JBRA assisted reproduction最新文献

Objective: To evaluate if blastomere/trophectoderm biopsy for preimplantation genetic testing affects early HCG levels.

Methods: A single-center retrospective study, encompassing data of 196 women who underwent IVF treatments with intracytoplasmic sperm injection (ICSI) with either a transfer of a fresh or frozen-thawed day-5 blastocyst. All women tested positive for HCG (>25 IU/L) two weeks after the transfer. Of those, 97 women underwent preimplantation genetic testing ("PGT", the study group) while the control group ("non-PGT") of 99 women, had IVF treatment without PGT.

Results: No significant difference was found in HCG levels between the PGT and non-PGT groups. Similarly, there were no significant disparities in pregnancy outcomes, including miscarriage, live birth rate (LBR), extrauterine pregnancy, and intrauterine fetal death.Multivariate analysis revealed that HCG levels were significantly associated with Body Mass Index (BMI) and protocol type (fresh vs. frozen), but not with the biopsy day. Logistic regression analysis adjusted to the women's age, endometrial thickness, and HCG levels, found no significant correlation between the likelihood of live birth and PGT performance or the biopsy day.

Conclusions: There is no apparent disparity in early HCG levels or pregnancy outcomes in IVF treatment with or without PGT. Notably, HCG levels are significantly higher in frozen-thawed cycles compared to fresh cycles, irrespective of PGT performed. Since HCG levels are associated with LBR, these findings enhance confidence of the non-detrimental effect of blastomere and trophectoderm biopsy.

Objective: To assess the prevalence, authorship, and reliability of educational fertility-related information shared on Brazilian Instagram, measured by the DISCERN instrument.

Methods: This cross-sectional study analyzed public fertility-related educational Instagram posts published in March 2021 related to the following hashtags: #infertility, #ivf, #endometriosis, #tryingtoconceive, #maternity, #humanreproduction, #pregnancy, #invitrofertilization, #assistedreproduction, #pregnant, #difficulttogetpregnant. Educational posts were evaluated using the DISCERN tool. Authorship was categorized as either healthcare professional (HCP) or layperson (LP).

Results: The majority of the 37 analyzed posts were authored by HCP (n = 33; 89.2%), with 24 of these being physicians, five fertility clinics, four allied HCP, one magazine, and three LP. Most posts (n = 15) focused on fertility treatments; other topics included information about diseases, exams, and diagnosis. The mean Discern analysis scores for each question were: (1) Are the aims clear? 4.86; (2) Does it achieve its aims? 4.75; (3) Is it relevant? 4.47; (4) Is it clear what sources of information were used to compile the publication (other than the author or producer)? 1.58; (5) Is it clear when the information used or reported in the publication was produced? 1.59; (6) Is it balanced and unbiased? 1.59; (7) Does it provide details of additional sources of support and information? 1.04; (8) Does it refer to areas of uncertainty? 1.39.

Conclusions: Although physicians authored most posts that clearly stated the aim and relevance, important issues such as the source of information used and details about additional sources of support and information were not available. The posts analyzed here failed to be balanced and unbiased and did not inform about potential areas of uncertainty.

Objective: Platelet-rich plasma (PRP) is currently utilized in several clinical fields, including infertility treatment. This study aimed to evaluate the effectiveness of intraovarian PRP injections in improving reproductive outcomes in women who have previously experienced unsuccessful IVF cycles.

Methods: In this Open-label Single-Arm Longitudinal clinical trial study, a number of 15 infertile patients, POSEIDON groups 1 and 3 (poor ovarian reserve), with no history of hematological, immunological, hormonal disorders, chromosomal and genetic abnormalities, and kidney failure were investigated. PRP was prepared using a standardized protocol and administered at a dose of 2.5 cc per ovary. Key reproductive parameters, including follicle development, oocyte quality, embryo formation, and endometrial thickness were measured before PRP treatment, immediately after treatment, and three months post-treatment. After collecting and sorting, the data was analyzed using SPSS Ver.26 statistical software.

