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SUMMARY OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients’ charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

Objective: To determine whether administration of progesterone on the day of oocyte retrieval may reverse accumulation of fluid in the endometrial cavity. Methods: A total of 50 patients who underwent assisted reproductive technology (ART) cycles with endometrial cavity fluid (ECF) observed by ultrasound at the time of oocyte retrieval were included. Upon the identification of ECF, vaginal administration of natural progesterone was started. Two days later, the endometrial cavity was re-evaluated, and embryo transfer was performed in the absence of ECF. Results: ECF was absent two days after administration of vaginal progesterone in 47 of the 50 patients (94%). ECF persisted in 3 of the 50 patients (6%). The clinical pregnancy rate per transfer was 34.0%, and the implantation rate was 21.6%. Conclusion: Our data suggest that, in the presence of ECF, administration of intravaginal progesterone in ART cycles must be initiated on the day of follicle aspiration to reverse ECF and to avoid the deleterious effects of fluid on the blastocyst-endometrial interaction.

SUMMARY OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Made available in DSpace on 2020-12-12T02:13:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 Objective: Patients submitted to oncological fertility preservation with letrozole and gonadotropins seem to present a higher rate of immature oocytes and lower fertilization rates in comparison to infertile patients submitted to IVF cycles with gonadotropins. The aim of this study was to evaluate the influence of letrozole on oocyte morphology in patients with breast cancer submitted to fertility preservation. Methods: Retrospective analysis performed at a pub-lic tertiary hospital in São Paulo, Brazil. The oocytes were retrieved from patients with breast cancer undergoing fertility preservation (n=69), and from infertile women undergoing in vitro fertilization (n=92). We evaluated 750 oocytes obtained from breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins, and 699 oocytes from patients without breast cancer submitted to ovarian stimulation for in vitro fertilization with go-nadotropins only due to male factor infertility. The mature oocytes retrieved were analyzed for the presence of re-fractile bodies, ooplasm color and regularity, central granulation degree, cortical granules, zona pellucida staining and regularity, perivitelline space, presence of vacuoles or abnormal smooth-surfaced endoplasmic reticle and oocyte retraction. Results: There was a higher incidence of alterations in oocyte morphology in the letrozole group when com-pared to the control group: increased perivitelline space (p=0.007), irregular zona pellucida (p

Objective This study aimed to assess a novel protocol designed to improve poor ovarian response through intra-ovarian androgenization. The endpoints were: number of oocytes and mature oocytes retrieved, fertilization, cancellation and pregnancy rates. Methods This prospective crossover study enrolled poor responders from previous ovarian stimulation cycles submitted to a novel protocol called ANDRO-IVF. The protocol included pretreatment with transdermal AndroGel(r) (Besins) 25 mg, oral letrozole 2.5 mg and subcutaneous hCG 2500 IU; cycle control was performed with estradiol valerate and micronized progesterone; ovarian stimulation was attained with gonadotropins FSH/LH 450 IU, GnRH antagonist and hCG 5000 IU. Results Fourteen poor responders were enrolled. One patient did not meet the inclusion criteria. Thirteen patients previously summited to the standard protocol were offered the ANDRO-IVF Protocol.-Standard Protocol: Mean age: 35.30 years; cancellation rate: 61.53%; mean number of MII oocytes retrieved per patient: 1.8; fertilization rate: 33.33%. Only two patients had embryo transfers, and none got pregnant.-ANDRO-IVF Protocol: Mean age: 35.83 years; cancellation rate: 7.69%; mean number of oocytes retrieved per patient: 5.58, MII oocytes: 3.91. ICSI was performed in 84.61% of the patients and a mean of 1.5 embryos were transferred per patient. Fertilization rate: 62.5%; cumulative pregnancy rate: 16.66%; mean duration of stimulation: 9.77 days. Conclusion ANDRO-IVF allows intra-ovarian androgenization by increasing serum and intra-follicular androgen levels and preventing androgen aromatization. This protocol apparently improved clinical outcomes of poor responders in parameters such as number of oocytes retrieved and clinical pregnancy rates. Further randomized controlled trials are needed to confirm these findings.

