Increased implantation and pregnancy rates obtained by placing the tip of the transfer catheter in the central area of the endometrial cavity.

The influence of endometrial cavity length (ECL) on implantation and pregnancy rates after 400 embryo transfers was studied prospectively in a population with the indication of IVF/intracytoplasmic sperm injection (ICSI). The tip of the transfer catheter was placed above or below the half point of the ECL in a randomized manner. Two analyses were performed: (i) absolute position (AP); embryo transfers were divided into three groups according to the distance between the end of the fundal endometrial surface and the catheter tip (DTC - distance tip catheter): AP1 (n = 212), 10-15 mm; AP2 (n = 158), 16-20 mm; and AP3 (n = 30), > or =21 mm. (ii) relative position (RP)--embryo transfers were divided into four groups according to their RP [RP = (DTC/ECL) x 100]: RP1 (n = 23), < or =40%; RP2 (n = 177), 41-50%; RP3 (n = 117), 51-60%; and RP4 (n = 83), > or =61%. Analysis based on relative distance revealed significantly higher implantation and pregnancy rates (P < 0.05) in more central areas of the ECL. However, analysis based on absolute position did not reveal any difference. In conclusion, the present results demonstrated that implantation and pregnancy rates are influenced by the site of embryo transfer, with better results being obtained when the catheter tip is positioned close to the middle area of the endometrial cavity. In this respect, previous analysis of the ECL is the fundamental step in establishing the ideal site for embryo transfers.

Concerns regarding the follow-up of children conceived after assisted reproduction in Latin America.

Children born through assisted reproduction are not usually followed up in Latin America. However, in spite of all the social-economic and cultural complexity of this part of the world, professionals involved in assisted reproduction should not relinquish the responsibility of following up these children. In May 2002, the Centre for Human Reproduction Sinhá Junqueira, started a specific project for evaluation and follow-up of its children. It is the first centre in Brazil, and probably in Latin America, with this aim, and this paper reports initial results concerning the intellectual development of these children.

Embryo selection by the first cleavage parameter between 25 and 27 hours after ICSI.

PURPOSE: The objective of this study was to assess first embryo cleavage (FEC) 25-27 h after intracytoplasmic sperm injection (ICSI) as a parameter for the embryo selection process. METHODS: From January 1998 to December 1999, a total of 670 patients were subjected to the ICSI programme at the Centre for Human Reproduction, Sinhá Junqueira Maternity Foundation, and the FEC parameter was evaluated in three situations. RESULTS: In the first, a total of 300 zygotes were analyzed on the basis of a score (16-18 h after ICSI) and observed for the presence or absence of FEC (25-27 h after ICSI). A significant (p < 0.02) presence of FEC was observed in zygotes with a score of 15 (ideal score). In the second, a total of 200 patients were selected and divided into two groups matched for age and laboratory performance. Group I (n = 100) was subjected to transfer of embryos with the absence of FEC only (since in this cycle no embryos with FEC were detected within 25-27 h after ICSI) and Group II (n = 100) was subjected to transfer of embryos with the presence of FEC only. The age of Group I patients (33.8 +/- 4.2 years) did not differ significantly (p = 0.50) from that of Group II patients (33.5 +/- 4.3 years). The number of embryos transferred was similar (p = 0.07) for Group I (2.7 +/- 1.1) and Group II (2.9 +/- 0.88). In Group II, the 17.5% implantation rate was significantly higher (p < 0.01) than the 5.9% rate obtained for Group I. The pregnancy rate for Group II was significantly higher (p < 0.01) (33%) than that for Group I (12%). The incidence of abortion was 16.6% in Group I as compared with 6% in Group II. In the third situation, we observed the frequency of embryos with FEC in 36 patients whose implantation rate was 100% (ideal result) and obtained a value of 82%. CONCLUSIONS: The data suggest that the presence of the FEC parameter that was evaluated 25-27 h after ICSI could be used to select embryos with a higher implantation power. The data reported here may justify routine analysis of embryos with FEC for the process of embryo selection after ICSI.

