JBRA Assist. Reprod. 2019;23(3):298-300
ORAL PRESENTATIONS
doi: 10.5935/1518-0557.20190051
Abstracts of the 23rd Annual Congress of the SBRA, Curitiba/PR, 2019
1Fertipraxis - RJ, Brazil
2Fertipraxis/Hospital Federal da Lagoa - RJ, Brazil
Objective: This study seeks to identify the role and possible participation of a psychologist/psychoanalyst inside an Oocyte Pick-up Room and a Recovery Room (OPR-RR) in an Assisted Reproduction clinic and the implications on patients and team.
Methods: Prospective study of psychological support during the procedures from September 2014 to December 2018. Most visits took place during oocyte retrievals, for either IVF/ICSI or gamete freezing.
Results: Of the total of 2,343 cases, the psychologist was present in 965 of them (41%), during oocytes retrievals, with available professionals in 59% of the times (722 cases). The embryo transfers (1,011) had psychological assistance in 20% of the times (218 cases). The intrauterine insemination cases were excluded for not happening in a surgical environment. The recovery room was identified as one of the spaces for welcoming and listening to anxieties, desires, projects, worries, fears, frustrations, joys and expectations of those who come to the clinic seeking the desire to gestate. The patients' talks, collected in observations transcribed from what was heard, with dates and types of procedures, were discussed with either the team or the assistant physician. The team stands positively in the presence of a psychologist/psychoanalyst, who brings new perceptions and the development of the whole art of listening, for all involved.
Conclusion: The presence of a psychologist/psychoanalyst in the Oocyte Pick-up Room and the Recovery Room in an Assisted Reproduction clinic means an opportunity to listen to patients' emotions, providing well being to patients and echoing in the teamwork relationships.
1Huntington Medicina Reprodutiva, São Paulo, SP - Brazil
2Clinica Eugin, Barcelona, Spain
3Pró-Criar Medicina Reprodutiva, Belo Horizonte, MG - Brazil
4Faculdade Ciências Médicas Minas Gerais, Belo Horizonte, MG, Brazil.
5Departmento de Ginecologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
Objective: To identify the main research interests of Brazilian patients in the field of infertility and assisted reproductive technology (ART) treatments.
Methods: Prospective, Brazilian, multicenter, cross-sectional study. Patients attending five fertility centers from the Huntington Group between October and December 2018 were invited to participate in the research protocol, which consisted of answering an anonymous survey online. Two hundred twenty-seven patients signed the consent form and received the survey link. The survey was elaborated on base in the James Lind Alliance Priority Setting Partnership protocol. The main topics approached in the survey related to infertility were somatic and psychological effects of treatments, prevention, assisted reproductive treatment (medications and techniques), success rates, risks, and emotional aspects.
Results: The response rate (RR) was 47.58% (108 patients, 88 women - RR 51.46% and 20 men - RR 35.71%). The mean age of patients was 36.5 years (SD 4.6). The top ten research priorities raised were 1) short- and long-term side effects of treatments; 2) how to cope with infertility; 3) risks associated with ART; 4) success rates in ART; 5) impact of diet on ART and fertility; 6) healthy habits; 7) alternative therapies; 8) impact of exercise on fertility and ART success; 9) oocyte quality and ovarian reserve; and 10) genetic or hereditary causes.
Conclusion: To better assist needs and develop patient-centered care in the field of infertility and ART treatments, clinicians, healthcare and the scientific community should identify patient's uncertainties and priorities and make efforts to address these questions.
1Humana Medicina Reprodutiva. Goiânia, GO, Brazil
Objective: To provide evidence available in the literature on the role of granulocyte colony stimulating factor (G-CSF) in women submitted to in vitro fertilization with repeated implantation failure associated with thin endometrium.
Methods: Systematic review of the use of G-CSF as part of assisted reproduction techniques in women with repeated failures of embryo implantation associated with thin endometrium. The research was carried out in the PubMed, BIREME and Elsevier database from 2008 to 2018, in English, Spanish and Portuguese.
Results: All included studies used intrauterine G-CSF. The increase in endometrial thickness was verified in eight of the 10 included studies. Of these, the implantation rate improved significantly in two studies, but the gestation rate in only one. The highest rates of implantation (32%) and pregnancy (48%) were observed in a non-randomized clinical trial. On the other hand, other two studies have not demonstrated an increase in the endometrial thickness and in the pregnancy rates in patients with thin endometrium submitted to the assisted reproduction in frozen embryo transfer cycles.
Conclusion: The literature published so far points to a positive influence on the use of G-CSF in relation to the improvement in endometrial receptivity and pregnancy rates. Therefore, there is a need for further studies to determine whether or not to use it, as well as the period, route of administration, dosage and duration of treatment.
1Fertility Medical Group- Sao Paulo - SP, Brazil
2Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida- Sao Paulo - SP, Brazil
Objective: To investigate the predictive factors for successful pregnancy in oocyte recipient ICSI cycles in an egg-sharing donation program.
Methods: Analysed data were obtained via chart review of 1505 vitrified oocytes donated from 268 patients to 225 oocyte recipients, undergoing 307 ICSI cycles. Patients were participating in an egg-sharing donation program between January 2015 and May 2017. Adjusted generalised linear models were used to investigate the impact of oocyte donor and recipient characteristics on recipients' pregnancy achievement.