Resumo A criopreservacao de oocitos contribuiu para o avanco das tecnicas em reproducao humana nas ultimas decadas. A metodologia tem sua aplicacao na preservacao da fertilidade, em programas de ovodoacao, como estrategia para reducao do numero de embrioes extranumerarios criopreservados com manipulacao de menor numero de oocitos a fresco e para acumulo de oocitos em ciclos com reduzida resposta ovariana. A partir do principio de que todo cidadao tem direito a saude, e dever do Estado garantir o acesso a todos os tipos de tratamento. O Centro de Referencia da Saude da Mulher – Hospital Perola Byington implantou a tecnica de vitrificacao de oocitos em 2010, aprimora os protocolos continuamente e busca melhores taxas de sobrevida, fertilizacao, clivagem e gestacao. Relatamos as duas primeiras gestacoes, com nascimento, obtidas a partir de oocitos vitrificados em nosso Centro, que comprovam a viabilidade da aplicacao dessa tecnica e oferecem, assim, atendimento ao publico com equidade e gratuidade integral.

Aim of the study : The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen. Material and methods : Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35–36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger. Results : The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10. Conclusions : The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.

ResumoA oncofertilidade é um campo de interesse interdisciplinar de desenvolvimento recente que busca mesclar os conhecimentos em oncologia e medicina reprodutiva, com a contribuição das técnicas de reprodução assistida, para o desenvolvimento de estratégias de preservação da função gonadal e oferecer a possibilidade da procriação biológica aos sobreviventes de câncer. As estratégias de preservação da fertilidade feminina em pacientes oncológicas atualmente aceitas para a prática rotineira são a criopreservação de embriões e a criopreservação de oócitos maduros. Ocorre que, para execução de ambos, a indução de ovulação é obrigatória e, com ela, vêm os riscos teóricos de estimulação do crescimento de tumores estrogênio‐dependentes e a postergação do início do tratamento antineoplásico. Os protocolos de estimulação ovariana de início aleatório contemplam a intenção de se minimizar o atraso no início da quimioterapia ou radioterapia e o bloqueio ao crescimento tumoral e oferecem resultados satisfatórios, semelhantes aos obtidos em protocolos de início habitual. Apresentamos neste artigo as diretrizes clínicas da Sociedade Brasileira de Reprodução Humana para indução de ovulação em pacientes com tumor estrogênio‐dependente.AbstractOncofertility is an interdisciplinary interest field of recent development, which aims to merge the knowledge in oncology and reproductive medicine, with the help of assisted reproductive technologies, to develop strategies for gonadal function preservation and to offer the possibility of biological procreation to cancer survivors. Preservation strategies of female fertility in oncological patients currently accepted for routine practice are the cryopreservation of embryos and cryopreservation of mature oocytes. It happens that ovulation induction is mandatory for executing both strategies, and with it the theoretical risk of stimulation of estrogen‐dependent tumors growth and the postponement of anti‐neoplastic treatment. Random‐start ovarian stimulation protocols include the intention of minimizing the delay in onset of chemo‐radiotherapy and to block tumor growth, providing satisfactory results, similar to those obtained in the usual beginning protocols. This article presents the clinical guidelines of the Brazilian Society of Human Reproduction for ovulation induction in patients with estrogen‐dependent tumors.

ResumoTodo serviço de reprodução humana necessita de um banco de dados para arquivar e manejar avaliações estatísticas. O serviço público de Reprodução Humana do Hospital Pérola Byington usava uma planilha Excel™ que se mostrou insuficiente para o adequado gerenciamento de informações, evidenciou a necessidade de um programa específico que facilitasse uma consulta rápida ao resumo dos ciclos de FIV, sem que houvesse qualquer probabilidade de erro no preenchimento e nas estatísticas posteriormente feitas. Considerando a inexistência de recursos para compra de um programa, tornava‐se necessária a criação de uma plataforma a partir de um software de uso livre. Optamos por usar a plataforma fornecida pelo Centers for Disease Control and Prevention e assim originou‐se o CRSMinfo, composto de formulários com subdivisões dos procedimentos, incluindo todas as informações relevantes para consulta e levantamento automatizado de dados. Seu uso mostrou‐se extremamente eficiente, aprimorou os protocolos laboratoriais e possibilitou estudos e pesquisas.AbstractEfficient software it's absolutely necessary for any human assisted reproduction (ART) lab. Perola Byington Public Hospital's ART center has used a spreadsheet in Excel with more than 200 columns for data storage of all in vitro fertilization cycles for years, making it very difficult to create complex statistics to analyze data and lead to quick statistic evaluation. Since we are working with a very tight budget, we selected an open source software created by the Centers for Disease Control and Prevention, and after months of programming we created CRSMinfo, which contains a form with subdivision of procedures, including all the information for research and automatic sorting of the data. The use of CRSMinfo software at Perola Byington Hospital has been extremely efficient, improving the protocols for the realization of studies and researches.