Power Doppler endometrial evaluation as a method for the prognosis of embryo implantation in an ICSI program.

PURPOSE: The objective of the present study was to evaluate power Doppler of the endometrium as a parameter for the prognosis of embryo implantation in patients who underwent intracytoplasmic sperm injection (ICSI). METHODS: The power Doppler was performed on a transverse section at the level of the uterine fundus on the day of human chorionic gonadotropin in 185 patients who submitted to ovarian stimulation for ICSI. The endometrium was divided into four equal quadrants and classified as grade I, II, III, or IV according to the visualization of the power Doppler in the quadrants. The color Doppler signal was considered to be positive when it reached at least the basal layer of the endometrium. RESULTS: Age, number of days of stimulation, number of follicles > or = 16 mm, number of oocytes in metaphase II retrieved, and fertilization rate did not differ patients with the four different types of endometrial grades. Endometrial thickness and the pulsatility index of uterine artery also were similar for the four grades. The rate of embryo implantation also did not differ significantly (P = 0.53) among groups: grade I = 10%; grade II = 11.6%; grade III = 15.4%; grade IV = 10.5%. The pregnancy rates were grade I = 25%; grade II = 29.7%; grade III = 37.5%; grade IV = 23.8% (P = 0.44). CONCLUSIONS: Our data demonstrate that isolated evaluation of endometrial vascularization with power Doppler is not an important factor for the prediction of pregnancy in an ICSI program.

Genetic disorders in normally androgenized infertile men and the use of intracytoplasmic sperm injection as a way of treatment.

OBJECTIVE: To determine the incidence of chromosomal abnormalities in normally androgenized infertile men with no other recognized causes of infertility or who had ever been submitted to other unsuccessful methods of treatment. DESIGN: Collaborative retrospective study of clinical experience collected by an endocrinologist and a geneticist over a 5-year period. SETTING: Outpatients at an endocrinology clinic. PATIENT(S): Infertile male patients with azoospermia (n = 23), oligozoospermia (n = 66), and normozoospermia (n = 14) presenting normal (n = 85) or subnormal (n = 18) testicular volume. INTERVENTION(S): All patients were submitted to cytogenetic analysis. MAIN OUTCOME MEASURE(S): Two patients were referred to intracytoplasmic sperm injection (ICSI), and in one case, a successful gemellar pregnancy ended up uneventful. Children's genetic testing were not performed according to parents' request. RESULT(S): Abnormal karyotypes were found in 11 (10.6%) patients. Chromosomal abnormalities were found in 17.3% of the 23 azoospermic patients, in 10.6% of the 66 oligozoospermic patients, and in none of the 14 normozoospermic patients. These disorders were found only in patients with normal testicular volumes and no more than 10 x 10(6) spermatozoa per mL. CONCLUSION(S): A high incidence of chromosomal abnormalities was found in a selected group of normally androgenized infertile male patients. The elevated rate of fertilization achieved in one patient indicates that ICSI is, at the moment, the only choice for treatment of male infertility because of chromosomal abnormalities.

Semi-programmed ovarian stimulation as the first choice in in-vitro fertilization programmes.

