JBRA assisted reproduction最新文献

Objective: Obesity is a major metabolic condition linked to reduced fertility. Excess adipose tissue disrupts the neuroendocrine axis and impairs several reproduc-tive processes. Evidence shows that, even when assisted reproductive technologies are used, women with obesity experience lower oocyte recovery, fewer viable embryos, and higher rates of miscarriage and gestational complica-tions. This study evaluated the relationship between obe-sity and female infertility by analyzing in vitro fertilization outcomes.

Methods: This quantitative, cross-sectional, retro-spective study included all in vitro fertilization cycles per-formed at a private assisted reproduction clinic in Goiânia between January and December 2022. Ethical approval was obtained from the Research Ethics Committee. After applying the inclusion and exclusion criteria, 226 cycles from women aged 24-46 years were analyzed. Logistic regression models were used to assess associations be-tween maternal and paternal body mass index and in vitro fertilization outcomes, as well as metabolic comorbidities, gestational, intrapartum, and neonatal complications, and miscarriage, prematurity, and newborn birth weight.

Results: Women with overweight (body mass index ≥25kg/m2) were 2.4 times more likely to develop gesta-tional complications (odds ratio, 2.42; 95% confidence in-terval, 1.048-5.598) and 2.8 times more likely to develop neonatal complications (odds ratio, 2.80; 95% confidence interval, 1.712-6.70) compared with eutrophic women. No other significant association was identified.

Conclusion: Higher maternal body mass index was as-sociated with increased gestational and neonatal compli-cations, but not with in vitro fertilization success. Further research using broader clinical and anthropometric indica-tors is needed to better characterize the impact of obesity and to guide preventive strategies.

Objective: To compare the effect of platelet-rich plas-ma (PRP) on pregnancy rates versus the placebo group in patients with normal endometrium undergoing advanced assisted reproduction treatments.

Methods: Randomized, double-blind clinical trial that compared the use of PRP versus placebo (sterile saline solution) in patients undergoing endometrial preparation for frozen embryo transfer after in vitro fertilization. A total sample size of 52 patients was determined, and the pa-tients were randomized into two groups (n=26 per group). The groups were treated with either PRP or a placebo at the appropriate time. The impact on pregnancy rates and endometrial thickness was analyzed subsequently. Groups were compared using t-tests, U-tests, or chi-squared tests. A p-value<0.05 was considered statistically significant.

Results: The study analyzed an intervention group (PRP) and a control group (placebo). The overall pregnan-cy rate during the study period (n=52) was 38.4%, and the live birth rate was 33.3%. The pregnancy rate was 26.9% in the intervention group and 46.2% in the control group, with no significant difference between the groups (p=0.15). Similarly, no differences were found in endome-trial thickness and endometrial morphology between the groups analyzed (p>0.05).

Conclusion: There are no differences in favor of the PRP or control group in terms of achieving pregnancy, so the use of PRP in normal endometrium does not currently show advantages as an adjuvant to what is already used in women without other factors that alter endometrial re-ceptivity.

Objective: To investigate the relationship between sperm DNA fragmentation (SDF) and sperm motility pa-rameters in men undergoing fertility evaluation.

Methods: This retrospective observational study in-cluded 589 men aged 18-50 years evaluated at a sin-gle Brazilian andrology center between August 2021 and February 2024. Only the first semen sample per patient was analyzed. SDF was assessed using the sperm chromatin dispersion (SCD) test, and semen pa-rameters were evaluated according to the sixth edition of the WHO Laboratory Manual. Data distribution was assessed using Shapiro-Wilk testing. As most variables were non-normally distributed, associations were ana-lyzed using Spearman's rank correlation, with Pearson's test performed as sensitivity analysis. Comparisons be-tween two groups (<20% vs ≥20%) were performed us-ing the Mann-Whitney U test. Comparisons among three fragmentation categories (<20%, 20-30%, >30%) were conducted using the Kruskal-Wallis test followed by Dunn's post-hoc analysis. A p-value <0.05 was consid-ered statistically significant.

