JBRA Assist. Reprod. 2015;19 (3):156-158
ORAL PRESENTATIONS
doi: 10.5935/1518-0557.20150035
Abstracts of the 19th Annual Congress of the SBRA, Búzios, RJ, 05-08 August 2015
G. R. Franco Rosário¹, A. C. Costa Franco¹, A. V. da Silva¹
¹Embryolife Instituto de Medicina Reprodutiva, São José dos Campos/SP
OBJECTIVE: Check that the sync of disappearance of the pro-nuclei, would have something to do with the time of cleavage of the blastomeres to D3 (timeline) and if there is something to do with the appearance of abnormalities in the embryo.
MATERIALS AND METHODS: The sample of the present study was designed upon a total of 100 embryos (n = 100). With the aid of an equipment embryonic analysis Time Lapse, we studied the embryonic morfocinética from the zygote stage to the D3.
RESULTS: When there occurred the synchronous disappearance of pronuclei 30.8% had normal cleavage, whereas when occurred the synchronous disappearance of pronuclei 44.8% had normal cleavage. When there was the disappearance of synchronous pronuclei 46.2% had some type of abnormality, whereas when occurred the synchronous disappearance of pronuclei 56.3% had some kind of abnormality.
CONCLUSIONS: Despite the statistical results have not accused significance, we believe that with a larger sample size, we can say with greater reliability, the analysis of the sync of pro-nuclei disappearance may in the near future indicate higher embryo quality.
D.P.A.F Braga1, A. S. Setti2, E. C. Cabral3, M. Eberlin4, E. G. Loturco1, E. Borges Jr5
1Disciplina de Urologia, Departamento de Cirurgia – UNIFESP - Brasil
2Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Assistida - Brasil
3Centro Pluridisciplinar de Pesquisas Químicas, Biológicas e Agrícolas – CPQBA – UNICAMP - Brasil
4Laboratório ThoMSon de Espectrometria de Massas – Instituto de Química – UNICAMP - Brasil
5Fertility – Medical Group – Sao Paulo - Brasil
OBJECTIVE: To identify lipid markers of blastocyst formation by day three culture medium mass spectrometry (MS) fingerprinting.
MATERIALS AND METHODS: For this study 50 embryo culture media samples were harvested on day three, from patients undergoing day five embryo transfers. Samples were split into groups based on their degree of expansion and hatching status on day five (Complete-Blastocyct, n=25 and No-Blastocyt, n=25) and its secretomes were analysed by MS. Mass spectra fingerprinting was acquired using a Q-Tof spectrometer (LC-MS, Agilent 6550 iFunnel Q-TOF) equipped with an automated injector. Data were analysed using the principal component analysis (PCA) followed by a partial least square discrimination analysis (PLS-DA), combined with variable influence in the projection (VIP) scores.
RESULTS: Overall, 1657 ions were observed, in which 165 ions were observed to be differentially expressed between groups, with a fold chance ≥ 4x and p<0.001, in the t-test. The PLS-DA showed a clear separation between the groups and among 15 selected VIPs selected by the program, 13 of them were high-expressed in the Complete-Blastocyct Group and in the No-Blastocyts Group. Besides the embryo status on day five, the PLS-DA was also able to split samples according to patients age. The lipids suggested to be high-expressed in the Complete-Blastocyst Group includes isoprenoids, diacylglycerols, sterols, fatty esters, secosteroids, phosphosphingolipids, glycerophosphates and diacylglycerophosphates, while fatty amides were suggested to be high expressed in the No-Blastocyts Group.
CONCLUSIONS: The day three culture medium MS be a promising approach for the identification of embryos that should be cultured until day five.
M. Roque¹, M. Valle¹, F. Guimarães¹, M. Sampaio², S. Geber²
¹ORIGEN – Center for Reproductive Medicine, Rio de Janeiro, Brazil
²ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
OBJECTIVE: To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer.
MATERIALS AND METHODS: This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles – 351 fresh embryo transfers and 179 freeze-all cycles – with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers.
RESULTS: The ongoing pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In Scenario 1, the included costs were those associated with ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of the supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen–thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per ongoing pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in the treatment costs per ongoing pregnancy.
