KPIs-score strategy with clinical and laboratorial parameters could be used to establish benchmarks for IQC in ART cycles. METHODS In this prospective cohort study, 280 patients (36.4±4.3years) underwent ART. The total KPIs-score was obtained by the analysis of age, AMH (AMH Gen II ELISA/pre-mixing modified, Beckman Coulter Inc.), number of metaphase-II oocytes, fertilization rates and morphological quality of the embryonic lot. RESULTS The total KPIs-score (C-KPIs+L-KPIs) was correlated with the presence or absence of clinical pregnancy. The relationship between the C-KPIs and L-KPIs scores was analyzed to establish quality standards, to increase the performance of clinical and laboratorial processes in ART. The logistic regression model (LRM), with respect to pregnancy and total KPIs-score (280 patients/102 clinical pregnancies), yielded an odds ratio of 1.24 (95%CI = 1.16-1.32). There was also a significant difference (p

Objective This study aimed to determine what Brazilian childless women of reproductive age think about oocyte cryopreservation to postpone pregnancy and their reasons for performing or not performing this procedure. Methods Women of reproductive age were randomly selected from the general population using different e-mail lists and were invited to participate in the study by completing an online web survey regarding social oocyte cryopreservation. The survey was also distributed through social media to women of reproductive age. Results Although most of the responders had a partner (86.9%) and had already planned the pregnancy of their first child (69.6%), 85.4% (379) considered the potential of social oocyte freezing to improve their chances of giving birth later in life. Those that had already planned pregnancy were two times more likely to intend to freeze their oocytes (p=0.03). The most important barrier for not undergoing oocyte cryopreservation was cost. The women who indicated that they could not currently undergo the procedure now because of cost were two times (p=0.03) more likely to intend to cryopreserve their oocytes than women who thought that they would not need to delay pregnancy. Conclusion Brazilian women who think that they are not ready to have a family are discovering the option of oocyte cryopreservation. Most participants considered safeguarding their reproductive potential. Making the procedure more accessible could give women the opportunity to make proactive decisions about the future of their fertility.

The laboratory procedures performed within the context of assisted reproduction are supported by rigorous internal (IQS) and external quality systems (EQS). European directives and recommendations require the use of IQS and EQS and the adoption of quality control principles in areas such as organization, management, personnel, equipment and materials, documentation, record keeping, and quality reviews (The ESHRE Guideline Group on Good Practice in IVF Labs, 2015). Despite the growing concern with the standardization of laboratory work, little has been done to establish clinical internal quality control measures to systematize and increase the consistency of ovarian stimulation (OS) protocols. The prevention of ovarian hyperstimulation syndrome (OHSS) is a key factor in the safe use of assisted reproduction technologies (ART). Thus, the determination of the ovarian reserve is a mandatory step in the individualization of the dosages of the drugs administered to patients undergoing ART.

The present study evaluated the effect of artificial oocyte activation (AOA) with calcium ionophore A23187 on intracytoplasmic sperm injection (ICSI) cycles using spermatozoa from different sources. The 314 cycles evaluated were divided into three groups according to sperm origin; the ejaculated group (n = 92), the epididymal group (n = 82), and the testicular group (n = 140). Each group was further split into experimental subgroups, depending on whether or not AOA was performed. In addition, the cycles of women younger than 36 years were evaluated separately. For each experimental group, ICSI outcomes were compared between subgroups. No significant difference was observed between subgroups for all sperm origin groups. When evaluating only the cycles of women younger than 36 years of age, AOA increased the percentage of high-quality embryos (74.5 versus 53.0%, P = 0.011) and the implantation rate (19.3 versus 10.5%, P = 0.0025) when it was used with ejaculated spermatozoa, and the percentage of high-quality embryos (64.4 versus 50.3%, P = 0.006) when epididymal spermatozoa were used. These results may suggest that both sperm maturity and oocyte quality play a role in oocyte activation. However, this study is to be continued to confirm these findings.