Cervical ectopic gestation is a serious and potentially lethal condition considered exceptional in in vitro fertilization. Early diagnosis is critical to successful treatment and preservation of fertility. We report a rare case of cervical pregnancy after in vitro fertilization and embryo transfer, successfully treated exclusively with electrical aspiration. Case report: A 36-year-old patient attended the Department of Human Reproduction at Pérola Byington Hospital in 2015 due to primary infertility with no apparent cause for seven years. Subjected to ovulation induction with recombinant depot FSH and GnRh analogue, triggered with chorionic gonadotropin. It evolved with the collection of ten oocytes and transfer of two embryos, with cryopreservation of the remaining ones. The control with serial ultrasound showed a gestational sac in uterine cervix topography, indicating gestation of six weeks, confirmed after 24 hours by a second operator. The treatment was successfully performed by electric aspiration with an EasyGrip® cannula of 6 mm in diameter, without the occurrence of hemorrhage or the need for other procedures. Early diagnosis allowed successful conservative treatment with only cervical aspiration. The literature review confirms the rarity of the case, but does not indicate consensus on the best treatment of cervical ectopic pregnancy.

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.

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.

Preimplantation genetic diagnosis was carried out for embryonic analysis in a patient with multiple endocrine neoplasia type 1 (MEN1). This is a rare autosomal-dominant cancer syndrome and the patients with MEN1 are characterized by the occurrence of tumors in multiple endocrine tissues, associated with germline and somatic inactivating mutations in the MEN1 gene. This case report documents a successful preimplantation genetic diagnosis (PGD) involving a couple at-risk for MEN1 syndrome, with a birth of a healthy infant. The couple underwent a cycle of controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Embryos were biopsied at the blastocyst stage and cryopreserved; we used PCR-based DNA analysis for PGD testing. Only one of the five embryos analyzed for MEN1 syndrome was unaffected. This embryo was thawed and transferred following endometrial preparation. After positive βHCG test; clinical pregnancy was confirmed by ultrasound, and a healthy infant was born. PGD for single gene disorders has been an emerging therapeutic tool for couples who are at risk of passing a genetic disease on to their offspring.

ResumoO hormônio anti-Mülleriano (HAM) é um marcador da reserva ovariana usado em técnicas de reprodução assistida com o objetivo de predizer a resposta inadequada à estimulação ovariana controlada. Também pode ser útil na predição de hiper-respostas em pacientes com síndrome dos ovários policísticos e colaborar para individualizar protocolos de estimulação mais adequados ao perfil de cada paciente e para o sucesso final do tratamento, muitas vezes dispendioso. Além do HAM existem outros marcadores da reserva ovariana, como contagem de folículos antrais (CFA) e hormônio folículo estimulante (FSH), juntamente com o Estradiol (E2) e a Inibina B.AbstractThe Anti-Müllerian Hormone (AMH) is a marker of ovarian reserve used in assisted reproductive technologies, aiming at predict the response to controlled ovarian stimulation. It may also be useful for the prediction of hyperresponse to ovarian stimulation, as frequently observed in patients with Polycystic Ovary Syndrome. Being so, it is useful to individualize ovarian stimulation protocols, making the treatment more cost-effective. Besides AMH, there are other markers of ovarian reserve, as antral follicle count (AFC), Follicle Stimulating Hormone (FSH) along with Estradiol (E2) and inhibin B.

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.

INTRODUCTION Ovarian stimulation is employed in assisted reproduction techniques in order to obtain as many oocytes as possible. The early rise in oestradiol levels may lead to the premature end of the respective cycle. In order to avoid such an effect, pituitary suppression has been employed. The aim of this study was to evaluate whether maintenance or replacement of the type of GnRH analogue (i.e., agonist or antagonist) employed for pituitary suppression in the consecutive intracytoplasmic sperm injection (ICSI) cycle would negatively influence oocyte quality and ICSI outcome. MATERIAL AND METHODS A retrospective observational study was conducted including 181 women with primary infertility. Patients were divided into four different groups according to the GnRH analogue used for pituitary suppression in the first and consecutive cycle. RESULTS When a GnRH agonist was employed for pituitary suppression in the first cycle, the consecutive cycle showed comparable outcomes when performed with either a GnRH agonist or a GnRH antagonist. When the first cycle was performed with a GnRH antagonist, the use of the GnRH agonist in the successive cycle led to an increased number of oocytes retrieved (7.5% vs. 10.3%, p = 0.032) and the production of a higher number of embryos (4.5% vs. 6.3%, p = 0.036). CONCLUSIONS When the first cycle is carried out with a GnRH antagonist, the use of a GnRH agonist in the successive cycle would lead to increased numbers of oocytes collected and embryos produced.

