Decreased fertility in poor responder women is not related to oocyte morphological status

Introduction: In women showing impaired fertility, a decreased response to ovarian stimulation is a major problem, limiting the number of oocytes to be used for assisted reproduction techniques (ART). Despite the several definitions of poor response, it is still a matter of debate whether young poor responder patients also show a decrease in oocyte quality. The objective in this study was to investigate whether poor ovarian response to the superstimulation protocol is accompanied by impaired oocyte quality. Material and methods: This study included 313 patients younger than 35 years old, undergoing intracytoplasmic sperm injection. Patients with four or fewer MII oocytes (poor-responder group, PR, n = 57) were age-matched with normoresponder patients (NR, n = 256). Results: A higher rate of oocyte retrieval and a trend towards an increase in MII oocyte rate were observed in the NR group when compared to the PR group (71.6 +/- 1.1% and 74.1 +/- 1.0% vs. 56.3 +/- 2.9% and 66.5 +/- 3.7%; p < 0.0001 and p = 0.056, respectively). A trend toward increased implantation rates was observed in the NR group when compared to the PR group (44 and 24.5 +/- 2.0% vs. 28.8 and 16.4 +/- 3.9%; p = 0.0305 and p = 0.0651, respectively). Conclusions: Low response to ovarian stimulation is apparently not related to impaired oocyte quality. However, embryos produced from poor responder oocytes show impaired capacity to implant and to carry a pregnancy to term

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

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

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

Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs.$5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs.$11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine

Decline in semen quality among infertile men in Brazil during the past 10 years

ABSTRACTPurpose:To investigate whether the semen quality of men undergoing conventional semen analysis is deteriorating over time.Materials and Methods:We analyzed and compared the sperm count, motility and morphology of 2300 semen samples provided by males undergoing conventional seminal analysis, from years 2000 to 2002 and 2010 to 2012. The incidences of severe oligozoospermia and azoospermia over time were also compared.Results:A total of 764 sperm samples were analyzed in 2000-2002 and 1536 in 20102012. Over time, the mean sperm concentration/ml decreased significantly from 61.7 million in 2000-2002 to 26.7 million in 2010-2012 (R2=11.4%, p<0.001), the total sperm concentration decreased significantly from 183.0 million to 82.8 million (R2=11.3%, p<0.001), and the percentage of normal forms decreased significantly from 4.6% to 2.7% (R2=9.8%, p<0.001). The incidence of severe oligozoospermia significantly increased from 15.7% to 30.3% (OR: 1.09, p<0.001) and the incidence of azoospermia increased from 4.9% to 8.5% (OR: 1.06, p=0.001).Conclusions:This study demonstrated a significant time-related decline in semen quality of infertile patients. This finding might have implications on fertility and emphasizes the need for further studies addressing subject's life-style in order to find and reduce the causative agents. Future prospective and multicenter studies including representative samples of the general population are needed to confirm whether semen quality is really declining

Strategies for the management of ohss: results from freezing-all cycles

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. 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 used 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. Conclusion: 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 risk of OHSS but also leads to a better pregnancy rate.Fertility – Medical Group - Sao Paulo – Brazil[Borges, Edson, Jr.Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução AssistidaDisciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São PauloDisciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São PauloWeb of Scienc