Purpose: to compare the efficacy of recombinant LH supplementation for controlled ovarian stimulation in recombinant FSH and GnRH-agonist protocol. Methods: Search strategies included on-line surveys of databases. The fixed effects model was used for odds ratio and effect size (weighted mean difference). Four trials fulfilled the inclusion criteria. Results: a fewer days of stimulation (p

This study aims to compare a psychological evaluation test to classical psychoanalysis in infertile women. Two hundred women were submitted to the Psychological Evaluation Test (PET). The sum of the scores for the responses ranged from 15 to 60 points, with scores ≥30 points being defined as ‘psycho-emotional maladjustment’ (cut-off point: median + 25%). For comparison, the patients were simultaneously submitted to a psychological examination by a psychologist, who was unaware of the PET results. Of the 200 patients, 66 (33%) presented a test with ≥30 points (‘psycho-emotional maladjustment’) and 134 (67%) a test with

Purpose: The objective of the present investigation was to determine implantation and pregnancy rates in patients undergoing ICSI and treated with β2-adrenergic agonists, considering the uterine-relaxing action of these agents. Methods: A total of 225 women undergoing ICSI at the Center for Human Reproduction, “Sinha Junqueira” Maternity Foundation, entered the study. Patient participation in each group was random, by drawing lots, using a randomization table previously elaborated for the study (2:2:1). The group I (90 women) received 10 mg of terbutaline daily for 15 days starting on the day of oocyte retrieval; group II (90 women) received 20 mg of ritodrine daily during the same period of time as group I; group III (45 patients) received no treatment and was used as control. The evaluation was interrupted in 3 patients of group I and in 30 patients of group II because of a high incidence of side effects. Results: Pregnancy, implantation, and miscarriage rates were not significantly different (p > 0.05) between the three groups: 29.88%, 13.25%, and 26.9% for group I; 33.33%, 17.5%, and 10.0% for group II; 28.88%, 15.07%, and 15.38% for group III, respectively. Conclusions: The results of this study do not support the routine use of β2-adrenergic agonists during the peri-implantation period in assisted reproductive technology cycles.

Objective To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design Prospective, randomized. Setting A private center. Patient(s) Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s) GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s) ICSI outcomes and treatment costs. Result(s) A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s) Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number NCT01468441.

Made available in DSpace on 2013-08-28T14:07:11Z (GMT). No. of bitstreams: 1 WOS000314711300001.pdf: 1191127 bytes, checksum: d0eabe31dd3830314003d7c40434c14a (MD5) Made available in DSpace on 2013-09-30T18:20:43Z (GMT). No. of bitstreams: 2 WOS000314711300001.pdf: 1191127 bytes, checksum: d0eabe31dd3830314003d7c40434c14a (MD5) WOS000314711300001.pdf.txt: 50115 bytes, checksum: 7302ae309486d05178dc76dbe7d3a0d6 (MD5) Previous issue date: 2012-11-21 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:40Z No. of bitstreams: 2 WOS000314711300001.pdf: 1191127 bytes, checksum: d0eabe31dd3830314003d7c40434c14a (MD5) WOS000314711300001.pdf.txt: 50115 bytes, checksum: 7302ae309486d05178dc76dbe7d3a0d6 (MD5) Made available in DSpace on 2014-05-20T13:35:40Z (GMT). No. of bitstreams: 2 WOS000314711300001.pdf: 1191127 bytes, checksum: d0eabe31dd3830314003d7c40434c14a (MD5) WOS000314711300001.pdf.txt: 50115 bytes, checksum: 7302ae309486d05178dc76dbe7d3a0d6 (MD5) Previous issue date: 2012-11-21 Background: The objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Mullerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.Methods: A total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).Results: The regression analysis demonstrated significant (P