CONCLUSIONS: The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.
E. De Conto1,2, V. K. Genro2,3, D. S. da Silva1,2, R. C. B. Chapon1,2, J. S. L. Cunha Filho1,2
1Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
2INSEMINE Center of Human Reproduction, Porto Alegre, RS, Brazil
3Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
OBJECTIVE: Verify the relationship between AMH blood levels and the chance of blastocyst formation.
MATERIAL AND METHODS: Two hundred ninety-two patients, 22-44 years of age, undergoing routine explorations during spontaneous cycles that preceded assisted reproductive technologies at our Center, were studied. As the present study did not require previous submission to our Institutional Review Board. Serum AMH and FSH levels were measured and laboratory data was obtained after ovulation induction with antagonist protocol. Participants were sorted into 2 different groups paired by age. The first group (No Blasto; n=219) was constituted of women having no blastocyst formation; the second group (Yes Blasto group; n=73) was constituted of those women who were considered eligible to undergo 5 days of embryo culture. Furthermore we analyzed the blastulation rate. Patients were divided into rate of blastocyst formation <0.43 (n=36) and ≥ 0.43 (n=37). The Statistical analysis was performed using SPSS version 20.0. It was performed Student’s t-test for independent samples and Pearson’s correlation. A p < 0.05 was considered significant.
RESULTS: AMH levels were statistically different (p=0.002) between YES and NO blasto group. Number of oocytes, MII oocytes and embryos were higher in Yes Blasto group. FSH levels were similar between groups (p=0.149). Pearson correlation coefficient shows that rate of blastocyst formation is inversely correlated to AMH levels.
CONCLUSIONS: We therefore conclude that patients that were considered elegible to undergo blastocyst formation have higher levels of serum AMH, however too high concentration of this hormone can be harmful to blastocyst development.
E. Borges Jr.¹, D. P. A. F. Braga², A. S. Setti¹, L. S. Vingris¹, R. C. S. Figueira¹, A. Iaconelli Jr¹
¹Fertility – Medical Group - Sao Paulo - Brasil
²Disciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São Paulo
³Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução Assistida
OBJECTIVE: To compare the use of GnRH agonist (GnRHa) or hCG trigger in potential OHSS patients undergoing freeze-all programs. We also compared the clinical outcomes when fresh versus freeze-thawed embryo transfers were performed in cycles with a high number of retrieved oocytes.
MATERIAL AND METHODS: The study included potential OHSS patients who received GnRHa (n=74) or hCG (n=49) trigger. The protocols were compared with respect to the clinical outcomes. We also compared the clinical outcomes of cycles in which hCG trigger was performed and more than 20 MII oocytes were retrieved when: fresh embryo transfer protocol (n=153) or freeze-all protocol (n=123) were performed.
RESULTS: A decreased serum estradiol level, a decreased number of retrieved oocytes, an increased MII retrieved rate, and decreased fertilization rate was observed in the hCG when compared with the GnRHa group. No significant differences were noted concerning clinical outcomes. When fresh cycles were compared with frozen-thawed cycles, the estradiol serum level and the number of cryopreserved embryos were higher in the frozen-thawed cycles. The clinical pregnancy rate was higher among freeze-all cycles, as well as the implantation and cumulative pregnancy rates, when compared with fresh embryo transfer cycles.
CONCLUSIONS: The use of GnRHa trigger may be a good alternative to prevent the OHSS in patients presenting an extreme ovarian response to COS, leading to similar clinical outcomes, when compared with the traditional hCG trigger. Moreover, our findings demonstrated that the strategy of freezing-all embryos not only decreases the OHSS risk but also leads to a better pregnancy rate.
E. Borges Jr.¹, D. P. A. F. Braga², A. S. Setti³, L. S. Vingris¹, R. C. S. Figueira¹, A. Iaconelli Jr¹
¹Fertility – Medical Group – São Paulo – Brasil
²Disciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São Paulo
³Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Assistida
OBJECTIVE: To identify any association between the presence of endometriosis and oocyte defects, embryo developmental potential and cycle outcomes.