Results: Nearly 27% of the participants achieved pregnancy, despite previous IVF failures. The findings revealed significant improvements in the median number of follicles larger than 17 millimeters, the number of oocytes, fertilizable oocytes, and endometrial thickness following PRP treatment (p<0.05). The number of embryos formed, as well as the frequency of A or B grade embryos, also increased significantly at three months post-PRP (p<0.001).

Conclusions: Intraovarian PRP injections show potential as an effective treatment for improving reproductive outcomes in women with a history of IVF failures. However, further research with larger sample sizes, control groups, and extended follow-up periods is needed to validate these findings and establish PRP as a standard therapy in reproductive medicine.

Objective: Thin endometrium is an increasingly recognized challenge in infertility treatment. This study aimed to compare endometrial gene expression between women with thin and normal endometrial thickness, and also to identify ovarian stimulation-related factors associated with thin endometrium.

Methods: Endometrial tissue samples were collected from infertile women undergoing controlled ovarian stimulation, including 10 samples with thin endometrium (less than 7 millimeters) and 10 with normal thickness (7 millimeters or more) on the day of egg retrieval. Gene expression was analyzed using quantitative real-time polymerase chain reaction.

Results: The relative expression of LGR5 in the luminal epithelium was slightly higher in the thin group, while POU5F1 expression in the stromal area was higher in the normal group. In the perivascular region, PDGFRB and SUSD2 were more highly expressed in the normal group, with SUSD2 showing a statistically significant difference (p=0.034). In addition, under higher serum estradiol levels, both POU5F1 and LGR5 showed greater expression in the normal group compared to the thin group with lower estradiol levels.

Conclusions: Reduced SUSD2 expression in the perivascular region, a marker of endometrial stem and progenitor cells, may contribute to impaired endometrial growth. Serum estradiol levels also appear to influence gene expression within different endometrial compartments. These findings may offer insights into new therapeutic strategies for managing thin endometrium.

Objective: This study evaluated whether consecutive ejaculate (CE) strategies improve intrauterine insemination (IUI) live birth rates (LBR) in women over 35 with unexplained or male-factor infertility. It also examined the influence of follicle number and sperm count thresholds on outcomes.

Methods: In this retrospective cohort study (2010-2019), 596 IUI cycles were analysed in 263 nulliparous women-230 with CE and 366 with standard IUI. Among them, 98 patients underwent CE IUI and 165 received non-CE IUI. Patients with total motile sperm count (TMSC) <5×106 were often fast-tracked to IVF, but CE was mostly attempted to boost sperm count beforehand. LBRs per cycle and per woman were compared between groups.

Results: LBR per cycle was 11.3% (CE) vs. 13.1% (control) (p=0.52); per woman, 26.5% (CE) vs. 29.1% (control) (p=0.65). Mean ages were similar (37.7 vs. 38.0 years; p=0.34). Success improved with TMSC >10×106; 65.4% (CE) and 87.5% (control). Over six cycles, LBR rose from 10.5% to 13.8% (CE) and 12.3% to 16.7% (control). Outcomes improved with two or three follicles, especially in women over 35.

Conclusions: CE IUI yields LBRs comparable to standard IUI and may offer a cost-effective, less invasive alternative to IVF for male-factor infertility in women over 35. The LBRs per woman undergoing IUI were of a similar magnitude to those reported in IVF cycles. Optimising IUI LBR may involve increasing follicle numbers and using a higher TMSC threshold (>10×106). CE IUI supports healthcare sustainability while expanding fertility treatment access.

Objective: To compare the effectiveness of microfluidic sperm sorting (MC) and traditional density gradient centrifugation (DGC) in reducing sperm DNA fragmentation index (DFI) and evaluate their impact on clinical outcomes in IVF cycles.