Made available in DSpace on 2013-08-28T14:08:29Z (GMT). No. of bitstreams: 1 WOS000308910500001.pdf: 221658 bytes, checksum: d864f7f93f4a2cdcf5f16330cfc3ef0a (MD5) Made available in DSpace on 2013-09-30T18:20:42Z (GMT). No. of bitstreams: 2 WOS000308910500001.pdf: 221658 bytes, checksum: d864f7f93f4a2cdcf5f16330cfc3ef0a (MD5) WOS000308910500001.pdf.txt: 51849 bytes, checksum: feaa0df4b446b5e195b5e9d457f76ca4 (MD5) Previous issue date: 2012-06-15 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:39Z No. of bitstreams: 2 WOS000308910500001.pdf: 221658 bytes, checksum: d864f7f93f4a2cdcf5f16330cfc3ef0a (MD5) WOS000308910500001.pdf.txt: 51849 bytes, checksum: feaa0df4b446b5e195b5e9d457f76ca4 (MD5) Made available in DSpace on 2014-05-20T13:35:39Z (GMT). No. of bitstreams: 2 WOS000308910500001.pdf: 221658 bytes, checksum: d864f7f93f4a2cdcf5f16330cfc3ef0a (MD5) WOS000308910500001.pdf.txt: 51849 bytes, checksum: feaa0df4b446b5e195b5e9d457f76ca4 (MD5) Previous issue date: 2012-06-15 Background: It is not well established whether the increased number of leukocytes in the seminal fluid impairs the outcomes of assisted reproductive technology (ART). This investigation analysed the outcomes of the intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) cycles in couples in which the male partner exhibited leukocytospermia.Methods: A total of 100 cycles in 100 couples were included in this study. For the ICSI or IMSI procedures, the patients were divided into two groups according to the presence or absence of leukocytospermia and then matched by (female) age:- ICSI: Group I (n = 25): Leukocytospermia - semen samples with a leukocyte count of greater than or equal to 1 x 10(6)/mL; and Group II (n = 25): Non-leukocytospermia - semen samples with a leukocyte count < 1 x 10(6)/mL.- IMSI: Group I (n = 25): Leukocytospermia; and Group II (n = 25): Non-leukocytospermia.The endpoints included the rates of fertilisation, implantation, clinical pregnancy, miscarriage, ongoing pregnancy and live birth. Student's t-tests, Mann-Whitney tests and Chi-square tests were performed, and P < 0.05 was considered significant.Results: The data from the ICSI groups showed that leukocytospermia did not have a negative influence on the rates of fertilisation (Group I: 57.9+/-30.2%, Group II: 61.9+/-27.7%; P = 0.74), implantation (Group I: 12.3%; Group II: 13.5%; P = 0.93), clinical pregnancy (Group I: 24%; Group II: 24%; P = 1.0), miscarriage ( Group I: 0, Group II: 0), ongoing pregnancy (Group I: 24%; Group II: 24%; P = 1.0), or live births (Group I: 24%; Group II: 24%; P = 1.0). Similarly, the data from the IMSI groups also showed that the leukocytospermia did not have a negative influence on the rates of fertilisation (Group I: 67.6+/-24.6%, Group II: 59.5+/-28.1%; P = 0.36), implantation (Group I: 17.5%; Group II: 16.7%; P = 0.90), clinical pregnancy (Group I: 28%; Group II: 24%; P = 1.0), miscarriage (Group I: 14.3%; Group II: 0; P = 0.33), ongoing pregnancy (Group I: 24%; Group II: 24%; P = 1.0), or live births (Group I: 24%, 6/25; Group II: 24%, 6/25; P = 1.0).Conclusions: The results indicate that the leukocytospermia may not have a negative effect on the outcomes of ICSI or IMSI cycles. Nevertheless, it seems that it is necessary to more precisely determine the effects, if any, of seminal leukocytes on fertilisation and implantation processes. Such efforts will help to establish a more reliable leukocyte threshold, which could eventually demonstrate whether there is a negative influence on the ART procedures. Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, Brazil Hosp Perola Byington, Womens Hlth Reference Ctr, São Paulo, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, Brazil São Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil São Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil

