The predictive value of serum concentrations of anti-Mullerian hormone for oocyte quality, fertilization, and implantation

Objective: This study aimed to identify a possible correlation between serum levels of anti-.Mullerian hormone (AMH) and oocyte quality, embryo developmental competence, and implantation potential. Methods: 4488 oocytes obtained from 408 patients undergoing ICSI cycles were evaluated. Oocyte dimorphisms, embryo quality on days two and three, blastocyst formation competence, fertilization rates, implantation rates, and pregnancy rates were correlated with serum levels of AMH using Pearson's correlation coefficient and regression analysis. Results: A positive correlation was observed between serum levels of AMH and number of retrieved oocytes (CC: 0.600, p<0.001), fertilization rate (CC: 0.595, p=0.048), and number of obtained embryos (CC: 0.495, p<0.001). AMH did not affect the quality of cleavage stage embryos or the chance of blastocyst formation. However, AMH levels affected oocyte quality (OR: 0.75, CI 0.44-.0.96, p<0.001), and implantation (CC: 0,116, p=0.031) and pregnancy (OR: 1.22, CI: 1.03-.1.53, p<0.001) rates. Conclusion: Serum levels of AMH are a useful predictor of ovarian response to COS, oocyte quality, and fertilization. However, AMH levels may also compromise clinical outcomeslower AMH levels did not impair embryo development.Fertil Med Grp, Sao Paulo, SP, BrazilCtr Estudos & Pesquisa Reprod Assistida, Inst Sapientiae, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, SP, BrazilWeb of Scienc

Zika Virus Outbreak - Should assisted reproduction patients avoid pregnancy?

Objective: To discuss the requirement from the National Health Surveillance Agency(ANVISA), for assisted reproduction treatment patients to undergo laboratory tests for ZIKV detection, and if the public health authorities and government leaders' recommendations to women simply avoid pregnancy is prudent. Methods: This study was performed in a universityaffiliated in vitro fertilization center in Brazil. We present a critical discussion on the risk of microcephaly due to ZIKV infection and the prevalence of other harmful pathogens to vulnerable pregnant women and infants. We assessed, 954 patients undergoing intracytoplasmic sperm injection cycles(ICSI), between April and November of 2016, concerning the results of ZIKV test, according to different regions in Brazil. Results: Patients undergoing ICSI cycles were split into groups, according to their region of origin: 28(3.0%) were from the North, 27(2.8%) were from the Northeast, 40(4.2%) were from the Midwest, 830(87.2%) were from the Southeast, and 29(3.0%) were from the South. Concerning the diagnosis, 112 samples had a positive or inconclusive result for ZIKV, by chromatography immunoassay. These samples were re-analyzed by ELISA and no result was positive. All positive results were from the Southeast region and none from the Northeast or Midwest regions, which are considered endemic regions. Conclusion: ZIKV test before the onset of assisted reproduction treatments does not rule out the risk of the infection during pregnancy. In addition, although ZIKV infection risk is extremely high, the microcephaly risk due to ZIKV is not higher than the risk of miscarriage and birth defects due to other recognized pathogens.Fertil Med Grp, Sao Paulo, SP, BrazilCtr Estudos & Pesquisa Reprod Humana Assistida, Inst Sapientiae, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, BrazilWeb of Scienc

Contributing factors for the incidence of aneuploidy in older patients undergoing intracytoplasmic sperm injection cycles

Abstract Purpose To evaluate different factors that might affect the incidence of embryo aneuploidy in intracytoplasmic sperm injection cycles (ICSI). Methods One hundred and ninety ICSI cycles in conjunction with preimplantation genetic screening (PGS) were included. The influence of the following variables on the aneuploidy incidence was evaluated: (i) maternal and (ii) paternal ages, (iii) dose of FSH administered, (iv) dose of FSH per number of retrieved matured oocytes (FSH/MII), (v) serum 17β-oestradiol levels on the ovulation trigger day, (vi) aspirated follicles and (vii) retrieved oocytes. Results A total of 440 embryos were successfully biopsied, of which 240 were considered euploid and 200 were considered aneuploid. The paternal age (Slope: 0.2, p00.372), total dose of FSH (Slope: 0.2, p00.218), FSH/MII (Slope: 0.1, p00.296) and 17β-oestradiol levels (Slope: 0.2, p0 0.378) were not correlated with the presence of aneuploidy. However, the maternal age (Slope: 1.7, p&lt;0.01), aspirated follicles (Slope: 1.9, p&lt;0.01) and retrieved oocytes (Slope: 2.6, p&lt;0.01) were negatively correlated with the incidence of aneuploidy. Conclusions Even in older patients, lower oocyte yields may represent a more appropriate response to ovarian stimulation, allowing the most competent follicles and oocytes to develop and thereby reducing the occurrence of embryo aneuploidy

