JBRA Assist. Reprod. 2018;22(3):263-266
Oral Presentations
doi: 10.5935/1518-0557.20180063
Objective: To study which factors affect perinatal outcomes in intracytoplasmic sperm injection (ICSI) cycles.
Methods: Data was obtained from 402 live births born to 307 patients undergoing ICSI cycles in a private university-affiliated IVF center between Jan/2014 and Dec/2015. The influences of the cycles' characteristics on the number of gestational weeks to livebirth (GW), baby birth weight (BW), and baby birth length (BL) were evaluated by linear regression models, adjusted for maternal age and body mass index, number of transferred embryos, number of gestational sacs, and number of born infants. In a subsequent analysis, GW, BW and baby sex were utilized for cycle classification into the groups Appropriate for gestational age (AGA n=256) and Small for gestational age (SGA n=146), which were compared by general linear models adjusted for the same confounder variables.
Results: The number of follicles (β=-0.069 p=0.018) and retrieved oocytes (β=-0.087 p=0.049) were negatively correlated with BL. The endometrial thickness was positively correlated with GW (β=0.198 p=0.003) and BW (β=28.351 p=0.044). When each baby was classified into AGA and SGA groups, it was observed that SGA babies were derived from cycles with higher estradiol levels at hCG day (SGA: 3897.01±550.35 vs. AGA: 2324.78±101.86 p=0.006) and higher number of retrieved oocytes (SGA: 16.70±1.78 vs. AGA: 12.92±0.42 p=0.042). The endometrial thickness was significantly lower in the SGA group (SGA: 10.27±0.23 vs. AGA: 11.68±0.17 vs. p=0.029).
Conclusion: Higher ovarian response to stimulation and suboptimal endometrial development are associated with adverse perinatal outcomes in ICSI cycles.
Objective: Multiple embryos have been transferred to compensate for low implantation rates, which in turn, increase the likelihood of multiple pregnancy. Despite the publication of clinical guidelines and a reduction in the number of embryos transferred, double embryo transfer is the most common practice yet. There is no clear evidence for whom the single embryo transfer (SET) should be applied, and good prognosis patients are more indicated. But it is not clear how much the presence of other infertility factors can affect the SET prognosis. The aim of this study was to evaluate differences in clinical pregnancy rates (CPR) of frozen-thawed SET cycles for women presenting different infertility factors.
Methods: Retrospective cohort study evaluated 305 frozen-thawed SET cycles performed in the last 10 years in a private IVF center. Patients undergoing ovarian stimulation cycle, using ejaculated sperm and had a frozen-thawed ET were included. Embryos were vitrified and warmed as routine and blastocysts were transferred after endometrium preparation. Cycles were categorized according to infertility factor classified by Society for Assisted Reproductive Technologies (SART) as anatomic female factor (n=55), endocrine female factor (n=26), endometriosis (n=37), male factor (n=60), ovarian insufficiency (n=26), unexplained (n=24), multiple factors (n=45) and other (n=32). CPR were compared between groups and multivariate analysis was performed to evaluate the association of each infertility factor and CPR adjusted for confounders.
Results: Women age varied from 18 to 44 years of age (35.9±3.8), presented BMI of 22.4±3.1 kg/m2, serum basal FSH of 7.4±8.3 IU/ml, had a mean of 11.0±8.4 MII oocytes recovered and 6.4±5.3 embryos cryopreserved. CPR according to infertility factors were: anatomic female factor (25.9%), endocrine female factor (30.8%), endometriosis (27.8%), male factor (20.7%), ovarian insufficiency (21.7%), unexplained (9.5%), multiple factors (17.1%) and other (20.7%). Multivariate analysis did not show significant association of infertility factors and CPR adjusted for confounders.
Conclusion: Patients presenting different infertility factors seem to have a satisfactory CPR for a SET cycle except those with unexplained infertility. This is a preliminary outcome and the number of patients by category is small, besides retrospective characteristic of study are limitations. Overall, our findings suggest patients presenting any infertility factor, except unexplained infertility, are suitable to receive a SET with satisfactory outcomes.
Objective: To identify potential blood serum metabolites as biomarkers of the response to controlled ovarian stimulation (COS), in patients undergoing intracytoplasmic sperm injection (ICSI) cycles.
Methods: For this case-control study, serum samples from 30 patients <36 years old, undergoing COS for ICSI cycles, from January 2017 to August 2017, in a university-affiliated assisted reproduction center were analyzed. Samples were split into three groups depending on the ovarian response to COS: Poor Response Group: <4 retrieved oocytes (PR group, n=10), Normo Response Group: ≥8 and ≤12 retrieved oocytes (NR group, n=10), and Hyper Response Group: >25 retrieved oocytes (HR, n=10). The metabolic profiles of the serum samples were compared between the groups using the Principal Component Analysis (PCA). Receiver Operating Characteristic (ROC) curves were constructed to evaluate model's potential to predict response to COS.