The objective of this work was to evaluate the results obtained with a protocol of semi-programmed ovarian stimulation (low-dose contraceptive pill+clomiphene citrate+human menopausal gonadotrophin+dexamethasone) used as the first-choice method for in-vitro fertilization (IVF). A total of 207 punctures was performed for oocyte collection from 168 patients (mean age 31.0 +/- 4.0 years); mean infertility duration was 5.81 +/- 3.30 years. The infertility factors indicating IVF for this population were as follows: tubo-peritoneal factor, 68%; pure or associated male factor, 9.2%; endometriosis, 11.1%; ovulatory factor, 4.3%; idiopathic factor, 11.6%; others, 2.4%. No oocyte was found on aspiration in five procedures (2.4%), with the mean number of oocytes collected per cycle being 5.87 +/- 3.3 (range 0-18). The cancellation rate per puncture was 5%. The mean embryo cleavage rate was 60.2 +/- 36.8%, with transfer of at least one embryo occurring in 82.6% of all punctures. The mean number of transferred embryos was 2.52 +/- 1.60 (range 1-5). The clinical pregnancy rates per started cycle and per puncture were 22.4 (218 ovarian stimulation cycles) and 23.6% (a total of 49 clinical pregnancies, 36 single, nine twins and four triplets) respectively. The clinical pregnancy rate per embryo transfer was 28.6%. The embryo implantation rate was 12.6%. The abortion rate was 16.3%. The index of deliveries per puncture was 19.8%. There were no cases of moderate or severe ovarian hyperstimulation syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Embryo cleavage rates after oocyte insemination with capacitated sperms in the presence or absence of follicular fluid.

The objective of the present study was to compare the rate of embryo cleavage after oocyte insemination with capacitated spermatozoa in the presence or absence of follicular fluid. In the first experiment, a total of 67 oocytes were inseminated with spermatozoa which had been submitted to part of the capacitation procedures in the presence of follicular fluid (21 oocytes) and with spermatozoa capacitated only with Menezo B2 culture medium (46 oocytes). Thirteen and 29 cleaved embryos were obtained, respectively (p = 0.89). In the second experiment, a total of 61 oocytes were inseminated with spermatozoa submitted to the entire capacitation procedure in follicular fluid (17 oocytes) and capacitated only with Menezo B2 culture medium (44 oocytes). Eleven and 31 cleaved embryos were obtained, respectively (p = 0.67). The absence of significant differences in cleavage rate between the two experiments indicates that the quality of the spermatozoa capacitation process is not changed by the addition of follicular fluid.

Donation of oocytes as treatment for infertility in patients with premature ovarian failure. Awarded the "Nicolau de Moraes Barros" prize for gynecology.

A total of 7 cycles of embryo transfer by oocyte donation were performed on 5 patients with premature ovary failure (POF). All donors were under 35 of age and the recipients average age was 38.6 years. For synchronization between donor and recipient a semi programmed menstrual cycle was used by means of oral contraceptive followed by ovarian stimulation of donor with clomiphene citrate and human menopausal gonadotrophin. The recipients were easily adjusted to the donors by a flexible model of gradually increasing doses of estradiol valerianate. The average number of oocytes donated was 3.14 and average embryo cleavage rate was 80.2%. The average number of embryos transferred was 2.57. Embryo implantation rate was 22.2%. Clinical gestations occurred in 57.1% of the cycles. This series is probably the first one in Brazilian literature on oocyte donation as treatment for infertility in patients with premature ovarian failure.

Doaçäo de oócitos como tratamento da infertilidade em pacientes com insuficiência ovariana precoce / Oocyte donation as treatment of infertility in patients with premature ovarian failure

Um total de sete ciclos de transferência de embrioes provenientes da doaçao de oócitos foram realizados em cinco pacientes portadoras de insuficiência ovariana precoce. As doadoras possuíam idade inferior a 35 anos e as receptoras apresentavam idade média de 38,6 anos. No esquema de sincronizaçao entre doadora e receptora usou-se um ciclo semiprogramado com pílula, seguido de estimulaçao da doadora com citrato de clomifeno e gonadrotrofina menopausal humana. As receptoras foram facilmente acopladas com as doadoras através de um modelo flexível de doses crescentes de valerianato de estradiol. O número médio de oócitos doados foi de 3,14, a taxa de clivagem embrionária média de 80,2 por cento, sendo o número médio de embrioes transferidos de 2,57. A taxa de implantaçao embrionária foi de 22,2 por cento. As gestaçoes clínicas ocorreram em 57,l por cento dos ciclos. Provavelmente, essa série é a primeira apresentada na literatura nacional sobre a doaçao de oócitos no tratamento da infertilidade em pacientes com insuficiência ovariana precoce.