Secretome of the preimplantation human embryo by bottom-up label-free proteomics

Abstract A bottom-up label-free mass spectrometric proteomic strategy was used to analyse the protein profiles of the human embryonic secretome. Culture media samples used for embryonic culture of patients undergoing intracytoplasmic sperm injection cycles were selected as a test case for this exploratory proof-of-principle study. The media were stored after embryo transfer and then pooled into positive (n = 8) and negative (n =8) implantation groups. The absolute quantitative bottom-up technique employed a multidimensional protein identification technology based on separation by nano-ultra-high pressure chromatography and identification via tandem nanoelectrospray ionization mass spectrometry with dataindependent scanning in a hydrid QqTOF mass spectrometer. By applying quantitative bottom-up proteomics, unique proteins were found exclusively in both the positive-and negative-implantation groups, which suggest that competent embryos express and secrete unique biomarker proteins into the surrounding culture medium. The selective monitoring of these possible secretome biomarkers could make viable procedures using singleembryo transfer

The Developmental Competence of Oocytes Retrieved from The Leading Follicle in Controlled Ovarian Stimulated Cycles

Abstract Background: This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles

Gender incidence of intracytoplasmic morphologically selected sperm injection-derived embryos: a prospective randomized study

Abstract The aim of this prospective randomized study was to determine if the use of intracytoplasmic morphologically selected sperm injection (IMSI) is associated with gender incidence. Couples who underwent IVF-preimplantation genetic screening (PGS) cycles, as a result of advanced maternal age, were randomly allocated into two groups: intracytoplasmic sperm injection (ICSI; n = 80) or intracytoplasmic morphologically selected sperm injection (IMSI; n = 80). The incidences of genders were compared between ICSI-and IMSI-derived embryos. Considering all the biopsied embryos were characterized as normal for sex chromosome, the results showed that IMSI results in a significantly higher incidence of female embryos as compared with ICSI (65.1% versus 54.0%, respectively, P = 0.0277). After analysing only euploid embryos for the eight selected chromosomes, a significantly higher incidence of XX embryos derived from IMSI was also observed compared with ICSI cycles (66.9% versus 52.5%, respectively, P = 0.0322). This result was confirmed by logistic regression, which demonstrated a nearly 2-fold increase in euploid XX embryos derived from spermatozoa selected by high magnification (OR 1.83, 95% CI 1.05-3.35, P = 0.032). A higher proportion of morphologically normal spermatozoa analysed under high magnification seem to carry the X chromosome

Are poor responders patients at higher risk for producing aneuploid embryos in vitro?

Abstract Purpose To test the hypothesis that aged women with poor ovarian response express an increase on embryo chromosomal alterations when compared to aged women who presented normal response. Methods Couples undergoing intracytoplasmic sperm injection cycles with preimplantation genetic screening, were subdivided into two groups: Poor Responder group (n=34), patients who produced ≤4 oocytes; and Normoresponder group (n=50), patients who produced ≥5 oocytes. Groups were compared regarding cycles&apos; outcomes and aneuploidy frequency. Results There were no significant differences between and groups regarding the fertilization rate (p=0.6861), clinical pregnancy (p=0.9208), implantation (p=0.6863), miscarriage (p=0.6788) and the percentage of aneuploid embryos (p=0.270). Embryo transfer rate was significantly lower on poor responder group (p=0.0128) and logistic regression confirmed the influence of poor response on the chance of embryo transfer (p=0.016). Conclusions Aged females responding poorly to gonadotrophins are not at a higher risk for producing aneuploid embryos in vitro

Concomitant use of FSH and low-dose recombinant hCG during the late follicular phase versus conventional controlled ovarian stimulation for intracytoplasmic sperm injection cycles

The objective of this study was to investigate the effects of low-dose hCG supplementation on ICSI outcomes and controlled ovarian stimulation (COS) cost. Three hundred and thirty patients undergoing ICSI were split into groups according to the COS protocol: (i) control group (n=178), including patients undergoing conventional COS treatmentand (ii) low-dose hCG group (n=152), including patients undergoing COS with low-dose hCG supplementation. Lower mean total doses of FSH administered and higher mean oestradiol level and mature oocyte rates were observed in the low-dose hCG group. A significantly higher fertilization rate, high-quality embryo rate and blastocyst formation rate were observed in the low-dose hCG group as compared to the control group. The miscarriage rate was significantly higher in the control group compared to the low-dose hCG group. A significantly lower incidence of OHSS was observed in the low-dose hCG group. There was also a significantly lower gonadotropin cost in the low-dose hCG group as compared to the control group ($1235.0 +/- 239.0x$1763.0 +/- 405.3, p<0.001). The concomitant use of low-dose hCG and FSH results in a lower abortion rate and increased number of mature oocytes retrieved, as well as improved oocyte quality, embryo quality and blastocyst formation and reduced FSH requirements.Clin Dept, Fertil Med Grp, Sao Paulo, SP, BrazilFac Ciencias Med Santa Casa Sao Paulo, Hlth Sci Dept, Sao Paulo, SP, BrazilCtr Estudos & Pesquisa Reprod Assistida, Inst Sapientiae, Sao Paulo, SP, BrazilSci Dept, Fertil Med Grp, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Cirurgia, Area Reprod Humana, Disciplina Urol, Sao Paulo, SP, BrazilWeb of Scienc