Results: Implantation rate in the oocyte donor was highly correlated with pregnancy achievement in the oocyte recipient's cycles (ExpB: 1.181, CI: 1.138-1.226, p < 0.001). The ROC curve analysis demonstrated that the implantation rate in the oocyte donor has a strong predictive value for pregnancy success in the oocyte recipient (area under the curve: 0.98, CI: 0.95-0.99, p < 0.001). Pregnancy in oocyte donors and recipients were highly associated (ExpB: 54.6, CI: 28.1-105.8, p < 0.001), regardless of the oocyte recipient's age. In oocyte recipients, the high-quality embryos rates on days 2 (ExpB: 3.397, CI: 1.635-7.054, p = 0.001) and 3 (ExpB: 6.629, CI: 1.185-37.092, p = 0.031), and blastocyst development rates (ExpB: 2.331, CI: 1.086-5.001, p = 0.030) were positively associated with pregnancy outcome.
Conclusion: The strong association in pregnancy success between donors and recipients, and the lack of correlation between donor characteristics and cycles' outcomes, demonstrate the power of oocyte quality on the success of ICSI treatment.
1Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
Objective: To evaluate the relation between morphology grading and morphokinetics parameters in blastocyst stage embryos cultured in a time-lapse system.
Methods: This is a retrospective cohort study from our clinic database. Patients undergoing assisted reproduction treatment in autologous oocyte cycles between October 2017 and May 2019 using a time-lapse system were included in this study. Embryos were morphologically graded according to Gardner and Schoolcraft criteria and morphokinetic parameters were annotated.
Results: Our results indicated that the time of pronucleous fading (tPNFf), cleavage to two-(t2), four-(t4), eight-cells (t8) and blastulation (tB) are significantly different according to the morfological quality of the blastocyst formed. Already in the early development stage, the tPNf, t2 and t4 differ good (AA, AB, BA, BB) from poor (CC) quality potential blastocysts. Time of cleavage to 8-cells sort embryos that will turn into AA morfology blastocyst from the ones with grade BB and ultimatly, earlier tB correlates with the best quality embryos (AA, AB, BA).
Conclusion: Our results showed that the first kinetic parameters (tPNf, t2 and t4) may be used to distinguish top-graded from low-graded blastocysts. Between top-graded blastocysts, t8 was predictable to differ BB blastocysts from AA grading. And finally, tB can also be used to differentiate BB blastocyst from AA, AB and BA grading. These time-points parameters may be considered to be applied in a laboratory routine, even in centers without time-lapse machines.
1Instituto Idéia Fértil de Saúde Reprodutiva, Santo André/SP, Brasil
Objective: Present clinical and laboratory data of a Brazilian social program for cancer fertility preservation.
Methods: A descriptive observational study was conducted between July 2011 and December 2018. 246 patients were included at the social program in a private assisted reproduction clinic in Santo André/Brazil for oocyte cryopreservation before starting oncological treatment.
Results: 246 cancer patients resorted to fertility preservation before initiating cancer treatment. These were diagnosed with 27 different types of cancer, being the breast type the most prevalent. 2528 MII oocytes (mean of 10.3 oocytes per patient) were vitrified. Four patients thawed their oocytes to submit in vitro fertilization, three had embryos transferred and one achieved pregnancy.
Conclusion: Preservation of fertility offers patients, especially at reproductive age, a viable way to perform their cancer treatment without compromising future gestation. It is important that oncological patients are duly counseled by the professionals so, if they wish, they can have the possibility to guarantee her fertility preserved.
1Instituto Idéia Fértil de Saúde Reprodutiva, Santo André/SP, Brazil
Objective: Evaluate the recovery of thawed blastocysts submitted to quarter laser assisted hatching and to correlate with pregnancy rates.
Methods: A cross-sectional study was carried out in which single blastocyst transfers were included from July 2017 to December 2018. 765 blastocysts were thawed and submitted to quarter laser assisted hatching technique was performed in the zona pellucida immediately after thaw and incubated for 3 hours until transfer time, when evaluating if they were collapsed or expanded and, if they were expanded, herniated or not. Statistical analysis was performed using the chi-square test.
Results: 627 expanded (81.9%) and presented a 40% pregnancy rate (251/627). 138 collapsed blastocysts after thawing (18.0%), resulted in 25.4% (35/138) (p = 0.001) gestation. After evaluating only the expanded blastocysts, 385 herniated (61.4%) and resulted in 43.9% (169/385) of pregnancy. The 242 non-herniated blastocysts (38.6%) presented 33.9% of gestation (82/242) (p = 0.013). Statistical analysis was considered statistically significant at p <0.05.
Conclusion: The quarter laser assisted hatching technique proved to be safe, valid and relatively easy and could be performed on thawed blastocysts. Blastocysts with the capacity to expand and herniate after the use of this technique, presented statistically superior results.
Objective: Compare laboratory results of embryo development from late matured oocytes in relation of mature oocytes in D+0.
Methods: A cross-sectional study was carried out during the period from January to December 2018, in which data collection was done through the medical records analysis. 913 oocytes were collected and divided into 3 groups: group 1 - 643 MII oocytes; group 2 - 119 MI oocytes and; group 3 - 151 PI oocytes. These studied oocytes were from different maternal ages and infertility factors. The analyzed variables were fertilization rate, embryo cleavage, top quality embryos on the third day of development, blastocyst stage, top quality blastocysts, euploid blastocysts, top quality blastocysts and gestation. The data were documented, and the statistical analysis was performed using the chi-square test (p <0.05).
Results: All MII oocytes were injected (643), 103/119 MI oocytes and 88/151 PI oocytes that matured late in D + 1, were also injected. The fertilization rate of the 3 groups did not present statistical difference. The oocytes of group 1 presented, statistically, a better prognosis than oocytes of groups 2 and 3 when compared, respectively, embryo cleavage (p = 0.000), top quality embryos on the third day of development (p = 0.000) and blastocyst formation rate (p = 0.004). In the LMO group there were no euploid embryos and, therefore, there was no embryo transfer.
Conclusion: Although late matured oocytes have made blastocyst formation possible, even if low rates, there were no viable embryos for transfer.