Made available in DSpace on 2013-08-28T14:09:24Z (GMT). No. of bitstreams: 1 WOS000307307000001.pdf: 639767 bytes, checksum: b78f9de52568816f019ce2c064623acd (MD5) Made available in DSpace on 2013-09-30T18:20:41Z (GMT). No. of bitstreams: 2 WOS000307307000001.pdf: 639767 bytes, checksum: b78f9de52568816f019ce2c064623acd (MD5) WOS000307307000001.pdf.txt: 49302 bytes, checksum: 51e5f2f668acfe2b84c709224143ca36 (MD5) Previous issue date: 2012-04-27 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:39Z No. of bitstreams: 2 WOS000307307000001.pdf: 639767 bytes, checksum: b78f9de52568816f019ce2c064623acd (MD5) WOS000307307000001.pdf.txt: 49302 bytes, checksum: 51e5f2f668acfe2b84c709224143ca36 (MD5) Made available in DSpace on 2014-05-20T13:35:39Z (GMT). No. of bitstreams: 2 WOS000307307000001.pdf: 639767 bytes, checksum: b78f9de52568816f019ce2c064623acd (MD5) WOS000307307000001.pdf.txt: 49302 bytes, checksum: 51e5f2f668acfe2b84c709224143ca36 (MD5) Previous issue date: 2012-04-27 Background: The selection of developmentally competent human gametes may increase the efficiency of assisted reproduction. Spermatozoa and oocytes are usually assessed according to morphological criteria. Oocyte morphology can be affected by the age, genetic characteristics, and factors related to controlled ovarian stimulation. However, there is a lack of evidence in the literature concerning the effect of gonadotropin-releasing hormone (GnRH) analogues, either agonists or antagonists, on oocyte morphology. The aim of this randomized study was to investigate whether the prevalence of oocyte dysmorphism is influenced by the type of pituitary suppression used in ovarian stimulation.Methods: A total of 64 patients in the first intracytoplasmic sperm injection (ICSI) cycle were prospectively randomized to receive treatment with either a GnRH agonist with a long-term protocol (n: 32) or a GnRH antagonist with a multi-dose protocol (n: 32). Before being subjected to ICSI, the oocytes at metaphase II from both groups were morphologically analyzed under an inverted light microscope at 400x magnification. The oocytes were classified as follows: normal or with cytoplasmic dysmorphism, extracytoplasmic dysmorphism, or both. The number of dysmorphic oocytes per total number of oocytes was analyzed.Results: Out of a total of 681 oocytes, 189 (27.8 %) were morphologically normal, 220 (32.3 %) showed cytoplasmic dysmorphism, 124 (18.2%) showed extracytoplasmic alterations, and 148 (21.7%) exhibited both types of dysmorphism. No significant difference in oocyte dysmorphism was observed between the agonist- and antagonist- treated groups (P > 0.05). Analysis for each dysmorphism revealed that the most common conditions were alterations in polar body shape (31.3%) and the presence of diffuse cytoplasmic granulations (22.8%), refractile bodies (18.5%) and central cytoplasmic granulations (13.6%). There was no significant difference among individual oocyte dysmorphisms in the agonist- and antagonist-treated groups (P > 0.05).Conclusions: Our randomized data indicate that in terms of the quality of oocyte morphology, there is no difference between the antagonist multi-dose protocol and the long-term agonist protocol. If a GnRH analogue used for pituitary suppression in IVF cycles influences the prevalence of oocyte dysmorphisms, there does not appear to be a difference between the use of an agonist as opposed to an antagonist. São Paulo State Univ UNESP, Dept Gynecol & Obstet, Botucatu Med Sch, Botucatu, SP, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, Brazil Perola Byington Hosp, Womens Hlth Reference Ctr, São Paulo, Brazil São Paulo State Univ UNESP, Dept Gynecol & Obstet, Botucatu Med Sch, Botucatu, SP, Brazil

Objective To compare the level of apoptosis and DNA fragmentation in the human granulosa cell (GC) layer exposed to an agonist or antagonist of GnRH in intracytoplasmic sperm injection (ICSI) cycles supplemented with recombinant LH (rLH). Study design Patients without ovulatory dysfunction, aged ≤37 years and in their first ICSI cycle were prospectively randomised to receive either a long GnRH agonist protocol or a multi-dose antagonist protocol. In both groups, recombinant FSH supplemented with rLH was used for ovarian stimulation, and the GCs were collected during oocyte denudation. The GCs were then analysed for DNA fragmentation by TUNEL assay and for apoptosis using the annexin-V assay. The outcomes were given as the percentage of GCs with DNA fragmentation and apoptosis out of the total number of GCs analysed. Comparison of the agonist versus the antagonist group was performed using the Mann–Whitney test. Results DNA fragmentation: 32 patients were included in either the GnRH agonist group ( n = 16) or the antagonist group ( n = 16). The percentage of GCs with positive DNA fragmentation did not differ significantly ( P = 0.76) between the agonist group (15.5 ± 9.4%) and the antagonist group (18.8 ± 13.3%). Apoptosis: 28 patients were included in either the GnRH agonist group ( n = 14) or the antagonist group ( n = 14). The percentage of GCs positive for apoptosis did not differ significantly ( P = 0.78) between the agonist group (34.6 ± 14.7%) and the antagonist group (36.5 ± 22%). Conclusions The results suggest that therapy with either an agonist or antagonist of GnRH is associated with comparable levels of DNA fragmentation and apoptosis in granulosa cells in ICSI cycles supplemented with rLH.

The objective of the present study was to compare the rate of embryo cleavage after oocyte insemination with capacitated spermatozoa in the presence or absence of follicular fluid. In the first experiment, a total of 67 oocytes were inseminated with spermatozoa which had been submitted to part of the capacitation procedures in the presence of follicular fluid (21 oocytes) and with spermatozoa capacitated only with Menezo B2 culture medium (46 oocytes). Thirteen and 29 cleaved embryos were obtained, respectively (p = 0.89). In the second experiment, a total of 61 oocytes were inseminated with spermatozoa submitted to the entire capacitation procedure in follicular fluid (17 oocytes) and capacitated only with Menezo B2 culture medium (44 oocytes). Eleven and 31 cleaved embryos were obtained, respectively (p = 0.67). The absence of significant differences in cleavage rate between the two experiments indicates that the quality of the spermatozoa capacitation process is not changed by the addition of follicular fluid.