Results: The mean SDF was 23.5%. SDF demonstrat-ed a moderate inverse correlation with rapid progressive motility (rho=-0.289, 95% CI [-0.361, -0.213], p<0.001) and a moderate positive correlation with immotile sper-matozoa (rho=0.335, 95% CI [0.261, 0.405], p<0.001).Samples with SDF ≥20% (n=276) showed significant-ly lower rapid progressive motility and higher immotility compared to those with SDF <20% (n=313) (p<0.01). Total motile sperm count was also reduced in the higher fragmentation group (p<0.01). Similar patterns were ob-served across the three fragmentation categories.

Conclusion: Higher sperm DNA fragmentation levels were associated with impaired motility patterns, partic-ularly reduced rapid progressive motility and increased immotility. These findings support the integration of SDF testing as a complementary parameter in the evaluation of male fertility.

Fragile X syndrome is a monogenic disorder caused by the expansion of CGG trinucleotide repeats in the fragile X mental retardation 1 (FMR1) gene and is a major cause of inherited intellectual disability and reproductive impair-ment. Preimplantation genetic testing for monogenic disor-ders (PGT-M) has become an important strategy in assisted reproduction to prevent the transmission of FMR1-related disorders. This narrative review aimed to summarize cur-rent evidence on the molecular basis, technical approaches, clinical outcomes, and challenges associated with PGT-M for FMR1 CGG repeat expansions. A literature search was performed in the PubMed database, including English-lan-guage original studies, clinical investigations, and reviews. The reviewed studies demonstrate that advances in multi-plex PCR, linked-marker analysis, and next-generation se-quencing have significantly improved diagnostic accuracy, overcoming earlier limitations related to CGG repeat analy-sis, allele dropout, and mosaicism. Although women carry-ing FMR1 premutations frequently present with diminished ovarian reserve and reduced response to ovarian stimula-tion, pregnancy and live birth rates per embryo transfer are comparable to those of non-carriers when individual-ized stimulation protocols are applied. The combined ap-plication of PGT-M and Preimplantation Genetic Testing for Aneuploidy may be considered in selected clinical scenarios to optimize embryo selection, although indications should be individualized. In addition to its clinical benefits, PGT-M raises ethical, psychological, and economic considerations, emphasizing the importance of genetic counseling in re-productive decision-making. Overall, PGT-M represents a safe and effective tool in assisted reproduction for couples at risk of transmitting FMR1 related disorders, with grow-ing relevance in clinical practice and public health.

Objective: Sperm cryopreservation serves as a vital technique in assisted reproductive technologies and the preservation of male fertility; however, this process often leads to a marked decline in sperm quality. Using exter-nal antioxidants to counteract the buildup of free radicals during cryopreservation has proven to be an effective ap-proach for improving sperm quality after thawing. This study aimed to evaluate the combined effect of Curcumin and L-carnitine on human sperm motility, viability, mor-phology, DNA integrity, and lipid peroxidation following cryopreservation.

Methods: Forty semen samples from normozoosper-mic men were divided into four groups: control, Curcum-in (20μm), L-carnitine (100μm), and a combination group (Curcumin + L-carnitine). Samples were cryopreserved for one week and subsequently thawed at 37∘C for 5 minutes. Post-thaw analysis included assessment of sperm motility (using CASA), viability (eosin-nigrosin staining), morphol-ogy, DNA fragmentation (TUNEL assay), and malondialde-hyde (MDA) levels (TBARS assay).

Results: Both Curcumin and L-carnitine treatments significantly improved sperm motility and viability com-pared to the control group (p<0.01). The combination group exhibited the highest levels of motility and the low-est levels of MDA and DNA fragmentation, indicating supe-rior protection against oxidative stress and DNA damage. No significant differences were observed in sperm mor-phology across the groups.

Conclusion: Supplementation with Curcumin and L-carnitine during sperm cryopreservation enhances post-thaw sperm quality, particularly improving motility and preserving DNA integrity. Further studies evaluating func-tional outcomes are necessary before clinical application.

Objective: Refined sugar is a widely consumed dietary component that has been implicated in several health complications, including reproductive dysfunction. Despite growing concern regarding its potential endocrine-disrupt-ing effects, the reversibility of its impact on male reproduc-tive parameters remains underexplored. This study aimed to evaluate the effects of oral refined sugar consumption on male reproductive parameters in Wistar rats and to in-vestigate the role of sugar cessation in potential recovery.