Birefringence or double refraction is the decomposition of a ray of light into two rays when it passes through an aniso- tropic material such as quartz. Sperm cells have been demonstrated to be optically anisotropic. The objective of this study was to evaluate the relationship between the pattern of human sperm head birefringence (SHBF) and DNA damage. A total of 26 patients with normal semen were included. DNA damage (fragmentation and denaturation) was evaluated in the sperm head in the context of birefringence, both total (SHBF-T) and partial (SHBF-P), by terminal deoxyribonucleotidyl transferase (TdT)-mediated dUDP nick-end labelling assay and acridine orange fluorescence, respectively. Positive DNA fragmentation in spermatozoa with SHBF-T (205/1053; 19.5%) was significantly higher (P < 0.0001) than in spermatozoa that presented SHBF-P (60/820; 7.3%). However, the percentage of denatured DNA in spermatozoa with SHBF-T (824/1256; 65.6%) was not significantly different from the ones with SHBF-P (666/1009; 66.0%). In conclusion, the data support a positive relationship between spermatozoa with total SHBF in their head and increased DNA fragmentation. RBMOnline

Summary The aim of this investigation was to determine the presence of abnormal sperm chromatin packaging in spermatozoa with large nuclear vacuoles (LNV) selected via high magnification by analysing the pattern of chromomycin A3 (CMA3) staining. A prospective observational study was designed to analyse semen samples obtained from 66 men undergoing infertility diagnosis and treatment. The numbers of cells with normal (dull yellow staining of the sperm head/CMA3-negative) and abnormal (bright yellow fluorescence of the sperm head/CMA3-positive) chromatin packaging were determined on slides with normal and LNV spermatozoa. The presence of bright yellow fluorescence (CMA3-positive) was significantly higher (p

Objective: The aim of this study was to evaluate the ef- fects of aging on semen quality in a population of infertile couples. Methods: A cross-sectional study of semen samples ob- tained from 1,500 men randomly selected from couples who attended an infertility clinic was conducted. The anal- yses were performed using Spearman's correlation and Mann-Whitney tests. The age groups consisted of men ≤ 35 years, from 36-45 years and > 45 years of age. The semen analysis was performed according to the WHO criteria, and morphology was evaluated using the motile sperm organelle morphology examination (MSOME). The percentages of normal spermatozoa and spermatozoa with large nuclear vacuoles (LNV, occupying > 50% nuclear area) were determined. The percentages of DNA fragmen- tation were assessed using the TUNEL assay. Results: A regression analysis revealed that the per- centages of LNV spermatozoa and sperm DNA frag- mentation positively correlated with age. Conversely, a regression analysis revealed that the percentage of nor- mal sperm, sperm progressive motility and sperm vi- tality negatively correlated with age. As in the previous test, the analysis by age group showed that there was a significant reduction (P < 0.05) in the percentage of normal sperm, sperm progressive motility and sperm vitality as age increased. Conversely, the percentage of spermatozoa with LNVs and sperm DNA fragmenta- tion significantly increased (P < 0.05) as age increased. Conclusion: Semen quality seems to be influenced by ag- ing. The age-related decrease in sperm quality suggests that delaying childbearing, not only for women but also for men, may jeopardize reproductive capacity.

The authors review the physiology of the ovulatory cycle and the role of the gonadotrophins in ovulation induction in patients with anovulatory disorders and in multifollicular development for assisted reproductive technologies. The use of gonadotrophins with luteinizing hormone (LH) activity and the use of recombinant LH associated with follicle stimulating hormone (FSH) are discussed. The authors point out that administration of gonadotrophins with LH activity is essential in hypogonadotropic hypogonadal anovulation, and data available in the medical literature allow the conclusion that recombinant LH may be added to all ovarian stimulation protocols because it is difficult to determine which patients will benefit from LH administration and there is no evidence that LH affects adversely the outcome of ovarian stimulation. The use of recombinant LH in addition to recombinant FSH may be particularly useful when a GnRH antagonist is associated with the ovarian stimulation regimen, by preventing the fall in estradiol and diminishing FSH requirements.