Made available in DSpace on 2013-08-28T14:08:25Z (GMT). No. of bitstreams: 1 WOS000294868500001.pdf: 897993 bytes, checksum: eda2565983a3da47f13d8e9050e8fd64 (MD5) Made available in DSpace on 2013-09-30T18:20:38Z (GMT). No. of bitstreams: 2 WOS000294868500001.pdf: 897993 bytes, checksum: eda2565983a3da47f13d8e9050e8fd64 (MD5) WOS000294868500001.pdf.txt: 48147 bytes, checksum: afd0d9e9e12e9ff71b5e226992e9601f (MD5) Previous issue date: 2011-08-23 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:37Z No. of bitstreams: 2 WOS000294868500001.pdf: 897993 bytes, checksum: eda2565983a3da47f13d8e9050e8fd64 (MD5) WOS000294868500001.pdf.txt: 48147 bytes, checksum: afd0d9e9e12e9ff71b5e226992e9601f (MD5) Made available in DSpace on 2014-05-20T13:35:37Z (GMT). No. of bitstreams: 2 WOS000294868500001.pdf: 897993 bytes, checksum: eda2565983a3da47f13d8e9050e8fd64 (MD5) WOS000294868500001.pdf.txt: 48147 bytes, checksum: afd0d9e9e12e9ff71b5e226992e9601f (MD5) Previous issue date: 2011-08-23 Background: Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI).Methods: A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400x magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined.Results: Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.Conclusions: The present findings support the use of high-magnification microscopy both for selecting spermatozoa and as a routine method for analysing semen before performing IUI. São Paulo State Univ UNESP, Botucatu Med Sch, Dept Obstet & Gynaecol, Botucatu, SP, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, Brazil São Paulo State Univ UNESP, Botucatu Med Sch, Dept Obstet & Gynaecol, Botucatu, SP, Brazil