Methods: Forty male Wistar rats were randomly divid-ed into eight groups (n=5): a control group, three treat-ment groups (low, medium, and high sugar doses), and corresponding cessation groups. Sugar dissolved in dis-tilled water was administered orally using an oropharyn-geal cannula for four weeks, followed by four weeks of withdrawal in the cessation groups. Reproductive parame-ters were then assessed.

Results: Refined sugar consumption resulted in statis-tically significant (p<0.05), dose-dependent reductions in relative testicular and epididymal weights, sperm count, motility, and morphology. Significant hormonal alterations were also observed, including reduced testosterone, LH, and FSH levels and increased estradiol levels (p<0.05). In addition, histological analysis revealed testicular degener-ation and vacuolization in all treatment groups. Notably, the cessation groups showed partial recovery in some pa-rameters, particularly the high-dose cessation group, with significant improvements (p<0.05) in sperm count and motility, a lower percentage of abnormal morphology, and increased testosterone, LH, and FSH levels.

Conclusion: Prolonged refined sugar intake impairs male reproductive health through structural and hormonal disruptions. However, cessation showed potential for par-tial recovery, underscoring the importance of dietary inter-vention in preserving male fertility.

Oxidative stress is a key contributor to impaired se-men quality in male infertility. Ceratonia siliqua L. (car-ob), a polyphenol-rich plant traditionally used to improve male fertility, has been investigated as a potential in-tervention for improving semen parameters and repro-ductive hormonal profiles. This systematic review and meta-analysis evaluated the effects of carob supplemen-tation on semen parameters and reproductive hormones in randomized controlled trials (RCTs) and in vitro studies. PubMed, Scopus, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform were searched up to December 2024. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool for RCTs and QUIN for in vitro studies. Random-ef-fects meta-analyses with Knapp-Hartung adjustment were performed. Ten studies were included, comprising five RCTs and five in vitro studies. Four RCTs involving 206 participants were eligible for meta-analysis; one RCT was excluded because data were reported as percentages without extractable means. Carob supplementation sig-nificantly increased sperm count (3 RCTs; n=166; WMD: 11.58 × 106/ml; 95% CI: 9.79-13.38; I2=38%) and total sperm motility (4 RCTs; n=206; WMD: 10.93%; 95% CI: 2.97-18.89; I2=69.9%), but had no significant effect on sperm morphology. Testosterone levels increased signifi-cantly (3 RCTs; n=157; WMD: 1.30; 95% CI: 0.93-1.67; I2=37.6%), whereas FSH and LH remained unchanged. In vitro studies showed improvements in progressive mo-tility (5 studies; n=180; SMD=4.37; 95% CI: 1.46-7.28; I2=98.6%) and viability (4 studies; n=140; SMD=3.97; 95% CI: 1.30-6.64; I2=98.0%), although the effect on viability lost statistical significance after Knapp-Hartung correction. The most favorable in vitro effects were ob-served at concentrations of 10-20µg/ml. Overall, carob supplementation may improve sperm count and motility, which are relevant parameters in male fertility and as-sisted reproductive settings, and in vitro findings suggest a potential role as a cryoprotectant additive. However, because of moderate-to-high heterogeneity and variable study quality, larger, well-designed randomized controlled trials are required to confirm these effects.

Objective: Testicular torsion (TT) may cause testicular necrosis. Although restoration of blood flow is essential to prevent testicular loss, reperfusion may induce testicular ischemia-reperfusion injury (TIRI), leading to testicular damage and potentially long-term infertility. All-trans reti-noic acid (ATRA) has been shown to enhance the transcrip-tion of antioxidant enzymes and anti-apoptotic proteins, inhibit NF-κB-mediated transcription of inflammatory cyto-kines, and support germ-cell differentiation and spermato-genesis. This study investigated the protective effect of ATRA on the ipsilateral testis following unilateral testicular torsion/detorsion.

Methods: Twenty-four male Wistar rats were divided into four groups (n=6): Sham, Torsion/Detorsion (TD), AT-RA+TD (7.5mg/kg administered 3 days before TIRI induc-tion), and TD+ATRA (7.5mg/kg administered 3 days after TIRI induction). Torsion was induced for 1 hour and was followed immediately by detorsion.