Results: The PCA was able to clearly distinguish the PR, NR and HR groups, and 10 ions were chosen as potential biomarkers of response to COS. Those ions are more specific for PR group when compared to NR group. The ROC curve considering PR and NR groups presented an area under the curve of 99.6% (CI 95%: 88.9 - 100%).
Conclusion: This preliminary evidence suggests that blood serum metabolites may be molecular predictive markers of ovarian response to controlled stimulation. The integration of clinical and "omics" findings would allow migration towards the era of personalized treatment in the field of reproductive medicine.
Objective: To evaluate the impact of professional nutrition assistance on assisted reproduction treatments, in terms of fertilization rates, embryo quality and gestations, for overweight-obese PCOS women.
Methods: The study is a retrospective analysis of seven cases of SOP patients, of which five were obese and two were overweight presenting a borderline BMI. Patients' records were obtained from the Clinic database and from the nutrition Professional records. Patients were diagnosed with PCOS according to the criteria established by the European Society for Human Reproduction and Embryology and American Society for Reproductive Medicine ESHRE-ASRM 2003 PCOS criteria. Patients underwent controlled ovarian stimulation for ICSI. Classical ART protocols for superovulation, oocyte colection, fertilization and embryo culture and transfer were employed for ICSI cycles. The parameters analyzed were total number of oocytes, day-2 and day-3 embryo quality, day 5 or 6 blastocyst rate, biochemical gestations, abortions and live births. All seven patients were seen by the nutrition Professional. The treatment was directed to the patients' weight loss, lifestyle improvement, identification of their dietary pattern and promotion of changes in it to benefit the ART outcomes.
Results: Only three out of the seven women that underwent ART had a pregnancy and live births. The remaining four patients did not have a successful outcome from their ART treatments. The three patients that achieved gestation and live birth were patients that have adhered to the behavioral changes recommended by the nutrition professional.
Conclusion: The present study shows that bad eating habits seem to be related to poor assisted reproduction outcomes, in terms of ongoing and full term gestations. Positive ART outcomes may be achieved by women that adhere to the nutritional and lifestyle changes and maintained the new habits for a period long enough to conceive and sustain a pregnancy.
Objective: To evaluate the influence of immunological factors (autoimmune and alloimmune) and thrombophilia (acquired and hereditary) in the reduction of ovarian reserve in young patients aged 18-35 years.
Methods: A cross-sectional study was carried with 96 women between 18 and 35 years of age. The ovarian reserve (OR) was evaluated on the third day of the menstrual cycle with the following predictors: antral follicle count (AFC), luteinizing hormone, antimullerian hormone, follicle stimulating hormone and estradiol. The sample was divided into two groups: Low Reserve (AFC≤5) and Normal Reserve (AFC>5). The presence of the following markers were evaluated: Autoimmunity (ANA, antinucleosome, lupus anticoagulant, anticardiolipin IgG, anticardiolipin IgM, antithyroglobulin, anti - DNA, CH50, C3, anti - TPO, TRAb); Hereditary Thrombophilia (Factor II, Factor V, A1298C and C677T alleles of the MTHFR enzyme); Alloimmunity (NK cell activity); Acquired thrombophilia (protein C and S deficiencies, homocysteine, and antithrombin III)
Results: The two groups were compared: Low Reserve (LR) (n=40) versus Normal Reserve (NR) (n=51) None of the autoimmune, alloimmune, and acquired thrombophilic factors were associated with decreased RO. However, the presence of hereditary thrombophilia factors were strongly associated with a decrease of ovarian reserve: Factor II was found in 23.8% LR versus 3.8% NR (OR 7.8, CI 1.2 - 34.4, p=0.04), presence of the MTHR C677T polymorphism allele in 47.8% LR versus 20.8% NR (OR 3.4, CI 1.8-12.5 , p=0.05) and the MTHFR A1298C polymorphism in 29.2% LR versus 6.7% NR (OR 5.7, CI 1.2-31 p=0.04).
Conclusion: The presence of autoimmune, alloimmune and acquired thrombophilia factors does not seem to influence the reduction of ovarian reserve in young patients. The presence of polymorphism in hereditary thrombophilia factors were strongly associated with decreased ovarian reserve, being that the presence of factor II, MTHFR C677T and MTHFR A1298C polymorphisms increasing the risk of ovarian reserve decreased by 7.8, 3.4 and 5.7 times respectively.
Objective: The aim of our study was to identify the prevalence of HPV in the semen of men submitted to ART treatment and to identify the possible impact of the virus in spermatic parameters.
Methods: Thirty-five patients in treatment for infertility were invited to participate in the study from March to August, 2016. Samples with a minimum concentration of 40x106 spermatozoa per milliliter were included in the study. After the evaluation of the seminal parameters (WHO 2010), DNA extraction and PCR were performed to verify the presence of HPV by electrophoresis in 8% polyacrylamide gel.