Made available in DSpace on 2013-08-28T14:10:13Z (GMT). No. of bitstreams: 1 WOS000290533800001.pdf: 1314192 bytes, checksum: f5c29809770a9567a94278da5590bb63 (MD5) Made available in DSpace on 2013-09-30T18:20:37Z (GMT). No. of bitstreams: 2 WOS000290533800001.pdf: 1314192 bytes, checksum: f5c29809770a9567a94278da5590bb63 (MD5) WOS000290533800001.pdf.txt: 30649 bytes, checksum: 4603f801aa75e03198ed572f4599ebc5 (MD5) Previous issue date: 2011-04-23 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:36Z No. of bitstreams: 2 WOS000290533800001.pdf: 1314192 bytes, checksum: f5c29809770a9567a94278da5590bb63 (MD5) WOS000290533800001.pdf.txt: 30649 bytes, checksum: 4603f801aa75e03198ed572f4599ebc5 (MD5) Made available in DSpace on 2014-05-20T13:35:36Z (GMT). No. of bitstreams: 2 WOS000290533800001.pdf: 1314192 bytes, checksum: f5c29809770a9567a94278da5590bb63 (MD5) WOS000290533800001.pdf.txt: 30649 bytes, checksum: 4603f801aa75e03198ed572f4599ebc5 (MD5) Previous issue date: 2011-04-23 Background: This study evaluated whether there is a relationship between the zona pellucida birefringence (ZP-BF) intensity and the nuclear (NM) and cytoplasmic (CM) in vitro maturation of human oocytes from stimulated cycles.Results: The ZP-BF was evaluated under an inverted microscope with a polarizing optical system and was scored as high/positive (when the ZP image presented a uniform and intense birefringence) or low/negative (when the image presented moderate and heterogeneous birefringence). CM was analyzed by evaluating the distribution of cortical granules (CGs) throughout the ooplasm by immunofluorescence staining. CM was classified as: complete, when CG was localized in the periphery; incomplete, when oocytes presented a cluster of CGs in the center; or in transition, when oocytes had both in clusters throughout cytoplasm and distributed in a layer in the cytoplasm periphery Nuclear maturation: From a total of 83 germinal vesicle (GV) stage oocytes, 58 of oocytes (69.9%) reached NM at the metaphase II stage. From these 58 oocytes matured in vitro, the high/positively scoring ZP-BF was presented in 82.7% of oocytes at the GV stage, in 75.8% of oocytes when at the metaphase I, and in 82.7% when oocytes reached MII. No relationship was observed between NM and ZP-BF positive/negative scores (P = 0.55). These variables had a low Pearson's correlation coefficient (r = 0.081). Cytoplasmic maturation: A total of 85 in vitro-matured MII oocytes were fixed for CM evaluation. Forty-nine oocytes of them (57.6%) showed the complete CM, 30 (61.2%) presented a high/positively scoring ZP-BF and 19 (38.8%) had a low/negatively scoring ZP-BF. From 36 oocytes (42.3%) with incomplete CM, 18 (50%) presented a high/positively scoring ZPBF and 18 (50%) had a low/negatively scoring ZP-BF. No relationship was observed between CM and ZP-BF positive/negative scores (P = 0.42). These variables had a low Pearson's correlation coefficient (r = 0.11).Conclusions: The current study demonstrated an absence of relationship between ZP-BF high/positive or low/negative score and nuclear and cytoplasmic in vitro maturation of oocytes from stimulation cycles. São Paulo State Univ, UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, Brazil São Paulo State Univ, UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:25:28Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:41:41Z : No. of bitstreams: 1 2-s2.0-79960559745.pdf: 340611 bytes, checksum: 48f2338ff315fa19c470805cab404c17 (MD5) Made available in DSpace on 2014-05-27T11:25:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-01 Objective: To describe two successful cases of utilizing refrozen blastocysts by vitrification derived from supernumerary embryos. Design: Case report. Setting: Private fertility clinic. Subjects: Two infertility couple. Interventions: Refrozen blastocysts by vitrification derived from supernumerary embryos. Main outcome measures: Obstetric and pediatric results. Results: Two pregnancies obtained from refrozen-warmed blastocysts led to two healthy babies being born without clinical or genetic problems. Conclusion: These case reports support the notion of safely repeating cryopreservation. However, despite these favorable results, there is still a need for prospective controlled studies on the obstetric and neonatal repercussions of refreezing and of vitrification in particular. © 2010 Middle East Fertility Society. Center for Human Reproduction Prof. Franco Jr. Ribeirão Preto, Av. Prof. Joã o Fiusa, CEP 14025- 310 Ribeirão Preto, São Paulo Paulista Center for Diagnosis Research and Training, Ribeirão Preto Department of Gynecology and Obstetrics Botucatu Medical School State University - UNESP, São Paulo Department of Obstetrics and Gynecology University of Schleswig-Holstein, Luebeck Department of Gynecology and Obstetrics Botucatu Medical School State University - UNESP, São Paulo

Made available in DSpace on 2013-08-28T14:13:59Z (GMT). No. of bitstreams: 1 WOS000282557500001.pdf: 1114958 bytes, checksum: 806fed24b1dc34c2158ea8bc33083f44 (MD5) Made available in DSpace on 2013-09-30T18:20:34Z (GMT). No. of bitstreams: 2 WOS000282557500001.pdf: 1114958 bytes, checksum: 806fed24b1dc34c2158ea8bc33083f44 (MD5) WOS000282557500001.pdf.txt: 40224 bytes, checksum: f6322e0be6883c574489f3d6e3320e8e (MD5) Previous issue date: 2010-09-08 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:35Z No. of bitstreams: 2 WOS000282557500001.pdf: 1114958 bytes, checksum: 806fed24b1dc34c2158ea8bc33083f44 (MD5) WOS000282557500001.pdf.txt: 40224 bytes, checksum: f6322e0be6883c574489f3d6e3320e8e (MD5) Made available in DSpace on 2014-05-20T13:35:35Z (GMT). No. of bitstreams: 2 WOS000282557500001.pdf: 1114958 bytes, checksum: 806fed24b1dc34c2158ea8bc33083f44 (MD5) WOS000282557500001.pdf.txt: 40224 bytes, checksum: f6322e0be6883c574489f3d6e3320e8e (MD5) Previous issue date: 2010-09-08 Background: The effects of gonadotrophin-releasing hormone agonist (GnRH-a) administered in the luteal phase remains controversial. This meta-analysis aimed to evaluate the effect of the administration of a single-dose of GnRH-a in the luteal phase on ICSI clinical outcomes.Methods: The research strategy included the online search of databases. Only randomized studies were included. The outcomes analyzed were implantation rate, clinical pregnancy rate (CPR) per transfer and ongoing pregnancy rate. The fixed effects model was used for odds ratio. In all trials, a single dose of GnRH-a was administered at day 5/6 after ICSI procedures.Results: All cycles presented statistically significantly higher rates of implantation (P < 0.0001), CPR per transfer (P = 0.006) and ongoing pregnancy (P = 0.02) in the group that received luteal-phase GnRH-a administration than in the control group (without luteal-phase-GnRH-a administration). When meta-analysis was carried out only in trials that had used long GnRH-a ovarian stimulation protocol, CPR per transfer (P = 0.06) and ongoing pregnancy (P = 0.23) rates were not significantly different between the groups, but implantation rate was significant higher (P = 0.02) in the group that received luteal-phase-GnRH-a administration. on the other hand, the results from trials that had used GnRH antagonist multi-dose ovarian stimulation protocol showed statistically significantly higher implantation (P = 0.0002), CPR per transfer (P = 0.04) and ongoing pregnancy rate (P = 0.04) in the luteal-phaseGnRH- a administration group. The majority of the results presented heterogeneity.Conclusions: These findings demonstrate that the luteal-phase single-dose GnRH-a administration can increase implantation rate in all cycles and CPR per transfer and ongoing pregnancy rate in cycles with GnRH antagonist ovarian stimulation protocol. Nevertheless, by considering the heterogeneity between the trials, it seems premature to recommend the use of GnRH-a in the luteal phase. Additional randomized controlled trials are necessary before evidence-based recommendations can be provided. Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, São Paulo, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, SP, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, SP, Brazil Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, São Paulo, Brazil