Results: TD reduced the levels of reproductive hormones (testosterone and inhibin), Bcl-2, sperm indices, SOD, CAT, GPx, GST, GSH, and total protein, with concomitant increas-es in testicular MDA, NO, TNF-α, MPO, IL-6, NF-κB, Bax, caspase-3, DFI, and 8-OHdG levels. Histological evaluation of TD rats revealed reduced spermatogenesis indices, disrup-tion of the seminiferous tubules, germ-cell loss, and vascular congestion. ATRA treatment significantly improved antioxi-dant enzyme activity, downregulated NF-κB and Bax signal-ing, restored reproductive hormones and sperm parameters, and protected testicular and epididymal structures.

Conclusion: ATRA protects against ipsilateral testicu-lar damage following torsion/detorsion, as shown by res-toration of depleted antioxidant enzymes, downregulation of inflammatory and pro-apoptotic markers, and enhance-ment of spermatogenesis and hormonal balance. These findings support the potential role of ATRA in preserving fertility after testicular torsion/detorsion.

In assisted reproductive technolog, both invasive and non-invasive criteria are widely used to identify oocytes and embryos with high developmental potential, with the ultimate goal of improving live birth rates. Since the earliest applications of in vitro fertilization in the 1970s, non-invasive assessment methods have played a central role in evaluating oocyte and embryo competence. These approaches rely primarily on morphological analysis, in-cluding assessment of the mature cumulus-oocyte com-plex (COC), the presence and morphology of the first polar body, zona pellucida thickness, characteristics of the peri-vitelline space, and cytoplasmic appearance. Oocyte quali-ty is a fundamental determinant of successful fertilization, subsequent embryo development, implantation, and the establishment of a healthy term pregnancy. The follicular environment also plays a crucial role in regulating oocyte maturation and developmental competence. Within the follicle, the COC functions as a coordinated unit in which the oocyte regulates its growth and development through metabolic interactions with the surrounding cumulus and granulosa cells. During maturation, the oocyte's energy requirements are largely met through the β-oxidation of fatty acids stored in lipid droplets (LDs). These LDs under-go spatial redistribution during maturation, which may be associated with changes in the oocyte's viscoelastic prop-erties. Alterations in lipid metabolism within the COC can impair oocyte developmental competence and may help explain the reduced survival of some oocytes after intra-cytoplasmic sperm injection. This review critically exam-ines the relationship between the follicular environment and oocyte metabolism, with particular emphasis on lipid metabolism and oocyte and embryo quality. It also dis-cusses established non-invasive markers of oocyte quality and emerging approaches based on oocyte biomechanical properties that may be associated with embryo viability, implantation, and term pregnancy.

Reproductive failure including recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF)-is often attributed to immune dysregulation at the maternal-fetal interface. Recombinant human granulocyte colony-stimu-lating factor (rhG-CSF) has been proposed as an immu-nomodulatory therapy to enhance reproductive outcomes. This systematic review and meta-analysis included 10 randomized controlled trials evaluating rhG-CSF in women diagnosed with RPL or RIF. The primary outcomes were clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Overall, rhG-CSF did not significant-ly improve CPR (odds ratio [OR]=1.16; 95% confidence interval [95% CI], 0.48-2.80; p=0.74) and showed high heterogeneity (I2=86%). Subgroup analysis indicated a significant increase in CPR among RIF patients (OR=1.73; 95% CI, 1.17-2.55; p=0.006; I2=17%), while no benefit was observed in RPL. No significant differences were found for LBR (OR=1.53; 95% CI, 0.88-2.66; p=0.13) or MR (OR=0.72; 95% CI, 0.26-1.96; p=0.52). Safety profiles and obstetric or perinatal outcomes were inadequately re-ported. The high heterogeneity likely reflects variation in patient selection, rhG-CSF dosing regimens, and the lack of immunological stratification for identifying responsive subgroups. While rhG-CSF may improve implantation out-comes in RIF, its effect on live birth remains uncertain. Fu-ture randomized trials should employ standardized treat-ment protocols and integrate immunogenetic diagnostics to optimize patient selection and clinical benefit.