Methods: In this randomized controlled trial, 119 couples undergoing IVF were allocated to either the MC or DGC group. Sperm DNA fragmentation was assessed before and after preparation. Primary outcomes included live birth rate and DFI reduction. Secondary outcomes were sperm quality parameters, fertilization rate, embryo development, and pregnancy outcomes. Subgroup analysis was conducted based on initial DFI levels (<15% vs. ≥15%).

Results: The MC group demonstrated significantly greater and more consistent DFI reduction, particularly in samples with high baseline DFI (≥15%), compared to the DGC group. Although the number of oocytes retrieved was higher in the MC group, no significant differences were observed between groups in fertilization rate, Day-2 embryo quality, clinical pregnancy, ongoing pregnancy, or live birth rates. Subgroup analysis also showed no significant differences in outcomes based on baseline DFI levels.

Conclusions: Microfluidics is an effective method for reducing sperm DNA fragmentation, particularly in samples with high DFI. However, this improvement does not necessarily guarantee better clinical outcomes in IVF. Baseline sperm DNA fragmentation index (DFI) may still act as an independent prognostic factor influencing IVF success, regardless of the sperm preparation method used.

We report a case of fertility preservation through ex vivo oocyte aspiration in an adolescent who underwent bilateral oophorectomy due to asynchronous borderline ovarian tumors. A 17-year-old nulligravid patient was initially diagnosed with a left-sided serous borderline ovarian tumor and treated with left salpingo-oophorectomy. One year later, a lesion was identified in the contralateral ovary, with surgical indication for salpingo-oophorectomy. Ovarian stimulation was performed using recombinant FSH and hMG, with final oocyte maturation triggered by a GnRH agonist. Oocyte retrieval was conducted ex vivo, immediately after surgical removal of the ovary. A total of 13 oocytes were obtained, 10 of which were in metaphase II and successfully cryopreserved. This case highlights the feasibility and efficacy of ex vivo oocyte retrieval as a fertility preservation strategy in oncology patients requiring urgent bilateral oophorectomy.

Objective: To evaluate the effects of repeated heat exposure on testicular function and sperm quality in Wistar rats and to determine whether vitamin C mitigates heat stress-induced reproductive damage.

Methods: Twenty-four Wistar rats were allocated to four groups and treated for 28 days: (i) control, (ii) heat exposure (40°C for 4 hours/day), (iii) vitamin C (50 mg/kg), and (iv) vitamin C plus heat exposure. Antioxidant status (superoxide dismutase, catalase, reduced glutathione), oxidative/nitrosative stress markers (malondialdehyde, nitric oxide), reproductive hormones (testosterone, follicle-stimulating hormone, luteinizing hormone), testicular function markers (alkaline phosphatase, acid phosphatase, glycogen, protein), testicular cortisol and cholesterol, histological structure, body and testis weights, and sperm parameters (concentration, total count, motility profile) were assessed.

Results: Heat exposure significantly reduced antioxidant defenses (superoxide dismutase, catalase, reduced glutathione), increased malondialdehyde and nitric oxide levels, and disrupted reproductive hormones (decreased testosterone with increased follicle-stimulating and luteinizing hormones). Heat stress also decreased alkaline and acid phosphatase activities, glycogen, and protein levels, increased testicular cortisol and cholesterol, induced histological damage, and reduced body and testis weights. Sperm quality was impaired, with lower sperm concentration, total count, and fast motility, and higher slow and non-motile sperm fractions. Vitamin C co-treatment partially attenuated these effects, improving catalase activity, Nrf-2 levels, glycogen, testosterone, alkaline and acid phosphatase, and lessened lipid peroxidation.

Conclusion: Repeated heat exposure induced oxidative stress, hormonal imbalance, impaired sperm quality, and structural testicular injury in Wistar rats. Vitamin C provided partial protection against heat-induced testicular dysfunction, supporting its potential role as an adjunct antioxidant strategy; further studies should evaluate additional antioxidants and include gene expression analyses to clarify mechanisms and fertility outcomes.