To evaluate whether intracytoplasmic morphologically selected sperm injection (IMSI) could influence early paternal effects by observing embryo quality at day 2.The study included 30 couples with at least one of the following criteria: male factor infertility, at least 2 previous failures of implantation or previous miscarriages after IVF/ICSI. Sibling oocytes of each patient were randomly assigned to either the ICSI group or the IMSI group. For IMSI, spermatozoa were selected at 8400x magnification through an inverted microscope equipped with Nomarski differential interference contrast optics, Uplan Apo 100x oil/1.35 objective lens and variable zoom lens. For conventional ICSI, spermatozoa were selected at 400x magnification. An embryo was defined as top quality if there were four identical blastomeres on day 2 with no fragments or multinucleation of blastomeres. Data were analysed using the Wilcoxon and chi-squared tests. The significance level was set at P0.05. The variables were analysed in relation to the general population and the subpopulations with or without male factor.A total of 331 MII oocytes (30 oocyte retrievals) were selected and injected by the ICSI (n: 172) or IMSI (n: 159) procedure. For IMSI, only spermatozoa classified as morphologically normal at high magnification were used. No differences (P0.05) in fertilisation rate (ICSI: 70.9%; IMSI: 70.4%), early embryo cleavage rate (ICSI: 66.9%; IMSI: 60.4%) or cleavage rate (ICSI: 99.2%; IMSI: 99.1%) were observed. On day 2, as compared to ICSI, IMSI provided a similar proportion of top quality embryos (ICSI: 57.8%; IMSI: 52.2%; P0.05). These results were not influenced by the presence or absence of male factor.In terms of embryo quality at day 2, IMSI had the same performance as conventional ICSI. However, we cannot exclude the possibility that IMSI effects occur only as a positive later paternal effect.

Made available in DSpace on 2013-08-28T14:13:18Z (GMT). No. of bitstreams: 1 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) Made available in DSpace on 2013-09-30T18:20:33Z (GMT). No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Previous issue date: 2009-04-23 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:34Z No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Made available in DSpace on 2014-05-20T13:35:34Z (GMT). No. of bitstreams: 2 WOS000266491500003.pdf: 1371895 bytes, checksum: d45f32903f46b1730f38a0dc7a15caf3 (MD5) WOS000266491500003.pdf.txt: 35795 bytes, checksum: 782199993b53b4b4a36594a51672c768 (MD5) Previous issue date: 2009-04-23 Background: It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates.Methods: Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria.Results: When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (P = 0.96; OR = 0.99, 95% CI 0.78, 1.25). on the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (P < 0.0001; OR: 2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%).Conclusion: Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment. Ctr Human Reprod Prof Franco Jr, São Paulo, Brazil São Paulo State Univ UNESP, Dept Obstet & Gynecol, Botucatu Med Sch, São Paulo, Brazil São Paulo State Univ UNESP, Dept Obstet & Gynecol, Botucatu Med Sch, São Paulo, Brazil