Results: Patients' ages ranged from 27 to 68 years (mean 39.2 years). Semen analysis showed a mean volume of 2.5 mL; mean concentration 58.9x106 and mean motility of 51.8%. HPV vírus DNA was identified in seven semen samples from 25 patients (28%). Ten samples that were below the concentration of 10ng/µL of DNA were excluded from the study due to a loss in amplification quality. There was no statistically difference in seminal concentration between HPV negative and positive samples (65.9x106 vs. 62.3x106; p=0.70) however, sperm motility was significantly higher in the semen of HPV positive (65 vs. 46.6%; p=0.02).
Conclusion: HPV prevalence was 28% in semen of patients submitted to ART. These HPV positive samples also presenting a statistically increased motility compared to negative ones (65 vs. 46.6%; p=0.02).
Objective: To investigate the main causes of recurrent miscarriage (RM) in patients with spontaneous gestation (SG) and in post-fertilization in vitro (IVF).
Methods: A cross-sectional study with 59 patients with two or more abortions less than 12 weeks gestation (27 after IVF and 28 after SG) All patients were submitted to the following evaluation: Karyotype of the abortion material; Autoimmune markers (FAN, antinucleosome, lupus anticoagulant, anticardiolipin IgG/IgM, antithyroglobulin, anti-DNA, CH50, C3, anti-TPO, TRAb); Alloimunes markers (NK cell activity), Acquired thrombophilia (protein C and S deficiencies, homocysteine, and antithrombin III); Hereditary thrombophilia (factor II, factor V, MTHFR A1298C and C677T).
Results: Mean age was 35.85 years. Chromosomal abnormalities: 27.1%. In the autoimmune evaluation: positive ANF: 18.8%; anti-TPO: 29.5%; TRAb: 2.9%; anti-Tg: 27%; TSH elevation: 17.8%; C3: 11.8%; decrease of CH50, 9.1%. Acquired thrombophilia we found alterations: anticardiolipin IgG and IgM: 8.7% and 7.7%, respectively; lupus anticoagulant: 10.7%, Protein C: 13.6%, Protein S: 37.9%; Antithrombin III: 22.7%; hyperhomocysteinemia: 3.8%. In hereditary thrombophilias: polymorphism of MTHFR C677T: 12.7% and in Factor V: 11.1%. In the general evaluation of the causes of RM we found: 26% genetic factor, 28% autoimmune, 24% thrombophilic, 15% association between thrombophilic and autoimmune factor and only 7% without apparent cause. When comparing the two study groups for differences between factors influencing abortion after spontaneous and post-IVF pregnancies, all factors were similar, except for the higher ANF positivity in the SG group (35.7%) versus IVF (5.6%) p=0.03.
Conclusion: Our protocol identified the probable cause of RM in 93% of the cases, with only 7% being without an apparent cause. Of the factors identified, 26% were genetic causes, 28% autoimmune factors, 24% thrombophilic factors and 15% with autoimmune and thrombophilic association. The causes of RM in IVF or SG patients appear to be the same. This demonstrates that IVF with pre-implantation genetic analysis can reduce about 30% of abortion cases in RM patients, and that even patients with recurrent IVF losses should investigate the other factors.
Objective: Embryo transfer, the final stage of assisted reproductive technique (ART), is a crucial step in ensuring successful in vitro fertilization (IVF) cycles. Studies evaluating the ideal depth of embryo transfer in the uterine cavity have reported that fundic transfer is associated with higher pregnancy rates (PRs), but there is no consensus. The objective of the present study was to determine the influence of the embryo placement depth on the endometrial cavity in relation to the reproductive outcomes, after frozen-thawed embryo transfer of embryos performed under transabdominal ultrasound guidance.
Methods: Retrospective cohort study that evaluated the influence of the placement depth of the embryos in the endometrial cavity in relation to reproductive outcomes of patients submitted to cryotransfer cycles at a private assisted reproduction clinic, from 2012 to 2017. Patients were classified into three variables: ≤10 mm, 10 to 15 mm and >15 mm. Primary outcome was clinical pregnancy, and secondary outcomes were miscarriage, ongoing pregnancy and live birth. Data was summarized as relative risk, with a 95% confidence interval.
Results: Clinical and ongoing pregnancy rates were higher in the groups 10-15mm and >15mm, when compared to the group <10mm; there was no statistical difference between the groups for miscarriage and live birth rates. We performed a subsequent analysis, using the same sample of patients, comparing only the variables <10 mm and ≥10 mm. The group ≥10 mm showed better reproductive outcomes, with higher clinical and ongoing pregnancy rates.
Conclusion: Pregnancy rates are influenced by embryo transfer site, obtaining better results when the tip of the catheter is placed in the central area of the endometrial cavity, specially when the distance from the endometrial fundus is >10mm.