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.

Embryo transfer has received little clinical attention and has been, until recently, the most inefficient step in in-vitro fertilization (IVF). In this article, the authors review the literature and their personal experience regarding the process of intrauterine transfer of embryos, which remains the object of much discussion. Factors which appear to influence implantation rates are: contamination of the catheter tip with cervical bacteria, stimulation of uterine contractions during the procedure, the type of catheter, ultrasound guidance during the transfer, and the position of the embryos in the uterine cavity. Easy and atraumatic transfer is essential for successful implantation and the embryos need to be placed in the middle of the cavity, away from the fundus. Knowing, beforehand, the position and length of the uterus can provide better results and may reduce the rate of ectopic pregnancies. Evidence from randomized studies has supported this claim. Despite the number of available studies controlling certain variables, most authors, even using the same catheter, ultrasound guidance and/or a trial transfer use different protocols or similar instruments in different ways. Standardization of the transcervical intrauterine transfer of embryos in a large randomized study is needed before definitive conclusions can be drawn. The goal of improved implantation and pregnancy rates deserve these efforts.

This report describes the case of a 27-year-old woman with breast cancer who underwent ovarian stimulation for fertility preservation with recombinant FSH in conjunction with a gonadotrophin-releasing hormone (GnRH) antagonist and an aromatase inhibitor from the beginning of the treatment. A 3.75-mg triptorelin depot formulation was given intramuscularly when the follicular diameter of three follicles reached ⩾20mm and a total of 13 follicles reached ⩾15mm. Oocyte retrieval was scheduled for 36h later and 10 mature oocytes were collected and vitrified. This case report demonstrates that a depot GnRH-agonist trigger effectively leads to mature oocyte retrieval, with the advantage of initiating ovarian suppression for the purpose of fertility preservation during adjuvant chemotherapy in breast-cancer patients.

Made available in DSpace on 2014-12-03T13:10:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-10-22Bitstream added on 2014-12-03T13:23:08Z : No. of bitstreams: 1 WOS000326242800001.pdf: 282617 bytes, checksum: fb6540008c7a954d9d146e16337518dc (MD5) Background: Intrauterine insemination (IUI) is widely used to treat infertility, and its adequate indication is important to obtain good pregnancy rates. To assess which couples could benefit from IUI, this study aimed to evaluate whether sperm motility using a discontinuous gradient of different densities and incubation in CO2 in normospermic individuals is able to predict pregnancy.Methods: A total of 175 couples underwent 175 IUI cycles. The inclusion criteria for women were as follows: 35 years old or younger (age range: from 27 to 35 years) with normal fallopian tubes; endometriosis grades I-II; unexplained infertility; nonhyperandrogenic ovulatory dysfunction. Men with normal seminal parameters were also included. All patients underwent ovarian stimulation with clomiphene citrate and human hMG or r-FSH. When one or (at most) three follicles measuring 18 to 20 mm were observed, hCG (5000 UI) or r-hCG (250 mcg) was administered and IUI performed 36-40 h after hCG. Sperm processing was performed using a discontinuous concentration gradient. A 20 microliters aliquot was incubated for 24 h at 37 degrees C in 5% CO2 following a total progressive motility analysis. The Mann-Whitney and Chi-square tests, as well as a ROC curve were used to determine the cutoff value for motility.Results: Of the 175 couples, 52 (in 52 IUI cycles) achieved clinical pregnancies (CP rate per cycle: 29.7%). The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001). The comparison of progressive motility after processing and 24 h after incubation between these two groups indicated that progressive motility 24 h after incubation was higher in the pregnancy group. The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001). The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.Conclusions: We concluded that the sperm motility of normospermic individuals 24 h after incubation at 37 degrees C in 5% CO2, with a cutoff value of 56.5%, is predictive of IUI success. Ctr Human Reprod Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, Brazil Sao Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynaecol & Obstet, Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Bioestat, Botucatu, SP, Brazil Ctr Human Reprod Prof Franco Jr, Ribeirao Preto, SP, Brazil Paulista Ctr Diag Res & Training, Ribeirao Preto, SP, Brazil GERAR Fertil Clin, Recife, PE, Brazil Sao Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynaecol & Obstet, Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Bioestat, Botucatu, SP, Brazil

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.

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