The objective of this meta-analysis was to investigate the influence of meiotic spindle visualization in human oocytes on intracytoplasmic sperm injection (ICSI) outcomes. Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and Ovid). The fixed effect was used for odds ratio. Ten trials fulfilled the inclusion criteria comparing in-vitro and clinical ICSI outcomes with or without visualization of meiotic spindle in fresh and in-vivo matured oocytes. According to the meta-analysis, the results showed statistically significant higher fertilization rate (P < 0.0001) when the meiotic spindle was viewed than when it was not. Moreover, the percentage of pro-nuclear-stage embryos with good morphology (P = 0.003), cleavage rate (P < 0.0001), percentage of day-3 top-quality embryos (P = 0.003) and percentage of embryos that reached the blastocyst stage (P < 0.0001) were statistically significantly better among embryos derived from oocytes in which meiotic spindle was viewed compared with those in which meiotic spindle was not observed. However, these differences were not observed in the clinical pregnancy or implantation rates. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. However, additional controlled trials are needed to further confirm these results.

This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocyets retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further.

Laser-assisted hatching is little documented in the literature regarding its effi cacy in cryopreserved−thawed (CT) embryo transfer cycles. The aim of the present study was to evaluate in a randomized manner the effi cacy of thinning one quarter of the zona pellucida of CT embryos to a depth of 50-80% of the original thickness, via laser treatment (the qLZT-AH procedure), in improving implantation and pregnancy rates. Two populations were studied: population I, patients who had all their supernumerary embryos cryopreserved, regardless of their morphology, and population II, patients at risk of ovarian hyperstimulation syndrome who had all their embryos cryopreserved. Artifi cial and natural protocols were used for the embryo transfers. A total of 350 laser-thinned CT embryos were compared with 352 intact zona embryos. No difference in implantation or pregnancy rate was found after using qLZT-AH in either population. These fi ndings suggest that qLZT-AH should not be routinely performed in cryopreserved embryo programmes.

A total of 63 pregnancies (47 singleton, 15 twin, 1 triplet) from intracytoplasmic sperm injection cycles were analysed. In all embryo transfers, the catheter was introduced into the endometrial cavity guided by abdominal ultrasound, with the catheter tip placed at the middle point of the endometrial cavity. Gestational sacs (GS) were located 21–24 days after transfer (gestational age = 5 weeks) by two-dimensional and three-dimensional transvaginal ultrasound. The uterine cavity was divided into three parts: upper, middle and lower. Furthermore, the upper region was subdivided into right, middle and left areas, and the middle region was subdivided into right and left areas. The frequency of gestational sacs in each area was evaluated. In singleton pregnancies 66.0% (31/47) of the GS were detected in the upper region, 29.8% (14/47) in the middle region and 4.2% (2/47) in the lower region. In multiple pregnancies (twins and triplet) 45.5% (15/33) of the GS were detected in the upper region, 51.5% (17/33) in the middle region and 3.0% (1/33) in the lower region. In conclusion, the results demonstrate that when embryos are transferred to the central area of the uterine cavity there is an increase in implantation rate in the middle region compared with the rate expected in naturally conceived pregnancies (9–15%).

Objective: To determine the incidence of chromosomal abnormalities in normally androgenized infertile men with no other recognized causes of infertility or who had ever been submitted to other unsuccessful methods of treatment. Design: Collaborative retrospective study of clinical experience collected by an endocrinologist and a geneticist over a 5-year period. Setting: Outpatients at an endocrinology clinic. Patient(s): Infertile male patients with azoospermia (n = 23), oligozoospermia (n = 66), and normozoospermia (n = 14) presenting normal (n = 85) or subnormal (n = 18) testicular volume. Intervention(s): All patients were submitted to cytogenetic analysis. Main Outcome Measure(s): Two patients were referred to intracytoplasmic sperm injection (ICSI), and in one case, a successful gemellar pregnancy ended up uneventful. Children's genetic testings were not performed according to parents' request. Result(s): Abnormal karyotypes were found in 11(10.6%) patients. Chromosomal abnormalities were found in 17.3% of the 23 azoospermic patients, in 10.6% of the 66 oligozoospermic patients, and in none of the 14 normozoospermic patients. These disorders were found only in patients with normal testicular volumes and no more than 10 × 10 6 spermatozoa per mL. Conclusion(s): A high incidence of chromosomal abnormalities was found in a selected group of normally androgenized infertile male patients. The elevated rate of fertilization achieved in one patient indicates that ICSI is, at the moment, the only choice for treatment of male infertility because of chromosomal abnormalities.