MATERIALS AND METHODS: The influence of the presence of endometriosis on oocyte and embryo quality and blastocyst formation chance was evaluated. Moreover, the presence of endometriosis was correlated with cycles’ characteristics. To avoid any bias concerning the age of the female, in the first analysis only patients ≤ 36 years old were included and the cycles were split into: endometriosis infertility cycles (n=431 and 3172 oocytes) and others (n=2510 cycles and 24480 oocytes).
RESULTS: The number of retrieved oocytes (10.6±21.2 vs 14.6±21.1, p<0.001), oocyte yield (68.1±20.0% vs 70.6±19.6%, p=0.015), and embryos obtained (6.1±4.43 vs 7.8±5.12, p<0.001) were decreased among endometriosis patients. The implantation rate (28.1%±38.9% vs 33.9±42.7, p<0.001) was decreased among endometriosis patients, but the fertilization, pregnancy, miscarriage and cycle cancelation rates did not differ. There was also a significant increase in the incidence of extra-cytoplasmic, but not intra-cytoplasmic oocyte defects among endometriosis patients. Embryo quality (45.3% vs 47.3%, p=0.037) was decreased among embryos derived from endometriosis patients; however, the blastocyst formation rate was the same.
CONCLUSIONS: Endometriosis patients have a reduced oocyte and embryo quality, what may explain the lower implantation rate observed in this group of patients.
M. Bibancos1, M. Cavagnoli1, T. C. S. Bonetti2, E. Semaco1, E. L. A. Motta1,2, P. C. Serafini1,2
1Huntington – Medicina Reprodutiva – Sao Paulo - Brazil
2Departamento de Ginecologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP).
OBJECTIVE: The aim of the current study is to report our preliminary experience regards the use of letrozole in men with OA undergoing percutaneous epididymal sperm aspiration (PESA) for in vitro fertilization treatment using intracytoplasmic sperm injection (ICSI) which had a very low sperm recovery at PESA and unsuccessful ICSI. Our hypothesis was that letrozole therapy could improve testicular function by increasing serum gonadotropins and T levels, stimulate testicle germ cells and most importantly that it enhanced the motile sperm count at a second attempt.
MATERIALS AND METHODS: We reported our preliminary experience with letrozole therapy for 11 men with obstructive azoospermia, who failed to achieve a pregnancy in the first PESA–ICSI and did not have spermatozoa cryopreserved for a second attempt. Patients received 3 months of letrozole at 2.5 mg/day therapy and underwent PESA–ICSI after 6.1±3.8 months. Patients were 48.6 ± 9.6 years of age, and underwent ate least two PESA procedures. We evaluated the total motile sperm count per PESA sample, as the increases in serum FSH, LH, and T levels after treatment.
RESULTS: All parameters increased significantly at 3 months following letrozole therapy for most of patients. The total motile sperm count increased from 40 to 500% compared to first PESA.
CONCLUSIONS: The use of letrozole can be considered a reliable treatment to improve sperm recovery for men with OA undergoing PESA–ICSI cycles by increasing serum gonadotropins and testosterone (T) levels, and—most importantly—the motile sperm count.
M. Santos¹, E. B. Cordts¹, B. Bianco¹, C. P. Barbosa¹, D. M. Christofolini¹
¹Instituto Ideia Fértil de Saúde Reprodutiva – Faculdade de Medicina do ABC
OBJECTIVE: The present study consists of quality comparison among oocytes retrieved from woman under 37 years old showing increased levels of FSH (candidates to premature ovarian insufficiency) and woman with the same age with normal hormone levels.
MATERIAL AND METHODS: Oocyte quality was accessed according Lucinda L. Veeck parameters (1986) and statistical analyses were carried out using chisquared, SPSS for Windows 13.0 (SPSS, Inc., Chicago, IL). All pvalues were twotailed, and 95% confidence intervals (CIs) were calculated. A p value <0.05 was considered statistically significant.
RESULTS: Eight variables of morphologic alterations were considered in the study and two of them showed statistically significant differences between cases and controls: granular cytoplasm (p=0.002) and presence of vacuoles (p=0.025), both more frequent in case group.
CONCLUSIONS: As a conclusion, patients with increased FSH levels presented oocytes with worst quality variables than controls. It can be an indicative of ovarian aging and can impact negatively on the oocytes development into viable embryos.