Radiologic evaluation of incremental intrauterine instillation of contrast material.

In view of the contradictory results of IUI reported in the literature, the present study was undertaken to determine whether the volume of material injected into the uterus can affect the delivery site of the sperm. Ten infertile women scheduled for HSG were submitted to intrauterine injection of different volumes of radiopaque dye (0.2 mL to 1.0 mL) before the procedure to mimic IUI. An x ray taken immediately after injection showed that volumes of > or = 0.4 mL reached the uterus and tubes, whereas the 0.2-mL volume did not reach the tube. These data show that volume injected is an important variable in IUI.

Amniotic fluid lysozyme activity in fetal distress.

Lysozyme activity was measured in amniotic fluid samples from 90 pregnant women with gestational age ranging from 30 to 41 weeks. Twenty-nine samples were from high-risk subjects with different pathologies and signs of fetal distress. The control group consisted of 20 normal and 41 pathological pregnant women, whose disorders included Rh isoimmunization, diabetes, systemic arterial hypertension and pre-eclampsia without signs of fetal distress. Amniotic fluid lysozyme levels in normal controls were similar to those detected in abnormal pregnant women without signs of fetal distress (means = 156.0 vs 131.8 micrograms/ml for 34-37 weeks of gestation), with a tendency toward higher values as pregnancy progressed to term (means = 182.1 vs 155.4 micrograms/ml for 38-41 weeks of gestation). Lysozyme levels were significantly lower in high-risk pregnant women with signs of fetal distress, regardless of neonate birth weight, than in subjects showing no such signs (means = 40.3 and means = 25.4 micrograms/ml at 34-37 and 38-41 weeks of gestation, respectively). These data support the possibility of using amniotic fluid lysozyme activity levels as an indicator of fetal distress.

Ammiotic fluid lysozyme activity in fetal distress

Lysozyme activity was m,easured in amniotic fluid samples from 90 pregnant women with gestacional age ranging from 30 to 41 weeks. Twenty-nine samples were from high-risk subjects with different pathologies and signs of fetal distress. The control group consisted of 20 normal and 41 pathological pregnant women, whose disorders included Rh isoimmunization, diabetes, systemic arterial hypertension and pre-eclampsia without signs of fetal distress. amniotic fluid lysozyme levels in normal controls were similar to those detected in abnormal pregnant women without signs of fetal distress (x = 156.0 vs 131.8 microng/ml for 43-37 weeks of gestation), with a tendency toward higher values as pregnancy progressed to term in high-risk pregnant women with signs of fetal distress, regardless of neonate birth weight, than in subjects showing no such sugns (x = 40.3 and x = 25.4 microng/ml at 34-41 weeks of gestation, respectively). These data support the possibility of using amniotic fluid lysosyme activity levels as an indicator of fetal distress

Uma opiniäo sobre o sistema atual de pós-graduaçäo em tocoginecologia / An opinion about the actual system of postgraduation in tokogynecology

A opiniäo de uma populaçäo de 22 professores e 49 alunos de pós-graduaçäo em tocoginecologia foi analisada através da resposta a um questionário-padräo. Há evidencias que sugerem a necessidade de melhores critérios para uma avaliaçäo científica da eficácia desse sistema após 18 anos de uso no País

[Influence of digitoxin on isolated segments of lateral branches of human vena saphena (author's transl)]. / Zur wirkung von Digitoxin auf isolierte Segmente von Saphena-Seitenästen des Menschen

The effect of digitoxin on isolated segments of lateral branches of the human saphenous vein perfused in vitro with constant volumes is reported. Digitoxin, depending on concentraion, effected rise in perfusion pressure and intensification of reaction to norepinephrine. Some venous segments showed spontaneous activity. The tests were supported by histological studies.